Nursing Care and the Activities of Living

Ian Peate is Head of the School of Nursing and Midwifery, Thames Valley University, UK

Contributors xi

Acknowledgements xv

Introduction – Ian Peate xvii

1 The Nature of Nursing 1
Lynn Quinlivan

 Introduction 1

The Nursing and Midwifery Council 2

Registration and professional accountability 2

Standards of conduct and performance 3

Maintenance of a register of nurses and midwives 3

Duty of care 4

Fitness to practise 5

Nurses and accountability 5

Nursing hierarchy 6

Government directives 9

The structure of the NHS in England 13

The structure of the NHS in Scotland 15

The structure of the NHS in Wales 15

The structure of the NHS in Northern Ireland 15

Conclusions 16

References 17

2 Safeguarding Vulnerable Adults 19
Victoria Darby

Introduction 20

Defining a vulnerable adult and abuse 20

Ethics and safeguarding the vulnerable adult 23

Policies and legislation for safeguarding the vulnerable adult 28

Safeguarding vulnerable adults from unprofessional nurses 32

Fitness to practise panels 32

Interprofessional collaboration 33

Reporting suspicions of abuse as a nurse 33

Assessing the seriousness of abuse 34

Reporting suspicions of abuse as a student nurse 34

Conclusions 35

References 36

3 Assessing Needs and the Nursing Process 38
Lynda Sibson

Introduction 39

Models of nursing 39

Activities of living 40

Organisation of nursing care 40

Nursing practice 41

Nursing history 41

Elements in nursing 42

Theories, concepts and models 43

Nursing process 46

Conclusions 57

References 58

4 Promoting Safety 60
Janet G. Migliozzi

Introduction 60

Risk assessment 61

Common risks in health care 63

Common factors affecting patient safety 64

Minimising the risk of medication error 64

Minimising the risk of falls 66

Minimising the risk of health care-associated infection 68

Conclusions 79

References 80

5 Communicating Effectively 83
David Briggs

Introduction 84

Talking to patients, carers and colleagues effectively and clearly conveying and receiving the intended message 85

Facilitating patients and their carers to communicate effectively 86

The importance of listening effectively 87

Potential communication difficulties 87

The differing methods of communication used by individuals 88

Communicating with people from different cultures 89

Coping in a very specific and difficult situation 90

Using body language effectively 90

Using the electronic means of distributing information 91

The ability to know when someone needs to know a piece of information 92

Information and record keeping 93

Communication and reflective practice 94

Conclusions 95

References 98

6 Eating and Drinking: Fluid and Nutritional Care in Practice 100
Jane Say

Introduction 101

Nutritional issues and clinical practice 101

Obesity 101

Undernutrition 102

Disease-related factors 102

Non-disease-related factors 103

Providing nutritional care in practice 103

Screening/assessment to identify patients’/clients’ nutritional needs 104

Body mass index 105

Weight loss 105

Recent dietary intakes 108

Stress factors/nature of current illness 108

Further action, assessment and referral 109

Planning, implementation and evaluation of nutritional care 109

Monitoring and re-screening 109

Factors that affect nutritional care: the hospital and care environment 110

Assistance with eating and drinking 111

Food provision 113

Nutritional support 114

Improving oral intakes 114

Oral supplements 114

Enteral (or tube) feeding 115

Specific nursing care associated with enteral feeding 116

Parenteral nutrition 120

Fluid management in clinical practice 121

Clinical assessment of fluid balance 121

Conclusion 125

References 126

7 Elimination – Alimentary and Urinary Tract 129
Muralitharan Nair

Introduction 129

The oral cavity 131

Pharynx 132

Oesophagus 132

Stomach 133

Small intestine 134

Large intestine 134

The accessory organs 135

Care of patients with gastrointestinal disorders 137

Renal system 143

The prostate gland 144

Care of patients with urological disorders 145

Conclusions 148

References 149

8 Breathing 151
Sean Mallon

 Introduction 151

Structure and function of the respiratory tract 152

Assessment of respiration 156

Measuring respiratory rate, depth and rhythm 157

Respiratory sounds 158

Observation of cough and sputum 159

Other methods of assessing respiratory function 162

Aerosols and nebulisers 163

Some common respiratory diseases 164

Conclusions 168

References 169

9 Personal Cleansing and Dressing 171
Laureen Hemming

Introduction 172

Anatomy and physiology of the skin 173

Cultural perspectives 176

Nursing care 177

Cleansing products 180

Conclusions 184

References 185

10 An Ergonomic Approach to Safe Manual Handling 188
Kim Walter

Introduction 189

Principles of safe handling and the biomechanics of back injury 189

Ergonomics 192

Risk assessment 193

Controversial techniques and hazardous tasks 203

The management of bariatric patients 205

Conclusions 206

References 208

11 Maintaining Body Temperature 210
Guy Dean

 Introduction: temperature and metabolism 211

Control of temperature 211

Factors influencing body temperature 212

Body heat considerations 213

Taking the temperature 218

Body temperature 218

Hypothermia 220

Conclusions 222

References 223

12 Work and Leisure 224
Jackie Hulse

 Introduction 225

Family life and gender 227

Employment and inequalities 227

Unemployment 228

Health and safety 229

Informal carers 230

Illness and employment 231

Retirement 231

Leisure 232

Conclusions 233

References 234

13 The Sexual Being 236
Ian Peate

Introduction 237

Policy and key drivers 238

Defining key terms 239

Assessing sexual health 242

Approaches to assessment 244

Older people’s sexuality and health 246

Sexual problems 247

Barriers to sexual discussion 248

Conclusions 251

References 252

14 Sleep and Rest 255
Debbie Davies

 Introduction 255

What is sleep? 256

Physiology of sleep 256

The states and stages of sleep 257

Theories of the need for sleep 258

Dreaming and sleep 260

Sleep needs over the life cycle 260

Factors influencing sleep 261

Common primary sleep disorders 265

Promoting sleep 267

Nursing assessment 268

Planning care 269

Implementing care 269

Evaluation 269

Conclusions 269

References 270

15 Death and Dying 273
Mary Greeno

Introduction 273

Death and dignity 274

Palliative care 275

Where to die 277

Some of the losses a dying patient or the family may experience 278

Family involvement 278

The needs of the dying patient 279

Good practice in caring for patients and relatives/friends before death 281

Signs of approaching death 282

Procedures after death 282

Last offices 284

Cultural and religious beliefs 285

Breaking bad news 286

Conclusions 290

References 291

Appendix: Normal Values 293

Index 297