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Tracheostomy care: the role of the nurse before, during and after insertion
A tracheostomy is a surgical procedure that involves creating an opening and inserting a tube in the trachea to enable air transit from the external atmosphere to the lungs. The insertion of a tracheostomy is a common procedure used to wean patients from mechanical ventilation and to manage patients with upper respiratory tract complications. Furthermore, the coronavirus disease 2019 (COVID-19) pandemic has resulted in many patients requiring a tracheostomy as part of respiratory management. The two most commonly used tracheostomy insertion procedures are the open surgical tracheostomy and the percutaneous dilatation tracheostomy, both of which are associated with a range of complications. This article outlines the indications, benefits and complications of tracheostomy insertion, as well as the various types of tracheostomy tube that may be used. It also explains the role of the nurse in caring for patients before, during and after tracheostomy insertion, including the management of tracheostomy-related complications and emergencies.
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Tourette’s syndrome: challenging misconceptions and improving understanding
Tourette’s syndrome affects about 1% of the school-age population. Children and young people with the condition exhibit involuntary motor and vocal (also known as phonic) tics. Only 10% of those with Tourette’s syndrome have coprolalia, which involves involuntary swearing and inappropriate language. Tourette’s syndrome often presents with other conditions such as obsessive-compulsive disorder, autism and attention deficit hyperactivity disorder.Those affected by Tourette’s syndrome may be able to manage the condition with little or no professional support, but some may need pharmacological and nonpharmacological input, particularly from mental health services. It is essential that peers, teachers, healthcare staff and members of the public are aware of Tourette’s syndrome to ensure that children and young people living with the condition are supported well.
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Understanding the principles and aims of intravenous fluid therapy
A balance between the volume of fluid taken in by the human body, and the volume of fluid excreted, is essential for life. Body fluid balance, which is maintained via various homeostatic mechanisms, can be disrupted by injury or disease. Prompt action is usually required to replenish fluid volumes and restore homeostasis, which is achieved via intravenous (IV) fluid therapy. Nurses will often encounter patients with a disrupted fluid balance, particularly in critical care. They will be involved in assessing patients’ fluid status and administering and monitoring therapy. Therefore, nurses have an important role in ensuring the safety and effectiveness of IV fluid therapy. This article provides an overview of the principles and aims of IV fluid therapy. It also explains the physiology of body fluid and mechanisms of fluid balance regulation, outlines the principles of patient assessment and indications for IV fluid therapy, and details its potential risks and complications.
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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.
