Neurological observations in infants, children and young people: part one

Caring for infants, children and young people with an acquired brain injury (ABI) can be challenging due to their developing brain and reliance on parents and caregivers. It is essential that children's nurses are able to perform effective neurological observations, because these can identify deterioration and inform the management of patients with an ABI. This is the first of two articles that aim to encourage accuracy and consistency when undertaking neurological observations in infants, children and young people with an ABI to optimise their care. This first article details the pathophysiology, types and causes of ABIs and explains the potential complications that can occur following such injuries.

Dementia in care homes: increasing the diagnosis rate among undiagnosed residents

It has been estimated that 70% of care home residents have dementia on admission or develop it after admission, but that many do not have or receive a formal diagnosis of dementia. People with dementia often have significant care needs and it is important that the condition is diagnosed even at an advanced stage. This will enable nurses to predict the person's care needs, develop appropriate care plans and arrange pre-emptive decisions. In 2021-22, a quality improvement project took place in care homes in West Norfolk. This project piloted an abbreviated memory assessment model based on the Diagnosing Advanced Dementia Mandate (DiADeM) tool to increase the rate of diagnoses among residents showing signs and symptoms of cognitive impairment but not formally diagnosed with dementia. Out of 109 residents assessed, 95 were diagnosed with dementia. The pilot is being extended locally and replicated across England.

Developing an oral healthcare assessment strategy to enhance patient care

The promotion of oral healthcare is an integral part of nursing care. However, research has shown that staff in hospitals and community care settings often lack oral healthcare skills. This article details a quality improvement project in which a scoping exercise was undertaken in one NHS trust to assess whether ward-based oral healthcare provision was adequate. The scoping exercise identified that there was a need to address the lack of oral healthcare provision in the trust. Subsequently, a multidisciplinary working group developed an oral healthcare assessment tool and rolled this out across the trust. The authors also provided online training for nurses in the trust to assist them in using the new tool. At the same time, an audit of the oral healthcare products used in the trust, and their appropriateness, was undertaken.

Effective handovers on escalation of care for the deteriorating patient

Evidence suggests that improvements in clinical practice are required to ensure that deteriorating patients are rapidly identified and assessed in a systematic manner. The important step of escalating care involves a detailed handover to the most appropriate colleague so that interventions can be put in place to reverse or optimise the patient's condition. However, multiple issues can hinder this handover process, including a lack of confidence among nurses and suboptimal team dynamics or cultures. Using structured communication tools such as situation, background, assessment, recommendation (SBAR) can assist nurses in delivering a handover that results in the desired outcome. This article explains the steps involved in identifying, assessing and escalating the care of deteriorating patients, and describes the components of an effective handover.

Identifying the relationship between delirium and falls

Delirium, which may present as acute fluctuation in arousal and attention and changes in a person's behaviours, can increase the risk of falls, while a fall can increase the risk of developing delirium. There is, therefore, a fundamental relationship between delirium and falls. This article describes the main types of delirium and the challenges associated with recognition of the condition and discusses the relationship between delirium and falls. The article also describes some of the validated tools used to screen patients for delirium and includes two brief case studies to illustrate this in practice.

Identification, assessment and treatment of urinary incontinence and bowel control issues

Urinary incontinence and bowel control issues are prevalent within the general population and have significant adverse effects on peoples' daily lives and quality of life. This article examines the prevalence of urinary incontinence and bowel control issues and describes some of the more common types of issues. The author explains how to undertake a basic urinary and bowel continence assessment and outlines some of the treatment options, including lifestyle interventions and medicines.

Recognising, reducing and preventing deconditioning in hospitalised older people

Deconditioning is caused by complex physiological changes occurring as a result of immobility, for example during or after a period of acute illness or injury and hospitalisation. It leads to functional decline and compounds or contributes to conditions such as frailty and sarcopenia. In the past, prolonged bed rest was considered therapeutic, but the need to reduce or avoid prolonged immobility is now widely recognised. Hospital-associated deconditioning can be reduced or prevented through mobilisation strategies such as those promoted by the #EndPJparalysis campaign. This article explains the importance of reducing or preventing hospital-associated deconditioning and nurses' role in this.

The transcultural adaptation and validation of the Chinese version of the Attitudes Toward Recognizing Early and Noticeable Deterioration scale

Background

In China, clinical deterioration events present a real problem for every clinical nurse. Patient deterioration is determined in part by nurses' attitudes toward early recognition of clinical deterioration. However, research on attitudes toward the early identification of clinical deterioration is still in its infancy, and even less research has been done on ward nurses' attitudes toward the early identification of clinical deterioration. To drive behavioral change and improve the care of deteriorating patients, nurses need comprehensive, valid, and reliable tools to assess their attitudes toward early identification of deterioration.

Objective

In this study, we aimed to translate the Attitudes Toward Recognizing Early and Noticeable Deterioration (ATREND) scale into Chinese and to assess its validity and reliability tests.

Methods

From March 2022 to July 2022, the ATREND scale was translated, back-translated, and cross-culturally adapted into the Chinese version using a modified Brislin translation model. Then, 460 ward nurses were recruited from tertiary Grade A general hospitals in two cities: Shenyang and Jinzhou in Liaoning Province, China. Reliability analyses were conducted using internal consistency, split-half, and test-retest reliability. We convened a committee of experts to determine the validity of the content. Tests of the structural validity of the scale were conducted using exploratory and validation factor analyses.

Results

The Cronbach's α value of the Chinese version of the ATREND scale was 0.804, and the Cronbach's α value of the dimensions ranged from 0.782 to 0.863. The split-half reliability and test-retest reliability were 0.846 and 0.711, respectively. Furthermore, the scale has an index of content validity of 0.922, indicating a high level of content validity. In exploratory factor analysis, eigenvalues, total variance explained, and scree plot supported a three-factor structure. The three-factor model supported by this study was confirmed by confirmatory factor analysis (CFA). Moreover, the model fitting indexes (e.g., χ ²/DF = 1.498, GFI = 0.954, RMSEA = 0.047) were all within acceptable limits based on the CFA.

Conclusion

The Chinese version of the scale is reliable and valid among ward nurses. Nursing educators and clinicians will be able to develop targeted educational programs to enhance the competence and behaviors of Chinese ward nurses in recognizing clinical deterioration. It will be based on the developed scale to assess Chinese nurses' attitudes and practices regarding early recognition of clinical deterioration. As a result, it is necessary to consider the Chinese scale's three-factor structure. The developed three-factor structured scale will assess Chinese ward nurses' attitudes and practices toward patient observation and vital sign-monitoring empowerment, enlightening them on the importance of patient observation, encouraging ward nurses to use a wider range of patient assessment techniques to capture early signs of clinical deterioration, and helping ward nurses to develop clinical confidence to monitor clinical deterioration.

Recognition and management of patients with frailty in the emergency department

In the UK, around 10% of adults aged over 65 years and around one quarter to a half of adults aged over 85 years have frailty. Early identification of frailty can improve patient outcomes, so it is vital that emergency department (ED) healthcare professionals, including nurses, understand and can recognise the signs and symptoms of this health state. This article describes frailty and outlines the relationship between common presenting complaints in older people in the ED and frailty syndromes. The article summarises some commonly used frailty screening tools that have been validated for use in acute and emergency care settings and details a frailty screening tool used in the authors' hospital. The authors also outline some important principles of management of patients with frailty in the ED.

Assessment, diagnosis and treatment of children who present with stridor

The presence of stridor in children signifies a partial obstruction in the upper airways, the cause of which may range from mild to life-threatening depending on aetiology. The most common causes of stridor in this population are laryngotracheobronchitis (viral croup) and foreign body aspiration. This article gives an overview of the signs, symptoms and potential causes of stridor and the signs and symptoms of, and diagnostic criteria for, viral croup. The author also discusses evidence-based assessment criteria and treatments and criteria for admission or discharge. A case study is used for illustration.

Recognising eating disorders in older people

Changes in eating behaviours, weight and mental health in older people may be related to psychological distress and indicate the presence of a diagnosable eating disorder, rather than 'anorexia of ageing'. Eating disorders in older people may be overlooked because signs and symptoms are assumed to be part of normal ageing. The role of nurses in the care of older people with eating disorders is likely to be detection, referral and support in accessing specialist intervention. This article offers an overview of eating disorders in older people and discusses why they may arise, why they may not be detected and how to recognise them. The authors describe a framework that nurses can use when assessing older people to determine whether they may have an eating disorder.

When the dressing does not fit: choosing the right dressing for the right patient

There is a lot of literature about selecting a primary dressing for a wound. However, not much is made available on the selection of a secondary dressing, which is just as important, as it allows the primary dressing to remain in place. This article looks at selecting a secondary dressing that is appropriate for a patient, considering the patient's mobility or immobility, where the wound is located, how exudate can cause dressings to become detached, controlling a wound's odour, selecting a secondary dressing that will not damage a patient's skin and how nurses can keep themselves up-to-date with dressings.

Safe intravenous sedation for oral surgery in a primary care setting

Conscious sedation is a useful adjunct in oral surgery due to the invasive nature of procedures and the prevalence of dental anxiety in the general population. The most common conscious sedation technique used in the UK is intravenous sedation with a single drug, midazolam, which has an excellent record of safety. This paper gives an overview of areas to consider when planning oral surgery procedures in primary care under intravenous sedation with midazolam, to enhance success and patient safety. The fundamentals of providing safe sedation include careful patient assessment, patient preparation, a good understanding of the complexity of treatment, and an appropriately trained team. This paper also reviews the current guidance on conscious sedation in the UK, the governance of sedation in dentistry, the medications used, and training of the sedation team.

Frailty: an overview of concepts, risk factors, assessment tools and interventions

Frailty is a distinctive health state and a life-limiting syndrome seen in older people and in those living with multiple long-term conditions. It is likely that every nurse will encounter patients living with frailty in their clinical practice, even more so if they work in older people's nursing. People living with frailty are more vulnerable than others to stressors and insults due to a decline in their physiological reserve and function. There are tools that can be used to assess people's frailty or risk of frailty and interventions that can be used to prevent or reduce frailty. This article describes frailty and explains how to assess, prevent and reduce it. The article also outlines the relationship between frailty and coronavirus disease 2019 and the frailty trajectory at the end of life.

How to interpret arterial blood gas results

Arterial blood gas analysis is designed to measure the levels of oxygen and carbon dioxide in the blood, as well as the acid-base (pH) balance. Arterial blood gas analysis can assist healthcare professionals to evaluate respiration, circulation and metabolic processes in deteriorating patients. Arterial blood gas analysis is usually undertaken by a trained healthcare professional where patients are acutely unwell or deteriorating. REFLECTIVE ACTIVITY: 'How to' articles can help to update your practice and ensure it remains evidence based. Apply this article to your practice. Reflect on and write a short account of.

Identifying and managing acute kidney injury

Acute kidney injury, previously referred to as acute renal failure, is a common and often preventable condition that is seen in patients in acute and primary care settings. Nurses in both settings should be able to identify and assess patients at risk of acute kidney injury, and those with developing acute kidney injury, and understand the principles of clinical management. Early identification can assist in prevention of acute kidney injury, while supportive management and interventions can prevent further deterioration in patients diagnosed with the condition. This article describes acute kidney injury and outlines the pathophysiology, staging, and signs and symptoms. The author also describes the clinical management of patients with acute kidney injury and the long-term effects of the condition.

Patients' Assessment of Chronic Illness Care (PACIC): Validation and Evaluation of PACIC Scale among Patients with Type 2 Diabetes in Hungary

Introduction:

The aims of this study were to evaluate the psychometric properties of the Hungarian translation of the PACIC in a sample of patients with type 2 diabetes and to reveal the associations between the mean PACIC scores and the number of chronic diseases, or visits to GPs, and specialist. An exploratory factor analysis (EFA) has also been performed to test the structural validity of the PACIC scale.

Methods:

The Hungarian version of PACIC was validated using randomly selected patients with type 2 diabetes (N = 684) from licensed GP practices.

Results:

Floor (1.6%–30.2%) and ceiling effects (11.3–33.6%) were similar of the PACIC scale. The internal consistency of the total scale (Cronbach’s alpha 0.93) was excellent and subscales were good (between 0.73–0.9). The mean scores of each PACIC subscale group were between 2.99–3.53. There was a weak significant correlation between the mean PACIC scores of subscales and the number of GP visits (p < 0.001), and specialist visits (p < 0.001). The EFA identified four factors on the sample (KMO = 0.931). Gender and education showed correlation with some new factors.

Conclusion:

The psychometric properties of the Hungarian version of PACIC questionnaire showed a reasonable level of validity among patients with type 2 diabetes. Now, this instrument is ready to assess the chronic care of diabetic patients in Hungary.

Supporting the emotional well-being of patients with diabetes mellitus in primary care

Diabetes mellitus is a condition characterised by elevated blood glucose levels that can lead to significant acute and long-term complications. Alongside these physical complications, the condition can have substantial effects on people's emotional well-being, potentially resulting in diabetes distress and/or major depressive disorder. Therefore, timely assessment and referral of patients with diabetes who display signs and symptoms of diabetes distress or other mental health conditions are essential. This article discusses emotional well-being in patients with diabetes, and outlines some diabetes-specific validated assessment tools that can be used in practice. It also discusses the management and appropriate onward referral of people with diabetes who require support.

Clinical assessment of lower urinary tract symptoms in adults

Lower urinary tract symptoms (LUTS) result from conditions and diseases that affect the bladder and the urethra, and can occur in men and women of all ages. LUTS can be debilitating and affect a person's quality of life significantly. This article describes the definitions and classification of various LUTS, explains the aspects of an initial LUTS assessment and outlines the validated tools that can be used to support this process, including questionnaires and bladder diaries. It also provides information about the contributing factors associated with LUTS and the effects of these symptoms on patients' quality of life.

Self-harm and suicide: occurrence, risk assessment and management for general nurses

Suicide is a tragic event that has traumatic and far-reaching effects on families, friends and healthcare professionals, for whom feelings of guilt, blame and regret are common. Although there have been reductions in suicide rates globally and in the UK over past decades, it remains one of the leading causes of death. Assessing and supporting people who present with self-harm and risk of suicide are essential aspects of all nurses' clinical practice. This article explains the relationship between suicide, self-harm and other risk factors. It also provides guidance for general nurses on evidence-based approaches to managing self-harm and assessing suicide risk collaboratively with service users.

Comprehensive geriatric assessment: outcomes of an advanced nurse practitioner-led service for older people requiring emergency surgery

A comprehensive geriatric assessment (CGA) is a holistic multidimensional review of older people living with frailty or at risk of frailty. In emergency surgical settings, CGAs can be used to identify medical issues and geriatric syndromes among older patients and consequently try to improve their post-operative outcomes. However, there is a lack of geriatrician input in hospitals beyond medical wards, which means that older people who need emergency surgery do not always undergo a CGA, with potential negative repercussions for their post-operative outcomes. One solution to this issue is to employ advanced nurse practitioners (ANPs) to deliver equivalent services. This article presents and discusses the results of an audit of an ANP-led CGA service for older people admitted to hospital for emergency surgery. The ANP reviewed 147 patients during the audit period and identified frailty in 37% and new medical issues in 89% of patients. Interventions initiated by the ANP based on the CGA included requests for additional investigations, referral to allied health professionals and discharge planning. The audit results suggest that ANPs can conduct CGAs in emergency surgical settings effectively.

Role of medicines management in preventing falls in older people

Falls are common in older people and are a cause of preventable morbidity and mortality. As well as causing injury, falls can result in pain, distress, loss of confidence, loss of independence and increased mortality. Older people are more likely to visit an emergency department following a fall, therefore these incidents place a high burden on these patients and their carers, as well as on healthcare systems. Appropriate risk assessment accompanied by multifactorial falls prevention interventions can reduce the risk of falls. Assessments should include a medication review because various medicines, sometimes referred to as 'falls risk increasing drugs', can precipitate or contribute to falls. This article examines some of the medicines in this group that can contribute to falls, serious injuries and fractures in older people. It also discusses the importance of medicines management as part of falls risk assessment and prevention interventions.

Managing a patient presenting to the emergency department with upper gastrointestinal bleeding

Upper gastrointestinal (GI) bleeding is a common presentation in emergency departments (EDs). This medical emergency has a mortality rate of up to 14%, particularly in men and older people. The most frequent cause of upper GI bleeding is peptic ulcer disease. Management has not changed significantly in the past 50 years and there is ongoing debate in the literature about the most effective treatment protocols. This article uses a case study of a patient who presented to an ED with upper GI bleeding caused by peptic ulcer disease to examine the evidence on treatment and management. The article also discusses a care bundle that has been developed for rapid assessment and management of patients with acute upper GI bleeding.

Acute coronary syndrome: role of the nurse in patient assessment and management

Coronary heart disease is a leading cause of mortality, morbidity and hospitalisation in the UK and worldwide. Acute coronary syndrome (ACS) is a serious manifestation of coronary heart disease. ACS encompasses several conditions that represent acute injury or damage to the myocardium, including ST-elevation myocardial infarction (STEMI), unstable angina and non-ST elevation myocardial infarction (NSTEMI). Management may differ depending on the diagnosis, so prompt and accurate assessment is crucial to establish the patient's condition and ensure timely initiation of the appropriate treatment. This article explains how ACS develops and what characterises its different types. It also outlines the assessment and management of patients with ACS, and explains the nurse's role in these processes.

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.