British journal of nursing (Mark Allen Publishing)
-
Up to 40% of patients taking opioids develop constipation. Opioid-induced constipation (OIC) may limit the adequate dosing of opioids for pain relief and reduce quality of life. ⋯ Lifestyle modification and alteration of aggravating factors, the use of simple laxatives and, when essential, the addition of newer laxatives or opioid antagonists (naloxone, naloxegol or methylnaltrexone) can be used to treat OIC. This review discusses the recent literature regarding the management of OIC and provides a rational approach to assessing and managing constipation in individuals receiving opioids.
-
This article explores bullying behaviours in nursing in the UK and other countries, why bullying happens, and suggests actions to prevent or combat it. Bullying involves intentional and repeated psychological violence, humiliating and isolating staff from colleagues. Current literature reports that 20-25% of nursing staff experience bullying behaviour. ⋯ Silence and inaction by managers and colleagues allows this behaviour to continue. A zero-tolerance policy and the addressing of this behaviour clearly and promptly by managers should be instigated. Staff being bullied should be supported by colleagues.
-
Effective symptom management for a patient with a palliative diagnosis can be challenging. There are some symptoms that may be more difficult to control and understand than others. ⋯ Understanding the predisposing factors and the manifestations may aid the health professional in the assessment and identification of this distressing symptom, facilitating more effective management and care of those who are approaching the end of life. This article attempts to address some of the challenges and offer a number of suggestions that may aid in identifying delirium in patients at the end of life, but also examines some of the dilemmas when attempting to treat delirium.
-
Pain following craniotomy is common, however, achieving effective analgesia can be difficult. The assessment of pain postoperatively can be a challenge in patients who are obtunded (not fully alert) and the severity of pain has historically been underestimated. There are also concerns about side-effects from drugs, particularly with opioids, which may lead to reluctance to administer effective doses. ⋯ Opioids are effective but side effects of pupillary constriction and respiratory depression may be problematic in the neurosurgical patient. The total use of systemic analgesia can be minimised with the use of regional techniques, such as local anaesthetic nerve blocks. A multimodal technique, using different agents, is most likely to be effective.