Clinical

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Our clinical nursing articles aim to inform and educate nurse practitioners and students. This is achieved through the publication of peer-reviewed, evidence-based, relevant and topical articles.

Understanding obesity and addressing stigma: the role of healthcare professionals

Why you should read this article: • To enhance your knowledge of the prevalence of obesity and overweight in the UK • To increase your understanding of obesity as a complex multifactorial disease • To learn ways to advocate for respectful policies and practices in relation to overweight and obesity The coronavirus disease 2019 (COVID-19) pandemic has further emphasised the importance of recognising obesity as a health issue for adults and children, with associated increases in obesity prevalence and risk of severe illness and death from COVID-19. Obesity is highly visible and highly stigmatised. It is frequently regarded as a result of lifestyle choices and behaviours, with a focus on personal responsibility rather than as a complex, multifactorial disease with a strong genetic component. Healthcare professionals, including nurses, have an important role in supporting behaviour changes, and discussing weight with patients in neutral and respectful ways. This article outlines the effects of the COVID-19 pandemic on weight and weight-related behaviours and discusses the complexity of obesity and weight stigma. It also emphasises the importance of nurses advocating for action to address the obesogenic environment.

Moral distress in advanced practice nurses during the COVID-19 pandemic

Why you should read this article: • To familiarise yourself with the principles of moral distress • To understand how moral distress may have affected advanced practice nurses during the coronavirus disease 2019 (COVID-19) pandemic • To appreciate how burnout caused by moral distress can have a negative effect on nurse retention in the NHS Background Moral distress arises when a person is aware of the right course to take but is prevented from acting on it by institutional constraints. While this concept has been considered by nursing ethicists for many years, it has been particularly associated with the unprecedented healthcare conditions caused by the coronavirus disease 2019 (COVID-19) pandemic. Aim To investigate the level of moral distress affecting advanced practice nurses (APNs) in the UK during the COVID-19 pandemic. Method This was a mixed-methods study in which a bespoke cross-sectional survey was sent to 243 APNs from across the UK who had been recruited to a broader longitudinal cohort study. The survey asked about their experiences, well-being and moral distress. Open-ended questions asked about their concerns regarding the health and well-being of their patients and colleagues. Findings A total of 97 APNs completed the survey, yielding a 40% response rate. Levels of moral distress were significantly higher among APNs working in secondary care (P=0.026) compared with those working in primary care. All of the respondents expressed concerns about patients due to delayed care and about the mental well-being of their colleagues, particularly those who were redeployed to COVID-19 wards. Conclusion The COVID-19 pandemic has caused moral and psychological distress for APNs. However, the type of distress and its direct causes varied among these practitioners. Tailored support is required to address moral distress and subsequently improve staff retention.

Managing symptoms at the end of life: a guide for non-palliative care nurses

Why you should read this article: • To understand the role of non-palliative care nurses in providing end of life care • To recognise the signs and symptoms that can indicate a person is in the last days or hours of life • To enhance your knowledge of the interventions that can be used to manage common symptoms at the end of life Nurses, regardless of their area of practice, may have to care for a person in their last days and hours of life. However, many nurses outside of specialist palliative and end of life care settings do not feel adequately prepared for this. Nurses can usually obtain advice from specialists working in local hospices or palliative care centres, but they may still find it challenging to act on that advice if it is not underpinned by their own knowledge base. This article provides a guide to assist non-palliative care nurses in recognising dying and managing common symptoms at the end of life.

Genetic haemochromatosis: diagnosis and treatment of an iron overload disorder

Why you should read this article: • To increase your awareness and understanding of genetic haemochromatosis, an iron overload disorder • To recognise the signs and symptoms of genetic haemochromatosis • To enhance your ability to support patients who require life-long treatment for genetic haemochromatosis Genetic haemochromatosis is a potentially serious iron overload disorder, yet there is a lack of awareness of the condition among the public and many healthcare professionals. In the UK, around one in 150 people have the genetic mutations that cause the condition, meaning that they are at increased risk of developing iron overload. If undiagnosed, prolonged iron overload can lead to liver, heart and endocrine failure and may be fatal; however, early diagnosis, treatment and maintenance can enable patients to have a normal lifespan. This article provides an overview of genetic haemochromatosis, including its types, origins, signs and symptoms, diagnosis, screening and treatment.

Essentials of wound care: assessing and managing impaired skin integrity

Why you should read this article: • To recognise the holistic factors that need to be considered when assessing and managing wounds • To enhance your awareness of the available tools that can be used to structure a wound assessment • To acknowledge the importance of shared decision-making in developing wound care regimens The assessment and management of impaired skin integrity as part of wound care is a common nursing task. Specific wound assessment tools may assist nurses to structure an assessment, but wider holistic factors also need to be considered. The TIMERS (tissue, inflammation and infection, moisture balance, edge, repair and regeneration, and social factors) tool offers a flexible approach to assessing wounds holistically and can be applied in all wound aetiologies. This article provides nurses with an overview of the assessment and management of impaired skin integrity using the TIMERS tool. It also discusses the importance of shared decision-making between nurses and patients when formulating a wound care regimen.

Access to pain management from a legal and human rights perspective

Access to pain management from a legal and human rights perspective

Understand healthcare professionals’ legal, moral and professional obligations

Exploring support strategies for improving nursing student retention

Exploring support strategies for improving nursing student retention

What some HEIs offer and how this may increase the likelihood of students staying on a course

Pharmacological management of chronic heart failure

Pharmacological management of chronic heart failure

Update your knowledge of the common medicines used to treat chronic heart failure

Prostate cancer: understanding patients’ treatment options

Prostate cancer: understanding patients’ treatment options

How to support patients to make informed decisions about their care

Supporting patients to achieve remission of type 2 diabetes

Supporting patients to achieve remission of type 2 diabetes

The link between diet, weight loss programmes and remission - and how to advise your patients

Partnership working between nurses and patients’ families in the critical care environment

Partnership working between nurses and patients’ families in critical care

Practical interventions that can improve care delivery in this setting

Transforming staff training at an acute trust in response to COVID-19

Transforming staff training at an acute trust in response to COVID-19

Understand the changes required when moving from face-to-face to virtual training

Identifying and managing adverse drug reactions to promote medicines adherence

Expand your knowledge of how nurses can reduce medicines-related harm

Providing palliative and end of life care for people with advanced disease

How to manage some of the common physical, psychological and emotional symptoms

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

Enhance your understanding of diabetes distress and major depressive disorder

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

Learn about evidence-based approaches and how to work collaboratively with service users

Preventing healthcare-associated infections by decontaminating the clinical environment

Understand and address barriers to adherence to infection prevention and control guidance

Providing music therapy for people with dementia in an acute mental health setting

Enhance your knowledge of the benefits of music therapy for this patient group

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