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Supporting people with dementia who mobilise excessively around and outside of the home
Family carers of people with dementia often report that the person they care for appears to ‘wander’ around or wants to leave the home. Community nurses are in an ideal position to offer guidance and support to carers who may not understand this behaviour. This article discusses the potential reasons why people with dementia may be increasingly mobile and/or walk with purpose. It provides information for community nurses on how they can support and advise family carers. It also details practical measures that can be taken to ensure the safety of people with dementia, in a person-centred and compassionate manner.
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Using team formulation in mental health practice
Formulation is a process of developing an understanding of what is happening for a person and why, and therefore what might be helpful for them. It involves gathering information, drawing from personal meanings and theoretical understandings to develop a coherent narrative. Traditionally, formulation is undertaken by a practitioner and a service user on an individual basis, but it can also be undertaken in a team context.This article explores team formulation, outlining its ideas, implementation and potential effects. It describes some of the evidence, outlines some techniques that can be used and reflects on team formulation in practice. However, it is not a systematic review of the evidence. It is hoped that this process will enable readers to develop an enhanced awareness of the concepts and issues involved, feel more confident engaging in team formulation and recognise the challenges and value that it can bring to clinical practice.
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Assessing and managing people with sickle cell disease presenting with vaso-occlusive crisis in the emergency department
Sickle cell disease is a group of inherited blood disorders characterised by atypical haemoglobin molecule structures (haemoglobin S) which can manifest as painful vaso-occlusive crises, chronic anaemia and progressive organ damage. This article aims to raise greater awareness of sickle cell disease, its acute manifestations and the potential for rapid clinical deterioration that can occur in patients with this condition. The article outlines the main aspects of the assessment and management of patients presenting to the emergency department (ED) with vaso-occlusive crisis, describes the barriers to effective care that they commonly experience and explains how their care could be improved. The authors emphasise the importance of timely management of these patients by ED staff, including emergency nurses.
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Reducing the use of restrictive practices by applying a human rights-based approach
In 2021 the Welsh Government launched a new framework for reducing the use of restrictive practices in childcare, education, health and social care settings. A series of reports and guidelines have stressed the importance of ensuring that restrictive practices, if used at all, respect people’s human rights. Human rights that are particularly relevant in this context include the right to not be subjected to inhuman or degrading treatment, the right to have one’s autonomy and physical and psychological integrity respected, and the right to not be discriminated against in the application of the Human Rights Act 1998. This article explores how applying a human rights-based approach can support learning disability nurses to consider the legal and ethical aspects of restrictive practices, use a person-centred approach that respects service users’ dignity and autonomy, and recognise their role in reducing the use of restrictive practices.
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Breaking bad news to patients in the emergency department
Breaking the news of potentially serious and new diagnoses to patients in the emergency department (ED) is a common but challenging aspect of the autonomous practitioner’s role. It is a complex process, requiring expertise and skill. If the news is delivered appropriately there is evidence to suggest a beneficial effect on the patient’s ability to cope, yet there is little formal training available and literature focused on the ED setting is limited. This article aims to guide and prepare autonomous practitioners in the ED to break bad news to patients, including during remote consultations introduced due to the coronavirus disease 2019 pandemic. It identifies the importance of preparation; different approaches to breaking bad news, namely the six-stage SPIKES framework and a case study exploring its application in practice; the range of potential patient reactions and how these can be managed, including the provision of support; and how to involve and communicate with other members of the multidisciplinary team. Suggestions for further training are outlined.
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How to get care right for people with learning disabilities in the emergency department: ask and engage
Healthcare professionals are legally obliged to make reasonable adjustments to ensure that people, including those with learning disabilities, can access appropriate and timely care. However, although people with learning disabilities are high users of general health services, staff have little understanding of learning disability with a negative effect on patient experience and outcomes.This article explores some of the challenges experienced by people with learning disabilities in the emergency department (ED). Each section focuses on a different aspect of how to adjust the delivery of healthcare to meet their needs, along with exercises to ensure those adjustments have been understood and to provide practical learning outcomes. Personal stories are also used to identify examples of when and where these adjustments could have been used to provide equal healthcare in the ED.
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Managing violence and aggression in the emergency department
Half of all reported violent incidents in healthcare settings occur in the emergency department (ED), so ED nurses are disproportionately affected by violence and aggression. Violence and aggression can cause physical injury, psychological harm, delays to patient care, eroded staff morale, increased sick leave and low staff retention. This article explores potential causes and risk factors for violent or aggressive behaviour from patients and visitors in the ED. It discusses risk assessment tools, management approaches and risk reduction strategies that can be used in the ED to tackle violence and aggression. The article also features a case study describing a successful small-scale trial of body-worn cameras at an East London ED.
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Meeting the needs of homeless people attending the emergency department
Homelessness is on the rise in the UK and, over the past few years, there has been a significant increase in the number of emergency department (ED) attendances and admissions by homeless people. Those attending the ED will often have multiple unmet health, housing and social care needs. While it is not possible to meet all these needs in the ED, emergency nurses should be equipped with the knowledge and skills required to communicate with, refer and signpost patients who are homeless.Under the Homelessness Reduction Act 2017, ED staff have a duty to refer homeless people, with their consent, to local authorities for assistance. This article details the barriers that homeless people may experience when accessing healthcare services and explains how these can be addressed. It also outlines the actions that emergency nurses can take to improve the care of homeless people in the ED at an individual and a systems level.
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Continuing professional development: lymphoma in primary care
Lymphoma encompasses a heterogeneous group of haematological malignancies that require complex management. Patients with lymphoma experience a wide range of physical, social and emotional issues.This article summarises the diagnosis, treatment and long-term consequences of lymphoma, and outlines the role of the primary care practitioner in the lymphoma care pathway.
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Sepsis: an overview of the signs, symptoms, diagnosis, treatment and pathophysiology
Sepsis is a common phenomenon surrounded by uncertainty and misunderstanding. The urgency for treatment is complicated by the vagueness of signs and symptoms and lack of a conclusive diagnostic test. This article unpicks the signs and symptoms of sepsis with guidance for emergency department nurses who are responsible for assessing patients with potential sepsis. The article also relates monitoring, investigation and treatment expectations to the underlying pathophysiology and refers to the individual and global implications of the condition.
