British journal of nursing (Mark Allen Publishing)
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Peripherally inserted central catheters (PICCs) can adequately and safely meet the needs of patients who require short- to long-term therapy in many clinical settings. Moreover, PICCs have been successfully used in the delivery of i.v. therapy in the patient's home. There is evidence available which indicates that a PICC can minimize the trauma to patients who undergo multiple, repeated cannulations. ⋯ The use of PICCs has been shown to be clinically effective as well as cost-effective. In many centres nurses are leading developments in IV therapy. In order to ensure that high quality, clinically effective patient care is developed, patients must undergo thorough assessment before device selection.
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Up to 90% of patients experience hypothermia perioperatively. Inadvertent hypothermia can have a profound physiological effect on the body, varying from mild vasoconstriction and feeling cold to cardiac arrest and death. Anaesthesia, general or regional, increases the risk as the normal protective reflexes such as shivering are absent, particularly when muscle relaxants are used. ⋯ Forced air warmers such as the Bair Hugger are the most effective means of preventing and treating heat loss. They should be used routinely although their contribution to infection also needs to be considered. Nurses should be aware of the risks of hypothermia so that modes of prevention can be employed to minimize the risks of inadvertent hypothermia.
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Cardiac arrest is the ultimate medical emergency. Without rapid action by witnesses and responding health professionals, chances of survival are remote. ⋯ The importance of calling for skilled help at the earliest opportunity is emphasized, facilitating rapid access to emergency services (in the community) and the cardiac arrest team (in hospital). The advent of the automated external defibrillator (AED) presents additional opportunities to save lives and it is recommended that registered nurses are trained in, and authorized to use, AEDs in their professional practice.
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This article identifies the difficulties often associated with breaking bad news, from a nursing perspective. The additional considerations involved in breaking bad news to people with learning disabilities are identified, and a six-step protocol (Buckman, 1991) is introduced and explored in relation to this client group. ⋯ Finally, recommendations for helping professionals to learn how to break bad news sensitively to this client group are suggested. They include multi-agency working, education and training opportunities, standard statements, resources, support and research initiatives.