Foundations of Nursing Practice E-Book

Chris Brooker; Anne Waugh

BOOK

Foundations of Nursing Practice E-Book

Chris Brooker | Anne Waugh

(2013)

Additional Information

Book Details

ISBN: 978-0-7020-5333-7
Edition: 2
Language: English
Pages: 676
Subjects: Geriatric medicine
Nursing
Surgical nursing

Abstract

This second edition of Foundations of Nursing Practice has been revised and updated specifically to meet the needs of nursing students in all fields of practice The book explains how and why sensitive, safe, evidence-based holistic nursing care is carried out, including topics common to all fields of practice. Core nursing skills are emphasised to reflect the importance of clinical skills as well as the underpinning theory.

Aids to learning in each chapter:

Learning outcomes

Interactive boxes for all age groups and fields of nursing practice

Key words and phrases for literature searching

Useful websites, references and further reading.

This book provides a comprehensive introduction to nursing that will meet the needs of students, nurses returning to practice, mentors and other registered nurses.

Relevant to all branches of nursing settings: infants, children, adults, pregnant women, older people and people with a learning disability or mental health problems

Themes relevant to all stages and fields of nursing practice include safety, infection prevention and control, managing stress, communication, managing wounds and pressure ulcers, and dealing with loss

Scenarios develop the skills of evidence-based practice, critical thinking, reflection and health promotion, and encourage further learning

The areas of psychology, sociology, physiology and pathology are clearly related to nursing practice

Key principles of health promotion, the law and ethics, the human lifespan and development are explained in earlier chapters, then applied in later chapters

Cultural diversity information helps with understanding the needs of people from different backgrounds

Person-centred approach encourages problem solving and application to practice

Evidence-based practice is explicit throughout, and best-practice guidelines underpin exploration/explanation of nursing care.
Easy-reference Glossary at the back of the book.

Meets the requirements of the new pre-registration nursing curriculum including the NMC (2010) competencies and Essential Skills Clusters

Greater emphasis on safeguarding vulnerable people, maternal health and first aid

Self-test questions with answers available on accompanying website.

Section Title	Page	Action	Price
Front cover	cover
Half title page	i
Foundations of Nursing Practice	iii
Copyright page	iv
Table of Contents	v
Contributors	vi
Foreword	viii
Preface	ix
Acknowledgements	ix
How to use this book	x
1 Health, nursing and healthcare systems	1
1 Understanding health and health promotion	3
Learning outcomes	3
Introduction	3
Definitions of health	4
Dimensions of health	4
Holistic health	4
The body as a machine	4
The continuum of health	5
Positive and negative health	5
WHO definitions of health	5
Defining mental health	6
Lay and professional definitions of health	6
Models of health and illness	6
The medical model	7
Mental health language and the medical model	7
The social model	7
The patient-centred model	7
Service user and carer involvement	7
Health beliefs	8
Early health beliefs	8
Religion and health	8
Supernatural ideas and health	8
Scientific developments and health	8
Current lay health beliefs	8
Lay beliefs about the causes of illness	9
Children’s health and illness beliefs	9
Becker’s health belief model	10
The nurse’s role and application of the HBM	10
Attitudes, values and behaviours	11
Public and private attitudes	11
Cognitive dissonance	11
Values	11
Stereotyping	11
Lifestyle, health behaviours and locus of control	12
Factors influencing health	13
Determinants of mental health and well-being	14
Poverty as the key determinant of health	14
Relative poverty and participation in society	15
Components of poverty	15
Social class and health inequalities	15
Research into health inequalities	15
Changing trends in health and illness	16
Health promotion	17
Emergence of health promotion	18
Principles of health promotion	18
Health promotion and public health	18
National health promotion organizations	19
Settings and skills for health promotion	19
Approaches to health promotion	20
The medical approach	20
The behavioural change approach	20
The educational approach	20
The client-centred approach	20
The societal approach	21
Models of health promotion	21
Tannahill’s model of health promotion	21
The Tones model	22
Health education	22
Approaches to health education	23
Health education in the NHS	23
Levels of health education	23
Primary health education	23
Secondary health education	24
Tertiary health education	24
UK health policy context	25
Measuring health and illness	25
Purposes of measuring health and illness	26
Common methods of health and illness measurement	26
Incidence	26
Prevalence	27
Distribution	27
Other approaches to measurement of health and illness	27
Needs assessment	27
Social audit	27
Community profiling	27
Priorities	28
Illness behaviour	28
Self-help and self-care	28
The effects of illness	29
Help-seeking behaviour	29
The sick role	29
Useful websites	30
References	31
Further reading	31
2 Evolution of contemporary nursing	33
Learning outcomes	33
Introduction	33
Evolution of nursing	33
Nursing in the eighteenth and nineteenth centuries	33
The influence of Florence Nightingale	34
Mary Seacole	34
Health visiting	35
Development of nursing specialties	35
Children’s nursing	35
Mental health nursing	35
The beginning of education and regulation	35
Nursing in the twentieth century	35
The 1930s	36
The impact of the Second World War	36
The influence of the National Health Service (NHS) on nursing	37
Emergence of humanism	37
The influence of nursing theory	38
The early influence of nursing research	39
The late twentieth century	39
Code of professional conduct	39
University education for student nurses	39
Moving towards evidence-based practice	39
Approaches to nursing practice	42
Holistic care	42
Person-centred care	42
Involving users and carers	42
Effective teamwork	42
Nurses as members of a multidisciplinary team	44
Approaches to organizing nursing care	44
Task allocation	44
Patient allocation	44
Team nursing	44
Primary nursing	45
Care delivery in practice	45
Contemporary nursing	46
Nursing today	46
Influences on nursing today	47
Technology	48
Consumerism	48
Diversity and equality	48
Human rights	48
Nursing in different settings	48
Community nursing roles	48
School health advisors	49
Health visiting	49
Public health nursing	49
Family health nursing	49
District nursing	49
Hospital nursing	49
Intermediate care	50
Becoming a nurse in the twenty-first century	50
Pre-registration nursing programmes	50
Fields of nursing practice	51
Adult nursing	51
Learning disability nursing	51
Mental health nursing	53
Children’s nursing	54
Roles of non-registered staff	55
National vocational qualifications	55
Roles of the nurse	55
Generic roles of the RN	55
Mentoring	55
Roles of experienced RNs	56
Nurse practitioners	56
Teaching	56
Clinical leadership	56
Clinical nurse specialists	57
Nurse consultants	57
Lead roles	57
Nurses as researchers	58
Student nurses’ contribution to nursing and its evolution	58
Useful websites	59
References	59
Further reading	60
3 Health and social care delivery systems	61
Learning outcomes	61
Introduction	61
Health and social care provision	61
Creation and evolution of the NHS	62
Changes – 1960s and 1970s	62
Changes – 1980s and 1990s	62
Changes – twenty-first century	64
Types of health and social care provision	64
Funding of health and social care in the UK	65
Comparisons of the UK funding model with other systems	66
The National Health Service	67
Structure and functions of the NHS	67
Primary healthcare	67
Newer first access routes	68
Intermediate care	68
Secondary and tertiary healthcare	68
Services for specific groups	69
Mental healthcare	69
Children’s healthcare	69
Ambulance Service Trusts	70
Special health authorities	70
Multidisciplinary teamwork	70
Social care provision	71
Structure and funding of social care provision	71
Social care provision by the voluntary sector	71
Social workers	71
Safeguarding children and vulnerable adults	72
Social services for older adults	73
Social services for children	73
Social services for people with a learning disability	74
Providing high quality health and social care	74
Clinical governance and high quality care	75
Dimensions of high quality care and their implementation	75
Patient safety	76
Clinical guidelines	76
National Service Frameworks	76
Care Quality Commission (CQC)	77
NHS Commissioning Board (NCB)	77
Effectiveness and efficiency	77
Measuring quality and performance	77
Benchmarking	77
Audits	78
Patient surveys	78
User choice and voice	78
User choice	78
User voice	79
Local HealthWatch	79
HealthWatch England	79
Patient Advice and Liaison Services	79
Complaints	79
Useful websites	80
References	80
Further reading	81
2 Professional practice	83
4 Learning and teaching	85
Learning outcomes	85
Introduction	85
Theories of learning	85
Behaviourism	85
Cognitive theories of learning	86
Humanistic theories of learning	86
Andragogy	87
Kolb’s experiential learning cycle	87
Concrete experience	88
Reflective observation	88
Abstract conceptualization	88
Active experimentation	88
Summary	88
Race’s ripples model	88
Wanting to learn	88
Needing to learn	88
Learning by doing	89
Learning through feedback	89
Making sense of things	89
Coaching, explaining and teaching	89
Making informed judgements	89
Summary	89
Interprofessional learning	89
The learning process	89
Learning styles	89
Activists	89
Reflectors	89
Theorists	90
Pragmatists	90
Deep, strategic and surface learning	90
Deep approach to learning	90
Strategic approach to learning	90
Surface approach to learning	91
Summary	91
Reflection	91
Purpose of reflection	91
Models of reflection	91
Gibbs’ reflective cycle	91
Atkins and Murphy’s framework for reflection	91
LEARN framework for reflection	92
The process of reflection	92
Critical thinking	94
Factors influencing learning	94
Motivation	94
The place of feedback in learning	95
How do you learn?	95
Readiness to learn	96
Individuals disadvantaged when considering information needs	98
People who have problems in learning	98
The learning environment	98
Role models	99
Summary	100
Teaching and learning methods	100
Mass instruction methods	100
Individualized methods	100
Group methods	100
Role of teacher	100
Action learning	100
Problem-based learning	101
Portfolios	101
The process of teaching	101
Assessment	102
Planning	102
Aims and learning outcomes	103
Useful websites	104
References	104
Further reading	105
5 Evidence-based practice and research	107
Learning outcomes	107
Introduction	107
What is evidence-based practice?	107
Defining EBP	108
The EBP cycle	108
Questioning practice	108
Refining the question into a workable search question	108
Finding the evidence	108
Appraising the evidence	108
Implementing the evidence	109
Evaluating or auditing practice	109
Literature searching	109
Sources of literature	109
Bibliographic/electronic databases	109
Books	109
The Internet	109
Journals and newsletters	110
Reports	110
Developing a search question	110
Searching databases	111
Indexing terms	111
Free text terms	111
Combining your search terms	112
Sources of knowledge to support evidence-based practice	114
What is meant by ‘evidence’?	114
Tradition and ritual	115
Experience	115
Intuition	115
Authorities and experts	115
Service users and their families	115
Research studies	116
Audit	116
Guidelines	116
Best evidence	116
Overview of the research process	117
Quantitative research	117
Qualitative research	117
Quantitative and qualitative research in nursing	117
Different types of research design	118
Sampling strategy	118
Types of data collection	118
Observation	118
Questionnaires	118
Documents	118
Interviews	118
Ethical issues and research	118
Appraisal of the evidence	119
Critical awareness	119
Strategies to develop critical appraisal skills	120
Questions to ask when critically appraising a research paper	120
Appraising different research designs	120
Appraising qualitative research	121
Appraising systematic reviews	121
Appraising randomized controlled trials	121
Appraising survey designs	121
Appraising guidelines	122
Putting evidence into practice	122
Challenges to the use of evidence in practice	122
Implementing evidence	123
Useful websites	123
References	124
Further reading	124
6 Legal issues that impact on nursing practice	125
Learning outcomes	125
Introduction	125
Legal frameworks	125
Structure of law	125
Sources and types of law	126
Acts of Parliament	126
Court system (England and Wales)	127
Important legislation for nursing	127
The Human Rights Act	128
Mental health legislation	129
Rights for children and child protection	130
Data Protection Act	130
Legal concepts integral to nursing	131
Safeguards for practice	131
Statutory regulation	131
Contracts of employment	131
Professional indemnity insurance	132
Conscientious objection	132
Policies, procedures and guidelines	132
Documentation and record-keeping	132
Reporting incidents/accidents	133
Duty of care and negligence	133
Negligence	133
Accountability to employer	134
Professional accountability to the NMC	134
Civil accountability	134
Criminal accountability	134
Confidentiality	135
Consent	135
Consent in children	136
Consent – people with learning disability or fluctuating mental capacity	136
Adult refusal to treatment	137
Advance decisions and advance statements	137
End-of-life issues	138
Useful websites	139
References	139
Further reading	139
7 The NMC Code of conduct and applied ethical principles	141
Learning outcomes	141
Introduction	141
The role of the Nursing and Midwifery Council (NMC)	141
Protection of the public	141
Quality assurance of educational programmes	141
Registration of students as qualified practitioners	141
Register of practitioners	142
Post-registration education and practice	142
Fitness to practise	142
NMC expectations of nursing students	142
NMC documentation	142
The code of professional conduct	142
Implications of The code for nursing students	143
Confidentiality	143
Access to patient and client records	144
Confidentiality in practice	144
Ethical principles	145
Autonomy and justice	145
Non-maleficence and beneficence	145
The ethical and moral dimensions of nursing practice	146
Ethics and morals	146
Ethical theories	146
Consequentialist ethics	147
Strengths and limitations of a utilitarian approach	147
Unpredictability of outcomes	147
What counts as ‘benefit’?	148
Are numbers all that count?	148
Does the end result justify the means?	148
Rule utilitarianism	148
Consequentialist ethics: summary	148
Deontological ethics	148
Areas of potential conflict	149
Virtue ethics	149
Intellectual and moral virtues	149
Concerns about virtue ethics	149
Constraints on ethical behaviour	150
Ethical theories: summary	150
Power: its use and abuse	150
An abuse of power?	150
Vulnerable groups	151
Vulnerable adults and children	151
Restrictive physical intervention and therapeutic holding	152
Ethical frameworks and models	152
The DECIDE model	152
The DECIDE model in practice	152
Defining the problem(s)	152
Ethical review	154
Consider and investigate options	154
Decide on action	154
Evaluate results	154
Useful websites	155
References	155
Further reading	155
3 Nursing and lifespan implications	157
8 Impact of lifespan on nursing interventions	159
Learning outcomes	159
Introduction	159
Psychology and sociology related to development and nursing	159
What is psychology?	159
Psychodynamic approach	160
Behaviourist approach	160
Humanistic approach	160
Applying psychology to health	160
Motivation	160
The ‘instinct’ theory of motivation	161
Behaviourist theories of motivation	161
Drive theory	161
Humanistic motivation	161
What is sociology?	162
Conflict approaches	163
Microsociological approach	163
Why is sociology relevant to nursing?	163
Common sense and sociology	164
Culture	165
Beliefs	165
Values	165
Norms	165
Cultural universals	165
Cultural bias and relativism	165
Subcultures	166
Culture shock	166
Culture and healthcare (see Ch. 1)	166
Socialization	167
Primary socialization	167
Secondary socialization	167
Roles	168
Role conflict	168
The family	168
Family structures	168
Trends in family structures	169
Development across the lifespan	169
Physical development	170
Conception to birth	170
Infancy (0–12 months)	171
Childhood (1–10 years)	171
Adolescence (11–18 years)	171
Younger adulthood (18–40 years)	172
The middle years (40–65 years)	172
Older adulthood	172
Developmental milestones	175
Psychosocial development	176
Infancy and childhood	176
Adolescence	176
Younger adulthood	176
The middle years	176
Older adulthood	177
Mental health problems across the lifespan	177
The ‘self’ and ‘self-concept’	177
Self-image	177
Personality traits	177
Roles	177
Factual	179
Self-esteem	179
Development of the self	180
Cognitive (intellectual) development	181
Piaget’s four stages of cognitive development	182
Sensorimotor stage (0–2 years)	182
Preoperational stage (2–7 years)	182
Concrete operational stage (7–11 years)	182
Formal operational stage (11–15+ years)	183
Alternative theories of intellectual development	184
Cognitive approaches to moral development	184
Kohlberg’s work	184
Alternative theories of moral development	184
Freudian psychodynamic theory and moral development	184
Behaviourism (conditioning)	184
Social observational learning theory	185
Development of interpersonal bonds (attachment)	185
The significance of attachment	185
Reactions to separation from attachment figures	185
Looked-after children, fostering and adoption	186
Working mothers	186
Hospitalization	186
Parental loss by death or divorce	186
Variations in the attachment process	186
Freud’s psychodynamic theory	187
Safety valves	187
Psychosexual personality development	188
Oral stage (0–24 months)	188
Anal stage (2–3 years)	188
Phallic stage (4–5 years)	189
Latent stage (6–11 years)	189
Genital stage (12 years and above)	189
Criticisms and benefits of the psychodynamic approach	189
Erikson’s stage theory of psychosocial development	190
Useful websites	191
References	191
Further reading	192
9 Relationship, helping and communication skills	193
Learning outcomes	193
Introduction	193
Communication theory	194
Models for communication	194
Blueprint of Behaviour model	194
A model derived from Shannon and Weaver’s model	195
Communication process – getting the message across	195
Language	195
Language development in children	196
Play as a communication tool	196
Developmental problems – receptive and expressive language	197
Language styles and influences	198
Formality	198
Age	199
People with learning and physical disabilities, and mental distress	199
Accommodating and diverging in communication	200
Interpersonal communication skills	200
Courtesy	200
Verbal communication	201
Strategies – questioning with good intentions	201
Open questions	201
Closed questions	201
Funnelling	201
Summarizing	201
Paraphrasing	201
Clarifying	201
Feedback	201
Assertive communication	201
Negotiation and delegation	202
Non-verbal communication	202
Gesture	203
Touch	203
Proxemics	203
Posture	204
Listening skills	204
Characteristics of good listening	204
Appropriate eye contact	204
Mirroring	204
Guggles	204
Active listening	205
Nursing relationships	205
Therapeutic relationships	205
Self-awareness skills	206
Attributes of a nurse–patient/client relationship	206
Being there	206
Self-disclosure	206
Being concerned	207
Trust	207
Being ‘as if’ – emotional labour	207
Empathy	207
Rapport	208
Facilitating change	208
Positive regard	209
Boundaries are healthy	209
Therapeutic relationship stages	209
Pre-orientation stage	210
Orientation stage	210
Working stage	210
Termination stage	210
Working in partnership with families – confidentiality	210
Managing significant information	210
Professional relationships	211
Communication and care coordination within the MDT	211
Leadership	212
Leadership behaviours	212
Emotional intelligence	212
Promoting quality and standards	213
Relationships with families and main carers	213
Barriers to communication	214
Conflict	214
Task-orientated culture	215
Internal noise, mental/emotional distress	215
Difficulty with speech and hearing	215
Medication	215
Cultural factors acting as barriers	215
Differences in language and communication rules	216
Intonation	216
Emphasis	216
Loudness	216
Sentence structure	216
Taking turns and guggling	217
Working with interpreters	217
Useful websites	217
References	218
Further reading	218
10 Sleep, rest and complementary and alternative medicine	219
Learning outcomes	219
Introduction	219
Sleep, rest and relaxation	219
Biorhythms	220
Physiology of sleep	220
Reticular formation – the reticular activating system	221
The biological ‘body clock’	221
Neurotransmitters involved with sleep–wake physiology	221
Stages of sleep	222
NREM sleep	222
REM sleep	222
Functions of sleep	223
Effects of sleep deprivation	223
Factors that affect normal sleep patterns	223
Sleep patterns during the lifespan	224
Infancy and childhood	224
Adolescents/young adults	224
Adulthood and midlife	224
Older adults	224
Factors disrupting normal sleep patterns	225
Lifestyle factors	225
Shift working	226
Environment	226
Psychosocial factors	227
Mental health problems	227
Physical and physiological changes	227
Physical health problems	227
Effects of medication	228
Sleep disorders – an outline	228
Nursing interventions to promote sleep, rest and relaxation	228
Nursing assessment of sleep	228
Keeping a sleep diary	230
Improving sleep hygiene and the sleep environment	231
Relaxation and sleep	232
Sleep medications	232
Orthodox medications	232
Herbal medicines	232
Complementary and alternative medicine	233
The emergence, development and regulation of CAM	233
Integrated medicine	234
CAM therapies	234
Acupuncture	234
Integration of acupuncture into conventional healthcare	234
Chiropractic	235
Integration of chiropractice into conventional healthcare	235
Herbal medicine	235
Integration into conventional healthcare	236
Homeopathy	236
Integration with conventional medicine	237
Osteopathy	237
4 Developing person-centred nursing skills	279
13 Safety in nursing practice	281
Learning outcomes	281
Introduction	281
A critical or questioning approach	281
Recognize limitations of knowledge and skills, and seek support	282
Evidence-based practice	282
Use of reflection during and after practice situations	282
Risk assessment	282
Risk assessment principles	282
Step one: Look for the hazard	283
Step two: Decide who may be harmed and how	283
Step three: Evaluate the risks and decide whether existing precautions are adequate or more should be done	283
Step four: Record the findings	283
Step five: Review the assessment regularly and revise if necessary	284
Individual risk assessments	284
Health and safety legislation	284
Maintaining safety and promoting health	285
Health and safety in healthcare settings	285
Control of Substances Hazardous to Health (COSHH)	286
Reporting of Incidents, Diseases and Dangerous Occurrences Regulations (RIDDOR)	286
Equipment used at work	287
Manual Handling Operation Regulations 1992 (amended 2002)	287
The TILE framework	288
The task (T)	288
Individual capabilities (I)	288
The load (L)	288
The environment (E)	289
First aid	289
Dealing with incidents, emergencies and prioritizing	289
Assess the situation	290
Protect yourself and casualties from danger	290
Give early treatment and prioritize injuries	291
Call for help	291
Provide first aid	291
After the event	291
Dealing with burns and scalds	291
Electrical burns	292
Chemical burns	293
Dealing with poisoning	293
Emergency childbirth	293
Infection control and standard precautions	294
Principles of managing violence, anger and aggression	295
Minimizing violence, anger and aggression	295
Environment	296
Education	296
Improving communication and preventing incidents	296
Dealing with and reporting violent incidents	297
Restraint	298
Fire safety	299
Fire risk assessment	299
Fire detection and warning systems	299
Emergency plans and means of escape	299
Facilities for fighting fire	300
Fire safety training	300
Useful websites	301
References	301
Further reading	302
14 The nursing process, holistic assessment and baseline observations	303
Learning outcomes	303
Introduction	303
The nursing process	303
Assessment	304
Holistic assessment	305
Sources of information	306
Primary source	306
Secondary sources	306
Discharge planning	306
The assessment interview	307
Privacy	307
Interpretation of information	307
Staging assessment	308
Documentation	308
Assessment tools	308
Planning	308
Prioritizing care	310
Actual and potential problems	310
Goal setting as part of care planning	310
Implementation	311
Evaluation	311
Nursing models	311
Approaches to care planning for adults	311
The Roper, Logan and Tierney model for nursing	311
The individual	311
Activities of living	311
Lifespan	312
Factors influencing the ALs	312
Biological factors	312
Psychological factors	313
Sociocultural factors	313
Environmental factors	313
Politicoeconomic factors	313
Roy’s adaptation model	313
Adaptive modes	314
Assessment	314
Planning	314
Evaluation	314
Approaches to planning care for people with learning disability	314
Person-centred planning	315
Consulting the person throughout the planning process	315
The person chooses who to involve	316
The person chooses the setting and timing of meetings	316
Approaches to planning care in mental health nursing	316
The Tidal model	316
Approaches to planning care for children	317
The Nottingham model	317
Negotiated care	318
Building an equal partnership	318
Casey’s model	318
Integrated care pathways	318
Variance	319
Documentation and record-keeping	319
Vital signs	319
Body temperature	319
Distribution of body heat	319
Heat balance	319
Heat conservation	319
Heat loss	320
Physiological influences on body core temperature	320
Diurnal cycles	320
Age	320
Menstrual cycle	320
Other factors	320
Environmental influences on body temperature	320
Care of people with temperature abnormalities	321
Caring for patients with pyrexia or hyperpyrexia	321
Caring for patients with hypothermia	322
Body temperature assessment tools	323
Electronic thermometers	323
Tympanic thermometers	323
Single-use thermometers	324
Glass-and-mercury thermometers	324
Thermometer placement sites	324
Oral cavity	324
Tympanic membrane	324
Axilla	324
Rectum	324
Skin	325
Interpreting temperature measurements	325
Pulse	325
Principal pulse points	325
Normal pulse rate	326
Factors that affect heart rate	326
Assessing the pulse	326
Regularity	326
Volume	326
Features of the pulse in newborns, infants and children	327
Apical pulse	327
Blood pressure	327
Factors that determine blood pressure	327
Blood pressure values	327
Equipment used for BP measurement	327
Sphygmomanometers	328
BP cuffs	328
Measuring BP	328
Measuring BP in newborns, infants and children	330
Inflating the cuff	330
Korotkoff sounds	330
Assessing respirations	330
Respiratory rate	331
Counting respiratory rate in adults	332
Counting respiratory rate in infants and small children	332
Respiratory rhythm	332
Abnormal respiratory rhythms	332
Depth of breathing	332
Effort of breathing	332
Noises associated with breathing	332
Early Warning Score (EWS)	332
Calling criteria	334
Height and weight	334
Useful websites	335
References	335
Further reading	336
15 Preventing the spread of infection	337
Learning outcomes	337
Introduction	337
Overview of microbiology	337
Epidemiology of infectious diseases	338
Healthcare-associated infections (HAIs)	338
Prevalence, surveillance and reporting of HAIs	338
Chain of infection	338
Infectious agent (pathogen)	339
Reservoirs	339
Portals of exit and entry	340
Transmission of infection	340
Contact transmission	340
Droplet transmission	341
Airborne transmission	341
Susceptible host	341
Infectious disease and associated terminology	341
Host defence mechanisms	342
External defences	342
Inflammation	343
Specific resistance	344
Development of immunity	344
Active immunity	344
Passive immunity	344
Infection control	344
Standard infection control precautions	344
Hand hygiene	344
Indications for handwashing	345
Types of handwashing and preparations used	346
Handwashing with liquid soap and running water (social handwashing)	346
Handwashing with antiseptic preparations and running water (aseptic handwashing)	346
Alcohol-based hand rubs	346
Personal protective equipment	346
Disposable gloves	346
Types of gloves and their uses	346
Removal of gloves	347
Health risks associated with glove use	347
Gowns and aprons	348
When to wear gowns and aprons	348
Masks and eye protection	349
Safe use and disposal of sharps	349
What are sharps?	349
How injuries occur	350
Preventing sharps injuries	350
Managing injuries and exposure to body fluids	350
Management of waste	350
Classification of waste	351
Clinical (hazardous) waste	351
Domestic waste	351
Safe handling of clinical waste in healthcare facilities	351
Safe handling of clinical waste in people’s homes	351
Management of linen	351
Safe handling of linen	352
Safe handling of soiled linen	352
Decontamination of patient-care equipment	353
Levels of decontamination	353
Cleaning	353
Sterilization	353
Disinfection	353
Additional precautions	354
Aseptic technique	354
Indications for aseptic technique	355
Components of aseptic technique	355
Clean technique	355
Isolation precautions	356
Principles of isolation nursing	357
Patient accommodation	357
Patient movement	357
Psychological effects of isolation	357
Categories of isolation	357
Airborne precautions	357
Droplet precautions	358
Contact precautions	358
Protective isolation	358
Specimen collection	359
Collection of clinical specimens	359
Transport of specimens	360
Useful websites	360
References	360
Further reading	361
16 Personal care, sensory impairment and unconsciousness	363
Learning outcomes	363
Introduction	363
Personal hygiene and appearance	363
Structure and functions of the skin	364
Normal skin flora	364
Appendages of the skin	364
Functions of the skin	364
Assessment of the skin	366
Infestation	366
Factors influencing appearance and personal hygiene	367
Physical	367
Psychological factors	367
Social, cultural and religious factors	367
Environmental factors	367
Economic factors	367
Lifespan factors	367
Infancy	367
Childhood	368
Puberty	368
Older adults	368
Assisting with bathing, washing and showering	368
Maintaining privacy and dignity	368
Washing and drying the skin	369
Bathing and showering	369
Bathing aids	370
Bedbathing	370
Perineal care	371
Menstrual hygiene	372
Care of the feet, hands and nails	372
Care of the eyes	372
Accessory structures of the eye	373
Eye care	373
Spectacles	373
Contact lenses	373
Artificial eyes	373
Care of the ears	374
Hearing aids	374
Care of the nose	374
Hair care	375
Hairwashing	375
Head lice	375
Care of facial hair	376
Dressing	376
Dressing aids	377
Prostheses	377
Summary – personal hygiene	377
Dental health and oral hygiene	377
Anatomy and physiology: the mouth	377
Salivary glands	377
Teeth	378
Maintaining oral health	378
Oral care	379
Toothbrushing and flossing	379
Care of dentures	379
Tooth and gum disorders	379
Dental caries	379
Periodontal disease	379
Malocclusion	379
Oral assessment and oral hygiene	379
Oral assessment tools	380
Oral hygiene: nursing interventions	380
Sensory considerations	380
The eye and vision	380
Anatomy and physiology of the eye (see p. 373 for accessory structures)	380
Visual acuity	382
Sight impairment	382
Describing sight impairment	382
Helping people with sight impairment	383
Communication	383
Maintaining a safe environment	384
Services and support	384
The ear and hearing	384
Anatomy and physiology	384
Assessment and prevention of hearing loss	384
Hearing impairment	385
Describing deafness	386
Communicating with hearing-impaired people	386
The unconscious patient	386
Levels of consciousness	387
The Glasgow Coma Scale	387
Neurological observations in hospital	388
The unconscious casualty	388
Common conditions affecting the nervous system	389
Seizures	389
Nursing the unconscious person	391
Positioning the unconscious patient	394
Recovery position	394
Lateral position	395
Communicating with an unconscious person, their relatives and friends	395
Planning nursing interventions	395
Useful websites	396
References	396
Further reading	396
17 Breathing and circulation	397
Learning outcomes	397
Introduction	397
An overview of breathing and circulation	397
Cardiovascular system – outline of anatomy and physiology	398
The heart	398
Coronary circulation	398
Conduction	399
Cardiac cycle	399
Sinus rhythm	399
Systemic and pulmonary circulation	399
Blood: outline of anatomy and physiology	400
Plasma	400
Blood cells	400
Erythrocytes (red blood cells)	401
Leucocytes (white blood cells)	401
Thrombocytes (platelets)	401
Haemostasis	401
Blood groups	401
Respiratory system: outline of anatomy and physiology	402
Respiratory structures	402
Nose	402
Pharynx	402
Larynx	403
Trachea	403
Bronchi, bronchioles and alveoli	403
Lungs	403
Breathing (ventilation)	403
Common conditions affecting breathing and circulation	404
Common cardiovascular conditions	404
Cardiac arrhythmias	404
Congenital heart disease (CHD)	404
Cardiovascular disease (CVD)	404
Heart failure	404
Hypertension	404
Rheumatic heart disease	405
Valvular heart disease	405
Common blood (haematological) conditions	405
Anaemia	405
Deep vein thrombosis (DVT)	405
Haemoglobinopathies	406
Leukaemia	406
Common respiratory conditions	406
Asthma	406
Bronchiectasis	406
Bronchiolitis	406
Chronic obstructive pulmonary disease (COPD)	406
Croup	407
Cystic fibrosis (CF)	407
Lung cancer	407
Pneumonia	407
Pulmonary embolism (PE)	407
Tuberculosis (TB)	407
Basic life support – airway maintenance and cardiopulmonary resuscitation	407
Adult basic life support	408
Basic life support for infants and children	410
Assessment and observation – circulation and breathing	410
Skin – general assessment	410
Changes in skin colour	410
Skin turgor and oedema	411
Capillary refill time	411
Heart/pulse rate	411
Peripheral pulses	412
The electrocardiogram	412
Blood pressure	412
Blood pressure during pregnancy	413
Central venous pressure	413
Breathing – general assessment	414
Respiratory rate	414
Breathing patterns – depth and rhythm	414
Abnormal breath sounds	415
Cough and sputum	415
Peak expiratory flow rate	416
Pulse oximetry	417
Pain associated with breathing or circulation problems	417
Common investigations – breathing and circulation	418
Care of the person with breathing and/or circulation problems	419
Communication and relief of anxiety	419
Positioning to relieve breathlessness	419
Personal hygiene and skin care	419
Nutrition and hydration	420
Helping the person with expectoration	420
Breathing exercises and coughing	420
Postural drainage	421
Suctioning	421
Inhaled medication	421
Nebulizers	422
Dry powder inhalers	422
Metered-dose inhalers	422
Oxygen therapy	423
Problems associated with oxygen therapy	423
Oxygen administration systems	424
Fixed performance Venturi systems (high-flow)	424
Variable performance systems	424
Nasal cannulae/nasal prongs	424
Headbox, body/trunk box	424
Incubator	425
Continuous positive airway pressure (CPAP)	425
Humidification	425
Respiratory support – artificial ventilation	426
Care of patients requiring a blood transfusion	426
Monitoring during blood transfusion	427
Ensuring transfusion safety	427
Transfusion complications	427
Alternatives to donated blood transfusion	428
Home-monitoring in patients with conditions affecting breathing or circulation	428
Rehabilitation for conditions affecting breathing or circulation	428
Useful websites	429
References	429
Further reading	430
18 Mobility and immobility	431
Learning outcomes	431
Introduction	431
The musculoskeletal system	431
Muscles	431
The structure and function of voluntary (skeletal) muscles	431
Voluntary muscles	431
Fascia	432
Bones	433
Care of people wearing casts	436
Joints	436
Posture, balance and movement	437
Development of the spinal curves	437
Adaptive postures	438
Effects of gravity on height	440
Effects of ageing on the spinal curves	440
Movement	440
Gait	440
Efficient handling and moving (EHM)	441
Principles of safe handling and moving	442
Equipment	442
Glide sheets	442
Transfer boards	442
Hoists	442
Standing and raising hoist	442
Passive lifting hoists	442
Accessories	444
Rope ladders	444
Turning discs	444
Using equipment to move people	444
Checking equipment	444
Risk assessment	444
Effective communication	444
Finding the most suitable equipment	445
Handling and moving people	445
Turning a person in bed	445
Regaining balance	445
Helping a person to sit up in bed	445
Helping a person to get out of bed	447
Helping a person to stand up from a chair	447
Helping people to mobilize	447
Walking frames	448
Walking sticks	448
Wheelchairs	448
Falls	449
Care of people who have fallen	450
The benefits of mobility and hazards of immobility	450
Benefits of mobility	450
Children	451
Teenagers	451
Adults and older adults	451
Hazards of immobility	451
Maintaining healthy joints and muscles	452
Active exercises	452
Passive exercises	452
Prevention of deep vein thrombosis	453
Preventing chest infection	453
Pressure ulcers	453
Constipation	453
Maintaining well-being	453
Caring for people confined to bed	453
Regaining mobility	453
Physiotherapy	454
Occupational therapy	454
Home assessment	454
Useful websites	454
References	455
Further reading	455
19 Promoting hydration and nutrition	457
Learning outcomes	457
Introduction	457
Maintaining fluid, electrolyte and acid–base balance	457
Body fluids and fluid compartments	458
Electrolytes	458
Movement of water and electrolytes	459
Osmosis	459
Diffusion	459
Filtration	459
Active transport	459
Acid–base balance	459
Disorders of acid–base balance	460
Alkalosis	460
Acidosis	460
Normal fluid and electrolyte balance	460
Factors that regulate normal fluid and electrolyte balance	460
Common disorders of fluid and electrolyte balance	460
Common disorders of fluid balance	460
Electrolyte imbalances	460
Factors that can lead to fluid and/or electrolyte imbalance	460
Age	461
Fasting	461
Fluid and electrolyte loss	461
Alcohol and excessive caffeine drinks	461
High level of dependency	462
Mental health problems	462
Immobility and lack of manual dexterity	462
Swallowing problems (dysphagia)	462
Fear of incontinence	462
Drugs	462
Breathlessness (dyspnoea)	462
Serious organ disorders	462
Lack of access to clean water	462
Nursing interventions: promoting and maintaining hydration	462
Assessing hydration	462
Skin	463
Fontanelles	463
Weight	463
Sunken eyes	463
Mouth	463
Behaviour	463
Bowel function (see Ch. 21)	464
Urine output and specific gravity (see Ch. 20)	464
Blood pressure	464
Pulse	464
Respiration	464
Skin temperature	464
Central venous pressure	464
Fluid balance charts	464
Oral fluids	464
Helping people to drink	465
Fluid restriction	468
Caring for the person with fluid imbalance	468
Fluid depletion	468
Oedema	468
Caring for the person who is vomiting	468
Subcutaneous fluids (hypodermoclysis)	468
Intravenous fluids	469
Equipment	469
Crystalloids and colloids	470
Principles of care for infusions	470
Flow rate calculation and regulation	472
Complications of i.v. therapy	473
Nutrition	473
The gastrointestinal tract	473
Parts of the gastrointestinal tract	474
Overview – general functions of the gastrointestinal tract	474
Smell and taste	474
Alterations to smell and taste	474
Nutritional and upper gastrointestinal tract disorders	475
Principles of nutrition and the healthy diet	477
Macronutrients	478
Carbohydrates	478
Fats	478
Proteins	478
Micronutrients	478
Recommendations for a healthy balanced diet	479
Specific lifespan requirements: supplements and advice	480
Infant feeding	480
Factors that affect food intake and appetite	481
Malnutrition in vulnerable people	482
Independence in eating	482
Nursing interventions – maintaining nutritional status	482
Nutritional screening and assessment	482
Nutritional screening audit tool	483
Nutritional screening and assessment in infants and children	483
Common investigations	483
Helping people to eat	483
Making appropriate healthy choices	483
Environment and mealtimes	483
Food fortification	484
Feeding	485
Clients requiring special diets	485
Nutritional support	485
Enteral feeding	485
Parenteral nutrition	487
Useful websites	489
References	489
Further reading	490
20 Elimination of urine:	491
Learning outcomes	491
Introduction	491
Overview – anatomy and physiology of the urinary system	491
The kidneys	491
Nephron	492
Control of blood flow into the glomerulus	493
Control of blood volume	493
Urine production in the nephron	493
Lower urinary tract	493
Ureters	493
Bladder	493
Urethra	494
Urinary elimination	494
Factors affecting micturition	495
Common urinary disorders	496
Assessment and observation of urine and urinary elimination	496
Measuring urine output and observing voiding patterns	496
Fluid balance chart	497
Weighing nappies	498
Frequency–volume charts	498
Observation of urine and urinalysis	498
Collection of urine samples for the laboratory	498
Common urinary investigations	501
Nursing interventions – micturition	502
Use of urinal, bedpan and commode	502
Promoting continence	503
Normal voiding habits	503
Achieving urinary continence during childhood	504
Pelvic floor awareness and exercise	505
Use of frequency–volume charts	505
Types of urinary incontinence	505
Management of urinary incontinence	506
Continence nurse specialist	506
Continence aids (devices)	506
Pads	506
Urinary sheath	507
Care of people with a urinary catheter	508
Types of catheter	510
Catheter length	510
Catheter materials	510
Catheter lumen size	510
Balloon size	511
Drainage systems	511
Collecting a catheter specimen of urine	512
Catheter hygiene	512
Removal of a self-retaining catheter	513
Sexual activity and urethral catheterization	513
Complications of catheterization	514
Urinary stomas	514
Useful websites	515
References	515
Further reading	515
21 Elimination of faeces:	517
Learning outcomes	517
Introduction	517
An overview of defecation	517
Large intestine, rectum and anal canal	518
Structure	518
Functions	518
Normal process of defecation	519
Factors affecting defecation	519
Age and defecation	520
Holistic assessment of defecation	520
Assessing normal bowel habit – patterns of defecation and characteristics of faeces	520
Nursing history	521
Common bowel conditions	523
Common investigations	523
Nursing interventions to promote defecation	523
Environment and facilities	525
Cultural needs	526
Bedpans and commodes	526
Constipation	527
Contributing factors and causes of constipation	527
Effects of constipation	528
Assessment of constipation	528
Management of constipation	528
Enemas	529
Suppositories	531
Manual faecal evacuation	531
Diarrhoea	532
Contributing factors and causes of diarrhoea	532
Effects of diarrhoea	532
Assessment of diarrhoea	532
Management of diarrhoea	532
Faecal incontinence	533
Causes of faecal incontinence	534
Effects of faecal incontinence	534
Assessment of faecal incontinence	534
Managing faecal incontinence	535
Encopresis	535
Caring for a person with a stoma	536
Specific care for patients having a stoma	536
Appliances and skin care	537
Continuing stoma care – advice and support for patients	537
Living with a stoma: psychological and social impact	538
Useful websites	540
References	540
Further reading	540
22 Promoting the safe administration of medicines	541
Learning outcomes	541
Introduction	541
Legislation concerning medicines	541
The Medicines Act 1968	541
The Misuse of Drugs Act 1971	542
The Misuse of Drugs Regulations 1985	542
Non-medical prescribing	542
Patient Group Directions (PGD)	542
Professional advice that affects nurses	542
Storage of medicines	543
Storage of non-controlled medicines in hospitals and nursing homes	543
Storage of controlled drugs in hospitals and nursing homes	544
Storage of medicines in the home	544
Ordering drugs in hospitals	546
Controlled drugs	546
Non-controlled drugs	546
Principles of prescribing	546
Introduction to pharmacology	546
Pharmacodynamics	546
Pharmacokinetics	546
Absorption	546
First pass metabolism	546
Distribution	547
Plasma binding	547
Metabolism	547
Half-life	547
Excretion	547
Therapeutic range	548
Adverse drug reactions	548
Type A	548
Type B	548
Surveillance for ADRs	548
Naming of drugs and common groups	548
Naming of drugs	548
Common groups of drugs and their actions	548
Medicinal preparations and routes of administration	550
Oral medication	550
Sublingual route	551
Parenteral medication	551
Administering prescribed medication	551
Consent	551
Covert administration of medicines	552
Calculation of drug doses	552
Tablets and capsules	552
Liquid preparations	552
Calculations based on body weight or surface area	553
Body weight	553
Surface area	553
Preparation for the administration of medications	553
Administration of oral medications	554
Injections	554
Preparing and giving injections	554
Skin cleansing prior to injections	554
The intramuscular route	555
Deltoid muscle	555
Dorsogluteal site	555
Ventrogluteal site	555
Vastus lateralis muscle	556
Rectus femoris	556
Administering intramuscular injections	556
Subcutaneous injections	557
Rectal administration	557
Inhaled medication	558
Administration of topical medication	558
Transdermal patches	558
Other routes	558
Post-drug administration measures	559
Adherence and polypharmacy	559
Adherence	559
Non-adherence	559
Polypharmacy	560
Improving medicines adherence	560
Dosette boxes	560
Self-medication	561
Drug administration errors	561
Minimizing errors	561
Dealing with drug errors	561
Useful websites	562
References	562
Further reading	562
23 Pain management – minimizing the pain experience	563
Learning outcomes	563
Introduction	563
The nature of pain	563
Types and characteristics of pain	564
Acute pain	564
Chronic pain	564
Chronic non-malignant pain	564
Chronic malignant pain	565
Gate control theory	565
Physiology of pain	566
Transduction	566
Transmission	567
Modulation	568
Perception	568
Pain threshold and pain tolerance	568
Pain psychology – personal and sociocultural influences	569
Pain – myths, misconceptions and facts	569
Pain assessment	570
Holistic pain assessment	571
Behavioural responses to pain	571
Pain language	571
Assessing children’s pain	572
Pain history	572
Pain diaries	572
Pain maps	572
Pain assessment tools	573
Self-report scales	573
Visual analogue scale	573
Verbal numerical rating scales	573
Categorical rating scale	573
Self-report scales for children	573
Observation techniques	574
Physiological measurements	574
Multimethod approaches to pain assessment	575
Assessment for different types of pain	575
Pain management	575
Pharmacological management	575
Age and analgesic drugs	576
Pregnancy and analgesic drugs	577
Drugs used in pain management	577
Routes of administration	578
Patient-controlled analgesia	579
Administration of analgesic drugs	579
Analgesic potency	580
Pre-emptive and procedural pain management	581
Drug tolerance and dependence	581
Non-pharmacological methods of pain control	582
Simple comfort measures	582
Information giving	583
Relaxation	583
Hypnosis	583
Distraction	583
Imagery	584
Massage	584
Therapeutic touch	584
Acupuncture	584
Transcutaneous electrical nerve stimulation	584
Aromatherapy	584
Surgical intervention	585
Useful websites	586
References	586
Further reading	587
24 Caring for the person having surgery	589
Learning outcomes	589
Introduction	589
Types of surgery	589
Elective surgery	590
Day surgery	590
Emergency surgery	591
Preoperative care	591
Pre-assessment clinics	591
Investigations	591
Smoking cessation	592
Psychological preparation for surgery	592
Preoperative considerations for children	592
Benefits of providing preoperative information	592
Common sources of preoperative anxiety	592
Obtaining consent	593
Preoperative fasting	594
Skin preparation	594
Hair removal	594
Preventing potential postoperative complications	595
Chest infection	595
Deep vein thrombosis	595
Bowel preparation	595
Preparation for intravenous cannulation	596
Final preoperative care	596
Transfer to theatre	596
Anaesthetic room	596
Anaesthesia	598
Theatre	598
Recovery room	598
Discharge from the recovery room	598
Postoperative care	598
Clinical assessment and monitoring	600
Airway	600
Breathing	601
Circulation	601
Cardiovascular management	601
Cardiovascular stability	601
Prevention of DVT	601
Respiratory management	601
Preventing chest infections	601
Fluid, electrolyte and renal management	601
Fluid balance	601
Fluid intake	602
Urine output	602
Nasogastric aspirate	602
Nutrition	603
Nausea and vomiting	603
Preventing constipation	603
Pain management	603
Wound management	604
Wound drainage	604
Skin closure removal (Fig. 24.2)	605
Wound complications	605
Regaining mobility	605
Discharge planning	605
Useful websites	606
References	607
Further reading	608
25 Wound management	609
Learning outcomes	609
Introduction	609
Types of wound	609
Wound classification and categories	609
Acute wounds	610
Surgical wound categories (see Ch. 24)	610
Wound healing	611
Stages of wound healing	611
Stage 1 – Vascular response (0–3 days)	611
Stage 2 – Inflammation/inflammatory response (1–6 days)	612
Stage 3 – Proliferation (3–20 days)	612
Stage 4 – Maturation (21 days to >1 year)	612
Factors influencing healing	612
Local wound factors	612
Wound complications	613
Systemic or patient-related factors	613
Age	613
Nutritional status	613
Dehydration	613
Systemic diseases	613
Medication	614
Smoking	614
Stress	614
Wound management	614
Wound assessment	614
Wound characteristics	614
Cause of the wound	614
Location	615
Condition of the surrounding skin	615
Size	615
Types of tissue present in wounds	616
Exudate	616
Odour	617
Wound pain	617
Social factors	618
Environmental factors	618
Organizational factors	618
Wound cleansing	618
Wound débridement	619
Wound dressings	619
Aims of treatment	619
Choosing an appropriate dressing	619
Types of dressing	620
Chronic wounds	620
Pressure ulcers	620
Risk factors for pressure ulcers	621
Extrinsic factors	621
Intrinsic factors	621
Pressure ulcer risk assessment tools	621
Pressure ulcer prevention	622
Repositioning	623
Pressure-redistributing equipment	623
Skin assessment	623
Pressure ulcer grading	623
Leg ulcers	624
Causation of venous leg ulceration	624
Characteristics of venous ulceration	625
Specific assessment	625
Management of venous leg ulcers	627
Compression therapy	627
Useful websites	628
References	628
Further reading	629
Multiple choice questions	e1
Questions	e1
Chapter 1	e1
Self-test questions and answers	e14
Glossary	631
References	637
Index	639
A	639
B	641
C	642
D	645
E	646
F	648
G	648
H	649
I	650
J	651
K	651
L	652
M	652
N	654
O	655
P	655
Q	658
R	658
S	659
T	661
U	662
V	663
W	663
X	663
Y	663
Z	663

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