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Adult Nursing

Seeing the Wood and the Trees: Using Construal Level Theory to see what Proxy Decision Makers are thinking about

23 Apr, 17 | by josmith

Helen Convey. Lecturer in Adult Nursing, School of Healthcare, University of Leeds

Individuals who are living with dementia and who lack decision making capacity require proxy decision makers to make decisions for them. Individuals may express their interests and desires through behaviour and verbal communication, however, memory loss results in a lack of psychological continuity between the past and the present self. When there is a conflict between the individual’s past values and interests and their present values and interests proxy decision makers encounter an ethical dilemma. The aim of this feasibility study was to explore the potential use of Construal Level Theory (CLT) as a way of analysing the thinking of proxy decision makers where this conflict occurs.

CLT (Liberman and Trope, 2014; Trope and Liberman, 2010) contends that people use mental construal to traverse psychological distance and to think about choices, alternatives and perspectives in different dimensions; temporal, spatial, social and hypothetical. In mental construal abstraction is used to move beyond direct, real experiences of the self, across psychological distance, to form a subjective view of an object or action. High-level construal is more abstract, central values receive attention. Low-level construal is concrete, detailed and contextualised.

Participants were given a scenario in one to one semi-structured interviews. They read the scenario and were asked what they were thinking and feeling. Thematic analysis was used to discover patterns of decision making. Participant responses within the themes were then analysed for abstractness of language using the Linguistic Category Model (Semin and Fiedler, 1991). Participants were found to travel across psychological distance to think abstractly about the person in the scenario. They used mostly abstract thinking to establish central values and beliefs and mostly concrete thinking to express pragmatic concerns. We concluded that CLT can be used to analyse the thinking of proxy decision makers.


References:

Liberman, N. and Trope, Y. 2014. Traversing psychological distance. Trends in Cognitive Sciences. 18(7), pp.364-369.

Semin, G.R. and Fielder, K. 1991. The Linguistic Category Model, its Bases, Applications and Range. European Review of Social Psychology. 2(1), pp.1-30.

Trope, Y. and Liberman, N. 2010. Construal-Level Theory of Psychological Distance. Psychological review. 117(2), pp.440-463.

 

 

To tell or not to tell? Honesty and hope in cancer nursing.

19 Mar, 17 | by dibarrett

Jan Hunter, Lecturer in Nursing, University of Hull

In the rather paternalistic past of the NHS, the established wisdom was that ‘doctor knew best’. If it was deemed a patient didn’t need to know they had a poor prognosis, then they didn’t find out (unless they had the wherewithal to put two and two together, or the audacity to ask outright). Thankfully, we are moving away from the days of selectively withholding information, with candour and truth-telling now at the centre of patient care. Nurses – with their ability to forge strong bonds of trust with patients – are well-placed to act as leaders in the discussion of disease progression and prognosis. Though this cements the place of nurses as autonomous practitioners, it also requires us to face one of the key challenges in cancer care: how do we balance truth-telling with the desire to reduce distress and give hope to patients and carers?

In some patients, there may be a temptation to try and ‘soften the blow’ of bad news. For example, a measured disclosure of bad news over time may be deemed the most appropriate approach in patients we judge to be vulnerable or those we perceive to have a lower ability to cope. Superficially, holding back some information might be viewed as nothing more than a ‘white lie’ to protect patients and help prepare them for bad news. However, no matter how well intentioned, making judgements on when to offer full disclosure may serve to undermine the bond of trust between a patient and nurse.

more…

Recognising, Assessing and Managing Deteriorating Adult Patients

20 Nov, 16 | by josmith

By Gilberto Buzzi Senior Lecturer, School of Health and Social Care / Institute of Vocational Learning | London South Bank gilberto-buzziUniversity e-mail: buzzig2@lsbu.ac.uk

When patients are admitted to hospital, the expectation is that they entering a place of safety. Their families, relatives and friends trust that once in the hands of healthcare professionals, their loved ones are not only going to find comfort but also receive the best treatment possible. Patients trust they will be looked after by competent and confident nurses who will prevent their situation from getting worse, and in the event their condition deteriorates, that they will indeed manage it effectively. Sadly, this is not always the case. Hospital mortality statistics have been linked to staff failures to identify or manage early signs of deterioration.

Recognising and responding to deteriorating hospitalised patients is an important global issue in nursing. By closely monitoring changes in physiological observations and interpreting early sings of physical and psychological decline, nurses are more likely to identify, manage and therefore avoid serious adverse events before they occur. The National Early Warning System (RCP, 2012) has been introduced to help address this issue. The system is based on objective physiological parameters being scored according to the amount of deviation from normal. The scores are weighted depending on the severity of deviation.  screen-shot-2016-11-18-at-17-37-47
The aggregate score is then calculated and acted upon accordingly. As with everything, the tool is only as good as the professional using it. Therefore, all nursing staff caring for patients in acute hospital settings must be competent in monitoring, measurement, interpretation and prompt response to the acutely ill patient, appropriate to the level of care they are providing as supported by their code of conduct (NMC, 2015).

To be able to calculate accurate NEWS the following should be assessed and documented.

  1. RR (respiratory rate) Record rate on every set of observations (RR is an early indicator of clinical deterioration.
  2. Oxygen Saturations (SpO2) Oxygen saturation should be measured by pulse oximetry.
  3. Temperature (Internal body temperature is preferable over axilla).
  4. BP (Systolic blood pressure) in case of acute deteriorating or if automated machines giving an inaccurate or suspect reading then check with a manual sphygmomanometer.
  5. HR (heart rate) Palpate the pulse, assess rhythm and rate and volume.
  6. Level of Consciousness (AVPU – Alert, responds to Voice, responds to Pain or Unresponsive, is a quick and easy method to assess level of consciousness. Change in consciousness is another sensitive indicator of clinical deterioration.

more…

The challenges of embedding spirituality into acute healthcare settings

2 Oct, 16 | by josmith

This wescreen-shot-2016-09-23-at-12-50-34ek’s EBN Twitter Chat is on Wednesday 5th October between 8-9 pm (BST) and will be hosted by Dr Janice Jones (@JaniceJ6873404) senior lecturer in the Institute of Vocational Learning, London South Bank University,

Wilf McSherry, Professor in Dignity of Care for Older People School of Nursing and Midwifery, screen-shot-2016-09-23-at-12-51-43Staffordshire University, The Shrewsbury and Telford Hospital NHS Trust, UK; Part-time Professor VID Specialized University (Haraldsplass Campus), Bergen, Norway (@WilfredMcSherr1), and

Dr JIMG_0206oanna Smith (@josmith175) lecturer in Children’s Nursing, University of Leeds. The chat will focus on the challenges of embedding spirituality into acute healthcare settings.

Participating in the Twitter chat requires a Twitter account; if you do not already have one you can create an account at www.twitter.com. Once you have an account, contributing is straightforward. You can follow the discussion by searching links to #ebnjc, or contribute by creating and sending a tweet (tweets are text messages limited to 140 characters) to @EBNursingBMJ and add #ebnjc (the EBN Twitter chat hash tag) at the end of your tweet, this allows everyone taking part to view your tweets.

Cultural, religious and spiritual beliefs influence how an individual makes sense of the world, often shaping their experiences. During acute or life-threatening illness drawing on these beliefs can provide comscreen-shot-2016-09-23-at-12-48-12fort, strength and support and often assume greater importance in times of stress. Spirituality can foster the development of coping strategies during acute illness where there is often a search for meaning and purpose in response to changing circumstances. 1 There is increased recognition that individual beliefs such as faith and hope can impact on the healing process, usually enhancing, but sometimes hindering, recovery. Incorporating spiritual care into practice helps health professionals to understand patients’ perspectives, and has the potential to increased patient satisfaction with care delivery.

Meeting the spiritual beliefs of patients in acute health care setting is challenging because of the increased demands on acute care services and meeting the needs of an increasingly diverse populations. Traditional working practices must adapt and respond to change yet ensuring patients are treated with respect, dignity and compassion remain fundamental to the provision of holistic, person-centred care needs to respect the patient’s cultural, religious and spiritual needs. 2 Spiritual care matters because it focuses care delivery on the individual, and recognises and utilises patients’ own resources, strengths, aspirations, hopes and experiences.3

Question to think about in advance of the Twitter Chat:

  1. What are your experiences of supporting patients in meeting their spiritual needs in acute healthcare settings?
  2. How can health professionals working in acute healthcare settings can practice holistically to address their patients’ spiritual needs?
  3. Lack of preparation to address the spiritual needs of patients is often cited as a barrier to implementation. What are your experiences of pre registration preparation or CPD opportunities to enhance your understanding of spirituality?
  4. How do you feel the wide range of dimensions relating to spirituality from religious and non religious perspectives relate to healthcare practice?

References

1Clarke, J. (2013) Spiritual Care in Everyday Nursing Practice. A New Approach. Basingstoke: Palgrave Macmillan;

2McSherry, W., Smith, J. (2012) Spiritual Care. In McSherry, W., McSherry, R., Watson, R. (eds) (2012) Care in Nursing: Principles, values and skills. Oxford: Oxford University press;

3McSherry, W., Jamieson, S. (2013) The qualitative findings from an online survey investigating nurses’ perceptions of spirituality and spiritual care. Journal of Clinical Nursing, 22, 3170-3318.

Reflections on the hidden extent of restraint in critical care

11 Sep, 16 | by josmith

Angela Teece (A.M.Teece@leeds.ac.uk). Trainee Lecturer in Adult Nursing, University of Leeds

Angela

I recently left clinical practice, where I had worked as a critical care sister in a large district general hospital, to undertake a university role. Stepping back from practice and reading recent legislation on the deprivation of liberty (DoLS), enabled me to reflect on how the care I provided to patients could be viewed as restrictive.

Deprivation of liberty could relate to:

  • Is the patient under close supervision?
  • Is the patient free to leave the clinical area?

Clearly, on this level, all critical care patients, and many patients on general wards, are being deprived of their liberty. DoLS guidance is supported by the 2005 Mental Capacity Act (MCA) in its definition of restraint. This can be physical, chemical or verbal, for example, the use of bed rails restricts patient mobility, and regulated visiting times and controlled entry to the unit reduce opportunities for the patient to interact with their family.

Critical care is a specialised area of practice. Patients are commonly sedated to enable tolerance an endotracheal tube, ventilator and multiple vascular access devices. Each of these things, although used in the patient’s best interest, could be considered a form of restraint under the MCA and DoLS. Physical restraints in the form of ‘boxing gloves’ may be used to prevent agitated patients interfering with life-saving treatment (Happ, 2000) and chemical restraint may also be used to control agitation (Hofso and Coyer, 2007).

Screen Shot 2016-09-03 at 11.35.41On reflection, I believe nurse are generally tasked with applying restraints, either by putting ‘boxing mitts’ on an agitated patient, or by administering at their discretion as required medication. Nurses must be able to justify their actions. Any restrictive intervention must be in the patient’s best interests and decisions can only be made for a patient if they lack capacity (MCA, 2005). Nurses should fully assess the need to restrain their patient using a validated tool, and conduct reassessment regularly whilst maintain their patient’s dignity whilst restraints are being used. Links have been made to patient experience of critical care and long-term psychological problems such as post-traumatic stress disorder (Jones et al., 2001). Rigorous nursing documentation, completion of DoLS referrals and regular patient observation and evaluation are vital to prevent prolonged restrain and promote patient dignity.

Happ, M.B. 2000. Preventing treatment interference: The nurse’s role in maintaining technologic devices. Heart & Lung: The Journal of Acute and Critical Care. 29(1), pp.60-69.

Hofso, K. and Coyer, F.M. 2007. Part 1. Chemical and physical restraints in the management of mechanically ventilated patients in the ICU: contributing factors. Intensive Crit Care Nurs. 23(5), pp.249-255.

Jones, C., Griffiths, R.D., Humphris, G. and Skirrow, P.M. 2001. Memory, delusions, and the development of acute posttraumatic stress disorder-related symptoms after intensive care. Critical Care Medicine. 29(3), pp.573-580 578p.

Contemporary topics in respiratory care

4 Sep, 16 | by josmith

Following our summer recess, we are delighted at EBN to welcome new and established Tweeters to our next series of Twitter chats. We have an exciting range of topics planned, starting on Wednesday the 7th of September 8-9pm (UK/BST) with a debate on developments in respiratory care hosted by Jacqui Pollington a respiratory nurse specialist (Jacqui.Pollington@midyorks.nhs.uk).  She leads a home oxygen assessment and review service and an outreach service for patients who are frequently admitted with exacerbations of respiratory disease.

Participating in the twitter chat requires a Twitter account; if you do not already have one you can create an account at www.twitter.com. Once you have an account contributing is straightforward – follow the discussion by searching links to #ebnjc or @EBNursingBMJ, or better still, create a tweet (tweets are text messages limited to 140 characters) to @EBNursingBMJ and add #ebnjc (the EBN chat hash tag) at the end of your tweet, this allows everyone taking part to view your tweets.

The last 10 years have seen significant advances in the diagnosis and management of non malignant respiratory disease. There are around 11 inhaler devices available now, and in total around 25 choices depending on drug, dose and combination required – all to treat airways disease, be that asthma, COPD or….dare I say, ACOS (asthma/copd overlap syndrome). Phenotyping could be considered the vogue, but it is very likely in the era of personalised medicine that phenotyping is here to stay and therefore significantly expand the diagnostic workup currently undertaken by many in primary care. The increasing identification of multi-morbidity in COPD and the profound effects of some comorbidity (for example, the biggest co-morbid predictor of death in the female with COPD is anxiety) brinScreen Shot 2016-09-02 at 17.54.38gs another clinical dimension to respiratory care. In this context, how does the nurse dealing with a patient with obstructive respiratory disease keep up to date in this very changeable clinical landscape.

Screen Shot 2016-09-02 at 17.57.13

 

https://www.nice.org.uk/Guidance/cg101

https://www.guidelines.co.uk/gold/copd

This twitter chat will focus on the following key themes:

  • NICE or GOLD in COPD? Which guidance should we be following and why?
  • ICS or not? That is the question? And after the pneumonia? Do we involve patients in the decision?
  • Pulmonary rehab….why wait til MRC3?
  • Smoking – how do we expose the elephant in the room? What do respiratory clinicians know about addiction?
  • How can nursing influence lung health?

Health care management of advanced, irreversible chronic kidney

21 Apr, 16 | by josmith

Helen Noble, Associate Editor EBN

I am a researcher in health services research contributing to health care management of advanced, irreversible chronic kidney disease (CKD). This is evidenced by publications in leading international journals, leadership of successful funding bids, (most recently a multi-institutional NIHR study) and research awards. My research mainly focuses on people with advanced chronic kidney disease opting for conservative management rather than dialysis. The number of these patients is unknown but likely to be growing as increasingly frail patients with advanced renal disease present to renal services. Conservative kidney management includes ongoing medical input and support from a multidisciplinary team. There is limited evidence concerning patient and carer experience of this choice.

I am leading the PAlliative Care in chronic Kidney diSease: (PACKS study) which is exploring quality of life, decision making, costs and impact on carers in people managed without dialysis. This study, funded by the National Institute of Health Research in the UK, is also investigating symptoms, cognition, frailty and performance. Recruitment opened in January 2015 and patients are being recruited in the UK, by renal research nurses, once they have made the decision not to embark on dialysis. Recrutiment finishes in May 2016 with a further 3 months follow up. Carers are asked to ‘opt-in’ with consent from patients. The approach includes longitudinal quantitative surveys of quality of life and quality of life and costs for carers. Additionally, the decision making process is being explored via qualitative interviews with renal physicians/clinical nurse specialists.

The study is designed to capture patient and carer profiles when conservative kidney management is implemented, and understand trajectories of care-receiving and care-giving with the aim of optimising palliative care for this population. It is exploring the interactions that lead to clinical care decisions and the impact of these decisions on informal carers with the intention of improving clinical outcomes for patients and the experiences of care givers.

The #hellomynameis campaign reaches its 3rd anniversary

28 Feb, 16 | by josmith

This weeks ENB twitter chat on Wednesday the 2nd of March between 8-9pm(GMT) UK will be hosted by Kate Granger a doctor, but also a terminally ill cancer patient. and founder of the #hellomynameis campaign, and will focus on the importance of healthcare workers introducing themselves to patients. Participating in the twitter chat requires a Twitter account; if you do not already have one you can create an account at www.twitter.com. Once you have an account contributing is straightforward – follow the discussion by searching links to #ebnjc or @EBNursingBMJ, or better still, create a tweet (tweets are text messages limited to 140 characters) to @EBNursingBMJ and add #ebnjc (the EBN chat hash tag) at the end of your tweet, this allows everyone taking part to view your tweets.

Hello, my name is Kate Granger and I’m the founder of the #hellomynameis campaign, which will reach its third anniversary in August 2016.  Three years of tireless work trying to spread one simple message across the globe. Three years of trying to improve the experience for other patients all facing their own health problems. A straightforward premise that any healthcare worker who approaches a patient should first introduce themselves, with the innovative use of social media to spread the message.

more…

Dementia and Advance Care Planning

19 Feb, 16 | by Gary Mitchell, Associate Editor

We are delighted to share with you our latest guest blog, in partnership with @WeEOLC, from Sarah Russell on the topic of dementia and advance care planning.

Sarah Russell is the Head of Research and Clinical Innovation at Hospice UK.  She is also the full time carer for her mother who lives well with Alzheimer’s.  Sarah tweets as @learnhospice, @WeEOLC and @swaydemfriend

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Click Here to Read Sarah’s Guest Blog

Therapeutic Lying in Dementia Care

29 Dec, 15 | by Gary Mitchell, Associate Editor

In our #ebnjc blog series we have already celebrated children’s nursing; with blogs from Jayne Pentin, Kirsten Huby & Marcus Wootton, learning disability nursing; with blogs from Professor Ruth Northway, Jonathan Beebee & Amy Wixey, midwifery; with blogs from Louise Silverton CBE , Gina Novick & Lynsey Wilgaus, and adult nursing from Clare McVeigh, Professor Roger Watson, Professor Jan Dewing & Professor Elizabeth Robb

This week our #ebnjc December blog series concludes with four guest blogs on mental health nursing from Neil Withnell, Jessie McGreevy, Paul Canning & Peter Jones.

Today we welcome Jessie McGreevy, a dementia care specialist from Four Seasons Health Care.  Today Jessie, a finalist in the recent Nursing Times Awards, discusses the topical issue of therapeutic lying in dementia care.

imageimage

Click Here to Read Jessie McGreevy’s Guest Blog

Analysis and discussion of developments in Evidence-Based Nursing

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