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Implementing trauma-informed care in mental health services
It has been recognised that trauma underpins several mental health conditions, and that retraumatisation, in which a person re-experiences a traumatic event, is common in mental health services.This article explores the effects of childhood trauma on adult mental distress, and describes the symptoms and behaviours associated with trauma. Mental health practitioners, services and organisations need to ensure trauma-informed care is standard practice to enable service users to move beyond the traumatic events they have experienced. Trauma-informed care should be viewed as a concept rather than an intervention to promote a cultural shift from what is ‘wrong’ with a person to what has happened to them.
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Optimising professional communication with patients
Communication between a nurse and a patient may seem intuitive. However, communicating effectively with patients while applying the principles of person-centred care can be challenging. Patients’ perceptions of suboptimal care and healthcare services may be influenced by how nurses communicate with them, since communication may be used as a quality indicator, as well as an indicator of patient experience. This article considers how nurses can communicate effectively with patients to optimise care. It explores the theoretical principles of interpersonal and professional communication, and discusses practical methods of listening and speaking to patients that nurses can apply in their clinical practice.
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Well-being, physical and mental health: part 3. Helping service users cope with schizophrenia
Schizophrenia affects the mental well-being of service users but also their physical and social well-being. This article explores the causes of schizophrenia and how the illness can contribute to self-neglect. The interaction of mental and physical health in people with schizophrenia is explored and how mental health nurses might work with colleagues to help service users to cope. A case study is used to illustrate how healthcare professionals from different backgrounds worked with a service user and his family to help manage his self-care and improve his well-being. This is the third article in a series on well-being, physical and mental health.
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Effective nurse leadership in times of crisis
The emergence of coronavirus disease 2019 (COVID-19) has meant that nurse leaders need to respond rapidly and decisively to the demands and challenges of a pandemic in a context of increased staff shortages and limited resources. This article suggests essential leadership skills and characteristics that nurses can use to underpin effective leadership in a crisis, emphasising the importance of decision-making and emotional intelligence. It also addresses two important questions: ‘what do leaders in a crisis need to do that differs from any other time?’ and ‘what does effective leadership look like in a crisis?’
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Well-being, physical and mental health: part 2. Responding to trauma
Mental and physical health work together to support well-being, and never more importantly than when a patient experiences a sudden and devastating trauma. This article explores the interplay of mental and physical health in the context of acid attack burns to someone’s face. It explains trauma in event terms and how an understanding of types of psychological trauma can be drawn on to advance collaborative nursing practice in a burns unit. While nurses have been educated in separate disciplines, it is argued that working across the traditional divide can be advantageous in trauma situations. This is the second article in a series on ‘well-being, physical and mental health’.
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Using Benner’s model of clinical competency to promote nursing leadership
This article explores the concept of leadership in health and social care. All nurses have an important leadership role, which is reflected in the principles of the NHS Leadership Academy and in the new curriculum for nursing students. By critically applying the ‘novice to expert’ model of clinical competence to leadership, nurses are encouraged to consider the skills involved in moving from novice to expert alongside identifying the strengths and skills they wish to develop. Nurses are encouraged to reflect on leadership approaches operating in health and social care and to consider the type of leader they want to be. This article examines what expert or exemplary leadership might involve and some of the characteristics that are required. An expert leader can recognise their own values and beliefs, and the values and beliefs of those they lead and serve.
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Biological basis of child health 15: understanding the renal system and common renal conditions in children
This article, the 15th and last in a series on the biological basis of child health, focuses on the renal system, in particular the kidneys. It provides an overview of their role, function, anatomy and physiology, and embryological development. The renal system has a crucial role in homeostasis, so renal function impairment can have wide-ranging and potentially serious consequences for a child’s overall health. The article describes some of the common renal conditions seen in children and how these are managed. It explains how to interpret the results of renal function tests and urine sampling conducted to assess renal function and to investigate acute and chronic disease.
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Tracheostomy care: the role of the nurse before, during and after insertion
A tracheostomy is a surgical procedure that involves creating an opening and inserting a tube in the trachea to enable air transit from the external atmosphere to the lungs. The insertion of a tracheostomy is a common procedure used to wean patients from mechanical ventilation and to manage patients with upper respiratory tract complications. Furthermore, the coronavirus disease 2019 (COVID-19) pandemic has resulted in many patients requiring a tracheostomy as part of respiratory management. The two most commonly used tracheostomy insertion procedures are the open surgical tracheostomy and the percutaneous dilatation tracheostomy, both of which are associated with a range of complications. This article outlines the indications, benefits and complications of tracheostomy insertion, as well as the various types of tracheostomy tube that may be used. It also explains the role of the nurse in caring for patients before, during and after tracheostomy insertion, including the management of tracheostomy-related complications and emergencies.
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Tourette’s syndrome: challenging misconceptions and improving understanding
Tourette’s syndrome affects about 1% of the school-age population. Children and young people with the condition exhibit involuntary motor and vocal (also known as phonic) tics. Only 10% of those with Tourette’s syndrome have coprolalia, which involves involuntary swearing and inappropriate language. Tourette’s syndrome often presents with other conditions such as obsessive-compulsive disorder, autism and attention deficit hyperactivity disorder.Those affected by Tourette’s syndrome may be able to manage the condition with little or no professional support, but some may need pharmacological and nonpharmacological input, particularly from mental health services. It is essential that peers, teachers, healthcare staff and members of the public are aware of Tourette’s syndrome to ensure that children and young people living with the condition are supported well.
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Understanding the principles and aims of intravenous fluid therapy
A balance between the volume of fluid taken in by the human body, and the volume of fluid excreted, is essential for life. Body fluid balance, which is maintained via various homeostatic mechanisms, can be disrupted by injury or disease. Prompt action is usually required to replenish fluid volumes and restore homeostasis, which is achieved via intravenous (IV) fluid therapy. Nurses will often encounter patients with a disrupted fluid balance, particularly in critical care. They will be involved in assessing patients’ fluid status and administering and monitoring therapy. Therefore, nurses have an important role in ensuring the safety and effectiveness of IV fluid therapy. This article provides an overview of the principles and aims of IV fluid therapy. It also explains the physiology of body fluid and mechanisms of fluid balance regulation, outlines the principles of patient assessment and indications for IV fluid therapy, and details its potential risks and complications.
