British journal of nursing (Mark Allen Publishing)
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Older clients are at increased risk during surgical intervention because of age-related system changes and comorbid conditions. However, recent advances in surgical and anaesthetic techniques, together with modern monitoring technology and the proliferation of ambulatory surgery, have reduced mortality in older patients undergoing surgery. Nevertheless, inadvertent hypothermia in older clients remains problematic. Therefore, an understanding of specific diseases prevalent in old age, coupled with a comprehensive knowledge of the physiological impact of ageing in all body systems, underpins the role of the anaesthetic nurse.
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Chronic neuropathic pain is experienced by a large number of patients. It can affect the individual physically, psychologically and socially. This review examines the evidence base for the assessment of chronic neuropathic pain and discusses some of the main tools and their suitability for use for this particular type of pain. ⋯ The evidence recommends that chronic pain be assessed using a multidimensional assessment tool. Currently the only tool specifically designed to measure neuropathic pain is the Neuropathy Pain Scale. The author describes how the evidence was applied to make changes in her own area of practice and why the Brief Pain Inventory was considered more suitable than the Neuropathy Pain Scale.
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Around 10% of hospital patients acquire a healthcare-associated infection and it has been estimated that around one-third of these could be prevented. This article discusses the causal link between hand hygiene and infection and the reasons why healthcare workers (HCW) fail to comply with hand-hygiene policies. ⋯ In order to move forward, it is suggested that the problem has to be managed through cultural change, making it easier for HCWs to comply by improving hand-cleansing facilities and materials and providing feedback to personnel on local infection rates so that high-priority areas can be targeted. This may be facilitated by locally based action research.
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This article describes a nurse-led telephone service that was introduced to improve the quality of patient discharge from the emergency assessment area (EAA) of a large NHS acute teaching trust. The service originated from concerns regarding the increasing volume of telephone enquiries received from patients after discharge. In addition, an audit of patients' discharge plans revealed a minimalist/cursory approach to documentation. ⋯ Evaluation over the first 12 months demonstrated improvement in the quality of discharge documentation and more explicit discharge plans. The service has successfully addressed issues regarding follow-up arrangements, documentation, new prescribed medications and GP letters. For its second year of operation, the service has been refocused using criteria linked to a new 'patient-focused' discharge checklist before discharge, to determine who is most likely to need telephone follow-up.