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Sexuality and sexual intimacy in later life
Sexuality is as important in older age as it is throughout life, and its expression can be positive, empowering, joyful and life-affirming. The concept of sexuality has many dimensions including identity, need and desire, relationships and behaviour, all of which develop through ageing and life experiences. The evidence on all aspects of sexuality in later life tends to focus on biological dysfunction rather than fulfilment, well-being and quality of life, and does not acknowledge the enormous diversity of older people in terms of age, sexualities, ethnicity and culture. However, the evidence base is growing and, in broad terms, what older people want is becoming more clearly articulated.This article acknowledges the current evidence and, building on this, suggests ways in which nurses working in health and social care services can address some of the challenges, enhance their own understanding and skills, and work creatively with older individuals to offer services that help them to live, and end, their lives according to their individual identities, choices and deepest, most personal, priorities.
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Recognising and managing non-tuberculous mycobacterial pulmonary disease
Non-tuberculous mycobacteria (NTM) are organisms that live in water systems, soil and vegetation. Humans come into contact with NTM every day, but relatively few people become unwell as a result. In those that do, pulmonary symptoms are the most common effects. The incidence of NTM pulmonary disease (NTM-PD) is increasing worldwide. However, early diagnosis of the infection is challenging and treatment can be unsuccessful. Moreover, the effects of the coronavirus disease 2019 (COVID-19) pandemic are likely to have delayed diagnosis of many cases of NTM-PD.Patients with NTM-PD have multiple needs, so appropriate person-centred support should be in place. This article explains the epidemiology, risk factors, symptoms, diagnosis and treatment of NTM-PD. It also details the long-term follow-up care and support that healthcare services should provide to patients in the community and emphasises the need for community NTM infection services and NTM nurse specialist roles.
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How to discuss the human papillomavirus infection with patients in primary care
Human papillomavirus infection is extremely common and is often eliminated by the immune system without being detected or causing harm. However, in some cases, it becomes persistent, and can induce cell changes that may potentially lead to cancer. Despite HPV infection being common, there is a lack of knowledge about it, as well as associated misconceptions and stigma. The UK cervical screening programme is moving from cytology to HPV testing as the primary method of reducing the risk of cervical cancer. This means that many women will be diagnosed with HPV infection and may consequently have concerns or experience distress.This article provides an overview of HPV, including its types, transmission, natural history, links to cancer and testing. It also explains how nurses working in primary care can discuss HPV infection with patients, providing information, reassurance and support.
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How to make clear and compelling written arguments: advice for nurses
Nurses are regularly required to make clear and coherent written arguments. Formulating arguments is an important element of academic coursework for nursing students, while nurses are required to demonstrate evidence of their learning, reflection and continuing professional development as part of their revalidation. Improving their practice knowledge and skills also requires nurses to reason and express themselves in writing. This article explains how context contributes to the formulation of arguments and how to differentiate between argument and opinion. It details how premises and supporting information are used to underpin an argument. The article uses a case study to demonstrate how a coherent written argument can contribute to practice improvement.
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Tracheostomy care in community settings
A tracheostomy can be a life-saving and life-giving procedure, but it can lead to complications that have serious consequences. In the lead author’s (CR) experience, there has been a noticeable increase in the number of patients leaving hospital with tracheostomies over the past two decades.This article will help community teams to recognise and plan for the many aspects to be considered when embarking on tracheostomy care in community settings. It identifies priorities of clinical care, offers advice about preparing the patient’s environment, and discusses the knowledge and skills required to deal with issues arising from tracheostomy. The aim is to enhance patient and carer confidence, and thereby promote independence, safety and quality of life.
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Understanding the health risks of varicella zoster virus in pregnancy
Varicella zoster virus (VZV) is a common illness that causes varicella (chickenpox) and shingles. It is prevalent mostly during childhood but there are additional co-morbidities from this disease for a woman and her fetus, if she contracts it during pregnancy. Many developed countries vaccinate children who have not acquired immunity to prevent their developing complicated varicella as adults. Countries that have implemented widespread vaccination have fewer hospital admissions for such complications.The UK does not have a national VZV vaccination programme and there is no strategy for reporting and documenting the incidence of the illness, so it is difficult to determine the potential prevalence of gestational VZV and its associated outcomes. The aim of this article is to provide an understanding of the aetiology of VZV and the potential health risks to unimmune women who may contact it during pregnancy, to advise them about their healthcare choices.
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Health promotion in emergency care: rationale, strategies and activities
The concept of health promotion emerged in the 1970s, prompting global health leaders to adopt a perspective on maintaining and improving the population’s health that accounts for the underlying causes of ill-health and mortality. Health is affected by social, economic and environmental factors, which explains why there are health inequalities within and between countries. Health services have been partly reoriented to focus on promoting health as well as treating ill-health, but health promotion is still misunderstood, including in the nursing profession. Health promotion is often viewed as being concerned with addressing patients’ lifestyle behaviours, but this is only one aspect of a much broader framework of health promotion strategies.This article introduces the concept of health promotion, explains its relevance to nurses working in the emergency department (ED), and identifies activities ED nurses can undertake to promote the health of patients, staff and the wider community. It also explains how ED nurses can play a role in health activism to better understand the social determinants of health and address health inequalities.
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Ethical practice in dementia care
This article draws on a range of case study examples from dementia care and explains how ethical theory can be applied to enhance professional practice. Ethical concepts are critically examined in this context and tensions between them are explored. The article demonstrates how an established ethical framework can assist with application in practice situations. It also argues that cultivating virtues, such as courage and receptivity, is an essential aspect of providing ethical nursing care for people with dementia.
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Promoting healthy eating in nurses
Across the world obesity rates in the general population have been increasing in recent years, a trend that has also been seen among nurses. Alongside the negative health effects of obesity such as type 2 diabetes mellitus and cardiovascular disease, the condition affects an individual’s ability to work and results in increasing rates of absenteeism. However, the nature of nursing shift patterns and the healthcare workplace itself can influence a nurse’s ability to eat healthily.This article discusses how obesity and healthy eating can affect the nursing role, as well as examining leadership and management practices that can support healthy eating in the workplace. The article is aimed at supporting nurse managers to reflect on their own lifestyle behaviour, which in turn will enable them to engage more with the topic of healthy eating among staff.
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Use of individual formulation in mental health practice
Formulation is a collaborative process that promotes shared understanding of a service user’s narrative to ensure their care is meaningful. This article provides an overview of individual formulation in mental health practice. It explores the interaction between formulation and interventions, and how mental health practitioners can work with service users by using formulation to plan and implement care. The article also presents two models of formulation – the five-area and 5Ps models – and explains how these can be used across a wide range of clinical presentations to understand a service user’s immediate problems and longer-term challenges, thus supporting the selection of appropriate evidence-based interventions.
