The evidence

The issue of nailbrushes seems to be unidentified by infection control literature, including the Infection Control Nurses' Association hand hygiene guidelines. The infection risk is, however, that they will be used as communal items, like a bar of soap, so may transmit micro-organisms. Therefore, in acute care their use should be discouraged. If used, they should be single use, and then disposed of.

Intrapleural chest drainage

Abnormal fluid or air between the pleura results in respiratory distress and can cause death, if untreated. Intrapleural chest drains are used to remove abnormal accumulations of fluid or air. Caring for patients with intrapleural chest drains requires knowledge and skill to ensure patient safety. This article describes the pathophysiology, treatment and nursing care of patients who require intrapleural chest drains.

Abdominal aortic aneurysms: clinical features, treatment and care

Aneurysms can occur in any blood vessel, but aortic aneurysms in the abdominal aorta are particularly common. Large aortic aneurysms are likely to progress to life-threatening rupture or dissection, which is usually fatal. Elective repair of large aneurysms therefore reduces mortality and morbidity. Small aneurysms may be present in patients who present with other conditions. They will be monitored, but do not usually warrant the risks of undertaking repair on the body's main artery. This article reviews the pathophysiology, medical treatments and nursing care of abdominal aortic aneurysms.

An introduction to electrocardiogram interpretation: part 1

This article describes how to interpret the single-lead electrocardiogram (ECG). The author also describes cardiac electrophysiology and how this is represented by ECG graphs. Part 2 of this article, to be published in the next issue, will describe 12-lead ECGs and acute coronary syndromes.

Introduction to electrocardiogram interpretation: part 2

Twelve-lead electrocardiograms (ECGs) record 12 different views of cardiac electrical activity, or leads. They therefore provide more information than bedside monitors, which usually record one or sometimes two leads. Many acutely ill patients have 12-lead ECGs recorded either on admission to hospital, before undergoing operations or when specific cardiac concerns have arisen. Traditionally, ECGs have aided clinical diagnoses and, by learning how to understand and interpret them, nurses will know when they need to summon expert help. This article describes what each of the 12 leads represents, outlines the main indications for recording 12-lead ECGs and identifies likely causes of error in interpreting them.

Vital signs: a nurse-led education initiative for occupational therapists

This article describes a collaborative development between a critical care outreach team and occupational therapists to improve the therapists' awareness of vital signs. Occupational therapists are increasingly involved in patient discharge from acute care areas; traditionally, their role focused on rehabilitation of patients who had recovered from acute crises. In accordance with improving patient safety, occupational therapists need to be able to recognise the early warning signs of acute deterioration and understand the significance of vital signs to be able to raise concerns with nursing and medical staff.

An introduction to electrocardiogram interpretation: part 2

Twelve-lead electrocardiograms (ECGs) record 12 different views of cardiac electrical activity, thus providing more information than bedside monitors, which usually display one or sometimes two leads. Many acutely ill patients have 12-lead ECGs recorded on admission to hospital and at other times, such as pre-operatively or when there are specific cardiac concerns. ECGs have traditionally been an aid to medical diagnosis, but understanding and being able to interpret them enables nurses to summon help urgently if needed. This article describes what each of the 12 leads represents, outlines the main indications for recording 12-lead ECGs and identifies likely causes of error.

An introduction to electrocardiogram interpretation: Part 1

This article describes how to interpret the single-lead electrocardiogram (ECG). The author also describes cardiac electrophysiology and how this is represented by ECG graphs. Part 2 of this article, to be published next week, will describe 12-lead ECGs and acute coronary syndromes.

Arterial catheters: promoting safe clinical practice

Arterial catheters are commonly used to monitor blood pressure continuously and to take blood gas samples from patients in intensive care units. The National Patient Safety Agency (NPSA) issued a rapid response report in 2008 because of a number of incidents related to their use. This article describes the risks associated with the use of arterial catheters and outlines the recommendations made by the NPSA to promote safe practice.

Guidance is needed on storing drugs during a heatwave

DRUGS DURING A HEATWAVE The recent heatwave prompted a number of health warnings. One possible consequence that does not seem to have been considered is the effect of heat on drug stability.

Caring for patients receiving oxygen therapy

Although respiratory disease can occur at any age, older people are more likely to suffer both acute and chronic respiratory disease. Without sufficient oxygen, cells fail and die, and extensive cell death causes body systems to fail. This article considers the principles of short-term oxygen therapy and offers guidance to nurses who may be required to administer such treatment in their work with older people.

Comparing no-touch and tympanic thermometer temperature recordings

Temperature is a vital sign which can be measured using various types of clinical thermometers. Pulmonary artery temperature is considered the 'gold standard', but this measurement is not usually clinically practical. There is currently no consensus for optimal alternative site or equipment. This research compares 178 simultaneous measurements from 5 clinical areas, using two types of thermometers: tympanic and no-touch temporal. No-touch thermometers were all set to oral equivalent. Tympanic thermometers were adjusted to either oral (n=105) or core (n=73) equivalent. Maximum acceptable difference was identified as 1oC. Two data sets (oral/core; oral/oral) were analysed using Bland-Altman method on Excel programmes, comparing all thermometers and separating oral and core-equivalent tympanics. The two thermometers were found not to be equivalent. As a simple comparison between two thermometers, this research cannot identify which thermometer is more accurate.

Responsible and accountable

Healthcare assistants are valuable members of the multi-disciplinary team, using many skills outlined in previous articles in this series. But anyone exceeding the limits of their skills can cause harm and may be called to account. This article explains how everyone is accountable.

Arterial blood gas analysis

With increasing use of arterial blood gas analysis in various ward and other hospital settings to aid medical diagnosis and management, nurses who can interpret results are often able to initiate earlier interventions and understand the reasons for medical interventions. This article enables nurses to interpret such results.

Using non-invasive ventilation in acute wards: Part 2

The second part of this article on non-invasive ventilation (NIV) examines the use of bilevel non-invasive ventilation, discussing the differences between CPAP and bilevel NIV. It also focuses on how to assess and monitor patients receiving either CPAP or bilevel NIV, and patient outcomes.

Using non-invasive ventilation in acute wards: Part 1

Non-invasive ventilation (NIV) is increasingly being used in domestic and acute health settings. Part one of this article identifies the benefits of NIV and describes the use of continuous positive airway pressure (CPAP). Part two, published in next week's Nursing Standard, discusses bilevel NIV, which has fewer complications and so is largely replacing CPAP. Part two also examines how to monitor and assess patients receiving NIV.

Anthrax: forms, symptoms and treatment

BACKGROUND

This article examines the history of anthrax, the organism, the different forms of human anthrax, its symptoms and treatment. Set against fears of a bioterrorist attack, the article also examines the potential threat of anthrax as a weapon.

CONCLUSION

Frontline staff such as nurses can contribute greatly to increasing survival by recognising symptoms, treating patients promptly and helping to allay public concern.

A course in critical care for ward staff

A government review has acknowledged that many critically ill patients are being cared for on acute wards. A lack of resources and intensive care beds, combined with low staffing levels, have led to increased demands being placed on wards that are already struggling to care for critically ill patients. Research shows that ward nurses are well placed to identify early indications of complications and initiate appropriate interventions, and that poor outcomes and some deaths are potentially avoidable. This article describes how one trust developed an in-house education programme to support nurses caring for acutely and critically ill patients on the wards.

Managing patients with a tracheostomy in acute care

Most acute wards occasionally receive patients with tracheostomies, but relatively infrequent experience of caring for these patients means that nurses have limited opportunities to practise their knowledge and skills. This article examines the indications for using a tracheostomy and provides a problem-centred approach to patient care.

The symptoms and management of respiratory failure

Nurses are often in the best position to detect any breathing problems in patients. This paper describes the mechanisms of respiration, the reasons why respiratory difficulties can develop and explains how problems can be detected and alleviated. It includes a series of reflective exercises that aim to enhance nurses' understanding of this life-threatening condition.

Measuring respiratory function to wean patients from non-invasive ventilation in a ward environment

Non-invasive ventilation (NIV) is increasingly being introduced into various ward environments. NIV is usually used on wards to treat acute exacerbations of chronic obstructive pulmonary disease (COPD). In patients with COPD, carbon dioxide removal will be impaired. In critical care, arterial blood gas sampling remains the 'gold standard' for assessing carbon dioxide levels. Obtaining arterial blood gas samples in a ward environment is problematic, and potentially dangerous. There is currently no reliable substitute for arterial sampling to monitor for hypercapnia in ward areas.

Central venous catheters and central venous pressure

Central venous catheters are increasingly being used in a variety of clinical areas outside critical care. Philip Woodrow examines the indications, measuring techniques and complications associated with central venous pressure monitoring.

Should older people be admitted to intensive care?

As you are reading Nursing Older People, your answer to the question 'Should older people be admitted to intensive care?' is probably yes, perhaps qualified by 'when appropriate'. But as well as appropriateness (individual best interests), the quality of services is also affected by attitudes within society and health care. So why is this important for you?

Establishing an in-house journal

Articles in journals such as Nursing Standard offer nurses a valuable means to keep their knowledge updated, but how many people do you know who have written an article? The majority of research undertaken by nurses remains unpublished (Humphris 1999), so much potentially useful experience, knowledge, ideas and research are lost. This article describes how the School of Health, Biological and Environmental Sciences (HeBES) at Middlesex University established an in-house journal to encourage nurses to develop their skills of writing for publication.

Will nursing ICU patients in semi-recumbent positions reduce rates of nosocomial infection?

Ventilator-associated pneumonia is the main cause of ICU-acquired infection. Infection significantly increases mortality, length of ICU stay and costs (both financial and humanitarian). Ventilator-associated pneumonia is usually caused by aspiration. Ventilator-associated pneumonia risks are highest among patients who are fed through a nasogastric/orogastric tube. A semi-recumbent position reduces the risk of aspiration, so should reduce the risk of acquiring ventilator-associated pneumonia.

Head injuries: acute care

Nurses working in acute care settings will encounter patients with various head injuries. Philip Woodrow describes the nurse's role in care planning, monitoring and assessing these patients, and in providing a safe environment for their recovery.

Pulse oximetry

Pulse oximetry provides a non-invasive means to measure pulse rate and haemoglobin saturation. Philip Woodrow describes the nurse's role in its use.

Interventions for confusion and dementia. 5: Changing cultures

Previous articles in this series (Vol 7(15): 891-94; Vol 7(17): 1018-20; Vol 7(19): 1145-49; Vol 7(20): 1247-50) have explored the promotion of quality of life for people with dementia and how this can be achieved through existing interventions. This final article moves from discussing specific interventions to cover wider issues around healthcare beliefs and values. A brief historical overview of dementia care is given, outlining the inherited structures and values. Much valuable work has been carried out by the Bradford Dementia Group, who has described changes in dementia care as moving from an 'old' to a 'new' culture. This 'new culture', offering a comprehensive person-centred approach to holistic care, is explored with reference to the work of Kitwood, who has done much to promote quality of life for people suffering from dementia.

Interventions for confusion and dementia. 4: Alternative approaches

While reality orientation and reminiscence are useful therapies, recent years have been a growing awareness of other approaches to caring for people with dementia. This article discusses some of the less established, but potentially valuable, approaches--validation therapy, resolution therapy and multisensory environments. Validation therapy seeks to help care givers understand the thoughts and feelings of care receivers. In contrast to the confrontational approach of reality orientation, it encourages empathy between giver and receiver. Resolution therapy develops aspects of validation therapy, adopting a less structured, more psychodynamic and individualistic approach. Multisensory environments use sensory stimulation to achieve pleasure for the individual. All three approaches have a limited knowledge base, but share a humanistic philosophy that enables them to contribute to a person's quality of life.

Interventions for confusion and dementia. 3: Reminiscence

The aims of reality orientation, which was discussed in the previous article of this series (Vol 7(17): 1018-20), are to achieve behavioural improvements. The aims of reminiscence, however, are empowerment and the provision of pleasure and it is therefore more associated with quality of life and quality of care. Reminiscence can be an enjoyable activity. Used in a structured way, it can achieve a sense of wellbeing, and increase empathy between healthcare workers and clients. This article discusses the benefits and problems of reminiscence, and suggests means to develop reminiscence skills and materials.

Interventions for confusion and dementia. 2: Reality orientation

This article, the second of a five-part series exploring interventions for confusional states, discusses reality orientation (RO). For many decades, this form of intervention has been widely used and accepted as a way of reducing symptoms of confusion. However, an argument against RO is that it makes the person a passive recipient and reinforces feelings of disempowerment. This article describes the development of RO, exploring its strengths and weaknesses. Literature on the subject is largely anecdotal and dated as RO has been largely superseded by the interventions discussed in later articles, e.g. reminiscence and validation therapy.

Interventions for confusion and dementia. 1: Quality of life

This series of articles examines some of the more commonly used interventions for confusional states/dementia. This article explores issues around quality of life. Quality of life is a subjective and potentially undefinable concept. Yet in recent years it has been used widely in the nursing literature. However it is defined, it is fundamental to humanity and underpins all the interventions discussed in the later articles. When continuing health care fails to offer hope of a medical cure, the focus necessarily shifts to care. Good care and quality of life are inextricably linked. This article raises awareness of some key issues to guide readers when deciding whether or not to adopt a particular intervention; a prescriptive approach to quality of life is deliberately avoided. Later articles in this series will discuss reality orientation, reminiscence, validation, and multisensory environments.