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.

Challenges of Using Instant Communication Technology in the Emergency Department during the COVID-19 Pandemic: A Focus Group Study

A record outbreak of community-spread COVID-19 started on 10 May 2021, in Taiwan. In response to the COVID-19 pandemic, care facilities have adopted various protocols using instant communication technology (ICT) to provide remote yet timely healthcare while ensuring staff safety. The challenges of patient evaluation in the emergency department (ED) using ICT are seldom discussed in the literature. The objective of this study was to investigate the factors influencing the utility of ICT for patient assessment in emergency settings during the pandemic. The patient flow protocol and the ED layout were modified and regionalized into different areas according to the patient’s risk of COVID-19 infection. Nine iPads were stationed in different zones to aid in virtual patient assessment and communication between medical personnel. A focus group study was performed to assess and analyze the utility of the ICT module in the ED. Eight emergency physicians participated in the study. Of them, four (50%) had been directly involved in the development of the ICT module in the study hospital. Three main themes that influenced the application of the ICT module were identified: setting, hardware, and software. The setting theme included six factors: patient evaluation, subspecialty consultation, patient privacy and comfortableness, sanitation, cost, and patient acceptability. The hardware theme included six factors: internet connection, power, quality of image and voice, public or personal mode, portable or fixed mode, and maintenance. The software theme included six factors: platform choices, security, ICT accounts, interview modes, video/voice recording, and time limitation. Future studies should focus on quantifying module feasibility, user satisfaction, and protocol adjustment for different settings.

'Five things about me' - enhancing person-centred care for older people

Although person-centred care represents the gold standard of nursing practice, there are still instances of care that fail to recognise patients as individuals. Person-centred care depends on the nurse's knowledge of the whole person, including their values, beliefs and aspirations. This article describes a quality improvement project that sought to develop patient profiles based on the concept of 'five things about me', thereby contributing to person-centred care for older people on a medical ward. The effect on staff, older people and their families was assessed through questionnaires, and group and individual discussions. During the project period, 37 person-centred profiles were completed from 52 eligible patients. Ward staff reported increased confidence when delivering person-centred care and older people and their family members confirmed improvements in care delivery and strengthened relationships with staff.

Respiratory assessment: undertaking a physical examination of the chest in adults

Nurses frequently encounter patients in respiratory distress or with respiratory complications, whether from acute disease or a long-term condition. A physical examination of the chest should be conducted as part of a comprehensive respiratory assessment of the patient, and should follow a systematic approach that includes inspection, palpation, percussion and auscultation. Nurses undertaking these hands-on components of respiratory assessments need to have adequate knowledge of the procedures involved, as well as practical skills that need to be practised under supervision. This article outlines how to undertake a physical examination of the chest in adults.

Supporting older people experiencing anxiety through non-pharmacological interventions

Anxiety is a debilitating condition that adversely affects people's quality of life. It is challenging to differentiate anxiety from other physical and mental health conditions in older people, particularly those with co-morbid dementia or depression. The coronavirus 2019 pandemic has compounded social isolation and loneliness in older people, causing increased levels of anxiety. Nurses need to be able to detect and assess anxiety in older people and offer short, low-intensity interventions to support older people's mental health or refer them to specialist assessment and treatment. While research on anxiety in older people is lacking, cognitive behavioural therapy, mindfulness, yoga, music therapy and pleasant activities have shown potential as non-pharmacological interventions for alleviating anxiety in older people. This article explores the role of nurses in identifying when an older person may be experiencing anxiety and then choosing the optimal non-pharmacological intervention to support them.

Assessing Preoperative Anxiety: Nurses Versus Health Care Assistants

PURPOSE

Our objective was to compare the difference in anxiety levels self-reported by patients and those estimated by health care assistants and nurses in two ambulatory surgery settings.

DESIGN

We performed a prospective study.

METHODS

Patients' preoperative anxiety was graded using a visual analog scale.

FINDINGS

Between September 1 and November 31, 2019, a total of fifteen health care assistants and fourteen nurses assessed anxiety scores of 170 patients, including 92 women and 78 men. At admission, the mean visual analog scale anxiety score declared to health care assistants and nurses was 5.3 (SD = 2.9) and 4.2 (SD = 3.1), respectively (P = .02). The correlation between health care assistants' assessment of the patients' anxiety and the declared level of anxiety was significantly higher than nurses' assessment (r = 0.83 vs r = 0.12; P < .001).

CONCLUSIONS

Nurse assistants estimate patients' preoperative anxiety with more accuracy than nurses in our hospital. Nursing education curriculum should continue to include addressing preoperative patient anxiety.

Frailty assessment and interventions for community-dwelling older adults: a rapid review

Frailty is a syndrome involving increased vulnerability that usually develops from age-related decline in physiological reserves and function in multiple organ systems, resulting in an impaired ability to respond to acute changes in health conditions. It is imperative that healthcare providers who work with older adults in primary care and community settings understand how to assess frailty and can identify appropriate interventions. This article reports the results of a rapid review that examined how frailty is assessed in community-dwelling older adults and what interventions are used to address frailty in this population.

Comparative Study of Oral Health-Related Quality of Life (OHRQL) between Different Types of Orthodontic Treatment

Background and objectives: Although the main objective of any orthodontic treatment is to correct malocclusion, a range of psychosocial and/or esthetic factors drive patients to undergo orthodontic treatment. The aim of the present study was to analyze variations in oral health-related quality of life (OHRQL) levels in patients undergoing orthodontic treatment by means of four types of appliances: fixed buccal metal brackets, fixed buccal esthetic/ceramic brackets, fixed lingual brackets, and clear aligners. Material and Methods: The study sample comprised 120 patients aged 18 to 68 years who attended the Orthodontic department at the Dental Clinic of the University of Valencia. The Index of Orthodontic Treatment Need (IOTN) was used to measure orthodontic treatment need. Each patient completed three different intervals of the 14-item Oral Health Impact Profile (OHIP-14): before treatment (T0); six months after placing the orthodontic appliances (T1) and at the end of orthodontic treatment (T2). Results: All groups suffered a reduction in quality of life from T0 to T1 except the metal bracket group which presented the same level for the functional limitation domain (p = 1.000), the lingual bracket group for the psychological discomfort domain (p = 1.000) and clear aligner group for the physical disability domain (p = 0.118) and psychological disability domain (p = 1.000). Nevertheless, quality of life for most domains was similar in all groups at the end of treatment (T2). Conclusions: Patients underwent a significant reduction in quality of life during treatment in comparison with their pre-treatment condition but showed significant improvements at the end of treatment.

Building safety cultures at the frontline: An emancipatory Practice Development approach for strengthening nursing surveillance on an acute care ward

AIM

To evaluate an emancipatory Practice Development approach for strengthening nursing surveillance on a single medical-surgical ward.

BACKGROUND

Registered nurses keep patients safe in acute care settings through the complex process of nursing surveillance. Our interest was understanding how frontline teams can build safety cultures that enable proactive nursing surveillance in acute care wards.

DESIGN

A year-long emancipatory Practice Development project.

METHODS

A collaborative relationship was established around a shared interest of nursing surveillance capacity and researcher embedded on a medical-surgical ward. Critical analysis of workplace observations and reflection with staff generated key sites for collective action. Ward engagement was supported by creative Practice Development methods including holistic facilitation, critical reflection and action learning. An action learning set was established with a group of clinical nurses, facilitating practitioner-led change initiatives which strengthened nursing surveillance and workplace learning. Evaluation supported an iterative approach, building on what worked in an acute care context. Immersive researcher evaluation, drawing on multiple data sources, generated an analysis of how ward nursing surveillance capacity can be strengthened. COREQ criteria guided reporting.

RESULTS

The ward moved through a turbulent and transformative process of resistance and retreat towards a new learning culture where nursing surveillance was visible and valued. Staff developed and sustained innovations including the 'My MET Call series', a 'Shared GCS initiative', an enhanced 'Team Safety Huddle', and staff-led Practice Development workshops. These new practices affirmed nurses' agency, asserted nurses' clinical knowledge, positioned nurses to participate in team decision-making and humanised care.

CONCLUSION

Working collaboratively with frontline staff enabled bottom-up sustainable innovation to strengthen nursing surveillance capacity where it mattered most, at the point of care.

RELEVANCE TO CLINICAL PRACTICE

Emancipatory Practice Development enables the profound impact of small-scale, microsystem level practice transformation. It is an accessible methodology for clinical teams to develop effective workplace cultures.

Recognising and assessing acute pain

This article considers two areas of practice that are fundamental to the provision of high-quality nursing care for people experiencing acute pain: the initial recognition of pain, and the formal assessment of pain. The initial recognition of a patient's pain is a subject that is frequently overlooked in the literature. However, if nurses are unable to identify that a patient is experiencing pain, then a formal pain assessment may not take place, which in turn negatively affects the quality of any subsequent pain management. This article explores some of the barriers to the initial recognition of pain and examines how a formal pain assessment can support optimal patient care.

Preventing, identifying and managing delirium in nursing homes and acute settings

Older people, particularly those in nursing homes, are vulnerable to delirium, which is a condition characterised by confusion. This article outlines the risk factors, prevention, identification and management of delirium in older people in nursing homes and acute settings. It uses a case study approach to encourage nurses to consider the challenges faced in these settings and how they could address delirium. The article also details the multicomponent interventions that can be used for prevention, as well as the available delirium assessment tools, with a focus on selecting tools based on the person's health status and the healthcare setting.

Associations of practical, emotional, and physical problems with psychosocial distress among cancer patients

OBJECTIVE

To better understand the relationship between cancer patient distress and psychosocial variables, including problem types, to improve ability to predict and address psychosocial need.

METHODS

A variation of National Comprehensive Cancer Network (NCCN) Distress Thermometer (DT) was administered and collected at four sites from an Integrated Network Cancer Program (INCP). The presence of moderate/severe distress was examined relative to patient demographics, disease characteristics, and psychosocial problems.

RESULTS

Distress scores were positively correlated with all problem counts. For every count increase of practical, emotional, and physical problems, and for every cancer stage increase the odds of reporting a moderate/severe distress score was significantly higher. Relative to patients with one cancer treatment type, patients with three cancer treatment types were significantly less likely to report moderate/severe distress.

CONCLUSION

Problem count could be a useful indicator for clinical intervention. Stage and number of treatment types may also be considered clinically relevant distress predictors.

How to take a patient's temperature

Being able to accurately assess and record a patient's temperature is an essential nursing skill, and should be undertaken as part of a wider systematic assessment of the patient. Any concerns regarding individual recordings or trends should be escalated to other members of the healthcare team as appropriate. REFLECTIVE ACTIVITY: 'How to' articles can support you to update your practice and ensure it remains evidence-based. Apply this article to your practice. Reflect and write a short account of.

Assessment and management of metastatic bone cancer in emergency departments

A cancer diagnosis in emergency departments (EDs) is often associated with advanced or metastatic cancer. Patients with bone metastases have a complex range of physical and psychological needs. Meeting the needs of patients with cancer is an important part of the role of emergency nurses, but evidence suggests that they often do not feel adequately prepared to provide effective care for this patient group. This article uses a case study of a patient who presented to an ED with metastatic cancer in his right lower limb, to provide an overview of bone metastases, including the relevant anatomy, pain management and psychological support. The article also outlines the signs and symptoms of bone metastases and discusses patient assessment, symptom management and available treatments.

Hand injury: investigating the accuracy of referrals to a specialist trauma centre

Hand injury is a common presentation in the emergency department (ED). The accurate assessment of hand injuries is essential to ensure optimal management, which may need to include referral to a tertiary trauma centre. However, hand injury assessment can be challenging, particularly in children. A better understanding of the accuracy of hand injury referrals to tertiary care can help improve clinical practice and clinician training. This article reports on a service improvement project that aimed to determine the accuracy of hand injury referrals from EDs and general practices to a tertiary trauma centre. The retrospective investigation found the accuracy of referrals to be high, but also identified areas where hand injury assessment required improvement, one of them being the training of clinicians referring complex cases to tertiary care.

Ensuring contact: calling rural Appalachian older adults during the COVID-19 epidemic

INTRODUCTION

Older adults, especially those aged 85 years or older, remain at significantly higher risk for COVID-19. This group, along with those with pre-existing heart and lung disease and diabetes, have accounted for 80% of hospitalizations and an even higher percentage of COVID-19 related deaths in the USA. West Virginia, the only state in the USA located completely within Appalachia, has a higher percentage of elderly than all but two states in the nation. Rural seniors are hesitant to use hospital emergency departments and attend routine care visits for fear of exposure to the virus. Restricted cell phone and internet service may limit effective technological outreach to more isolated rural older adults. More information is needed to develop effective, safe, and acceptable approaches to care for rural, isolated older adults.

METHODS

Telephone interviews were conducted with 124 community-dwelling residents in four counties in rural Appalachia between 1 and 22 April 2020. Participants were aged 75 years or older. Descriptive statistics were calculated and Fisher's Exact Test was used to examine for associations among variables.

RESULTS

Participants consisted of 86 (69.4%) women and 38 (30.6%) men with an average age of 82.5 years. Telephone contact was the preferred method of contact among all but four participants (96.8%). Seventeen calls (13.7%) resulted in some form of intervention, including arranging for emergent home repairs, treatment of severe hypertension, scheduling urgent laboratory testing, arranging for terminal care, treating acute conditions, and providing durable medical equipment. The 17 participants requiring intervention were significantly more likely to be aged 85 years or older (p=0.004), and report two or more chronic conditions (p<0.001). Those describing themselves as 'lonely' were significantly more likely to live alone (p=0.009) and describe themselves as 'anxious' or 'depressed' (p<0.001).

CONCLUSION

A telephone call appears to be the most effective means of communication with patients in these rural Appalachian counties. Patients aged 85 years or older and those living alone should be given highest priority for regular outreach by healthcare providers. In this population, systematically calling rural elderly patients during the COVID-19 epidemic and its aftermath represents an effective strategy for providers who care for elderly rural patients.

A survey of nurses involved in assessing the eligibility of older people for NHS continuing healthcare

BACKGROUND

Nurses in England play a prominent role in NHS continuing healthcare (CHC) assessments, but there are no overview data on their knowledge and educational needs.

AIM

An online survey was conducted to identify the educational status and development needs of nurses involved in CHC assessments.

METHOD

The survey was informed by a literature review and focus group discussions, and distributed via email to the members of the Royal College of Nursing older people's forum. Descriptive data analysis was undertaken.

RESULTS

Overall, respondents were confident about their ability to undertake CHC-associated work and manage each aspect of the CHC process. However, respondents were less confident about how to determine whether a primary health need exists based on the four main criteria - nature, complexity, intensity and unpredictability - of a person's health and social care needs. This was one of the respondents' priorities for training and development.

CONCLUSION

The survey demonstrates the importance of face-to-face and multidisciplinary CHC training delivered locally. It also confirms the need for a standardised approach and more consistency in the CHC assessment process. A CHC competency framework would contribute to standardise the process and benefit all involved.

Use of PADIS Assessment Tools by Critical Care Nurses: An Integrative Review

The purpose of this integrative review was to evaluate the literature from January 2013 to April 2020 and to explore critical care nurses' perspectives of and intent to use recommended Pain, Agitation/Sedation, Delirium, Immobility, and Sleep Disruption (PADIS) patient assessment tools in adult critical care units. A literature search was performed with a total of 47 studies included in the final analysis for this review. The studies' data were organized and further reduced based on The Reasoned Action Approach behavioral theory to reflect the extent to which a nurse plans to use a PADIS assessment tool. Extracted themes were related to behavioral beliefs in patient-centered care and critical thinking; normative beliefs about communication and prioritization; and control beliefs concerning autonomy and confidence. Contextualizing the international phenomenon of variation in PADIS assessment tool use by critical care nurses provides a deeper understanding of its complexity for use in the clinical setting.

Undertaking a systematic assessment of patients with a traumatic brain injury

Traumatic brain injury (TBI) is a time-critical injury, which means it is essential that patients with suspected TBI are assessed promptly and systematically using an approach such as ABCDE (airway, breathing, circulation, disability, exposure). Existing or emerging abnormal physiological parameters must be identified and addressed to maintain adequate brain perfusion, limit neurological cell death and minimise long-term disability. This article explains the pathophysiology of TBI and outlines the elements of a systematic patient assessment using the ABCDE approach.