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Biological basis of child health 10: function and formation of blood and common blood disorders in children
This article, the tenth in a series on the biological basis of child health, focuses on blood. Blood has a crucial role in the transport of substances such as respiratory gases, nutrients and antibodies, as well as in acid-base balance, fluid balance, blood clotting and the immune system.This article describes the composition, formation and function of blood, outlines normal blood count values and explains the effects of low blood cell counts in children. It also provides an overview of the blood disorders that are commonly seen in children, including anaemia, sickle cell disease, clotting disorders and blood cancers. It is essential for children’s nurses to have knowledge and an understanding of blood, including its physiology and pathophysiology, to provide optimal care and support to children and young people and their families.
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Insertion and care of nasogastric tubes in adults with intellectual disabilities
Many adults with intellectual disabilities require nutritional support as feeding problems are prevalent in this population. While many types of nutritional support are available, enteral feeding tubes, such as nasogastric (NG) tubes, are considered safe and effective. NG tube feeding is a common clinical procedure carried out to maintain patients’ nutritional needs when they have swallowing difficulties or cannot tolerate oral feeding. Insertion of an NG tube provides adequate nutrition and improves positive health outcomes and quality of life, but being fed through an NG tube may alter patients’ perceptions of feeding and mealtimes.Healthcare professionals, including intellectual disability nurses, should not underestimate the social aspect of mealtimes or the physical and psychological effects of NG tube feeding in patients with intellectual disabilities. Demonstrating competence and compassion with regard to insertion and care of an NG tube and applying best practice to ensure patient safety and well-being are critical to supporting patients with intellectual disabilities.
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Improving safety by developing trust with a just culture
This article presents a simple conceptual road map for implementing a just culture in healthcare settings. The concept of just culture was developed as one of five fundamental elements of a safety culture by psychology professor James Reason in 1997. A just culture requires an unbiased method of judging human error and is designed to develop organisational trust so that adverse medical events (errors) are reported and corrected before they combine with other errors to cause injury or death. To implement a just culture properly so as to increase organisational safety, practitioners must understand its role in enabling the error reporting needed to develop a safety culture. This article reviews these foundational concepts and explores the human causes of errors that a just culture addresses, the psychological importance of a just culture in enabling error reporting and how to implement a just culture in organisations.
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Inhaler and nebuliser technique for people with a learning disability
Healthcare professionals who support people who require an inhaler or nebuliser need to know how to use the devices, monitor and assess patients’ inhaler techniques effectively. Often, people have inadequate inhaler techniques, which can lead to poor management of their respiratory condition, increased signs and symptoms, reduced quality of life and increased use of primary/secondary care services and treatment costs. This article explains how to use inhalers and nebulisers appropriately and considers some of the challenges for children and adults with a learning disability. It also describes some devices and assessment tools, and explores assessment/review methods to help ensure people use their inhalers/nebulisers successfully.
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Using coaching and action learning to support staff leadership development
During the coronavirus disease 2019 pandemic, nurse leaders and managers have been compelled to prioritise immediate issues in their clinical areas and put aside the professional development of staff. However, leadership development for individuals and teams is essential to ensure nurses feel valued and develop the skills required for team cohesion, problem-solving, decision-making and innovation. Simple and effective approaches to staff leadership development are needed. Two such approaches are coaching and action learning.This article provides an introduction to coaching and action learning as approaches nurse leaders and managers can use to promote leadership development among individual team members and within the team. It describes how coaching and action learning work and their potential benefits and challenges. It explains how the two approaches can be used to underpin effective problem-solving and goal setting, and support nurses in their professional development, the ultimate aim being to deliver safe and effective patient care.
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Implementing cultural safety to enhance the care of mental health service users
Culture plays an important role at every level of healthcare and in every healthcare encounter. Cultural factors significantly affect the interactions between mental health nurses and service users, the experience of mental health service users and ultimately their health-related outcomes. The concept of cultural safety originates from the work of Maori nurse leaders in New Zealand. It builds on concepts such as transcultural nursing, intercultural competence, cultural congruence and cultural competence, enabling a deeper exploration of the underlying issues of inequality affecting people from minority groups. Implementing cultural safety in mental health nursing practice can enhance the quality of care by promoting culturally sensitive communication and prompting nurses to better accommodate the needs of service users.This article discusses the concept and benefits of cultural safety in the context of mental health nursing and explains how mental health nurses can use cultural safety to enhance the experience and health-related outcomes of service users with diverse cultural backgrounds.
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The Me first communication model
This article explores communication and decision-making with children and young people in healthcare. Children and young people report that healthcare professionals are good at explaining and helping them to understand what will happen to them, but that they do not feel involved in decision-making about their care or treatment. To improve communication with children and young people, they need to be involved in decision-making about their care and treatment. In partnership with children, young people and healthcare professionals Common Room Consulting, Great Ormond Street Hospital for Children NHS Foundation Trust and Health Education England have co-produced a communication model, Me first, to support decision-making with children and young people in health care. This article introduces the Me first model and explores how it can be applied in clinical practice.
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Supporting people who are experiencing domestic abuse
Supporting the health, well-being and safety of people who are experiencing domestic abuse can be a life-saving intervention and is an important part of the mental health nurse’s role. This article details best practice in safely assessing and supporting these people, and outlines the associated indicators and the potential effects that domestic abuse can have on health. The article also details the actions that mental health nurses can take to improve the care of victims, and explains the importance of effective communication skills, risk management and record-keeping.
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Identifying and managing patients with disease-related malnutrition in primary care
Disease-related malnutrition can be challenging to treat. A disease, its treatment or the consequences of treatment can cause patients to experience a reduction in appetite and the desire to eat, resulting in an inability to consume sufficient food and drink to maintain or improve nutritional status. This article summarises a four-step approach to identifying and managing patients with disease-related malnutrition, and details how community and primary care nurses can effectively identify and manage the underlying causes of malnutrition and assist in advising on dietary modifications to enable enhanced patient outcomes.
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Supporting women’s sexual safety in acute mental health settings
Sexual safety in mental health settings is being increasingly recognised as a complex issue and a crucial aspect of organisational and practice responsibilities. However, concerns have been raised in relation to sexual safety for service users admitted to mental health inpatient wards in the UK. While sexual safety is a concern for everyone, the experiences and nature of concerns may vary across different groups and between individuals. It is also acknowledged that although interest in sexual safety is increasing, there remains limited evidence available from the perspectives of those who use mental health services. This article defines sexual safety and discusses its various components, and discusses a project that was undertaken to explore women’s perspectives and experiences of sexual safety in inpatient mental health settings. It also provides recommendations for maintaining sexual safety in clinical practice.
