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Abemaciclib▼ for the treatment of hormone receptor-positive (HR+), human epidermal growth factor receptor 2-negative (HER2−) metastatic breast cancer
Many patients with metastatic breast cancer develop resistance to endocrine therapy. Therefore, treatments with novel molecular targets have been developed to overcome endocrine resistance in patients with hormone receptor-positive (HR+), human epidermal growth factor receptor 2-negative (HER2−) metastatic breast cancer, including cyclin-dependent kinase 4 and 6 (CDK4 and CDK6) inhibitors. CDK4 and CDK6 inhibitors such as abemaciclib offer a new treatment option for patients with metastatic breast cancer.Nurses have an important role in providing guidance, education and support to patients with breast cancer. Since more patients are likely to receive abemaciclib, it will become increasingly important for nurses to understand how it works, how to effectively manage potential side effects and how to support patients with adhering to treatment.This article describes the rationale for the use of CDK4 and CDK6 inhibitors in patients with breast cancer, and provides practical advice on how to manage patients with metastatic breast cancer who have been prescribed abemaciclib.
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Protecting nurses against the risks of occupational exposure to systemic anticancer therapy agents
Many agents used for systemic anticancer therapy (SACT), which include chemotherapy drugs, monoclonal antibodies and other biological therapies, are known to be carcinogenic, teratogenic and mutagenic. Occupational exposure to SACT agents carries a proven risk of short- and long-term adverse health effects such as nausea, headaches, dizziness, hair loss, impaired fertility and cancer. The risk of contamination exists not only for staff who prepare or administer SACT agents, but also for those involved in transport, storage and waste disposal. In the UK, the handling of SACT agents is subject to a series of laws, regulations and guidelines. However, there are still inconsistencies in practice and a lack of awareness of the risks involved and need for training. The necessary preventive measures are not always in place and some staff remain exposed to cytotoxic agents. Furthermore, the risk of occupational exposure to SACT agents has intensified in recent years due to a significant increase in their use. This article prompts nurses to reflect on the health risks associated with handling SACT agents and the preventive and protective measures required.
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Differentiating between dementia, delirium and depression in older people
Older people can find hospital stays challenging and distressing. When their presenting symptoms make it challenging for healthcare professionals to differentiate between dementia, delirium and depression, their experience may be increasingly distressing, and can result in delays in diagnosis and treatment, as well as an increased risk of morbidity. This article considers each of the conditions of dementia, delirium and depression, their presenting features and how nurses can differentiate between them to enable comprehensive assessment, diagnosis and treatment in older people.
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Prevention and management of urinary catheter blockages in community settings
Self-management of long-term urinary catheters can be challenging for patients, and recurrent catheter blockages may cause concern among patients, carers and healthcare professionals. Catheter blockages are a significant challenge for nurses practising in community settings, because frequent and unplanned catheter changes can be costly to healthcare services in terms of time and resources. This article details evidence-based recommendations for the assessment and diagnosis of catheter blockages, as well as the identification of risk factors. It also explains the interventions that can be used to prevent and manage catheter blockages and describes the role of the nurse in supporting patients with a long-term catheter in situ in community settings.
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Assessment and management of chronic pain
Chronic pain can have significant physical, psychological and social effects on a person’s life, as well as on their families and friends. However, it is often not well-recognised or understood, which can lead to further harm. Therefore, an individualised, person-centred approach to chronic pain is essential to accurately assess pain and to develop an appropriate treatment plan. This article outlines the biomedical and psychosocial factors that can influence an individual’s pain experience that should be considered as part of the assessment and management of chronic pain, and explores the assessment tools available to assist in this process. It also discusses the management options available for chronic pain, including neural blockade and analgesics, as well as non-pharmacological options such as psychological approaches, physical activity and exercise, and complementary and alternative therapies.
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Nursing management of paediatric asthma in emergency departments
Childhood asthma is a complex disease which may be resistant to treatment and varies in its clinical presentation. The number of children admitted to emergency departments (EDs) with acute exacerbation of asthma is high and many are managed solely in the department. The correct assessment of the severity of an exacerbation can be achieved through competent history taking, examination and accurate recording of observations. Nurses working in EDs should be able to recognise the clinical signs and symptoms of acute asthma, assess severity and advise on appropriate management. Nurses should have some knowledge of first-line management and how and when to help deliver these therapies. They should also be able to guide patients in discharge and follow-up care, develop a rapport with families and educate them on topics such as trigger avoidance. The assessment and management of these patients as outlined in this article is based on the British Thoracic Society/Scottish Intercollegiate Network guidelines (BTS/SIGN) (2016).
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Ensuring effective intercultural communication in the emergency department
Globalisation and migration trends are reflected in emergency departments (EDs), which increasingly care for patients and employ staff from diverse cultural and/or ethnic backgrounds. EDs are busy, pressured and unpredictable environments where effective communication with patients and families is challenging at the best of times. This is compounded by language and cultural barriers experienced by patients and families whose background differs from the prevailing culture. Cultural differences and language comprehension may also be a challenge for overseas nurses recruited to the ED, who may need support from colleagues and organisations. ED nurses therefore need to be competent in intercultural communication. This involves combining optimal interpersonal skills with cultural awareness, knowledge and sensitivity.
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Exploring the therapeutic relationship in nursing theory and practice
The therapeutic relationship is widely regarded as central to nursing practice, yet the concept is so familiar that it is easily taken for granted. However, like any relationship, a therapeutic relationship cannot be assumed, and to be therapeutic it requires investment from both nurse and service user. This article outlines the theoretical background and fundamental components of the therapeutic relationship, such as self-awareness, reflection and professionalism. The author also describes the skills required to develop therapeutic relationships with service users and introduces a new mnemonic – ATTACH – which encapsulates some of these qualities and skills.
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Improving the physical health of people with a mental illness: holistic nursing assessments
People with a mental illness are more susceptible to physical ill health than the general population, which leads to significantly higher mortality rates among this group. Reasons for this include lifestyle factors such as smoking, lack of exercise and poor diet. Inadequate knowledge and skills about physical health among mental health nurses can lead to uncoordinated care and inadequate access to physical health services for people with mental ill health. This article aims to guide nurses to make initial holistic assessments with specific focus on areas of greatest physical disparity: dental health, eye conditions, sexual and reproductive health, smoking, drugs and alcohol, and metabolic syndrome. Relevant screening tools and health resources are explored. If nurses carry out holistic assessments as a basis for care, make appropriate referrals and deliver timely health promotion, physical health outcomes for people with mental illness will improve.
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Biological basis of child health 14: understanding the immune system, vaccines, allergy and disease
This article, the 14th in a series on the biological basis of child health, focuses on the immune system. It provides an overview of pathogens to which the human body is susceptible, some of the milestones in the embryological development of the immune system, and some of the mechanisms of innate and acquired immunity. The article explains the importance of immunisations and provides examples of immune system dysfunctions and autoimmune conditions that children may experience. It is essential that children’s nurses have an understanding of how the immune system develops, how it is structured and how it functions, since such knowledge will be relevant in the care of a range of conditions where nurses need to explain infection, inflammation and immune processes to children and parents.
