NUR 260

Supplementary Workbook

September 2006 cohort

This supplementary workbook has been developed by the NUR 260 module team. The aim of the workbook is to give the student learning activities relating to the clinical skills themes of the module.

The aspects covered in the workbook include:

1. Pain management

2. Isolation nursing

3. Stoma care

4. Advanced wound management

5. Adjuncts to nutrition

6. Communication skills

Please complete the questions, activities and reflections contained in the workbook. This will help to consolidate your knowledge and experience and thus aid discussion during forthcoming NUR 260 teaching sessions.

Opportunities to complete the workbook have been allocated to you. These include the consolidation week, the reading weeks and time when your clinical skills group are not actively involved in clinical skills.

Please investigate the topics by searching for the best available evidence. This could be from national or local guidelines, policies and procedures i.e. utilise your evidence-based practice skills.

In the back of the supplementary workbook is a suggested reading list.

PAIN MANAGEMENT

A definition of pain

1.1 Review the Aetiology and pathophysiology of pain. Consider theories about pain i.e. Gate Control Theory. Construct your own definition of pain.

1.2 Differentiate between Types of pain

Acute Chronic

1.3 Review the signs and symptoms of pain

Acute Chronic

Pain assessment

1.4 Examine the evidence relating to the effectiveness of various types of Pain Assessment Tools i.e.

a. The PQRST method (Rahman 2004)

b. The British Pain Society & Royal College of GP’s method (2004)

c. The visual analogue scale

d. The numerical rating scale

e. The verbal descriptor scale

1.5 Clinical Activity– When next in clinical practice, ask your mentor about the pain assessment scale used in that placement. Compare and contrast it with other scales that you have found.

Drug treatments

1.6 Investigate the Pain Relief / Analgesic Ladder devised by the World Health Organisation. Reflect back upon a patient you have cared for who:

a. benefited from having their drug treatment linked to the principles of the analgesic ladder

b. may have benefited from having their drug treatment linked to the principles of the analgesic ladder

1.7 List non-opioid analgesic drugs which can be used. Explain their effect, via which route they can be administered and what the undesired side effects may be.

1.8 List opioid analgesic drugs which can be used. Explain their effect, via which route they can be administered and what the undesired side effects may be.

1.9 Define what compound analgesics are?

1.10 Investigate types of non-steroidal anti-inflammatory drugs. Explain their effect, via which route they can be administered and what the undesired side effects may be.

1.11 What are tricyclics & anticonvulsants ? Give some examples. What are their roles in pain management? Identify what their alternative use is.

1.12 Research Patient Controlled Analgesia. What is it? What are the main benefits and disadvantages of this type of analgesia? Cite your evidence or sources.

1.13 What is epidural analgesia? Investigate where the analgesia is administered. Discuss the specific nursing care associated with administering analgesia via this route.

1.14 Investigate non-pharmacological options for pain management. What is the evidence to show that the following types of therapies are effective?

a. physical therapies

b. cognitive & behavioural pain management

c. complementary therapies

d. TENS

e. Patient Support Groups

1.15 Linking to available evidence, examine the benefits of a Pain Management Team within health organisations?

1.16 Clinical Activity – When next in practice, explore the local guidelines and policies which relate to the drug management. Investigate from where they originated.

ISOLATION NURSING

2.1 Your mentor informs you that Mr Smith has to be isolated & will require isolation nursing.

a. Define what isolation nursing is

b. Differentiate between ‘protective’ & ‘source’ isolation

2.2 Investigate some reasons why Mr Smith may be isolated

2.3 How will you explain to Mr Smith that isolation nursing is going to happen?

2.4 Clinical Activity - Review the isolation nursing policy in the clinical area where you are working. Outline the main aspects.

2.5 Investigate the psychological effects of isolation nursing for the individual. How can being isolate affect Mr Smith? Cite some of the evidence.

2.6 How will you aid Mr Smith if he develops psychological effects from being isolated?

2.7 Review the role of the Infection Control Nurse / Team. Investigate evidence to show the effectiveness of the team. List some of your sources.

2.8 Clinical Activity - Find a Patient Information Leaflet relating to isolation nursing. Appraise the leaflet and judge whether you feel it will be effective in informing the patient concerning what isolation nursing entails.

STOMA CARE

3.1 Define what a colostomy is. Investigate reasons why a colostomy would be formed

3.2 Define what an ileostomy is. Investigate reasons why an ileostomy would be formed

3.3 Describe the faecal consistency from an ileostomy and from a colostomy. State why this occurs

3.4 Examine the pre-operative care of a patient having a stoma formation. Outline the role of a Stomatherapist.

3.5 Which sites on the abdomen should be chosen or avoided to facilitate the easy management of a stoma?

3.6 Examine the post operative care of a patient having a stoma formation

3.7 Discuss the post-operative stoma observations that should be undertaken. What is ‘normal’ or ‘abnormal’?

3.8 Identify the appliances worn by patients with an ileostomy or a colostomy. Make a list of the differences, advantages and disadvantages associated with these appliances.

3.9 Identify the dietary information that is given to a patient who has recently had an ileostomy or colostomy formed

3.10 Clinical Activity - Reflect upon the care of a patient who you have nursed and who may have experienced an alteration of their body image. How did they react to this change? Identify how you think you can help patients to cope with this difficult experience in the future.

ADVANCED WOUND MANAGEMENT

4.1Revise the stages / phases of wound healing

4.2Clinical Activity - What types of wound have you seen in practice?

4.3What were the causes or contributing factors of these wounds?

4.4List some examples of an ‘acute’ wound

4.5List some examples of a ‘chronic’ wound

4.6A wound is healing with ‘primary intention’. Explain what this is

4.7A wound is healing with ‘secondary intention’. Explain what this is

4.8A wound is healing with ‘tertiary intention’. Explain what this is

4.9What factors can affect wound healing and why?

4.10 You are caring for a patient with a wound. List some complications of:

a. An acute wound.

b. A chronic wound

4.11 What is the optimum environment for wound healing?

4.12 Clinical Activity - Review types of wound dressings in common usage and identify which types of wound they can be used

4.13 You have been asked to assess a patients wound:

a. Describe the holistic assessment of the patient

b. Describe the assessment of the wound

4.14 Clinical Activity - What Pressure Ulcer Risk Assessment Tools have been in use in your clinical areas? Review the effectiveness of these various tools. What has previously influenced your choice of tool?

4.15 What are the causes of pressure ulcers?

4.16 Clinical Activity - Explain how you have assessed a pressure ulcer / the pressure areas of a patient you have nursed.

4.17 What evidence would you utilise in order to prevent pressure ulcer formation?

ADJUNCTS TO NUTRITION

5.1 Who may make decisions relating to the requirement for nutritional support?

5.2Explain what enteral feeding is?

5.3Explain what parenteral feeding is?

5.4What are the indications for naso-gastric feeding?

5.5Investigate the correct method of naso-gastric feeding tube insertion

5.6Identify the correct methods of ensuring the naso-gastric feeding tube is in the correct position. Cite an up-to-date source for this information.

5.7Explore the types of feed which can be used for naso-gastric feeding

5.8Describe the principles for the safe administration of the naso-gastric feed

5.9When should naso-gastric administration sets be changed?

5.10 What are the complications of naso-gastric feeding?

5.11 Define what a PEG is

5.12 What are the indications for PEG feeding?

5.13 Explain how a PEG is inserted

5.14 Describe the care of a patient with a newly formed PEG

5.15 Discuss the psychological impact for the patient of having PEG

5.16 Investigate the safe administration of drugs via a feeding tube

COMMUNICATION SKILLS

6.1What may cause aggression in an individual?

6.2What may be some signs of anger in an individual?

6.3Clinical Activity - Think back to a situation involving anger or aggression. Can you visualise the situation escalating? Did you recognise any of these reactions?

6.4What skills are required to prevent and manage aggression in an individual?

6.5What is de-escalation?

6.6Define what ‘bad news’ is

6.7Clinical Activity - Write a reflection about:

a. The last time you received ‘bad news’

b. Who gave you the news?

c. How did they break the news to you?

d. What did they say to you?

e. How did you feel?

6.8Investigate the evidence relating to effective breaking of ‘bad news’

6.9Who can be responsible for telling a patient they are dying?

Further reading

Pain management

BNF (2008) British National Formulary London, BMJ Publishing

Hogston, R Marjoram, B (eds) (2007) Foundations of nursing Practice Basingstoke, Palgrave Macmillan

Mackintosh, C (2007) Assessment and management of patients with post operative pain Nursing Standard 22 (5): 49-55

Richardson, R (ed) (2008) Clinical skills for student nurses Exeter, Reflect Press

Scottish Intercollegiate Guidelines

Weetman, C Allison, W (2006) Use of epidural analgesia in post operative pain management Nursing Standard 20 (44): 54-64

WHO (1996) Cancer Pain Relief Geneva: WHO,

www.anaesthesiauk.com

www.action-on-pain.co.uk

www.britishpainsociety.org

www.nhs.uk/livewell/pain

www.painconcern.org.uk

www.painrelieffoundation.org.uk

Isolation nursing

Davies, H Rees, J (2000) Psychological effects of isolation nursing (1): mood disturbance Nursing Standard 14 (28): 35-8

Department of Health

Madeo, M (2003) The psychological impact of isolation Nursing Times 99 (7): 54

Nursing Times

Nursing Standard

www.infectioncontrol.nhs.uk

Stoma care

Hogston, R Marjoram, B (eds) (2007) Foundations of nursing Practice Basingstoke: Palgrave Macmillan

Vujnovich, A (2008) Pre and post operative assessment of patients with a stoma Nursing Standard 22 (19): 50-56

www.colostomyassociation.org.uk

www.the-ia.org.uk (The Ileostomy & Internal Pouch Support Group)

Advanced wound management

www.cochranewounds.org

www.epuap.com

www.ewma.org

www.medicaledu.com

www.tus.org.uk

www.woundcaresociety.org

www.worldwidewounds.com

Adjuncts to nutrition

Brogden, B (2004) Clinical skills: importance of nutrition for acutely ill hospital patients British Journal of Nursing, 13 (15): 914-920

Bosonett, L (2002) Total parenteral nutrition: how to reduce the risks Nursing Times 28 May 98, 22, 40-3

Mallet, J Bailey, C (eds) (2006) Manual of clinical nursing procedures 4th edition Oxford: Blackwell Science.

Pickering, K (2003) The administration of drugs via enteral feeding tubes Nursing Times 18 Nov 99, 46-9

www.bapen.org.uk

www.nutrition.org.uk

Communication skills

Baile, WF Buckman, R Lenzi, R Glober, G Beale, G Kudelka, AP (2000) ‘SPIKES’ a six step protocol for delivering bad news: application to the patient with cancer Oncologist, 5: 302-11

Chauhan, G Long, A (2000) Communication is the essence of nursing care1: breaking bad news British Journal of Nursing 9 (14): 931-8

Kubler-Ross, E Kessler, D (2005) On grief and grieving: finding the meaning of grief through the 5 stages of loss New York: Simon and Schuster