Foundations of Nursing Practice E-Book

Fundamentals of Holistic Care
 
 
Mosby Ltd. (Verlag)
  • 2. Auflage
  • |
  • erschienen am 8. Januar 2013
  • |
  • 676 Seiten
 
E-Book | ePUB mit Adobe DRM | Systemvoraussetzungen
E-Book | PDF mit Adobe DRM | Systemvoraussetzungen
978-0-7020-5333-7 (ISBN)
 

This second edition of Foundations of Nursing Practice has been revised and updated specifically to meet the needs of nursing students in all fields of practice The book explains how and why sensitive, safe, evidence-based holistic nursing care is carried out, including topics common to all fields of practice. Core nursing skills are emphasised to reflect the importance of clinical skills as well as the underpinning theory.

Aids to learning in each chapter:

    • Learning outcomes

    • Interactive boxes for all age groups and fields of nursing practice

    • Key words and phrases for literature searching

    • Useful websites, references and further reading.

    This book provides a comprehensive introduction to nursing that will meet the needs of students, nurses returning to practice, mentors and other registered nurses.

        • Relevant to all branches of nursing settings: infants, children, adults, pregnant women, older people and people with a learning disability or mental health problems
          • Themes relevant to all stages and fields of nursing practice include safety, infection prevention and control, managing stress, communication, managing wounds and pressure ulcers, and dealing with loss
            • Scenarios develop the skills of evidence-based practice, critical thinking, reflection and health promotion, and encourage further learning
              • The areas of psychology, sociology, physiology and pathology are clearly related to nursing practice
                • Key principles of health promotion, the law and ethics, the human lifespan and development are explained in earlier chapters, then applied in later chapters
                  • Cultural diversity information helps with understanding the needs of people from different backgrounds
                    • Person-centred approach encourages problem solving and application to practice
                      • Evidence-based practice is explicit throughout, and best-practice guidelines underpin exploration/explanation of nursing care.
                      • Easy-reference Glossary at the back of the book.
                      • Meets the requirements of the new pre-registration nursing curriculum including the NMC (2010) competencies and Essential Skills Clusters

                      • Greater emphasis on safeguarding vulnerable people, maternal health and first aid

                      • Self-test questions with answers available on accompanying website.


                      School of Acute and Continuing care Nursing, Napier University, Edinburgh
                      • Englisch
                      • London
                      Elsevier Health Sciences
                      • 34,72 MB
                      978-0-7020-5333-7 (9780702053337)
                      0702053333 (0702053333)
                      weitere Ausgaben werden ermittelt
                      • Front cover
                      • Half title page
                      • Foundations of Nursing Practice
                      • Copyright page
                      • Table of Contents
                      • Contributors
                      • Foreword
                      • Preface
                      • Acknowledgements
                      • How to use this book
                      • 1 Health, nursing and healthcare systems
                      • 1 Understanding health and health promotion
                      • Learning outcomes
                      • Introduction
                      • Definitions of health
                      • Dimensions of health
                      • Holistic health
                      • The body as a machine
                      • The continuum of health
                      • Positive and negative health
                      • WHO definitions of health
                      • Defining mental health
                      • Lay and professional definitions of health
                      • Models of health and illness
                      • The medical model
                      • Mental health language and the medical model
                      • The social model
                      • The patient-centred model
                      • Service user and carer involvement
                      • Health beliefs
                      • Early health beliefs
                      • Religion and health
                      • Supernatural ideas and health
                      • Scientific developments and health
                      • Current lay health beliefs
                      • Lay beliefs about the causes of illness
                      • Children's health and illness beliefs
                      • Becker's health belief model
                      • The nurse's role and application of the HBM
                      • Attitudes, values and behaviours
                      • Public and private attitudes
                      • Cognitive dissonance
                      • Values
                      • Stereotyping
                      • Lifestyle, health behaviours and locus of control
                      • Factors influencing health
                      • Determinants of mental health and well-being
                      • Poverty as the key determinant of health
                      • Relative poverty and participation in society
                      • Components of poverty
                      • Social class and health inequalities
                      • Research into health inequalities
                      • Changing trends in health and illness
                      • Health promotion
                      • Emergence of health promotion
                      • Principles of health promotion
                      • Health promotion and public health
                      • National health promotion organizations
                      • Settings and skills for health promotion
                      • Approaches to health promotion
                      • The medical approach
                      • The behavioural change approach
                      • The educational approach
                      • The client-centred approach
                      • The societal approach
                      • Models of health promotion
                      • Tannahill's model of health promotion
                      • The Tones model
                      • Health education
                      • Approaches to health education
                      • Health education in the NHS
                      • Levels of health education
                      • Primary health education
                      • Secondary health education
                      • Tertiary health education
                      • UK health policy context
                      • Measuring health and illness
                      • Purposes of measuring health and illness
                      • Common methods of health and illness measurement
                      • Incidence
                      • Prevalence
                      • Distribution
                      • Other approaches to measurement of health and illness
                      • Needs assessment
                      • Social audit
                      • Community profiling
                      • Priorities
                      • Illness behaviour
                      • Self-help and self-care
                      • The effects of illness
                      • Help-seeking behaviour
                      • The sick role
                      • Useful websites
                      • References
                      • Further reading
                      • 2 Evolution of contemporary nursing
                      • Learning outcomes
                      • Introduction
                      • Evolution of nursing
                      • Nursing in the eighteenth and nineteenth centuries
                      • The influence of Florence Nightingale
                      • Mary Seacole
                      • Health visiting
                      • Development of nursing specialties
                      • Children's nursing
                      • Mental health nursing
                      • The beginning of education and regulation
                      • Nursing in the twentieth century
                      • The 1930s
                      • The impact of the Second World War
                      • The influence of the National Health Service (NHS) on nursing
                      • Emergence of humanism
                      • The influence of nursing theory
                      • The early influence of nursing research
                      • The late twentieth century
                      • Code of professional conduct
                      • University education for student nurses
                      • Moving towards evidence-based practice
                      • Approaches to nursing practice
                      • Holistic care
                      • Person-centred care
                      • Involving users and carers
                      • Effective teamwork
                      • Nurses as members of a multidisciplinary team
                      • Approaches to organizing nursing care
                      • Task allocation
                      • Patient allocation
                      • Team nursing
                      • Primary nursing
                      • Care delivery in practice
                      • Contemporary nursing
                      • Nursing today
                      • Influences on nursing today
                      • Technology
                      • Consumerism
                      • Diversity and equality
                      • Human rights
                      • Nursing in different settings
                      • Community nursing roles
                      • School health advisors
                      • Health visiting
                      • Public health nursing
                      • Family health nursing
                      • District nursing
                      • Hospital nursing
                      • Intermediate care
                      • Becoming a nurse in the twenty-first century
                      • Pre-registration nursing programmes
                      • Fields of nursing practice
                      • Adult nursing
                      • Learning disability nursing
                      • Mental health nursing
                      • Children's nursing
                      • Roles of non-registered staff
                      • National vocational qualifications
                      • Roles of the nurse
                      • Generic roles of the RN
                      • Mentoring
                      • Roles of experienced RNs
                      • Nurse practitioners
                      • Teaching
                      • Clinical leadership
                      • Clinical nurse specialists
                      • Nurse consultants
                      • Lead roles
                      • Nurses as researchers
                      • Student nurses' contribution to nursing and its evolution
                      • Useful websites
                      • References
                      • Further reading
                      • 3 Health and social care delivery systems
                      • Learning outcomes
                      • Introduction
                      • Health and social care provision
                      • Creation and evolution of the NHS
                      • Changes - 1960s and 1970s
                      • Changes - 1980s and 1990s
                      • Changes - twenty-first century
                      • Types of health and social care provision
                      • Funding of health and social care in the UK
                      • Comparisons of the UK funding model with other systems
                      • The National Health Service
                      • Structure and functions of the NHS
                      • Primary healthcare
                      • Newer first access routes
                      • Intermediate care
                      • Secondary and tertiary healthcare
                      • Services for specific groups
                      • Mental healthcare
                      • Children's healthcare
                      • Ambulance Service Trusts
                      • Special health authorities
                      • Multidisciplinary teamwork
                      • Social care provision
                      • Structure and funding of social care provision
                      • Social care provision by the voluntary sector
                      • Social workers
                      • Safeguarding children and vulnerable adults
                      • Social services for older adults
                      • Social services for children
                      • Social services for people with a learning disability
                      • Providing high quality health and social care
                      • Clinical governance and high quality care
                      • Dimensions of high quality care and their implementation
                      • Patient safety
                      • Clinical guidelines
                      • National Service Frameworks
                      • Care Quality Commission (CQC)
                      • NHS Commissioning Board (NCB)
                      • Effectiveness and efficiency
                      • Measuring quality and performance
                      • Benchmarking
                      • Audits
                      • Patient surveys
                      • User choice and voice
                      • User choice
                      • User voice
                      • Local HealthWatch
                      • HealthWatch England
                      • Patient Advice and Liaison Services
                      • Complaints
                      • Useful websites
                      • References
                      • Further reading
                      • 2 Professional practice
                      • 4 Learning and teaching
                      • Learning outcomes
                      • Introduction
                      • Theories of learning
                      • Behaviourism
                      • Cognitive theories of learning
                      • Humanistic theories of learning
                      • Andragogy
                      • Kolb's experiential learning cycle
                      • Concrete experience
                      • Reflective observation
                      • Abstract conceptualization
                      • Active experimentation
                      • Summary
                      • Race's ripples model
                      • Wanting to learn
                      • Needing to learn
                      • Learning by doing
                      • Learning through feedback
                      • Making sense of things
                      • Coaching, explaining and teaching
                      • Making informed judgements
                      • Summary
                      • Interprofessional learning
                      • The learning process
                      • Learning styles
                      • Activists
                      • Reflectors
                      • Theorists
                      • Pragmatists
                      • Deep, strategic and surface learning
                      • Deep approach to learning
                      • Strategic approach to learning
                      • Surface approach to learning
                      • Summary
                      • Reflection
                      • Purpose of reflection
                      • Models of reflection
                      • Gibbs' reflective cycle
                      • Atkins and Murphy's framework for reflection
                      • LEARN framework for reflection
                      • The process of reflection
                      • Critical thinking
                      • Factors influencing learning
                      • Motivation
                      • The place of feedback in learning
                      • How do you learn?
                      • Readiness to learn
                      • Individuals disadvantaged when considering information needs
                      • People who have problems in learning
                      • The learning environment
                      • Role models
                      • Summary
                      • Teaching and learning methods
                      • Mass instruction methods
                      • Individualized methods
                      • Group methods
                      • Role of teacher
                      • Action learning
                      • Problem-based learning
                      • Portfolios
                      • The process of teaching
                      • Assessment
                      • Planning
                      • Aims and learning outcomes
                      • Useful websites
                      • References
                      • Further reading
                      • 5 Evidence-based practice and research
                      • Learning outcomes
                      • Introduction
                      • What is evidence-based practice?
                      • Defining EBP
                      • The EBP cycle
                      • Questioning practice
                      • Refining the question into a workable search question
                      • Finding the evidence
                      • Appraising the evidence
                      • Implementing the evidence
                      • Evaluating or auditing practice
                      • Literature searching
                      • Sources of literature
                      • Bibliographic/electronic databases
                      • Books
                      • The Internet
                      • Journals and newsletters
                      • Reports
                      • Developing a search question
                      • Searching databases
                      • Indexing terms
                      • Free text terms
                      • Combining your search terms
                      • Sources of knowledge to support evidence-based practice
                      • What is meant by 'evidence'?
                      • Tradition and ritual
                      • Experience
                      • Intuition
                      • Authorities and experts
                      • Service users and their families
                      • Research studies
                      • Audit
                      • Guidelines
                      • Best evidence
                      • Overview of the research process
                      • Quantitative research
                      • Qualitative research
                      • Quantitative and qualitative research in nursing
                      • Different types of research design
                      • Sampling strategy
                      • Types of data collection
                      • Observation
                      • Questionnaires
                      • Documents
                      • Interviews
                      • Ethical issues and research
                      • Appraisal of the evidence
                      • Critical awareness
                      • Strategies to develop critical appraisal skills
                      • Questions to ask when critically appraising a research paper
                      • Appraising different research designs
                      • Appraising qualitative research
                      • Appraising systematic reviews
                      • Appraising randomized controlled trials
                      • Appraising survey designs
                      • Appraising guidelines
                      • Putting evidence into practice
                      • Challenges to the use of evidence in practice
                      • Implementing evidence
                      • Useful websites
                      • References
                      • Further reading
                      • 6 Legal issues that impact on nursing practice
                      • Learning outcomes
                      • Introduction
                      • Legal frameworks
                      • Structure of law
                      • Sources and types of law
                      • Acts of Parliament
                      • Court system (England and Wales)
                      • Important legislation for nursing
                      • The Human Rights Act
                      • Mental health legislation
                      • Rights for children and child protection
                      • Data Protection Act
                      • Legal concepts integral to nursing
                      • Safeguards for practice
                      • Statutory regulation
                      • Contracts of employment
                      • Professional indemnity insurance
                      • Conscientious objection
                      • Policies, procedures and guidelines
                      • Documentation and record-keeping
                      • Reporting incidents/accidents
                      • Duty of care and negligence
                      • Negligence
                      • Accountability to employer
                      • Professional accountability to the NMC
                      • Civil accountability
                      • Criminal accountability
                      • Confidentiality
                      • Consent
                      • Consent in children
                      • Consent - people with learning disability or fluctuating mental capacity
                      • Adult refusal to treatment
                      • Advance decisions and advance statements
                      • End-of-life issues
                      • Useful websites
                      • References
                      • Further reading
                      • 7 The NMC Code of conduct and applied ethical principles
                      • Learning outcomes
                      • Introduction
                      • The role of the Nursing and Midwifery Council (NMC)
                      • Protection of the public
                      • Quality assurance of educational programmes
                      • Registration of students as qualified practitioners
                      • Register of practitioners
                      • Post-registration education and practice
                      • Fitness to practise
                      • NMC expectations of nursing students
                      • NMC documentation
                      • The code of professional conduct
                      • Implications of The code for nursing students
                      • Confidentiality
                      • Access to patient and client records
                      • Confidentiality in practice
                      • Ethical principles
                      • Autonomy and justice
                      • Non-maleficence and beneficence
                      • The ethical and moral dimensions of nursing practice
                      • Ethics and morals
                      • Ethical theories
                      • Consequentialist ethics
                      • Strengths and limitations of a utilitarian approach
                      • Unpredictability of outcomes
                      • What counts as 'benefit'?
                      • Are numbers all that count?
                      • Does the end result justify the means?
                      • Rule utilitarianism
                      • Consequentialist ethics: summary
                      • Deontological ethics
                      • Areas of potential conflict
                      • Virtue ethics
                      • Intellectual and moral virtues
                      • Concerns about virtue ethics
                      • Constraints on ethical behaviour
                      • Ethical theories: summary
                      • Power: its use and abuse
                      • An abuse of power?
                      • Vulnerable groups
                      • Vulnerable adults and children
                      • Restrictive physical intervention and therapeutic holding
                      • Ethical frameworks and models
                      • The DECIDE model
                      • The DECIDE model in practice
                      • Defining the problem(s)
                      • Ethical review
                      • Consider and investigate options
                      • Decide on action
                      • Evaluate results
                      • Useful websites
                      • References
                      • Further reading
                      • 3 Nursing and lifespan implications
                      • 8 Impact of lifespan on nursing interventions
                      • Learning outcomes
                      • Introduction
                      • Psychology and sociology related to development and nursing
                      • What is psychology?
                      • Psychodynamic approach
                      • Behaviourist approach
                      • Humanistic approach
                      • Applying psychology to health
                      • Motivation
                      • The 'instinct' theory of motivation
                      • Behaviourist theories of motivation
                      • Drive theory
                      • Humanistic motivation
                      • What is sociology?
                      • Conflict approaches
                      • Microsociological approach
                      • Why is sociology relevant to nursing?
                      • Common sense and sociology
                      • Culture
                      • Beliefs
                      • Values
                      • Norms
                      • Cultural universals
                      • Cultural bias and relativism
                      • Subcultures
                      • Culture shock
                      • Culture and healthcare (see Ch. 1)
                      • Socialization
                      • Primary socialization
                      • Secondary socialization
                      • Roles
                      • Role conflict
                      • The family
                      • Family structures
                      • Trends in family structures
                      • Development across the lifespan
                      • Physical development
                      • Conception to birth
                      • Infancy (0-12 months)
                      • Childhood (1-10 years)
                      • Adolescence (11-18 years)
                      • Younger adulthood (18-40 years)
                      • The middle years (40-65 years)
                      • Older adulthood
                      • Developmental milestones
                      • Psychosocial development
                      • Infancy and childhood
                      • Adolescence
                      • Younger adulthood
                      • The middle years
                      • Older adulthood
                      • Mental health problems across the lifespan
                      • The 'self' and 'self-concept'
                      • Self-image
                      • Personality traits
                      • Roles
                      • Factual
                      • Self-esteem
                      • Development of the self
                      • Cognitive (intellectual) development
                      • Piaget's four stages of cognitive development
                      • Sensorimotor stage (0-2 years)
                      • Preoperational stage (2-7 years)
                      • Concrete operational stage (7-11 years)
                      • Formal operational stage (11-15+ years)
                      • Alternative theories of intellectual development
                      • Cognitive approaches to moral development
                      • Kohlberg's work
                      • Alternative theories of moral development
                      • Freudian psychodynamic theory and moral development
                      • Behaviourism (conditioning)
                      • Social observational learning theory
                      • Development of interpersonal bonds (attachment)
                      • The significance of attachment
                      • Reactions to separation from attachment figures
                      • Looked-after children, fostering and adoption
                      • Working mothers
                      • Hospitalization
                      • Parental loss by death or divorce
                      • Variations in the attachment process
                      • Freud's psychodynamic theory
                      • Safety valves
                      • Psychosexual personality development
                      • Oral stage (0-24 months)
                      • Anal stage (2-3 years)
                      • Phallic stage (4-5 years)
                      • Latent stage (6-11 years)
                      • Genital stage (12 years and above)
                      • Criticisms and benefits of the psychodynamic approach
                      • Erikson's stage theory of psychosocial development
                      • Useful websites
                      • References
                      • Further reading
                      • 9 Relationship, helping and communication skills
                      • Learning outcomes
                      • Introduction
                      • Communication theory
                      • Models for communication
                      • Blueprint of Behaviour model
                      • A model derived from Shannon and Weaver's model
                      • Communication process - getting the message across
                      • Language
                      • Language development in children
                      • Play as a communication tool
                      • Developmental problems - receptive and expressive language
                      • Language styles and influences
                      • Formality
                      • Age
                      • People with learning and physical disabilities, and mental distress
                      • Accommodating and diverging in communication
                      • Interpersonal communication skills
                      • Courtesy
                      • Verbal communication
                      • Strategies - questioning with good intentions
                      • Open questions
                      • Closed questions
                      • Funnelling
                      • Summarizing
                      • Paraphrasing
                      • Clarifying
                      • Feedback
                      • Assertive communication
                      • Negotiation and delegation
                      • Non-verbal communication
                      • Gesture
                      • Touch
                      • Proxemics
                      • Posture
                      • Listening skills
                      • Characteristics of good listening
                      • Appropriate eye contact
                      • Mirroring
                      • Guggles
                      • Active listening
                      • Nursing relationships
                      • Therapeutic relationships
                      • Self-awareness skills
                      • Attributes of a nurse-patient/client relationship
                      • Being there
                      • Self-disclosure
                      • Being concerned
                      • Trust
                      • Being 'as if' - emotional labour
                      • Empathy
                      • Rapport
                      • Facilitating change
                      • Positive regard
                      • Boundaries are healthy
                      • Therapeutic relationship stages
                      • Pre-orientation stage
                      • Orientation stage
                      • Working stage
                      • Termination stage
                      • Working in partnership with families - confidentiality
                      • Managing significant information
                      • Professional relationships
                      • Communication and care coordination within the MDT
                      • Leadership
                      • Leadership behaviours
                      • Emotional intelligence
                      • Promoting quality and standards
                      • Relationships with families and main carers
                      • Barriers to communication
                      • Conflict
                      • Task-orientated culture
                      • Internal noise, mental/emotional distress
                      • Difficulty with speech and hearing
                      • Medication
                      • Cultural factors acting as barriers
                      • Differences in language and communication rules
                      • Intonation
                      • Emphasis
                      • Loudness
                      • Sentence structure
                      • Taking turns and guggling
                      • Working with interpreters
                      • Useful websites
                      • References
                      • Further reading
                      • 10 Sleep, rest and complementary and alternative medicine
                      • Learning outcomes
                      • Introduction
                      • Sleep, rest and relaxation
                      • Biorhythms
                      • Physiology of sleep
                      • Reticular formation - the reticular activating system
                      • The biological 'body clock'
                      • Neurotransmitters involved with sleep-wake physiology
                      • Stages of sleep
                      • NREM sleep
                      • REM sleep
                      • Functions of sleep
                      • Effects of sleep deprivation
                      • Factors that affect normal sleep patterns
                      • Sleep patterns during the lifespan
                      • Infancy and childhood
                      • Adolescents/young adults
                      • Adulthood and midlife
                      • Older adults
                      • Factors disrupting normal sleep patterns
                      • Lifestyle factors
                      • Shift working
                      • Environment
                      • Psychosocial factors
                      • Mental health problems
                      • Physical and physiological changes
                      • Physical health problems
                      • Effects of medication
                      • Sleep disorders - an outline
                      • Nursing interventions to promote sleep, rest and relaxation
                      • Nursing assessment of sleep
                      • Keeping a sleep diary
                      • Improving sleep hygiene and the sleep environment
                      • Relaxation and sleep
                      • Sleep medications
                      • Orthodox medications
                      • Herbal medicines
                      • Complementary and alternative medicine
                      • The emergence, development and regulation of CAM
                      • Integrated medicine
                      • CAM therapies
                      • Acupuncture
                      • Integration of acupuncture into conventional healthcare
                      • Chiropractic
                      • Integration of chiropractice into conventional healthcare
                      • Herbal medicine
                      • Integration into conventional healthcare
                      • Homeopathy
                      • Integration with conventional medicine
                      • Osteopathy
                      • Integration into conventional healthcare
                      • Alexander technique
                      • Integration into conventional healthcare
                      • Aromatherapy
                      • Integration into conventional healthcare
                      • Reflexology
                      • Integration into conventional healthcare
                      • Useful websites
                      • References
                      • Further reading
                      • 11 Stress, anxiety and coping
                      • Learning outcomes
                      • Introduction
                      • Nature of stress
                      • Understanding emotion
                      • Common causes of stress and anxiety
                      • Common themes in understanding what causes stress
                      • Change
                      • Hassles
                      • People
                      • Mediators and the stress response
                      • The role of the unconscious
                      • Identifying stressors
                      • The stress response
                      • Stress-related health problems
                      • Managing stress and anxiety
                      • Avoidance
                      • Dealing with the stressor
                      • Imposing structure
                      • Controlling the emotion
                      • Enhancing coping resources
                      • Relaxation techniques
                      • Complementary and alternative medicine (CAM) therapies
                      • Ability to tolerate stress
                      • The role of the nurse
                      • Global skills in stress management
                      • Stress and people
                      • Stress and nursing
                      • Burnout
                      • Managing work-related stress
                      • Traumatic stress
                      • Managing traumatic stress
                      • Stress: patients, clients and carers
                      • Body image
                      • Expressing sexuality
                      • Coping with illness
                      • Helping patients/clients and carers to cope - role of the nurse
                      • Stress and vulnerable individuals
                      • Stress and pregnancy
                      • Coping with serious illness, chronic problems and disability
                      • Chronic illness and disability
                      • Rehabilitation
                      • Models in rehabilitation
                      • Useful websites
                      • References
                      • Further reading
                      • 12 Loss and bereavement
                      • Learning outcomes
                      • Introduction
                      • Loss including death
                      • Types of loss
                      • Bereavement
                      • Anticipatory grief
                      • Grief and mourning
                      • Factors affecting grief
                      • Bereavement in children
                      • Bereavement in people with learning disabilities
                      • Complicated grief
                      • Palliative care
                      • What is palliative care?
                      • Palliative care for children
                      • Overview of palliative care services
                      • General palliative care
                      • Specialist palliative care
                      • Palliative care in hospitals
                      • Hospice care
                      • Community palliative care team
                      • Communicating with patients and families
                      • Care and symptom control
                      • Managing pain in palliative care
                      • Breathlessness
                      • Excess respiratory secretions
                      • Fatigue
                      • Nausea and vomiting
                      • Oral problems
                      • Constipation
                      • Terminal agitation
                      • Death and dying
                      • Sudden death
                      • Perception of the event
                      • External resources
                      • Inner resources
                      • Expected death and palliative care
                      • Recognizing that death is approaching
                      • Causes of death and the need for palliative care
                      • Main causes of death in the UK
                      • Death states
                      • Care around the time of death
                      • Cultural aspects of dying and death
                      • End-of-life ethical issues
                      • Care after death
                      • Useful websites
                      • References
                      • Further reading
                      • 4 Developing person-centred nursing skills
                      • 13 Safety in nursing practice
                      • Learning outcomes
                      • Introduction
                      • A critical or questioning approach
                      • Recognize limitations of knowledge and skills, and seek support
                      • Evidence-based practice
                      • Use of reflection during and after practice situations
                      • Risk assessment
                      • Risk assessment principles
                      • Step one: Look for the hazard
                      • Step two: Decide who may be harmed and how
                      • Step three: Evaluate the risks and decide whether existing precautions are adequate or more should be done
                      • Step four: Record the findings
                      • Step five: Review the assessment regularly and revise if necessary
                      • Individual risk assessments
                      • Health and safety legislation
                      • Maintaining safety and promoting health
                      • Health and safety in healthcare settings
                      • Control of Substances Hazardous to Health (COSHH)
                      • Reporting of Incidents, Diseases and Dangerous Occurrences Regulations (RIDDOR)
                      • Equipment used at work
                      • Manual Handling Operation Regulations 1992 (amended 2002)
                      • The TILE framework
                      • The task (T)
                      • Individual capabilities (I)
                      • The load (L)
                      • The environment (E)
                      • First aid
                      • Dealing with incidents, emergencies and prioritizing
                      • Assess the situation
                      • Protect yourself and casualties from danger
                      • Give early treatment and prioritize injuries
                      • Call for help
                      • Provide first aid
                      • After the event
                      • Dealing with burns and scalds
                      • Electrical burns
                      • Chemical burns
                      • Dealing with poisoning
                      • Emergency childbirth
                      • Infection control and standard precautions
                      • Principles of managing violence, anger and aggression
                      • Minimizing violence, anger and aggression
                      • Environment
                      • Education
                      • Improving communication and preventing incidents
                      • Dealing with and reporting violent incidents
                      • Restraint
                      • Fire safety
                      • Fire risk assessment
                      • Fire detection and warning systems
                      • Emergency plans and means of escape
                      • Facilities for fighting fire
                      • Fire safety training
                      • Useful websites
                      • References
                      • Further reading
                      • 14 The nursing process, holistic assessment and baseline observations
                      • Learning outcomes
                      • Introduction
                      • The nursing process
                      • Assessment
                      • Holistic assessment
                      • Sources of information
                      • Primary source
                      • Secondary sources
                      • Discharge planning
                      • The assessment interview
                      • Privacy
                      • Interpretation of information
                      • Staging assessment
                      • Documentation
                      • Assessment tools
                      • Planning
                      • Prioritizing care
                      • Actual and potential problems
                      • Goal setting as part of care planning
                      • Implementation
                      • Evaluation
                      • Nursing models
                      • Approaches to care planning for adults
                      • The Roper, Logan and Tierney model for nursing
                      • The individual
                      • Activities of living
                      • Lifespan
                      • Factors influencing the ALs
                      • Biological factors
                      • Psychological factors
                      • Sociocultural factors
                      • Environmental factors
                      • Politicoeconomic factors
                      • Roy's adaptation model
                      • Adaptive modes
                      • Assessment
                      • Planning
                      • Evaluation
                      • Approaches to planning care for people with learning disability
                      • Person-centred planning
                      • Consulting the person throughout the planning process
                      • The person chooses who to involve
                      • The person chooses the setting and timing of meetings
                      • Approaches to planning care in mental health nursing
                      • The Tidal model
                      • Approaches to planning care for children
                      • The Nottingham model
                      • Negotiated care
                      • Building an equal partnership
                      • Casey's model
                      • Integrated care pathways
                      • Variance
                      • Documentation and record-keeping
                      • Vital signs
                      • Body temperature
                      • Distribution of body heat
                      • Heat balance
                      • Heat conservation
                      • Heat loss
                      • Physiological influences on body core temperature
                      • Diurnal cycles
                      • Age
                      • Menstrual cycle
                      • Other factors
                      • Environmental influences on body temperature
                      • Care of people with temperature abnormalities
                      • Caring for patients with pyrexia or hyperpyrexia
                      • Caring for patients with hypothermia
                      • Body temperature assessment tools
                      • Electronic thermometers
                      • Tympanic thermometers
                      • Single-use thermometers
                      • Glass-and-mercury thermometers
                      • Thermometer placement sites
                      • Oral cavity
                      • Tympanic membrane
                      • Axilla
                      • Rectum
                      • Skin
                      • Interpreting temperature measurements
                      • Pulse
                      • Principal pulse points
                      • Normal pulse rate
                      • Factors that affect heart rate
                      • Assessing the pulse
                      • Regularity
                      • Volume
                      • Features of the pulse in newborns, infants and children
                      • Apical pulse
                      • Blood pressure
                      • Factors that determine blood pressure
                      • Blood pressure values
                      • Equipment used for BP measurement
                      • Sphygmomanometers
                      • BP cuffs
                      • Measuring BP
                      • Measuring BP in newborns, infants and children
                      • Inflating the cuff
                      • Korotkoff sounds
                      • Assessing respirations
                      • Respiratory rate
                      • Counting respiratory rate in adults
                      • Counting respiratory rate in infants and small children
                      • Respiratory rhythm
                      • Abnormal respiratory rhythms
                      • Depth of breathing
                      • Effort of breathing
                      • Noises associated with breathing
                      • Early Warning Score (EWS)
                      • Calling criteria
                      • Height and weight
                      • Useful websites
                      • References
                      • Further reading
                      • 15 Preventing the spread of infection
                      • Learning outcomes
                      • Introduction
                      • Overview of microbiology
                      • Epidemiology of infectious diseases
                      • Healthcare-associated infections (HAIs)
                      • Prevalence, surveillance and reporting of HAIs
                      • Chain of infection
                      • Infectious agent (pathogen)
                      • Reservoirs
                      • Portals of exit and entry
                      • Transmission of infection
                      • Contact transmission
                      • Droplet transmission
                      • Airborne transmission
                      • Susceptible host
                      • Infectious disease and associated terminology
                      • Host defence mechanisms
                      • External defences
                      • Inflammation
                      • Specific resistance
                      • Development of immunity
                      • Active immunity
                      • Passive immunity
                      • Infection control
                      • Standard infection control precautions
                      • Hand hygiene
                      • Indications for handwashing
                      • Types of handwashing and preparations used
                      • Handwashing with liquid soap and running water (social handwashing)
                      • Handwashing with antiseptic preparations and running water (aseptic handwashing)
                      • Alcohol-based hand rubs
                      • Personal protective equipment
                      • Disposable gloves
                      • Types of gloves and their uses
                      • Removal of gloves
                      • Health risks associated with glove use
                      • Gowns and aprons
                      • When to wear gowns and aprons
                      • Masks and eye protection
                      • Safe use and disposal of sharps
                      • What are sharps?
                      • How injuries occur
                      • Preventing sharps injuries
                      • Managing injuries and exposure to body fluids
                      • Management of waste
                      • Classification of waste
                      • Clinical (hazardous) waste
                      • Domestic waste
                      • Safe handling of clinical waste in healthcare facilities
                      • Safe handling of clinical waste in people's homes
                      • Management of linen
                      • Safe handling of linen
                      • Safe handling of soiled linen
                      • Decontamination of patient-care equipment
                      • Levels of decontamination
                      • Cleaning
                      • Sterilization
                      • Disinfection
                      • Additional precautions
                      • Aseptic technique
                      • Indications for aseptic technique
                      • Components of aseptic technique
                      • Clean technique
                      • Isolation precautions
                      • Principles of isolation nursing
                      • Patient accommodation
                      • Patient movement
                      • Psychological effects of isolation
                      • Categories of isolation
                      • Airborne precautions
                      • Droplet precautions
                      • Contact precautions
                      • Protective isolation
                      • Specimen collection
                      • Collection of clinical specimens
                      • Transport of specimens
                      • Useful websites
                      • References
                      • Further reading
                      • 16 Personal care, sensory impairment and unconsciousness
                      • Learning outcomes
                      • Introduction
                      • Personal hygiene and appearance
                      • Structure and functions of the skin
                      • Normal skin flora
                      • Appendages of the skin
                      • Functions of the skin
                      • Assessment of the skin
                      • Infestation
                      • Factors influencing appearance and personal hygiene
                      • Physical
                      • Psychological factors
                      • Social, cultural and religious factors
                      • Environmental factors
                      • Economic factors
                      • Lifespan factors
                      • Infancy
                      • Childhood
                      • Puberty
                      • Older adults
                      • Assisting with bathing, washing and showering
                      • Maintaining privacy and dignity
                      • Washing and drying the skin
                      • Bathing and showering
                      • Bathing aids
                      • Bedbathing
                      • Perineal care
                      • Menstrual hygiene
                      • Care of the feet, hands and nails
                      • Care of the eyes
                      • Accessory structures of the eye
                      • Eye care
                      • Spectacles
                      • Contact lenses
                      • Artificial eyes
                      • Care of the ears
                      • Hearing aids
                      • Care of the nose
                      • Hair care
                      • Hairwashing
                      • Head lice
                      • Care of facial hair
                      • Dressing
                      • Dressing aids
                      • Prostheses
                      • Summary - personal hygiene
                      • Dental health and oral hygiene
                      • Anatomy and physiology: the mouth
                      • Salivary glands
                      • Teeth
                      • Maintaining oral health
                      • Oral care
                      • Toothbrushing and flossing
                      • Care of dentures
                      • Tooth and gum disorders
                      • Dental caries
                      • Periodontal disease
                      • Malocclusion
                      • Oral assessment and oral hygiene
                      • Oral assessment tools
                      • Oral hygiene: nursing interventions
                      • Sensory considerations
                      • The eye and vision
                      • Anatomy and physiology of the eye (see p. 373 for accessory structures)
                      • Visual acuity
                      • Sight impairment
                      • Describing sight impairment
                      • Helping people with sight impairment
                      • Communication
                      • Maintaining a safe environment
                      • Services and support
                      • The ear and hearing
                      • Anatomy and physiology
                      • Assessment and prevention of hearing loss
                      • Hearing impairment
                      • Describing deafness
                      • Communicating with hearing-impaired people
                      • The unconscious patient
                      • Levels of consciousness
                      • The Glasgow Coma Scale
                      • Neurological observations in hospital
                      • The unconscious casualty
                      • Common conditions affecting the nervous system
                      • Seizures
                      • Nursing the unconscious person
                      • Positioning the unconscious patient
                      • Recovery position
                      • Lateral position
                      • Communicating with an unconscious person, their relatives and friends
                      • Planning nursing interventions
                      • Useful websites
                      • References
                      • Further reading
                      • 17 Breathing and circulation
                      • Learning outcomes
                      • Introduction
                      • An overview of breathing and circulation
                      • Cardiovascular system - outline of anatomy and physiology
                      • The heart
                      • Coronary circulation
                      • Conduction
                      • Cardiac cycle
                      • Sinus rhythm
                      • Systemic and pulmonary circulation
                      • Blood: outline of anatomy and physiology
                      • Plasma
                      • Blood cells
                      • Erythrocytes (red blood cells)
                      • Leucocytes (white blood cells)
                      • Thrombocytes (platelets)
                      • Haemostasis
                      • Blood groups
                      • Respiratory system: outline of anatomy and physiology
                      • Respiratory structures
                      • Nose
                      • Pharynx
                      • Larynx
                      • Trachea
                      • Bronchi, bronchioles and alveoli
                      • Lungs
                      • Breathing (ventilation)
                      • Common conditions affecting breathing and circulation
                      • Common cardiovascular conditions
                      • Cardiac arrhythmias
                      • Congenital heart disease (CHD)
                      • Cardiovascular disease (CVD)
                      • Heart failure
                      • Hypertension
                      • Rheumatic heart disease
                      • Valvular heart disease
                      • Common blood (haematological) conditions
                      • Anaemia
                      • Deep vein thrombosis (DVT)
                      • Haemoglobinopathies
                      • Leukaemia
                      • Common respiratory conditions
                      • Asthma
                      • Bronchiectasis
                      • Bronchiolitis
                      • Chronic obstructive pulmonary disease (COPD)
                      • Croup
                      • Cystic fibrosis (CF)
                      • Lung cancer
                      • Pneumonia
                      • Pulmonary embolism (PE)
                      • Tuberculosis (TB)
                      • Basic life support - airway maintenance and cardiopulmonary resuscitation
                      • Adult basic life support
                      • Basic life support for infants and children
                      • Assessment and observation - circulation and breathing
                      • Skin - general assessment
                      • Changes in skin colour
                      • Skin turgor and oedema
                      • Capillary refill time
                      • Heart/pulse rate
                      • Peripheral pulses
                      • The electrocardiogram
                      • Blood pressure
                      • Blood pressure during pregnancy
                      • Central venous pressure
                      • Breathing - general assessment
                      • Respiratory rate
                      • Breathing patterns - depth and rhythm
                      • Abnormal breath sounds
                      • Cough and sputum
                      • Peak expiratory flow rate
                      • Pulse oximetry
                      • Pain associated with breathing or circulation problems
                      • Common investigations - breathing and circulation
                      • Care of the person with breathing and/or circulation problems
                      • Communication and relief of anxiety
                      • Positioning to relieve breathlessness
                      • Personal hygiene and skin care
                      • Nutrition and hydration
                      • Helping the person with expectoration
                      • Breathing exercises and coughing
                      • Postural drainage
                      • Suctioning
                      • Inhaled medication
                      • Nebulizers
                      • Dry powder inhalers
                      • Metered-dose inhalers
                      • Oxygen therapy
                      • Problems associated with oxygen therapy
                      • Oxygen administration systems
                      • Fixed performance Venturi systems (high-flow)
                      • Variable performance systems
                      • Nasal cannulae/nasal prongs
                      • Headbox, body/trunk box
                      • Incubator
                      • Continuous positive airway pressure (CPAP)
                      • Humidification
                      • Respiratory support - artificial ventilation
                      • Care of patients requiring a blood transfusion
                      • Monitoring during blood transfusion
                      • Ensuring transfusion safety
                      • Transfusion complications
                      • Alternatives to donated blood transfusion
                      • Home-monitoring in patients with conditions affecting breathing or circulation
                      • Rehabilitation for conditions affecting breathing or circulation
                      • Useful websites
                      • References
                      • Further reading
                      • 18 Mobility and immobility
                      • Learning outcomes
                      • Introduction
                      • The musculoskeletal system
                      • Muscles
                      • The structure and function of voluntary (skeletal) muscles
                      • Voluntary muscles
                      • Fascia
                      • Bones
                      • Care of people wearing casts
                      • Joints
                      • Posture, balance and movement
                      • Development of the spinal curves
                      • Adaptive postures
                      • Effects of gravity on height
                      • Effects of ageing on the spinal curves
                      • Movement
                      • Gait
                      • Efficient handling and moving (EHM)
                      • Principles of safe handling and moving
                      • Equipment
                      • Glide sheets
                      • Transfer boards
                      • Hoists
                      • Standing and raising hoist
                      • Passive lifting hoists
                      • Accessories
                      • Rope ladders
                      • Turning discs
                      • Using equipment to move people
                      • Checking equipment
                      • Risk assessment
                      • Effective communication
                      • Finding the most suitable equipment
                      • Handling and moving people
                      • Turning a person in bed
                      • Regaining balance
                      • Helping a person to sit up in bed
                      • Helping a person to get out of bed
                      • Helping a person to stand up from a chair
                      • Helping people to mobilize
                      • Walking frames
                      • Walking sticks
                      • Wheelchairs
                      • Falls
                      • Care of people who have fallen
                      • The benefits of mobility and hazards of immobility
                      • Benefits of mobility
                      • Children
                      • Teenagers
                      • Adults and older adults
                      • Hazards of immobility
                      • Maintaining healthy joints and muscles
                      • Active exercises
                      • Passive exercises
                      • Prevention of deep vein thrombosis
                      • Preventing chest infection
                      • Pressure ulcers
                      • Constipation
                      • Maintaining well-being
                      • Caring for people confined to bed
                      • Regaining mobility
                      • Physiotherapy
                      • Occupational therapy
                      • Home assessment
                      • Useful websites
                      • References
                      • Further reading
                      • 19 Promoting hydration and nutrition
                      • Learning outcomes
                      • Introduction
                      • Maintaining fluid, electrolyte and acid-base balance
                      • Body fluids and fluid compartments
                      • Electrolytes
                      • Movement of water and electrolytes
                      • Osmosis
                      • Diffusion
                      • Filtration
                      • Active transport
                      • Acid-base balance
                      • Disorders of acid-base balance
                      • Alkalosis
                      • Acidosis
                      • Normal fluid and electrolyte balance
                      • Factors that regulate normal fluid and electrolyte balance
                      • Common disorders of fluid and electrolyte balance
                      • Common disorders of fluid balance
                      • Electrolyte imbalances
                      • Factors that can lead to fluid and/or electrolyte imbalance
                      • Age
                      • Fasting
                      • Fluid and electrolyte loss
                      • Alcohol and excessive caffeine drinks
                      • High level of dependency
                      • Mental health problems
                      • Immobility and lack of manual dexterity
                      • Swallowing problems (dysphagia)
                      • Fear of incontinence
                      • Drugs
                      • Breathlessness (dyspnoea)
                      • Serious organ disorders
                      • Lack of access to clean water
                      • Nursing interventions: promoting and maintaining hydration
                      • Assessing hydration
                      • Skin
                      • Fontanelles
                      • Weight
                      • Sunken eyes
                      • Mouth
                      • Behaviour
                      • Bowel function (see Ch. 21)
                      • Urine output and specific gravity (see Ch. 20)
                      • Blood pressure
                      • Pulse
                      • Respiration
                      • Skin temperature
                      • Central venous pressure
                      • Fluid balance charts
                      • Oral fluids
                      • Helping people to drink
                      • Fluid restriction
                      • Caring for the person with fluid imbalance
                      • Fluid depletion
                      • Oedema
                      • Caring for the person who is vomiting
                      • Subcutaneous fluids (hypodermoclysis)
                      • Intravenous fluids
                      • Equipment
                      • Crystalloids and colloids
                      • Principles of care for infusions
                      • Flow rate calculation and regulation
                      • Complications of i.v. therapy
                      • Nutrition
                      • The gastrointestinal tract
                      • Parts of the gastrointestinal tract
                      • Overview - general functions of the gastrointestinal tract
                      • Smell and taste
                      • Alterations to smell and taste
                      • Nutritional and upper gastrointestinal tract disorders
                      • Principles of nutrition and the healthy diet
                      • Macronutrients
                      • Carbohydrates
                      • Fats
                      • Proteins
                      • Micronutrients
                      • Recommendations for a healthy balanced diet
                      • Specific lifespan requirements: supplements and advice
                      • Infant feeding
                      • Factors that affect food intake and appetite
                      • Malnutrition in vulnerable people
                      • Independence in eating
                      • Nursing interventions - maintaining nutritional status
                      • Nutritional screening and assessment
                      • Nutritional screening audit tool
                      • Nutritional screening and assessment in infants and children
                      • Common investigations
                      • Helping people to eat
                      • Making appropriate healthy choices
                      • Environment and mealtimes
                      • Food fortification
                      • Feeding
                      • Clients requiring special diets
                      • Nutritional support
                      • Enteral feeding
                      • Parenteral nutrition
                      • Useful websites
                      • References
                      • Further reading
                      • 20 Elimination of urine:
                      • Learning outcomes
                      • Introduction
                      • Overview - anatomy and physiology of the urinary system
                      • The kidneys
                      • Nephron
                      • Control of blood flow into the glomerulus
                      • Control of blood volume
                      • Urine production in the nephron
                      • Lower urinary tract
                      • Ureters
                      • Bladder
                      • Urethra
                      • Urinary elimination
                      • Factors affecting micturition
                      • Common urinary disorders
                      • Assessment and observation of urine and urinary elimination
                      • Measuring urine output and observing voiding patterns
                      • Fluid balance chart
                      • Weighing nappies
                      • Frequency-volume charts
                      • Observation of urine and urinalysis
                      • Collection of urine samples for the laboratory
                      • Common urinary investigations
                      • Nursing interventions - micturition
                      • Use of urinal, bedpan and commode
                      • Promoting continence
                      • Normal voiding habits
                      • Achieving urinary continence during childhood
                      • Pelvic floor awareness and exercise
                      • Use of frequency-volume charts
                      • Types of urinary incontinence
                      • Management of urinary incontinence
                      • Continence nurse specialist
                      • Continence aids (devices)
                      • Pads
                      • Urinary sheath
                      • Care of people with a urinary catheter
                      • Types of catheter
                      • Catheter length
                      • Catheter materials
                      • Catheter lumen size
                      • Balloon size
                      • Drainage systems
                      • Collecting a catheter specimen of urine
                      • Catheter hygiene
                      • Removal of a self-retaining catheter
                      • Sexual activity and urethral catheterization
                      • Complications of catheterization
                      • Urinary stomas
                      • Useful websites
                      • References
                      • Further reading
                      • 21 Elimination of faeces:
                      • Learning outcomes
                      • Introduction
                      • An overview of defecation
                      • Large intestine, rectum and anal canal
                      • Structure
                      • Functions
                      • Normal process of defecation
                      • Factors affecting defecation
                      • Age and defecation
                      • Holistic assessment of defecation
                      • Assessing normal bowel habit - patterns of defecation and characteristics of faeces
                      • Nursing history
                      • Common bowel conditions
                      • Common investigations
                      • Nursing interventions to promote defecation
                      • Environment and facilities
                      • Cultural needs
                      • Bedpans and commodes
                      • Constipation
                      • Contributing factors and causes of constipation
                      • Effects of constipation
                      • Assessment of constipation
                      • Management of constipation
                      • Enemas
                      • Suppositories
                      • Manual faecal evacuation
                      • Diarrhoea
                      • Contributing factors and causes of diarrhoea
                      • Effects of diarrhoea
                      • Assessment of diarrhoea
                      • Management of diarrhoea
                      • Faecal incontinence
                      • Causes of faecal incontinence
                      • Effects of faecal incontinence
                      • Assessment of faecal incontinence
                      • Managing faecal incontinence
                      • Encopresis
                      • Caring for a person with a stoma
                      • Specific care for patients having a stoma
                      • Appliances and skin care
                      • Continuing stoma care - advice and support for patients
                      • Living with a stoma: psychological and social impact
                      • Useful websites
                      • References
                      • Further reading
                      • 22 Promoting the safe administration of medicines
                      • Learning outcomes
                      • Introduction
                      • Legislation concerning medicines
                      • The Medicines Act 1968
                      • The Misuse of Drugs Act 1971
                      • The Misuse of Drugs Regulations 1985
                      • Non-medical prescribing
                      • Patient Group Directions (PGD)
                      • Professional advice that affects nurses
                      • Storage of medicines
                      • Storage of non-controlled medicines in hospitals and nursing homes
                      • Storage of controlled drugs in hospitals and nursing homes
                      • Storage of medicines in the home
                      • Ordering drugs in hospitals
                      • Controlled drugs
                      • Non-controlled drugs
                      • Principles of prescribing
                      • Introduction to pharmacology
                      • Pharmacodynamics
                      • Pharmacokinetics
                      • Absorption
                      • First pass metabolism
                      • Distribution
                      • Plasma binding
                      • Metabolism
                      • Half-life
                      • Excretion
                      • Therapeutic range
                      • Adverse drug reactions
                      • Type A
                      • Type B
                      • Surveillance for ADRs
                      • Naming of drugs and common groups
                      • Naming of drugs
                      • Common groups of drugs and their actions
                      • Medicinal preparations and routes of administration
                      • Oral medication
                      • Sublingual route
                      • Parenteral medication
                      • Administering prescribed medication
                      • Consent
                      • Covert administration of medicines
                      • Calculation of drug doses
                      • Tablets and capsules
                      • Liquid preparations
                      • Calculations based on body weight or surface area
                      • Body weight
                      • Surface area
                      • Preparation for the administration of medications
                      • Administration of oral medications
                      • Injections
                      • Preparing and giving injections
                      • Skin cleansing prior to injections
                      • The intramuscular route
                      • Deltoid muscle
                      • Dorsogluteal site
                      • Ventrogluteal site
                      • Vastus lateralis muscle
                      • Rectus femoris
                      • Administering intramuscular injections
                      • Subcutaneous injections
                      • Rectal administration
                      • Inhaled medication
                      • Administration of topical medication
                      • Transdermal patches
                      • Other routes
                      • Post-drug administration measures
                      • Adherence and polypharmacy
                      • Adherence
                      • Non-adherence
                      • Polypharmacy
                      • Improving medicines adherence
                      • Dosette boxes
                      • Self-medication
                      • Drug administration errors
                      • Minimizing errors
                      • Dealing with drug errors
                      • Useful websites
                      • References
                      • Further reading
                      • 23 Pain management - minimizing the pain experience
                      • Learning outcomes
                      • Introduction
                      • The nature of pain
                      • Types and characteristics of pain
                      • Acute pain
                      • Chronic pain
                      • Chronic non-malignant pain
                      • Chronic malignant pain
                      • Gate control theory
                      • Physiology of pain
                      • Transduction
                      • Transmission
                      • Modulation
                      • Perception
                      • Pain threshold and pain tolerance
                      • Pain psychology - personal and sociocultural influences
                      • Pain - myths, misconceptions and facts
                      • Pain assessment
                      • Holistic pain assessment
                      • Behavioural responses to pain
                      • Pain language
                      • Assessing children's pain
                      • Pain history
                      • Pain diaries
                      • Pain maps
                      • Pain assessment tools
                      • Self-report scales
                      • Visual analogue scale
                      • Verbal numerical rating scales
                      • Categorical rating scale
                      • Self-report scales for children
                      • Observation techniques
                      • Physiological measurements
                      • Multimethod approaches to pain assessment
                      • Assessment for different types of pain
                      • Pain management
                      • Pharmacological management
                      • Age and analgesic drugs
                      • Pregnancy and analgesic drugs
                      • Drugs used in pain management
                      • Routes of administration
                      • Patient-controlled analgesia
                      • Administration of analgesic drugs
                      • Analgesic potency
                      • Pre-emptive and procedural pain management
                      • Drug tolerance and dependence
                      • Non-pharmacological methods of pain control
                      • Simple comfort measures
                      • Information giving
                      • Relaxation
                      • Hypnosis
                      • Distraction
                      • Imagery
                      • Massage
                      • Therapeutic touch
                      • Acupuncture
                      • Transcutaneous electrical nerve stimulation
                      • Aromatherapy
                      • Surgical intervention
                      • Useful websites
                      • References
                      • Further reading
                      • 24 Caring for the person having surgery
                      • Learning outcomes
                      • Introduction
                      • Types of surgery
                      • Elective surgery
                      • Day surgery
                      • Emergency surgery
                      • Preoperative care
                      • Pre-assessment clinics
                      • Investigations
                      • Smoking cessation
                      • Psychological preparation for surgery
                      • Preoperative considerations for children
                      • Benefits of providing preoperative information
                      • Common sources of preoperative anxiety
                      • Obtaining consent
                      • Preoperative fasting
                      • Skin preparation
                      • Hair removal
                      • Preventing potential postoperative complications
                      • Chest infection
                      • Deep vein thrombosis
                      • Bowel preparation
                      • Preparation for intravenous cannulation
                      • Final preoperative care
                      • Transfer to theatre
                      • Anaesthetic room
                      • Anaesthesia
                      • Theatre
                      • Recovery room
                      • Discharge from the recovery room
                      • Postoperative care
                      • Clinical assessment and monitoring
                      • Airway
                      • Breathing
                      • Circulation
                      • Cardiovascular management
                      • Cardiovascular stability
                      • Prevention of DVT
                      • Respiratory management
                      • Preventing chest infections
                      • Fluid, electrolyte and renal management
                      • Fluid balance
                      • Fluid intake
                      • Urine output
                      • Nasogastric aspirate
                      • Nutrition
                      • Nausea and vomiting
                      • Preventing constipation
                      • Pain management
                      • Wound management
                      • Wound drainage
                      • Skin closure removal (Fig. 24.2)
                      • Wound complications
                      • Regaining mobility
                      • Discharge planning
                      • Useful websites
                      • References
                      • Further reading
                      • 25 Wound management
                      • Learning outcomes
                      • Introduction
                      • Types of wound
                      • Wound classification and categories
                      • Acute wounds
                      • Surgical wound categories (see Ch. 24)
                      • Wound healing
                      • Stages of wound healing
                      • Stage 1 - Vascular response (0-3 days)
                      • Stage 2 - Inflammation/inflammatory response (1-6 days)
                      • Stage 3 - Proliferation (3-20 days)
                      • Stage 4 - Maturation (21 days to >1 year)
                      • Factors influencing healing
                      • Local wound factors
                      • Wound complications
                      • Systemic or patient-related factors
                      • Age
                      • Nutritional status
                      • Dehydration
                      • Systemic diseases
                      • Medication
                      • Smoking
                      • Stress
                      • Wound management
                      • Wound assessment
                      • Wound characteristics
                      • Cause of the wound
                      • Location
                      • Condition of the surrounding skin
                      • Size
                      • Types of tissue present in wounds
                      • Exudate
                      • Odour
                      • Wound pain
                      • Social factors
                      • Environmental factors
                      • Organizational factors
                      • Wound cleansing
                      • Wound débridement
                      • Wound dressings
                      • Aims of treatment
                      • Choosing an appropriate dressing
                      • Types of dressing
                      • Chronic wounds
                      • Pressure ulcers
                      • Risk factors for pressure ulcers
                      • Extrinsic factors
                      • Intrinsic factors
                      • Pressure ulcer risk assessment tools
                      • Pressure ulcer prevention
                      • Repositioning
                      • Pressure-redistributing equipment
                      • Skin assessment
                      • Pressure ulcer grading
                      • Leg ulcers
                      • Causation of venous leg ulceration
                      • Characteristics of venous ulceration
                      • Specific assessment
                      • Management of venous leg ulcers
                      • Compression therapy
                      • Useful websites
                      • References
                      • Further reading
                      • Glossary
                      • References
                      • Index
                      • A
                      • B
                      • C
                      • D
                      • E
                      • F
                      • G
                      • H
                      • I
                      • J
                      • K
                      • L
                      • M
                      • N
                      • O
                      • P
                      • Q
                      • R
                      • S
                      • T
                      • U
                      • V
                      • W
                      • X
                      • Y
                      • Z
                      • Multiple choice questions
                      • Questions
                      • Chapter 1
                      • Question 1
                      • Question 2
                      • Question 3
                      • Question 4
                      • Chapter 2
                      • Question 1
                      • Question 2
                      • Question 3
                      • Question 4
                      • Chapter 3
                      • Question 1
                      • Question 2
                      • Question 3
                      • Question 4
                      • Chapter 4
                      • Question 1
                      • Question 2
                      • Question 3
                      • Question 4
                      • Chapter 5
                      • Question 1
                      • Question 2
                      • Question 3
                      • Question 4
                      • Chapter 6
                      • Question 1
                      • Question 2
                      • Question 3
                      • Question 4
                      • Chapter 7
                      • Question 1
                      • Question 2
                      • Question 3
                      • Question 4
                      • Chapter 8
                      • Question 1
                      • Question 2
                      • Question 3
                      • Question 4
                      • Chapter 9
                      • Question 1
                      • Question 2
                      • Question 3
                      • Question 4
                      • Chapter 10
                      • Question 1
                      • Question 2
                      • Question 3
                      • Question 4
                      • Chapter 11
                      • Question 1
                      • Question 2
                      • Question 3
                      • Question 4
                      • Chapter 12
                      • Question 1
                      • Question 2
                      • Question 3
                      • Question 4
                      • Chapter 13
                      • Question 1
                      • Question 2
                      • Question 3
                      • Question 4
                      • Chapter 14
                      • Question 1
                      • Question 2
                      • Question 3
                      • Question 4
                      • Chapter 15
                      • Question 1
                      • Question 2
                      • Question 3
                      • Question 4
                      • Chapter 16
                      • Question 1
                      • Question 2
                      • Question 3
                      • Question 4
                      • Chapter 17
                      • Question 1
                      • Question 2
                      • Question 3
                      • Question 4
                      • Chapter 18
                      • Question 1
                      • Question 2
                      • Question 3
                      • Question 4
                      • Chapter 19
                      • Question 1
                      • Question 2
                      • Question 3
                      • Question 4
                      • Chapter 20
                      • Question 1
                      • Question 2
                      • Question 3
                      • Question 4
                      • Chapter 21
                      • Question 1
                      • Question 2
                      • Question 3
                      • Question 4
                      • Chapter 22
                      • Question 1
                      • Question 2
                      • Question 3
                      • Question 4
                      • Chapter 23
                      • Question 1
                      • Question 2
                      • Question 3
                      • Question 4
                      • Chapter 24
                      • Question 1
                      • Question 2
                      • Question 3
                      • Question 4
                      • Chapter 25
                      • Question 1
                      • Question 2
                      • Question 3
                      • Question 4
                      • Answers
                      • Chapter 1
                      • Chapter 2
                      • Chapter 3
                      • Chapter 4
                      • Chapter 5
                      • Chapter 6
                      • Chapter 7
                      • Chapter 8
                      • Chapter 9
                      • Chapter 10
                      • Chapter 11
                      • Chapter 12
                      • Chapter 13
                      • Chapter 14
                      • Chapter 15
                      • Chapter 16
                      • Chapter 17
                      • Chapter 18
                      • Chapter 19
                      • Chapter 20
                      • Chapter 21
                      • Chapter 22
                      • Chapter 23
                      • Chapter 24
                      • Chapter 25
                      • Self-test questions and answers
                      • Chapter 1
                      • Questions
                      • Chapter 1
                      • Answers
                      • Chapter 2
                      • Questions
                      • Chapter 2
                      • Answers
                      • Chapter 3
                      • Questions
                      • Chapter 3
                      • Answers
                      • Chapter 4
                      • Questions
                      • Chapter 4
                      • Answers
                      • Chapter 5
                      • Questions
                      • Chapter 5
                      • Answers
                      • Chapter 6
                      • Questions
                      • Chapter 6
                      • Answers
                      • Chapter 7
                      • Questions
                      • Chapter 7
                      • Answers
                      • Chapter 8
                      • Questions
                      • Chapter 8
                      • Answers
                      • Chapter 9
                      • Questions
                      • Chapter 9
                      • Answers
                      • Chapter 10
                      • Questions
                      • Chapter 10
                      • Answers
                      • Chapter 11
                      • Questions
                      • Chapter 11
                      • Answers
                      • Chapter 12
                      • Questions
                      • Chapter 12
                      • Answers
                      • Chapter 13
                      • Questions
                      • Chapter 13
                      • Answers
                      • Chapter 14
                      • Questions
                      • Chapter 14
                      • Answers
                      • Chapter 15
                      • Questions
                      • Chapter 15
                      • Answers
                      • Chapter 16
                      • Questions
                      • Chapter 16
                      • Answers
                      • Chapter 17
                      • Questions
                      • Chapter 17
                      • Answers
                      • Chapter 18
                      • Questions
                      • Chapter 18
                      • Answers
                      • Chapter 19
                      • Questions
                      • Chapter 19
                      • Answers
                      • Chapter 20
                      • Questions
                      • Chapter 20
                      • Answers
                      • Chapter 21
                      • Questions
                      • Chapter 21
                      • Answers
                      • Chapter 22
                      • Questions
                      • Chapter 22
                      • Answers
                      • Chapter 23
                      • Questions
                      • Chapter 23
                      • Answers
                      • Chapter 24
                      • Questions
                      • Chapter 24
                      • Answers
                      • Chapter 25
                      • Questions
                      • Chapter 25
                      • Answers

                      2 Evolution of contemporary nursing

                      Elaine Ball

                      Learning outcomes

                      This chapter will help you:

                      • Appreciate how nursing has evolved since the 1700s

                      • Explore contemporary nursing and how it is influenced by society

                      • Outline the different approaches to organizing nursing care

                      • Describe how to become a nurse in the twenty-first century, showing insight into the four fields of nursing practice

                      • Develop an awareness of the diverse roles undertaken by nurses in different settings.

                      Introduction


                      Nursing has always developed in response to the changing needs of society. As the structure of society alters, new nursing habits, customs, values and knowledge emerge in response to changes in the population and its health issues. Because of the influence of history and its corresponding knowledge-base on nursing, the evolution of contemporary nursing will be considered using a chronological approach from the 1700s to the present day and this chapter will demonstrate how nursing, which does not exist in isolation, has been influenced by society and the sociopolitical agenda of the day. The chapter explores how contemporary nursing and nursing roles have developed in response to the challenges facing healthcare delivery and what it means to become or be a twenty-first century nurse. Approaches to nursing practice are considered along with some key nursing roles in different settings. It is hoped that this chapter will provide a useful introduction for those embarking or enrolled on a pre-registration nursing programme.

                      Evolution of nursing


                      To most of us, the term ‘evolution’ suggests something that changes over time and this is not always easy to map out. This section outlines how early practices provided impetus for subsequent developments. Nursing activities such as understanding, empathy, sensitivity and advocacy, to name but a few, remain steadfast aims in nursing practice. Nursing as a discipline is not defined easily by the many examples located in history, instead it draws its fuller meaning from the women and men who seek to preserve nursing activities in everyday practice such as a caring look, gently holding someone’s hand or providing a listening ear.

                      There is no exact time or place when nursing began. There is, however, a period in history to which we can attribute defining texts that convey the principles of nursing. This section outlines nursing at different periods since the 1700s and some of the main events and contexts that influenced these changes are explored. Florence Nightingale, Mary Seacole and Ethel Fenwick are women who wrote about nursing, and respectively set protocols, policy and shaped nurse registration. Nursing is a responsive ever-evolving profession demanding from those who work within it an ability to translate its developments against the backdrop of historical and political changes. The influence of both World Wars (1914–1918 and 1939–1945), the inception and development of the NHS and the more recent developments in professional regulation and education, are considered together with changes to specialist nursing such as the care of children and people with mental health problems.

                      Nursing in the eighteenth and nineteenth centuries


                      In the 1700s, in times of accident or sickness, hospitals, as we know them today, did not exist and being cared for in one’s own home was the norm, with lay people largely performing nursing roles in the community. ‘Nursing’ was also associated with maternity care and the term could be extended to female neighbours who wet-nursed or delivered babies in the local community.

                      The influence of Florence Nightingale


                      Florence Nightingale was born in Florence, Italy, in 1820 of wealthy, middle-class parents. After several attempts to receive formalized training in 1850 and 1851, she spent brief periods in Germany at a Protestant institution that trained deaconesses in childcare and nursing. Soon afterwards, Florence Nightingale became Superintendent of Nurses at the Institution for the Care of Sick Gentlewomen in Distressed Circumstances in London. For this she received no pay but was able to display her skills in nursing and nursing administration, which included greatly improved standards of nurses and nursing care, and also the expectation that care should be based on compassion, observation and knowledge. One of her legacies, was the ‘Nightingale ward’, a ward layout where long rooms have beds spaced out on each side, which can still be found in some areas today. While working in the military hospital during the Crimean War, she established hygienic care and reduced overcrowding; and consequently, reduced the mortality rate of wounded soldiers. In addition, her caring attitude towards the wounded soldiers led to her becoming known as the ‘Lady with the Lamp’.

                      Because Florence Nightingale wrote about nursing, collating information about how nurses worked and recording the nursing activities that produced positive outcomes, an evidence-based structure and philosophy of nursing was established. By observing and testing its rudimentary practices, nursing could become more evidence-based. Florence Nightingale recorded nursing practices and produced statistical outcomes, now known as ‘model forms’. As a result of this revolutionary way of working and her model forms – that we would identify today as pie-charts – many now regard her as the first research nurse. Although Nightingale found she was a heroine, she never enjoyed her fame and disliked the sentimental reference that her name inspired. The only testimonial she would accept was a fund, heavily subscribed to by the public and named in her honour, which she used to found training schools for nurses.

                      The success of the Nightingale reforms led to the rapid expansion of nurse training schools, initially in London voluntary hospitals. This led to the growth of larger provincial voluntary hospitals, and finally to new hospitals being built by local government and poor law authorities (McDonald 2011). Despite this, there was still a lack of hospitals, which led to a need for nursing people at home and Nightingale worked closely with William Rathbone to establish training for district nurses. District nursing started as a voluntary service, run by voluntary committees, until the value of the service was recognized and local authorities gradually began to accept more responsibility for sick people in the community. Professional regulation marginalized those who had previously practiced in often maverick and ungoverned ways, e.g. in the delivery of babies or attempting to cure mental distress through quackery, deception and even rudimentary surgery.

                      As a result of her work, Nightingale was able to define the role of nursing clearly and how nursing was distinct from, and not subservient to, medicine (Box 2.1). This led to the establishment of nursing as a profession with a sound and specific education base.

                      Box 2.1  Reflective practice

                      Florence Nightingale’s values

                      Nursing is a calling


                      • Religious beliefs in the existence of ‘natural laws’ could be discovered and used to help people improve their health and existence

                      • Nursing was all-consuming in terms of time commitment, i.e. more than an occupation

                      • Nursing work was so important that it should be thought of as a religious vow.

                      Nursing is an art and a science


                      • The science of nursing needs formal education

                      • The art of nursing gave freedom to act, to be creative, proactive and function as an advocate for the patient.

                      Mankind can achieve perfection


                      • People can control the outcomes of their lives

                      • People can pursue perfection by understanding ‘nature’s laws’. This understanding would enable people to readily use these laws to benefit their existence, so pursuing perfect health

                      • The role of the nurse was to provide the optimum environment in which perfect health could be achieved.

                      Nursing requires a specific education


                      • Education for nurses was revolutionary in the nineteenth century

                      • The Nightingale approach required a blend of theoretical and clinical experience.

                      Nursing is distinct and separate from medicine


                      • Although physician and nurse deal with the same client population, nursing is aimed at discovering the ‘natural laws’ that will assist in putting the patient in the best possible condition so that nature can affect a cure.

                      Student activity


                      • Reflect on the values above and consider...

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