Clinical

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.

Managing behaviour that challenges in people with dementia in the emergency department

Managing behaviour that challenges in people with dementia in the emergency department

Why you should read this article: • To recognise the potential causes of behaviour that challenges among people with dementia in the emergency department (ED) setting • To understand the issues that may occur as a result of behaviour that challenges in the ED • To be aware of strategies to manage dementia-related behaviour that challenges that you can use in your practice Dementia symptoms can manifest in a variety of ways, such as anxiety, agitation and an inability to communicate unmet needs. In emergency departments (EDs), these symptoms, as well as various environmental factors, can lead to behaviour that challenges in people with dementia. Therefore, ED staff must be skilled in screening, assessing and managing this patient group effectively. This article details a literature review that was conducted to explore the evidence on managing behaviour that challenges in people with dementia in the ED and what de-escalation strategies may be useful. A literature search of eight databases was undertaken, resulting in 11 articles that were included in this literature review. Four main themes were identified: violence and aggression towards staff; manual and chemical restraint in the ED; identifying delirium and dementia; and environment and person-centred care. Strategies identified to de-escalate and reduce the risk of behaviour that challenges include: making environmental modifications to the ED; providing person-centred care; excluding or evaluating pain and unmet needs; using various tools and strategies to improve communication; and using distraction techniques.

Effectiveness of the sepsis six bundle in the management of acute adult sepsis in the UK

Effectiveness of the sepsis six bundle in the management of acute adult sepsis in the UK

Why you should read this article: • To understand the role of the sepsis six care bundle in managing patients with sepsis • To recognise the effectiveness of performing all six actions from the sepsis six care bundle within one hour of patient admission • To learn about potential barriers to clinician compliance with the sepsis six care bundle There are up to 11 million sepsis-related deaths worldwide each year. Management of sepsis requires early recognition, appropriate antibiotic treatment and careful management of haemodynamic status. In 2006, the UK Sepsis Trust introduced the sepsis six care bundle to simplify the guidelines for managing sepsis and identify actions for management that were more accessible to junior clinicians. This article reports findings from a literature review that explored the effectiveness of the sepsis six bundle in the management of adult sepsis patients in the UK and assessed the level of clinician compliance in UK clinical settings. The effectiveness of sepsis six was based on patient mortality during hospital stay, rate of intensive care unit admissions and length of hospital stay, all of which were found to have improved since the introduction of the tool.

Assessment and management of metastatic bone cancer in emergency departments

Assessment and management of metastatic bone cancer in emergency departments

The knowledge and skills required to care for patients with cancer

Improving the treatment of patients with dual diagnosis in emergency departments

Care of patients who present with symptoms arising from a combination of severe mental illness and substance misuse

Emotional labour

Insights into nurses’ precarious emotional labour in the emergency department

Service demands such as four-hour wait targets add a further layer of complexity and pressure

Expanding the emergency nurse role to meet demand: nurse and physician perspectives

Attitudes towards an expanded role for registered nurses in the emergency department

Analysing ambulance data to ascertain the prevalence and demographics of individuals who have died by suicide

Analysing ambulance data to ascertain the prevalence and demographics of individuals...

Service evaluation data collected by the North West Ambulance Service (NWAS) NHS Trust

Management of cardiac arrest following blunt trauma: a critical evaluation of resuscitative thoracotomy

Management of cardiac arrest following blunt trauma

A critical evaluation of resuscitative thoracotomy

Medicine wastage in a thromboprophylaxis protocol for ambulatory trauma patients

Medicine wastage in a thromboprophylaxis protocol for ambulatory trauma patients

Investigating the waste and cost with suggestions for changing dispensing practice

Treating buckle fractures in children with a soft cast and home removal: a quality improvement initiative

Treating buckle fractures in children with a soft cast and home removal

A quality improvement initiative introduced by advanced nurse practitioners

Exploring patients and family members’ experiences of care in the emergency department

Exploring patients and family members’ experiences of care in the emergency department

An investigation of patients and family members’ experiences of care in one ED in Iran

Optimising the conservative management of closed tendinous mallet finger injury

Optimising the conservative management of closed tendinous mallet finger injury

Understand the different splints used and read the latest evidence on immobilisation methods and treatment duration

The provision of emergency healthcare for women who experience intimate partner...

Strategies to address knowledge deficits and negative attitudes

Exploring medicines reconciliation in the emergency assessment unit: staff perceptions...

Staff perspectives on the time patients wait for their medicines to be prescribed

Managing the needs of frequent attenders of urgent care services

A case management approach of a new frequent service user manager service

Barriers to effective nurse-patient communication in the emergency department

Identifying what emergency nurses perceive as barriers to nurse-patient communication

Charcot’s foot: a clinical update for emergency nurses

Emergency nurses in the UK have an important role in recognising patients with this condition

Rhabdomyolysis: a case-based critical reflection on its causes and diagnosis

Rhabdomyolysis is a complex condition that can have traumatic and non-traumatic causes

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