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.
The advanced ophthalmic nurse practitioner is well-placed to provide high-quality care
Understand the challenges posed by urinary tract infections in older people
Why you should read this article: • To be aware that people living with advanced dementia whose ability to speak is limited may communicate using their body and facial responses • To identify the changing and complex health needs of people living with advanced dementia • To recognise the challenges experienced by family carers of people living with advanced dementia This is the first article in a six-part series in Nursing Older People exploring the nursing care of people living with advanced dementia. This article discusses the changes that may occur as dementia progresses, from the perspective of the individual, their family and other carers. A person living with advanced dementia is likely to experience physical, cognitive and social changes that can be profound and debilitating. Healthcare needs intensify as new and co-existing issues result in increasing dependency on others for support with activities of daily living. These activities can include eating, drinking, mobility and personal care. Consequently, family carers may find their role has to develop and change to provide increasing support in response to these complex needs. These increasing needs can result in care transitions to hospitals or care homes. Careful and collaborative management of care is crucial to maintain quality of life for the person with dementia and family carers.
Why you should read this article: • To increase your awareness of the post-diagnostic support needed by people with dementia and their family carers • To recognise the challenges involved in supporting carers of people with dementia by telephone • To enhance your understanding of how to use a framework to reflect on your practice In the UK, the quality of post-diagnostic care and support for people with dementia and their family carers is variable and depends on the availability of services in each person’s local area. This article considers the support services available for families affected by dementia and discusses how telephone helplines can assist those who may have no access to other types of support. It presents a case study describing a call to the Admiral Nurse Dementia Helpline, a service run by nurses with expertise in dementia care and provided by the charity Dementia UK. This is followed by a reflection on the call from the nurse’s perspective. The case study-based reflection demonstrates the complexity of providing support through a helpline and the specialist knowledge and skills required to provide the appropriate level of support.
Testing acceptability of Project Extension for Community Healthcare Outcomes (ECHO)
Why you should read this article: • To recognise the importance of evidence-based best practice for people living with advanced dementia, delivered with compassion and dignity • To be aware of the exceptional advanced nursing practice skills and knowledge required to deliver evidence-based care • To identify the main challenges experienced by nurses, nurse leaders and nurse educators in delivering evidence-based care to people living with advanced dementia This is the introductory article in a six-part series in Nursing Older People exploring the nursing care of people living with advanced dementia. It discusses the complex and progressive array of nursing required to meet the needs of individuals, the provision of personal care, learning and leadership, meaningful activity, and palliative and end of life care. A main theme of the series is the exceptional nursing skills and knowledge required to deliver evidence-informed care with compassion and respect for people living with advanced dementia. This introductory article provides background information to contextualise advanced dementia and identify the main challenges facing nurses, nurse educators and nurse leaders.
Why you should read this article: • To understand how suboptimal posture in older people can negatively affect their well-being • To recognise the role of night-time positioning equipment in improving posture in older people • To improve your knowledge on the wider benefits of night-time positioning in older people Background Twenty four-hour postural care that includes the use of night-time positioning equipment (NTPE) is being increasingly recommended. However, because most of the published studies focus on children, there is a lack of evidence on the use of NTPE in adults. Aim The aim of this pilot study was to assess the effect of NTPE use in UK care home residents with complex health conditions and postural asymmetry. Methods Ten care home residents trialled NTPE over a 12-week period. Qualitative and quantitative data were collected before and after each trial using standardised assessment tools. Semi-structured interviews were conducted with participants and relatives after each trial. Staff’s views were elicited via two focus groups at the end of the study. Results There were notable benefits of NTPE use in terms of participants’ pain levels, sleep quality, risk of pressure ulcers, risk of choking, and weight. There was also evidence of improvements in participants’ function, ability to undertake activities of daily living and quality of life. However, some equipment was abandoned during the trials because participants found it too hot or restrictive. Conclusion This pilot study increases the evidence base for a personalised approach to 24-hour postural care that can support older people’s health and well-being. Further empirical studies are required to determine how NTPE can be used to improve older people’s quality of life.
Why you should read this article: • To enhance your awareness of the potential benefits of digital health technology (DHT) • To understand the factors that can affect DHT implementation in nursing homes • To learn about the components of a three-step process model that could be used to implement DHT innovations in nursing homes Background Digital health technology (DHT), which includes digital algorithms and digital records, is transforming the way healthcare services are delivered. In nursing homes, DHT can enhance communication and improve the identification of residents’ health risks, but its implementation has so far been inconsistent. Therefore, the LAUNCH (Leadership of digitAl health technology Uptake among Nurses in Care Homes) study was undertaken to identify factors that may affect DHT implementation in these settings. Aim To identify the factors that enable nurses to implement DHT in nursing homes and to co-design a nurse-led stepped process supporting the effective implementation of DHT innovations in nursing homes. Method An appreciative inquiry methodology was used. A total of 20 interviews with managers, residents and relatives, and nurses from five nursing homes in England were undertaken. The interview questions focused on their understanding of DHT, their experiences of it, and its potential benefits in nursing homes. Data from the interviews were thematically analysed and the emerging themes were used to inform two co-creation workshops, during which participating nurses discussed a practical, evidence-based process for DHT implementation in nursing homes. Findings Three broad themes emerged from the interviews: improving communication; engaging with DHT and retaining humanised care; and introducing DHT and protecting data security. The co-creation workshop participants formulated the LAUNCH process model, a nurse-led, stepped approach supporting DHT implementation in nursing homes. Conclusion The LAUNCH study identified factors enabling staff in nursing homes to introduce and sustain DHT innovations. Participating nurses co-created a three-step process for the effective implementation of DHT innovations in nursing homes, which have the potential to release staff time, improve quality of care, and have positive effects on staff recruitment and retention.
Why you should read this article • To understand the different definitions of quality • To enhance your awareness of how quality in care homes is monitored • To familiarise yourself with the methods that can be used to improve quality in care homes Despite the focus on quality in care homes, and the body of evidence that drives policy and practice, care home residents in Wales experience variations in quality of care. Quality is not easily defined, and care providers may have differing views on quality and how it is monitored. Health and social care professionals – including nurses – should understand the factors that affect quality in care homes. Quality improvement projects can support the development of a workplace culture that can sustain quality in care homes. This article defines quality, details methods that may be used to monitor quality, and outlines how quality in care homes can be improved.
Policymakers should be aware of the need for investment in specialist dementia units
Nursing associates are well placed to address the needs of this patient population
Exploring the role of the ANP in identifying frailty and leading CGA for older people