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Contents

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

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