Patient and public involvement in healthcare

The impulse for patient and public involvement (PPI) in health services reflects wider societal and policy concerns with citizenship and democratic participation. A consumerist turn in health policy has opened the door to advances in involvement initiatives, with nurses often playing a lead role. These involvement practices have developed in the interlinked areas of nursing practice, research, and education. Effective involvement is predicated upon emancipatory values and, as such, involvement practices are concerned with prevailing power relations. The actual form that involvement takes can be thorough, systematic, and empowering or partial, tokenistic, and subsumed under oppressive governance systems. Ultimately, involvement poses key questions for professional nursing identity, allowing for a re-imagining of professionalism that is essentially democratized and cooperative.

Teamwork

The importance of teamworking has been long established in healthcare, with nurses working both as part of a nursing team and as members of the wider multidisciplinary team. The effective organization and delivery of healthcare services depends upon a wide range of health professionals, patients, families, and carers working together to achieve the best health outcomes and quality of life. Whether healthcare is necessary for an acute illness episode, helping someone with a long-term health condition achieve an acceptable level of function, or supporting a person who is dying, placing people at the centre of care decisions demands effective teamworking. Understanding the nature and characteristics of teams can help nurses to work effectively and uphold professional caring values when working with people in any healthcare setting. This chapter outlines the key definitions and characteristics of teamworking.

Leadership

There is an ongoing professional debate about the nature of effective nursing leadership. It is important that general adult nurses have an understanding of definitions and key principles of leadership, and the leadership skills and attributes which are relevant to nursing care delivery. Exploring these issues will support nurses in reflecting on their role and responsibilities, examining how, as a leader of care, they can enhance nursing practice and improve the patient experience. This chapter considers the broad principles of leadership which are relevant to general adult nurses and their practice.

Communication in a healthcare context

This chapter highlights the centrality of good communication in healthcare generally, and nursing practice in particular. It is proposed that language use needs to be understood as more than just a means of speaking to another person, or a group of people, about some aspect of the care process. Though this is important and essential to effective decision-making and nursing interventions, practitioners need to understand the political dimensions of talk as discourse, of how language plays a performative part in constructing, as well as describing, the social/clinical world. Attention is given to the damaging, as well as productive, attributes of communication—where the euphemistic concept of ‘empowerment’ has to be critically addressed and enacted. The contribution of humanistic psychology to nursing practice is discussed through the core conditions of person-centered working. Verbal and non-verbal skills and behaviours to enact an empathic, genuine, and unconditional foundation for care are outlined. Finally, specialist knowledge and skills, expressed through ‘family intervention’ therapy, locate communication within wider social relations.

Clinical emergencies

An important part of nurse decision-making is the prompt and appropriate response to clinical emergencies, wherever these occur. In hospital environments, nurses are guided by local policies and protocols and have access to sophisticated medical equipment and facilities and help from other healthcare staff. The situation may be very different for nurses working in community settings or those who are ‘off duty’, yet they too are bound by the NMC Code to offer help in clinical emergencies. This chapter outlines key points relating to a range of life-threatening and more minor clinical emergencies, whether seen in hospital, community, or social settings. It also describes the basic principles of first aid or first-line treatments, and key nursing considerations in the emergency situations are described.

Pain

It is widely recognized that the experience of pain is unique to the individual, which makes caring for people in pain a challenge. The general hospital nurse is most likely to see people in pain due to an acute injury, an episode of ill health, following surgery, or at a wound dressing change. People living with chronic pain conditions will most often be in the care of community nurses or specialist pain management teams. In both acute and chronic pain conditions, it is important that general nurses can accurately assess, monitor, and treat pain. This chapter identifies the key features of acute and chronic pain and describes pain assessment tools which are in widespread use. It outlines common pharmacological and non-pharmacological approaches to pain management, along with a summary table of frequently prescribed pain medications. Key considerations in nursing practice and decision-making are outlined.

Musculoskeletal conditions

The skeleton, skeletal muscles, joints, tendons, and ligaments function to protect the body’s internal organs and facilitate movement and mobility. Disorders of the musculoskeletal system will often be the result of trauma or long-term degenerative conditions, which can affect people of any age, although older people are at increased risk. Many people with musculoskeletal conditions will be treated by specialist orthopaedic and rheumatology services, but general adult nurses will come into contact with many people who are suffering from a range of musculoskeletal disorders. Whether these are muscle sprains, people living with long-term arthritic conditions, or those who have suffered a potentially life-threatening traumatic injury, all will have some degree of compromised movement. It is important that general adult nurses can work with people to help restore function and reduce risk from the many complications which can arise from immobility or disability. This chapter outlines key facts about musculoskeletal conditions which are likely to be useful to the general nurse, alongside clinical investigations, and key nursing considerations. A summary table of frequently prescribed medicines is also presented.

Renal and urinary tract conditions

Renal conditions can be an acute health problem or a debilitating life-limiting condition. Kidney failure can present as a slowly progressing chronic disease (chronic kidney disease) or as acute life-threatening medical emergencies known as acute kidney injury (AKI). People with chronic kidney failure will normally be cared for by specialist nurses and clinical teams working in hospital or community settings. General adult nurses will encounter people with kidney disease in all areas of clinical practice, either as a primary complaint or as a secondary complication of other disorders or treatments. This chapter outlines key facts about kidney disease which are likely to be useful to the general nurse. These include an overview of renal conditions and the principles of renal replacement therapy. Common urinary tract conditions and the management of urinary incontinence are also discussed, as are key nursing considerations when working with people with renal or urinary tract disorders. An overview of frequently prescribed medicines for renal and urinary tract conditions is presented in a summary table.

Respiratory conditions

Respiratory conditions can be an acute health problem or a long-term and debilitating health condition. They are common in the adult population, and many aspects of respiratory care are carried out by advanced practitioners and specialist nurses. General adult nurses are likely to encounter people with respiratory disease across all care settings. This chapter outlines key facts about respiratory disease which are likely to be useful to the general nurse. These include an overview of acute and chronic respiratory conditions and a summary of associated clinical investigations and treatment approaches, including a section on oxygen therapy. The chapter also has a short section on key facts related to surgical interventions. Key nursing considerations for working with people with respiratory disease, in hospital and at home, are outlined, and an overview of frequently prescribed medicines is presented in a summary table.

Breaking ‘bad news’

The communication of sensitive or upsetting information is now routinely undertaken by specialist nurses. This is typically spoken about as ‘breaking bad news’ and often involves disclosing a life-changing diagnosis. However, an understanding of what constitutes ‘bad news’ will very much depend on the culture and context of an interaction, and general adult nurses will often find themselves in everyday situations where they have to break bad news. Whilst this may not be life-changing information, in the context of everyday healthcare, bad news may be telling an inpatient they are unable to go home or that their routine surgery has been cancelled. These everyday realities can be very upsetting for people and mean that nurses need to be skilled in assessing when information is likely to have an emotional impact. This chapter locates the concept of ‘breaking bad news’ in the context of contemporary nursing and discusses one recognized model of managing the process.