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Clinical assessment and management of children with bronchiolitis
Bronchiolitis is a common seasonal viral illness in babies and children aged under two years. Its significance has increased in the light of a predicted surge in respiratory illness in children this winter and the continuing effect of the coronavirus disease 2019 (COVID-19) pandemic on parental anxiety and cross-infection. Children’s nurses will have a central role in delivering high-quality care and support to children and families during this time. To support children’s nurses to prepare for a surge, this article summarises the pathophysiology of bronchiolitis, risk factors, transmission, diagnosis and clinical management of children with the illness, including recent national policy changes. It also considers the potential effect of the COVID-19 pandemic on the healthcare system, children and families.
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Ethical issues arising from the assisted dying debate
The assisted dying debate is complex, with confusion over definitions and the stance taken by professional bodies. It can also be challenging to make sense of the claims made by those who support changes in the law regarding assisted dying. End of life care is an important aspect of a nurse’s role and therefore understanding the ethical issues arising from the debate is useful for nurses in clinical practice. This article outlines the legal position in the UK and the bills currently before the Westminster and Scottish parliaments proposing changes in the law. It also considers major ethical issues arising from the debate, along with the nurse’s role in caring for patients requesting assisted dying.
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Focus on asthma 3: the psychosocial effects of asthma on the child and the family
This article is the third in a series on asthma. The first article explored global and UK trends in asthma and asthma care as they relate to children and young people, while the second article identified the adverse effects of air pollution on children, particularly those with asthma.This article explores the potentially significant psychosocial effects of asthma on the child and the family. A family-centred approach to care relies on healthcare professionals listening to and understanding families’ health beliefs and narratives to target asthma education and aid self-efficacy, which can improve asthma control and quality of life.
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Conservative management of patients with end-stage kidney disease
The prevalence of end-stage kidney disease is increasing, particularly among older people and those with multiple comorbidities. Typically, patients who develop end-stage kidney disease receive renal replacement therapies such as dialysis; however, this treatment can significantly affect quality of life and may not prolong life in older patients. Therefore, some patients may choose not to undergo dialysis and instead choose conservative management, which involves a palliative approach that focuses on maintaining quality of life and advance care planning. This article details the steps involved in a conservative kidney management pathway for end-stage kidney disease, including symptom management and advance care planning. It also discusses the importance of a palliative approach for patients receiving dialysis.
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Equipping children’s nurses to de-escalate conflict and communicate challenging information
This article considers some of the challenging situations that children’s nurses may encounter when there are tensions and disagreements between the family of the child or young person in their care and the wider professional team. The focus is on disagreements about what some might consider futile critical care. It aims to equip children’s nurses with strategies for dealing with conflict and tensions, and support them to be proactive in identifying situations that might need de-escalation. The options available to support the healthcare team and therefore avoid litigation are explored, while avenues of support available to nursing staff are considered. Suggestions and examples of effective and skilful communication with families receiving challenging news are provided. The legal position designed to safeguard children’s nurses is reviewed and practical strategies are offered to support nurses to protect themselves from physical violence if the situation escalates.
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Applying transformational leadership in nursing practice
The updated Nursing and Midwifery Council (NMC) standards of proficiency for nurses emphasise the importance of nurse leadership, while the NHS has also developed models to support leadership development. There are several approaches to leadership that are applicable in nursing practice. Transformational leadership is an approach that focuses on the attributes and behaviours of the leader required to empower and motivate team members. This article outlines the four elements of transformational leadership – idealised influence, inspirational motivation, intellectual stimulation and individualised consideration – and discusses these in relation to the NMC standards. It also describes the advantages and disadvantages of transformational leadership, and suggests ways that this approach can be applied in nursing practice.
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Using cultural safety to enhance nursing care for people with a learning disability
Culture has an important role at every level of healthcare. It can have a significant effect on the interactions between nurses, other staff members in the multidisciplinary team, people with learning disabilities and their family members.This article outlines the concept of cultural safety and how it can enable learning disability nurses to work more effectively with people with a learning disability and their families. The authors provide specific tools which learning disability nurses can use to ensure that they consider diversity when providing care, thereby enhancing healthcare outcomes.
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Biological basis of child health 11: anatomy, physiology and development of the senses
This article, the 11th in the Biological basis of child health series, focuses on the senses. There are five basic senses in humans: hearing, sight, touch, smell and taste. Several congenital and acquired conditions can affect the senses and may have significant negative effects on a child’s development and ability to communicate with others.This article explores each of the five senses, discussing their anatomy, physiology and embryological development, as well as common conditions affecting sensory function in children. It aims to provide children’s nurses with an understanding of the role of the senses in supporting children to make sense of the world, and how knowledge of this can be linked to clinical practice.
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Biological basis of child health 9: development of the liver and clinical features of childhood liver disease
This article is the ninth in a series on the biological basis of child health and follows on from the previous article, which discussed the gastrointestinal system. The liver is the largest solid organ in the body and has more than 500 functions. These functions include: producing bile, which serves as a vehicle for waste products and as an aid for the digestion of dietary fat; synthesising most coagulation factors, needed in the clotting cascade; and transforming glycogen into glucose for use as energy in cell metabolism. While most liver conditions seen in children are rare, it is important that children’s nurses can identify the clinical features of childhood liver disease. This article provides an overview of the embryological development of the liver, its anatomy and functions, liver function tests in children, and the clinical features and pathophysiology of childhood liver disease.
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How to give an intramuscular injection to an adult with an intellectual disability
People with intellectual disabilities can have various healthcare needs across their lifespan, which may be closely linked to genetic, biological and/or psychosocial factors. As a result, they may require medicines – some of which may be administered intramuscularly – for various clinical reasons, including as part of the treatment of a range of comorbid physical and mental health conditions. Additionally, this population may not fully understand why certain medicines are administered via the intramuscular (IM) route, nor the potential risks that are involved. Some people with intellectual disabilities may find it distressing to receive medicines via this route, and they may depend on others when making decisions in relation to IM injections. Therefore, it is important for nurses to establish a rapport with patients with intellectual disabilities and gain their consent for the procedure. Nurses also require knowledge of the preparation and administration of IM injections to ensure positive health outcomes.This article aims to enhance intellectual disability nurses’ knowledge of this procedure, and to explain how they can mitigate the potential physical and psychological effects that IM injections may have for people with intellectual disabilities.
