Contents

How to use this book ii

List of figures viii
List of tables xi
Acronyms and abbreviations xiii
Notes on contributors xiv
Acknowledgements xvi
Introduction xvii
Alan Glasper, Gill McEwing and Jim Richardson

Chapter 1 Fundamental concepts for skills 1

Alan Glasper, Gill McEwing and Jim Richardson
Chapter 2 IT skills (ONLINE ONLY) 13
Mike Weaver

Part I Skills for communication 15

Chapter 3 Communication 17
Jan Orr and Diana Morris
4 Communicating with adolescents 28
Diana Morris and Jan Orr
5 Anxiety 36
Margaret Chambers
6 Sign language 47
Joanna Assey
7 Breaking significant news 55
Jennie Quiddington
8 Breakaway skills 68
Diane Carpenter and James Wilson
vi Contents

Part II Skills for physical needs 77

Chapter 9 Patient hygiene 79
Tim Coney
10 Pressure area care 87
Elaine Gibson and Cheryl Dunford
11 Eye care 100
Sara Raftery, Colleen O’ Neill and Mary Clynes
12 Mouth care 108
Mary Clynes
13 Catheterisation and catheter care 114
Steve Miles
14 Basic foot care and managing common nail pathologies 127
Matthew Cole
15 Care of the infant 138
Marion Aylott

Part III Skills for physiological assessment 151

Chapter 16 Vital signs 153
Pam Diggens
17 Blood pressure 164
Sharon Jones
18 Pulse oximetry 172
Sharon Jones
19 Blood sugar measurement (using a glucometer) 180
Mary Clynes, Colleen O’Neill and Sara Raftery
20 Neurological assessment 185
Jessica Knight and Rachel Palmer
21 Pain assessment: child 195
Alyson Davies
22 Pain assessment: adult 207
Chris Hanks and Tim Jenkinson
23 Diabetic foot assessment 219
Anita Stuart and Emma Toms
Contents vii

Part IV Skills for care management 233

Chapter 24 Assessing and managing hydration 235
Veronica Lambert and Doris O’Toole
25 Intravenous therapy 245
Carol Chamley and Michelle Wilson
26 Enteral feeding 262
Chris Hanks and Gill McEwing
27 Preparation of infant feeds 281
Doris Corkin and Andrea McDougall
28 Routes of medication administration 290
Tracey Harrington and Carol Barron
29 Patient-controlled analgesia 310
Mark Broom and Gareth Parsons
30 Universal precautions 318
Siobhan MacDermott
31 Wound assessment 326
Lesley Wayne
32 Aseptic technique and wound management 334
Pauline Cardwell
33 Central venous catheters 345
Janet Kelsey
34 Blood transfusion 357
Siobhan MacDermott and Karen Merrick
35 Oxygen therapy and suction therapy 370
Neil Bloxham, Sharon Jones and Gill McEwing
36 Basic life support: child 383
Janet Kelsey and Gill McEwing
37 Basic life support: adult 390
Jan Heath
38 Clinical holding for care, treatment or interventions 399
Philomena Morrow and Patricia McGuinness
39 Orthopaedic procedures 407
Ross Sherrington
40 Last offices 424
Deborah Heron and Lucy Smith
41 Specimen collection 431
Yvonne Corcoran

Index 441
Chapter 1 Fundamental concepts for skills 1

Chapter

1
Fundamental
concepts for skills

Alan Glasper, Gill McEwing

and Jim Richardson

l Links to other chapters in Foundation Skills for Caring

 Communication
 Communicating with adolescents
 Clinical holding for care, treatment or interventions

l Links to other chapters in Foundation Studies for Caring

Introduction
 Ethical, legal and professional issues
 Communication
 Culture
 Safeguarding children
 Safeguarding adults

w Don’t forget to visit www.palgrave.com/glasper for additional

online resources relating to this chapter.
2 Chapter 1 Fundamental concepts for skills

Introduction
This practical skills book and its companion website have been prepared to help you acquire
some of the fundamental skills required for practice. Each skill will be presented with some
essential theory and evidence base for the procedure. However, there are fundamental
concepts that need to be taken into account when undertaking any procedure, and these will
be discussed in this chapter.

Learning outcomes
This chapter will enable you to:

• understand consent for treatment and the capacity to
consent
• discuss the need for privacy and dignity to be
maintained during procedures
• the importance of risk assessment and patient safety
• explain the need for patient comfort
• be aware of the issues of safeguarding patients
• understand the role of documentation in healthcare
procedures
• understand your own and other people’s accountability
in practice.

Concepts
• Safety • Caring • Legal aspects of healthcare.
• Professionalism • Policies and procedures

Consent to treatment
The requirement for consent represents the legal and ethical expression of the human right to
have one’s autonomy and self-determination respected (McHale, Fox and Murphy, ). Its
purpose is to protect and respect a patient’s autonomy and to encourage meaningful decision
making (DH, e; NMC, ; Cable, Lumsdaine and Semple, ; Dimond, ).
A fundamental part of good practice is to obtain consent before providing care, and any
healthcare professional who does not obtain valid consent may be liable to legal action by the
patient and family, either in a civil or criminal offence of battery or in a claim for negligence
(DH, b).
Before any practical procedure is performed, the practitioner must ensure that a valid
and meaningful consent is obtained before continuing with the procedure. This is required
whenever a healthcare professional wishes to examine or treat any patient unless it is an
emergency.
It must be remembered that consent needs to be given each time a procedure is performed
and cannot be assumed to apply when a procedure for which consent has been given
previously is repeated at a later time.

Valid consent
Consent is the patient’s agreement for the healthcare professional to provide care (DH, b).
For consent to be valid the patient must have received sufficient information about the
procedure, be competent to make the particular decision and not be under duress (Kennedy
and Grubb, ; Aveyard, ; NMC, ; Montgomery, ).
All patients and clients have a right to receive information about their condition. You
must be sensitive to their needs and respect the wishes of those who refuse or are
unable to receive information about their condition. Information should be accurate,
truthful and presented in such a way as to make it easily understood.
(NMC, )
Chapter 1 Fundamental concepts for skills 3

Consent can be given in a number of ways. The form of consent acceptable for a procedure
will depend on the degree of risk involved, the treatment to be given and the clinical situation
(Terry and Campbell, ).
Implied consent relates to behaviour of a patient, or in the case of a child the parent,
that would indicate to the healthcare professional that he or she gives agreement for the
procedure to be carried out. Implied consent usually applies for uncomplicated acts of care,
such as assisting with personal hygiene. This may be given verbally but may also be non-verbal,
such as the patient pulling up a sleeve to prepare for a blood pressure recording.
For healthcare procedures it may be difficult to distinguish between compliance and
consent; therefore implied consent should not be relied upon and it is advisable to obtain
express consent (Aveyard, ).
Express consent applies to both written and verbal consent which is required when a
procure may involve an element of risk. The law does not specify when written consent is
necessary (Kennedy and Grubb, ; Montgomery, ). When a procedure has more
serious risks that may have major consequences, written consent is normally obtained. In
these instances a consent form is used which states that the patient or parent is consenting to
a clinical procedure that has associated risks. However written consent is only valid if all the
elements above have been met (DH, c). Although written consent provides evidence that
the patient signed a form, the crucial factor is whether the consent was valid. There is no legal,
ethical or professional distinction between the effectiveness of written, verbal and implied
consent (Kennedy and Grubb, ; DH, e; Dimond, ; Montgomery, ).
Express consent is achieved when all professionals involved in a procedure disclose
adequate relevant information to enable the patient to make an informed decision. Tacit
consent is when not all the relevant steps in the procedure are discussed and assumptions
are made that, if patients agree to a particular procedure, they are therefore agreeing to the
component parts without them being disclosed.

Information
An adult must be given adequate information about any treatment, disclosing its nature,
purpose, associated risks and alternative treatments available. For children, the child and legal
guardian need to understand the nature and purpose of the procedure (DH, b) but this
should be given in a way that meets the child’s individual needs. The legal guardian should be
provided with further information if required.
When performing nursing procedures, information should be provided describing the
procedure, why it is necessary, the perceived benefits and risks, any available alternatives and
the consequences of not performing the procedure.
Information may be given in a variety of ways, individualised to meet specific needs and
circumstances, and is usually best given in steps and repeated at different stages to improve
understanding (Kennedy, ). It should be honest and easily understood, and jargon should
be avoided. The recipient should be given time to ask questions at any time before or during
the procedure.

Voluntary
Consent must be voluntary, free from force, deceit, duress, overreaching or other ulterior
forms of constraint (Terry and Campbell, ).

Capacity
Capacity is defined by the Mental Capacity Act () as ‘the everyday ability to make
decisions or take actions that influence their life’. These decisions can be minor, everyday
events or those that are less frequent and may have a major impact on the individual’s life.
The Nursing and Midwifery Council () states that you should presume that every
patient and client is legally competent unless otherwise assessed by a suitably qualified
4 Chapter 1 Fundamental concepts for skills

practitioner. It is suggested that patients are legally competent if they have the capacity to
understand and retain information about the procedure and can use this to make an informed
choice. However those sectioned under the Mental Health Act () may have their rights to
w consent restricted (www.departofhealth.gov.uk).
The Mental Capacity Act () has been developed to support patient/clients/service
users and also professional and lay users with issues related to consent, and to help clarify
whether a person is capable of giving consent. It has five key principles:
• A presumption of capacity. Each person has the right to make his or her own decisions
unless proven incapable.
• Individuals are supported to make their own decisions. People should be given practical
help to make their own decisions.
• Unwise decisions do not mean that a person does not have the capacity to consent. Just
because an individual makes unwise decisions – for example, dressing in an unusual way –
this does not mean that person can be considered to lack capacity.
• Best interest. All actions (decisions) must be taken with the intention of the best interest
for the individual at all times.
• Least restrictive option. Everything done for or on behalf of the person must follow the
course that is least restrictive of his or her basic rights and freedoms.
The Mental Capacity Act () also defines what is considered to be incapacity. People are
deemed incapable when they are unable to make or communicate decisions because of an
impairment or disturbance in the function of their mind or brain at the time a decision has
to be made. An assessment that the impairment is sufficient can be made
when they cannot demonstrate knowledge and understanding related to
the issue or question they are being asked. An assessment process should a Learning
be used and the Act gives some suggestions of criteria: activity
• failing to demonstrate relevant understanding of the information given
to them when making a decision Look up Clause  of the
• being unable to retain information relevant to the decision Mental Capacity Act
• being unable to demonstrate that they can consider the pros and cons () to understand how
of information given to them healthcare professionals are
• being unable to communicate their decision by any means. protected when making
decisions in the best interest
Following the assessment, if it is considered in the best interest of patients,
of the patient.
a decision can be made for them and this will be considered a duty of care.

Consent when patients are less than 18 years old

A person under the age of  years is considered a minor and not an autonomous adult.
Consent by  and -year-olds is governed by the Family Law Reform Act (). They
are presumed to have capacity to give consent to medical procedures unless the contrary is
shown. In the United Kingdom except for Scotland, young people aged – can consent
to treatment, but cannot necessarily refuse treatment intended to save their lives or prevent
serious harm. If the patient refuses consent then those with parental responsibility, or a
court, can give consent to treatment which is in the child’s best interests. The British Medical
Association (BMA) guidelines () state that whilst young people’s right to consent to
treatment is now firmly established, their right to refuse it remains less certain. In Scotland if
a child or young person is considered competent they may consent to treatment irrespective
of age.
Children under  years old are presumed not to have capacity to consent unless they
satisfy health professionals that they do have such capacity. However the common law case of
Gillick () established that a child less than  years old who does have capacity (is ‘Gillick
competent’) can give consent for medical treatment. The Gillick case was about guidance on
contraceptive advice and treatment to girls under the age of , but the case resulted in two
Chapter 1 Fundamental concepts for skills 5

outcomes. One was that it is lawful to provide contraceptive advice and treatment to girls
under the age of  subject to certain guidelines (the Fraser guidelines). The other was that in
certain circumstances children under the age of  can give consent in their own right (Gillick
competence).
Larcher () gives some guidelines to help in judging capacity. These include being able
to:
• understand in simple terms the nature, purpose and necessity for the proposed treatment
• believe the information applies to them
• retain the information long enough to make a choice
• make a choice free from pressure.
Young people under  therefore may legally consent to treatment if they satisfy the criteria
of competence and voluntariness. However competence is context related, and although
the young person may have been able to give valid consent in one set of circumstances this
does not necessarily apply in another situation. In law, it is the doctor’s responsibility to assess
competence, although other professionals with appropriate skills may be delegated to help
(Larcher, ).
If a ‘Gillick competent’ child refuses a procedure, that does not mean that he/she lacks
capacity. It may be due to anxiety, such as fear of the pain when having a dressing removed.
In all cases effective preparation should be given, and where appropriate local anaesthetic,
systemic analgesia or sedation can be offered.
When children are not ‘Gillick competent’ at least one person with parental responsibility
should normally give consent. Those with parental responsibility are under a legal obligation
to act in the child’s best interests. If all those with parental responsibility refuse consent for
a procedure that the doctors think is strongly in the child’s best interests, then the doctors
should involve the courts. In an emergency, if parental consent is not forthcoming and there is
not time to involve the courts, act to save the child from death or serious harm.
For healthcare professionals it is important to be aware of who has parental responsibility.
According to current law, a mother always has parental responsibility for her child. However
fathers do not always have such responsibility. With more than one in three children now born
outside marriage, some parents may be unclear about who has legal parental responsibility for
their children (Directgov, ).
Living with the mother, even for a long time, does not give a father parental responsibility
and if the parents are not married, parental responsibility does not always pass to the natural
father if the mother dies.
• Those who have parental responsibility:
• mothers and fathers married to mother
• fathers not married to mother but who jointly register birth (after  December )
• adoptive parents
• by a parental responsibility agreement with the mother
• by a parental responsibility order, made by a court.
• Those who do not have parental responsibility:
• fathers not married to the mother
• step-parents.

Assent
Assent is an agreement given by a child who is not competent to give legally binding consent
under current legislation. Assent should always be obtained from children by the healthcare
professional to indicate that they are willing to participate, even when they are insufficiently
mature to make a fully informed decision to consent (Callery, Neill and Feasey, ).

In an emergency
When treatment is necessary to preserve life or where the lack of capacity of the patient is
6 Chapter 1 Fundamental concepts for skills

permanent or likely to be long-standing, in the absence of a legal guardian it is lawful to carry

out procedures that are in the best interest of the individual (DH, e, ; NMC, ;
Cable, Lumsdaine and Semple, ; Dimond, ; Montgomery, ). Best interests are
not confined to medical best interests but include the patient’s values and preferences when
competent.

Responsibility for gaining consent

Consent is usually obtained by the individual performing the procedure. Oral consent is likely
to be sought immediately before the procedure is carried out. In some circumstances it may
not be possible for the professional carrying out the procedure to gain consent; in these
circumstances another healthcare professional may be asked to do so on their behalf. The DH
() agrees that consent may be provided to another healthcare professional who has been
specially trained for that area of practice.

Withdrawal of consent during a procedure

Consent can be withdrawn at any time during the procedure. If this should occur then
it is best to stop the procedure and discover why the patient has withdrawn consent. The
consequences of stopping should be explained to the patient. Allowing patients, whether
adults or children, a feeling of control can help as sometimes the situation becomes
overwhelming and they find it difficult to cope. Giving them a short break or a choice in how
the procedure progresses may help them through the rest of it. If stopping the procedure is
dangerous for the patient, this needs to be considered and clearly explained to the patient; if
possible the procedure should be continued until the danger is over.

Risk assessment and patient safety

Adverse events occur in around  per cent of admissions to hospital or at a rate of an
estimated , each year. They cost approximately £ billion a year in additional
hospital stays alone. Approximately  people die or are seriously injured in adverse events
involving medical devices every year, and the NHS pays around £ million in settlement
of clinical negligence claims (DH, ). Adverse incidents occur when there is unexplained
or unintended harm to the patient. A near miss is when an occurrence might have led to a
patient being harmed but something prevented that from occurring and by chance alone no
harm resulted.
Risk assessment is simply an examination of any procedure undertaken during your work
that could harm yourself or others. It is an employer’s duty under the Management of Health
and Safety at Work Regulations () to provide safety in the work place and to ensure that
any risk is managed ‘so far as is reasonably practicable’. Health professionals must cooperate
with their employer in obeying health and safety regulations. Under the Nursing and Midwifery
Council’s Code of Conduct (: para ) all registered practitioners must ‘act to identify
and minimise the risk to patients and clients’ and ‘work with other members of the team to
promote healthcare environments that are conducive to safe, therapeutic and ethical practice’.
A risk assessment is a careful examination of the environment that could cause harm to
people. Once a hazard has been identified, precautions need to be put in place to reduce the
risk. It is a legal requirement to assess and minimise risk to anyone in a workplace (Hayes,
).
Within a hospital there is a health and safety department with a risk manager, and usually
there are risk assessors on each care unit, but it is everyone’s personal responsibility to raise
awareness of potential hazards so they can be removed or the risk minimised.

The five steps to risk assessment

• Look for hazards.
• Decide who might be harmed and how.
 Chapter 1 Fundamental concepts for skills 7

• Evaluate the risks and decide if existing precautions are enough or if more should be done.
• Record your findings.
• Review and revise if necessary.

a Learning activity
Think of a situation you have been in and work through the five steps listed in the text
to help you identify risk. Look up the following article, which will help you identify the
questions you should be asking yourself about the situation: Dimond, B. () ‘Risk
assessment and management to ensure health and safety at work’, British Journal of
Nursing (), –.

Common workplace injuries occur from manual handling, slips, trips and falls, and contact
with harmful substances. For healthcare professionals the situation is constantly changing and
risks should be evaluated when there are:
• new items of equipment • challenging behaviour of patients or
• new methods of working relatives.
• policy changes • new chemicals in the workplace
• MHRA medical devices alerts • changes in the environment.
It must be recognised that there are increased risks when caring
for pregnant mothers, children, the elderly and adolescents. w
Most simple hazards can be identified and acted upon, and a Learning
the risk resolved. Potentially serious hazards require formal activity
recording on a risk assessment form – which should be available
To find out more, visit the following
with instructions in your health and safety manual – and shown
websites: MHRA Medicines and
to your manager to action (Hayes, ).
Healthcare Products Regulations
A risk assessment should take place whenever you are
Authority: www.medical-devices.
carrying out a procedure, and guidelines should be followed at
gov.uk; and NHS Plus Health at work:
all times. Procedural guidelines should be updated frequently
www.nhsplus.nhs.uk/law&you/
and must be evidence based. The professional performing the
employers_riskassessment.asp.
procedure should be trained and competent to do so.

Dignity and privacy

The concept of the maintenance of dignity is central to good practice (Walsh and Kowanko,
). Whenever a procedure is planned and carried out in practice, the approach of the
nurse is crucial to the patient and every effort should be made to ensure it is a positive and
constructive experience. Nurses are advised through the Code of Professional Conduct (NMC,
) that they are ‘personally accountable for ensuring that they promote and protect the
interests and dignity of patients and clients, irrespective of gender age, race, ability, sexuality,
economic status, lifestyle, cultural and religious or political belief’.
The concept of dignity is linked to Article  of the  Human Rights Act, which
emphasises that individual patients should be treated as persons, and that respecting their
wishes and dignity is fundamental to quality care (Woogara, ). Dignity is defined as an
individual’s self-worth (Jacelon, ) and comprises individual and interpersonal attributes.
It is partly imparted by others in the immediate environment but it also exists independently.
There is increased difficulty when dealing with children as you must not only protect
the dignity of the child in his/her present state but also consider the dignity needs of the
individual that child may become (Reed et al, ).
The Essence of Care (DH, a) identifies privacy and dignity as one of nine key areas of
care. Privacy and dignity are also firmly embedded within the National Service Frameworks for
adults and children.
8 Chapter 1 Fundamental concepts for skills

e Evidence-based practice: a Learning activity

perceptions of dignity You have been asked to attend to the
hygiene needs of an -year-old woman
In a study by Walsh and Kowanko () the perceptions of nurses on a mixed gender ward who is not able
and patients with regards to dignity were compared. The results for to go to the bathroom. What would
patients and health professionals had many similarities, including you do to ensure that the privacy and
respect for privacy, not being exposed, not being rushed, having dignity of this lady is maintained?
time to decide, being seen as a an individual and not an object,
consideration for emotions and demonstrating respect.

The health professional should endeavour to maintain the patient’s dignity throughout
the procedure. Dignity needs to be considered throughout the three stages of the procedure:
before, during and after completion.
Before the procedure healthcare professionals should introduce themselves, effectively
communicate the elements of the procedure and offer any choices that may be available
throughout its delivery, such as when and where it should be performed, and whether pain
relief is required. This helps patients feel that their opinions are considered and that they have
some control. The environment should be prepared, taking into account issues of safety and
the age of the patient. Children should be told their parents can be present if they wish, and
play and distraction equipment may need to be assembled.
Dignity is enhanced by ensuring that the patient (or child/family) is made aware that he/
she is the most important person at that moment in time.
Throughout the procedure the patient should be made as comfortable as possible;
effective communication should continue throughout, offering appropriate reassurance.
Every effort should be made to ensure the body is not unnecessarily exposed or violated and
the procedure is carried out in privacy.
After the procedure, communication with the patient continues to be of vital importance.
Allow the patients to ask questions and express any concerns without feeling rushed.
Make sure clothing is replaced appropriately and the patient is happy with his/her physical
appearance before returning to the ward or having the curtains opened.
Privacy is the subject of one of the statements of the  European Convention on Human
Rights and violation of this by healthcare professionals must be avoided. Woogara ()
highlights that respecting privacy is manifested in a multitude of ways, including the right to
enjoy and control personal space and property, the right to confidentiality and the right to
expect treatment with dignity.
Breaches of privacy can easily be avoided during nursing procedures by thorough
preparation of the environment. Violation of privacy can occur when curtains are not shut
properly or when people walk through curtains when procedures are taking place, thereby
putting patients in a vulnerable state (Woogara, ). This can be prevented by clipping
curtains together or by using a ‘do not disturb’ notice. The major area for concern within
the realms of privacy is that of confidentiality. Whilst drawing curtains around a bed can
successfully protect the patient’s personal space, the curtains do not provide a barrier to
sound, and confidential information can easily be overheard. The best environment to
perform procedures is away from the ward area in a treatment room.

Comfort
The meaning of comfort is broad, complex and individualised (Tutton and Seers, ). Siefert
() defines comfort as ‘a state and/or process that is individually defined, multidimensional
and dynamic; it may be temporary or permanent and requires that one’s needs be satisfied in
 Chapter 1 Fundamental concepts for skills 9

the physical, psychological, social, spiritual and/or environmental domains within a specific
context.’
It appears that comforted patients heal faster, cope better, require less analgesia, have
shorter stays and are generally more satisfied with care (Walker, ; Kolcaba and Wilson,
). A patient will be comforted by meeting such needs as alleviation of pain or nausea. The
health professional should try to enable patients to achieve a state of calm or contentment
so they are able to manage pain or problems that cannot be removed. This is particularly
relevant when a painful procedure is performed and discomfort cannot be avoided (Kolcaba
and Wilson, ).
According to Robinson (), discomfort may have number of causes, including fatigue,
loss of appetite, being too hot or too cold, pain, bowel distress, loss of bodily control,
vulnerability, fear, embarrassment, stress or depression.
Comfort needs may be physical, psychospiritual, sociocultural or environmental. The
specific needs within each of these dimensions vary according to the individual and the
procedure to be performed. Concerns about physical comfort need pain control, which
should be assessed and the management of it planned before the procedure commences.
Psychospiritual comfort needs would be met through verbal or physical communication
such as touch. Cultural sensitivity would be addressed to meet the sociocultural needs; this
may also include the need for reassurance. Comfort needs may also include the appropriate
management of odours and maintaining a safe environment.
Patients’ comfort needs must be considered throughout all the stages of a procedure,
taking account of their fears, their need for privacy, confidentiality and safety, and their
physical state. The healthcare professional performing the procedure should help maintain
the patients’ comfort by showing that they are knowledgeable and competent in performing
the procedure and that they have the necessary equipment and facilities available to provide
high-quality care.

Safeguarding
It is essential that all healthcare professionals, whether they are caring for children or adults,
are aware of the need to safeguard their patients/clients. Abuse can occur to individuals of any
age: adults, children, and individuals with mental health problems or learning disabilities. The
perpetrator may be the parent, the partner, the siblings or the individual’s own children. A survey
of  people over  living in their own homes found that . per cent had experienced abuse
or neglect during the previous year. Neglect by partners significantly increased over age , and
O’Keeffe and colleagues () suggest that this may be due to the increasing frailty of both
partners, leading to an inability to continue to provide support for each other (ADSS, ).
The Department of Health (d: –) defines a vulnerable adult as:
a person who is or may be in need of community care by reason of mental or other
disability, age or illness, and who is or may be unable to protect him or herself against
significant harm or exploitation.
All children are considered to be vulnerable, and safeguarding children is the process of
protecting them from abuse or neglect and preventing impairment of their health or
development. Healthcare professionals have a duty to safeguard and promote the welfare of
all children within their care (DH, ).
The healthcare professional must:
• be aware of risk factors and be able to recognise signs of abuse and neglect
• be familiar with the organisation’s policies and procedures for safeguarding
• ensure the referral of concerns to social services or police (after discussion with a senior
colleague)
• document concerns and any related issues
• not promise confidentiality.
10 Chapter 1 Fundamental concepts for skills

When carrying out any procedure on an individual the following topics need to be considered:
• When dealing with a child, assess the parent’s capacity to support and care for the child
during the procedure.
• Implement an individual approach to ensure that the needs of the patient are respected
and provided for. This would include topics discussed earlier in the chapter such as
informed consent, dignity, privacy, comfort and safety.
• Reduce anxiety by effective communication and appropriate support.
• Ensure that the patient is not suffering abuse through the implementation of the
procedure. Ensure that the procedure is necessary and that there is no alternative
treatment.
• Ensure that procedures are carried out competently and efficiently in order to minimise
pain and suffering.
During a procedure factors that might cause concern would include: the reported cause of
injuries sustained not matching the injuries; a pattern of injuries of various ages; repeated visits
to the emergency department or admissions to hospital; worrying behaviour demonstrated
by the patient or the relatives.
It is important to share any concerns with other professionals and appropriate agencies.
The safety of the patient is paramount and any concern should be acted upon swiftly.

Documentation
The importance of record keeping cannot be over emphasised, and for the provision of high-
quality care accurate, complete and up-to-date records are vital (Moloney and Maggs, ).
Good-quality record keeping provides satisfactory communication, allows for continuity of
care and prevents omissions in care provision.
After the completion of all procedures, accurate documentation should be completed to
demonstrate that the duty of care has been fulfilled.
There is no single model for record keeping. The best format is one produced to meet the
needs of the environment and the patient through consultation with the users.
High-quality documentation helps protect the patient by:
• improving communication
• sharing information (in multidisciplinary teams)
• providing an accurate account of treatment/care
• helping detect problems/changes in condition
• promoting high standards of care
• promoting continuity of care.
(Guidelines for records and record keeping – NMC, )
The content and style of healthcare records should be:
• factual, consistent, accurate
• written soon after the event
• providing current information on the care and condition of the patient
• up to date
• written clearly/permanently (and in a form that will be legible when photocopied)
• signed/timed/dated
• alterations – dated, timed, signed
• without the use of:
• abbreviations
• jargon
• meaningless phrases
• irrelevant speculation
• offensive subjective statements
• consecutive – in the correct order and date
 Chapter 1 Fundamental concepts for skills 11

• with clear identification of problems and action taken

• with clear evidence of:
• care planned
• decisions made
• care delivered
• information shared
• written with involvement of the patient/carer
• understandable by the patient/carer.
(Guidelines for records and record keeping – NMC, )

Accountability
Accountability is defined as the obligation to be answerable for your own judgements and
actions (Martin, ). Qualified professionals are personally accountable for their actions
and any omissions in their practice. They must also have the knowledge to be able to justify
their decisions. As a student you should be practising under the supervision of a qualified
practitioner who is professionally responsible for your actions or omissions. However you can
still be called to account by the university or the law in response to your actions or omissions.
You have the responsibility to make your patients aware you are a student, and patients have
the right to refuse to allow you to participate in their care.
There will be times when you are not being directly supervised by a qualified professional.
If an emergency situation occurs at this time you should not participate in any procedure for
which you have not been adequately prepared.

Conclusion
Before commencing any procedure, you should consider the key concepts outlined in this
chapter. The healthcare professional should act as the patient’s advocate, safeguard vulnerable
individuals, and ensure that consent is obtained and the patient’s individual needs for
comfort, privacy and protection of dignity are met whilst providing care. The professionals
are accountable for their actions and should provide a safe environment, adhere to local
and national policies and procedures, and ensure that accurate documentation is made to
ensure continuity of care and patient safety and demonstrate that their duty of care has been
fulfilled.

References
Association of Directors of Social Services (ADSS) () Safeguarding
Adults: A national framework of standards for good practice and
outcomes in adult protection work, London, ADSS.
Aveyard, H. () ‘The requirements for informed consent prior to
nursing care procedures’, Journal of Advanced Nursing (), –.
Aveyard, H. () ‘Implied consent prior to nursing care procedures’,
Journal of Advanced Nursing (), –.
Beauchamp T. L. and Childress J. F. () Principles of Biomedical
Ethics, th edn, Oxford, Oxford University Press.
Beyea, S. () ‘Patient advocacy-nurses keeping patients safe’,
Association of Perioperative Registered Nurses AORN Journal, May,
–.
British Medical Association () Consent, Rights and Choices in
Healthcare for Children and Young People, London, BMJ Books.
Cable, S., Lumsdaine, I. and Semple, M. () ‘Informed consent’,
Nursing Standard (), –.
Callery, P., Neill, S. and Feasey, S. () ‘The evidence base for
children’s nursing practice’, Chapter  in Glasper E. A. and
Richardson, J. (eds), A Textbook of Children’s and Young Peoples
Nursing, Edinburgh, Churchill Livingstone.
Department of Health (DH) () Mental Health Act, London, DH.
DH () An Organisation with a Memory, London, Stationery Office.
DH (a) Essence of Care, London, DH.
DH (b) Good Practice in Consent Implementation Guide: Consent
to examination or treatment, London, DH.
DH (c) Reference Guide to Informed Consent for Examination or
Treatment, London, DH.
DH (d) The Report of the Public Inquiry into Children’s Heart
Surgery at the Bristol Royal Infirmary (–): Learning from
Bristol, London, DH.
DH (e) The Royal Liverpool Children’s Inquiry: Summary and
recommendations, London, Stationery Office.
DH () Model Policy for Consent to Examination or Treatment,
London, DH.
DH () Every Child Matters, London, Stationery Office.
DH () Mental Capacity Act (), London, Department of
Constitutional Affairs.
Dimond, B. () Legal Aspects of Consent, Salisbury, Quay Books.
12 Chapter 1 Fundamental concepts for skills
Dimond, B. () Legal Aspects of Nursing, Harlow, Essex, Pearson
Education.
Directgov () http://www.direct.gov.uk/en/Parents/ParentsRights/
DG_ (accessed  December ).
Dyer, C. () Doctors, Patients and the Law, London, Blackwell
Science.
Family Law Reform Act () S Age of Majority Act (NI), London,
Stationery Office.
Gates, B. () Advocacy: A Nurses Guide, London, Scutari Press.
Gillick v West Norfolk and Wisbech Area Health Authority []  All
ER  (HL).
Harrison, C., Kenny, N. P., Sidareous, M. and Rowell, M. ()
‘Bioethics for clinicians : Involving children in medical decisions’,
Canadian Medical Association Journal (), –.
Hayes () ‘Risk assessment’, pp. – in Glasper, E., McEwing, G.
and Richardson, J. (eds), Oxford Handbook of Children’s and Young
People’s Nursing, Oxford, Oxford University Press.
Jacelon, C. S. () ‘The dignity of elders in an acute care hospital’,
Qualitative Health Research (), –.
Kennedy, I. () Bristol Royal Infirmary Inquiry. Learning from Bristol:
the Report of the Public Inquiry into Children’s Heart Surgery at the
Bristol Royal Infirmary –, London, Stationery Office.
Kennedy, I. and Grubb, A. () Medical Law, rd edn, London,
Butterworth’s.
Kolcaba, K. () ‘Holistic comfort: Operationalizing the construct as
a nurse-sensitive outcome’, Advances in Nursing Science (), –.
Larcher, V. () ‘Consent, competence and confidentiality’, British
Medical Journal, ( February), –.
Mains, E. D. () ‘Concept clarification in professional practice:
dignity’, Journal of Advanced Nursing , –.
Malinowski, A. and Leeseberg Stamler, L. () ‘Comfort: exploration
of the concept in nursing’, Journal of Advanced Nursing , –.
Martin, E. A. () Oxford Dictionary of Nursing, Oxford, Oxford
University Press.
Moloney, R. and Maggs, C. () ‘A systematic review of the
relationships between written manual nursing care planning, record
keeping and patient outcomes’, Journal of Advanced Nursing (),
–.
McHale, I., Fox, M. and Murphy, J. () Healthcare Law Text and
Materials, London, Sweet and Maxwell.
Montgomery, J. () Healthcare Law, nd edn, Oxford, Oxford
University Press.
Nursing and Midwifery Council (NMC) () Code of Professional
Conduct, London, NMC.
NMC () The NMC Code of Conduct: Standards for conduct,
performance and ethics, London, NMC.
O’Keeffe, M., Hills, A., Doyle, M., McCreadie, C., Scholes, S.,
Constantine, R., Tinker, A., Manthorpe, J., Biggs, S. and Erens, B.
() UK Study of Abuse and Neglect of Older People, Prevalence
Survey Report, London, National Centre for Social Research.
Reed, P., Smith, P., Fletcher, M. and Bradding, A. () ‘Promoting the
dignity of the child in hospital’, Nursing ethics (), –.
Robinson, S. () ‘Warmed blankets: an intervention to promote
comfort for elderly hospitalized patients’, Geriatric Nursing ()
–.
Royal College of Nursing () Restraining, Holding Still and
Containing Children and Young People: Guidance for Nursing Staff,
London, Royal College of Nursing.
Siefert, M. L. () ‘Concept analysis of comfort’, Nursing Forum (),
–.
Terry, L. and Campbell, A. () ‘Legal aspects of child healthcare’, pp.
– in Glasper, A. and Richardson, J. A. Textbook of Children’s and
Young People’s Nursing, Edinburgh, Elsevier.
Tutton, E. and Seers, K. () ‘An exploration of the concept of
comfort’, Journal of Clinical Nursing (), –.
Walker, A. C. () ‘Safety and comfort work of nurses glimpsed
through patient narratives’, International Journal of Nursing Practice
(), –.
Walsh, K. and Kowanko, I. () ‘Nurses’ and patients’ perceptions of
dignity’, International Journal of Nursing Practice (), –.
Woogara, I. () ‘Human rights and patients’ privacy in UK
hospitals’, Nursing Ethics (), –.

A alcohol
ABC sequence, 387
ABPI test, 221, 223
abuse, 9
accountability, 7, 11, 81
acid-base balance, 249
acidity of aspirate, 267, 270
action learning, xxii
active learning, xx
activities of daily living, aids
for, 213
acute haemolytic transfusion
reaction (AHTR), 365
Adams, N., 41
admission to hospital
as an emergency, 210, 329
obtaining information
before and during, 49,
175
adolescents
communication with, 28–35
definition, 29
unhappiness of, 30
adverse events in healthcare,
6, 359
see also infection
adverse reactions to blood
transfusion, 364–5, 368
age
and consent, 401, 403
old see older people
see also adolescents,
children, infants
aggression, 23, 30–1, 59, 212
and anger, 70
and breakaway skills, 68–75
agonal breathing, 392–3
aids for daily living, 213
airway
diseases, 384
maintaining clear, 378–91
opening, 387–9, 393, 395
Index
dependency problems, 66
as disinfectant, 350
rubs, 321
allergies, 343
to latex, 254
reaction to blood
transfusion, 365
to soya protein, 285
see also anaphylaxis
alternative and
complementary therapies,
63, 214–15
Alzheimer’s disease, 210
ambulatory pumps, 252–3
amputees/amputations, 130,
135, 220
anaesthetic
gel, 123, 254
ice as, 302
for injection sites, 301–2
analgesia see drugs for pain
relief
anaphylaxis, 257–8, 365, 396–7
anger, 70
ankle brachial pressure index
see ABPI
anti-emboli stockings, 94
anti-reflux valve, 315
antibiotics, 139
antiseptic agents, 350
anxiety, 36–46
and communication, 32
definition, 40
management/reduction of,
10, 40–5
two forms, 38
appearance
appropriate clothing, 71, 72
(see also clothing)
impact of, 24, 71–2
appendicitis, 209
Armitage, G., 401
aromatherapy, 63, 214
arterial ulcers, 327
arteries, the main, 222
arthritis, 129, 208, 213
rheumatoid, 90, 213
asepsis, principles of, 336
aseptic technique, 102, 254,
277, 336–8, 349, 353
aspirate, gastric
acidity of, 270
colour of, 271
difficulty in obtaining, 271
assent, 5 (see also consent)
assertive
behaviour, 23, 31
communication model,
22–3
assessment
of capacity to consent, 4
of continence, 125
of current health status,
93–4
of feet, 129–30, 219–31
of hydration, 235–44
neurological, 185–94
nutritional, 95
oral, 110–11
of pain in children, 195–206
skills, 214
of wounds, 98
asthma, 293–4, 307, 371, 384
Atkinson, L., 315
Aubaniac, R., 247
autistic spectrum disorders,
48, 52
autologous blood donation,
368–9
avoidance, 31, 39
AVPU, 186–9
441
B
babies see infants
back pain, 208
bacteraemia, 115
bacteriuria, 115
Barness, L. A., 283
Barnett, M., 421
bathing patients, 82–4
bathing infants, 143–5
bed baths, 81–4
and skin inspections, 94
sponge baths for infants,
142
baths, 81–4
bed
linen changing, 84
behaviour
as indicator of pain, 199, 200
coping strategies for pain,
203
types of, 22–3, 30–1
bereavement, 426
Bergstrom score, 91
Biggs, S., 9
bilirubin, 272
Blackboard, xxv
blanching hyperaemia, 92
blood
alternative surgical
therapies, 368–9
anatomy and physiology of
pressure, 165–6
autologous donation of, 366
circulating volume, 242, 358
circulation system, 222, 251
composition, 358
flow to feet, 222–3
groups, 360
infections, 348
measuring pressure, 166–9,
223
oxygen in, 174–5 (see also
442 Index
pulse oximetry)
pH value, 249
prescriptions, 362
pressure, 164–71, 221
processing catheters, 347–8
products, 250, 361
storage, 362
sugar measurement/control,
180–4, 228, 239
taking samples, 183, 353–4,
362
therapies, 366–7
transfusion, 210, 357–69
Blood Safety and Quality
Regulations 2005, 359
Blundell, James, 358
blunting strategy, 39
body bag, 425
body language, 22–4, 30, 48–9
see also communication,
face
body mass index (BMI), 95
bolus dose, 313
bottle feeding, 283–8
Boyd, H. F., 40
bradycardia, 384
bradypnea, 161
breakaway skills, 68–75
breastfeeding, 283, 284, 288
breathing see respiration
Briggs, J., 338
British Dietetic Association,
285
British Hypertension Society,
170
British Medical Association
(BMA), 4
British Sign Language (BSL),
49, 50
British Thoracic Society, 371
Brooker, C., 253
Broviac catheters, 252
Brown, M. J., 170
Brown, S. J., 417
Bryant, R. A., 93
Buerger’s test, 224
C Children Act (1989), 401
callouses and corns, 229
calming techniques, 71, 141
cancer, xxv–xxvi, 25, 208, 213
cannulae, 251, 253
changing and removal, 257
insertion of, 254–5
nasal, 373–4
capacity, to give consent, 3–4
capillary refill time, 239
Capsicum cream, 228
carbon dioxide narcosis, 372
cardiorespiratory arrest,
384–5, 391
cardiovascular disease, 170,
347
care
in the community, xxvi
post intervention, 404–5
pre intervention, 403–4
care plans, 26, 342, 404
Carlowe, J., 30
Carroll, D., 61
case studies, use of, xx
catheterisation and catheter
care, 114–26, 240
bag emptying, 124–5
central venous catheters,
252, 345–56
connecting or changing
infusion set, 351, 355
equipment, 117–19, 350–1,
353
female catheterisation,
123–4
flushing catheters, 350–1
indwelling catheter, 115
insertion site, 346
for intravenous infusion,
251, 252
peripherally inserted central,
252, 346
problems with, 120–1, 352
reasons for catheterisation,
116, 347
removal procedure, 122
site monitoring, 349–50
sizes, 348, 377
for suctioning, 378–80
supports, 118
types of, 346–8
urine specimen using, 124
Cavilon, 339
cell salvage, 366
central venous pressure, 347
Chabner, B. A., 60, 63
Charriere size, 117
chemicals, risks of, 7
chest compressions
in adults, 394–5
in children, 386–9
Children (Northern Ireland)
Order (1995), 401
children
basic life support for, 383–9
care of by family members,
56
consent to treatment, 3,
4–5, 403
definition of, 401
development of, 29–30
enteral feeding procedure,
267–70
experience and assessment
of pain, 195–206
needing enteral feeding, 264
phrasing questions to, 190
preparation for stressful
healthcare encounters,
43
scenarios involving, 34,
56–7, 181, 292, 329, 332,
376, 405
using sign language with,
47–54
vulnerability of, 9
wound healing in, 335
wounds of, 334–44
see also adolescents, infants
chlorohexidine, 112–13
chronic obstructive
pulmonary disease
(COPD), 371–2
pain, 213–15
wounds, 327, 328
chronoemics, 24
Chung, F., 315
circulatory failure, 384
Clarke, M., 257
‘Cleanliness Champions’, 324
client-focused approach, xx
clients see patients
clinical holding, 399–406
clothing
appropriate for healthcare
professionals, 72, 80
footwear see footwear
protective see protective
clothing
uniforms, 80
cognitive appraisal, 199
collar and cuff, 408, 410
colloid solutions, 250, 255
comfort of patients, 8–9, 96,
120, 146, 203, 217, 302,
422
see also pain, management
of
communication
with patients, 8, 15–27
with adolescents, 28–35
analogical, 30
assertive model, 22–3
barriers to, 21, 32–3, 59, 264
by children, 29–30
conscious and unconscious,
competent and
incompetent, 19
definition, 18
digital, 30
during procedures, 404
effects of good and poor, 20
guidelines for effective, 33
location for, 58, 60
methods, 21, 48–53
with non-English speakers,
43, 217
non-verbal, 22, 24–5, 30,
48–53, 198, 210–11
about pain, 198, 210–11, 214
pitfalls in, 33
reasons for, 20, 48
relational, 30
of significant news, 55–67
skills for, 15–27
on specimen collection, 432
time needed for, 20–1, 32,
48, 53, 58, 61
total communication, 49
verbal, 30
within multiprofessional
teams, 25–6
compassion, showing, 61
competence, 19
confidentiality, 8, 34, 427
and abuse, 9
conflict management, 68–75
consciousness, assessment of
level, 188–94
Consent and Capacity
Assessment, 401
consent to treatment, 2–6, 94,
297–300, 342, 434
age of, 403
capacity to give, 3–4
and clinical holding, 400–1
consult family or others, 21
in an emergency, 5–6
express, 3
and Gillick competence,
4–5, 33
how to request, 188
to hygienic care, 81, 82
implied, 3
incapacity to give, 4
informed, 81, 254, 264, 380
to monitoring vital signs,
154
refusal of, 402, 403
responsibility for gaining, 6
tacit, 3
validity, 2–3
voluntary, 3
withdrawal of, 6
written, 3
consent
Constantine, R., 9
constipation, 120, 125
contraception, 5
control, patient’s need for, 41
Cooke, H., 427
Cooper, J., 423
coping strategies, 38–45, 197
for pain, 203, 214
problem-focused, 41–2
and stress, 38–9
 Index 443

coping style, 37, 39 discomfort, causes of, 9 303–4 for blood glucose
cost see also comfort eating disorders, 30 monitoring, 182–3
of adverse healthcare distraction strategy, 197, education of patients see for catheterisation, 117–19,
events, 6 203, 302, 341, 404 information 240, 350–1, 353
of healthcare associated documentation, 10–11, 22, 342 education of staff see training for diabetic foot assessment,
infection (HAI), 319 on blood transfusion, 367–8 Egberts, A. C. G., 295 220, 224–6
of pressure ulcer care, 89 on catherisation, 121 Eisenberg, P., 273 disposable, 132
counselling, 63 content of, 10–11 Eland colour scale, 200–1 for enteral feeding, 265–7,
techniques of, 65 of interventions, 402 elderly, the see older people 274
CRIES, 199–200 on intravenous therapy, 255, electrolytes, 248 for eye care, 102, 146
Crystal, D., 51 260 ELIOT, 425 for feeding infants, 286
crystalloid solutions, 249, 255 of last offices, 428 Ellet, M. L., 273 for foot care, 132
cultural issues, 204 patient records, 256 Ellison, N. M., 62 and health and safety, 7
Curtis, A. J., 43, 45 of specimens, 433 email, use of, xxv for humidification, 375–6
Cusell, M. B. I., 295 values of good, 10 emergencies for injecting drugs, 297–300
Cutter, J., 157 of wound assessment, 331 and consent, 5–6 for intravenous delivery,
cuts, in cutting toenails, 136 donation of tissue, 427 hospital admissions, 204 250–4, 364
cyanosis, 175, 269 Doppler device, 221–3 EMLA, 301 for measuring blood
Doyle, M., 9 emotion pressure, 166–9
D dressings difficulty in handling, 59 for mouth care, 110
Dallas, J., 22 for catheter sites, 349–50 emotional support, need for neurological assessment,
Davis, M., 170 changing, 432 for, 58 186
day centres, 213 choice of, 338–40 focused coping strategies, orthopaedic, 404–18
deaf people, 49–51 hydrocolloid, 272, 339 38–9, 40, 44–5 for oxygen therapy, 371–3
death securing and removal, 340–1 empathy, 62, 64–5, 71 for patient–controlled
care during and after, see also wound endorphins, 43 analgesia, 314–15
424–30 drug(s) enemas, 297 for pulse oximetry, 174–8
causes of, 115, 348, 366, 372, administered via a enquiry-based learning, xxii for suctioning, 379–81
385, 391 nasogastric tube, 275 enteral feeding, 262–80 for taking blood, 353
discussion of, 62 administration errors, 256, and drug administration, for umbilical cord care, 143
verification and certification, 264 295–6 Erens, B., 9
426 administration guidelines, equipment for, 265–7, 274, errors in drug administration,
deep reflex testing, 227–8 256 276 256, 264
defibrillator, 389 administration routes, via gastrostomy, 275–9 erythropoetin, 366
dehydration, 236–7, 239 290–317, 354 (see procedure for administering Essence of Care, 7, 20, 90
dementia, 20, 210, 236 also intravenous feed, 274–5, 278 ethical issues, 399–401
denial, 61 administration) procedure for passing tube, see also consent
Department of Health for anaphylaxis, 397 267–70 European Convention on
definitions, 9 complications with, 316 environment Human Rights, 8
policy on bereavement concern about taking, for breaking significant European Convention on the
services, 426 211–12 news, 56, 58, 60 Rights of the Child, 401
policy on end of life, 426 crushing tablets, 295–6 environmental cleaning, 323 European Pressure Ulcer
depression, 63 dose calculations, 252, 255, needed to ensure privacy, 8 Advisory Panel (EPUAP),
and chronic pain, 214 260, 291–4, 308 preparation of for 90, 93, 94
diabetes, 41, 85, 129–30, 136, injected, 297–303 interventions, 404 exercise, role in reducing
181, 224, 343 intravenous administration, epidural pumps, 252 stress, 43–5
diabetic foot assessment, 250–9, 347, 354–5 epilepsy, 34 extension, 190
219–31 irritant, 302 equipment extravasation, 259
diabetic ulcers, 327 in liquid form, 264, 275 for administering ear drops, eye
treatment of diabetic nebulised, 306 303 care, 85, 100–7
peripheral neuropathy, oral, 294–6 for administering eye care for infants, 145–6
228–31 oxygen as, 372 medication, 304 contact, 23, 65, 71
diarrhoea and vomiting, 236 for pain relief, 197–8, 204, for administering nasal drops, 105–6, 193, 304–5
Dias, L., 60, 63 209, 211–14, 302, medication, 305 irrigation, 104
dieticians, 274, 283 310–17 for administering oral movements and
see also nutrition rectal, 296–7 medicines, 295 communication, 24
diffusion, 248 topical, 307 for administering topical ointment, 105–6, 304–5
dignity of patients, 7–8, 81, 94, dry gangrene, 143 medication, 307 opening assessment, 189
426, 434 for aseptic technique, 337 pointing, 49
discharge from care, 26 E for bathing patients, 82, 142, pupil assessment, 186,
delayed, 60 ear drops, administering, 144 192–3
444 Index
sight problems, 130
swabs, 432
F percentage in body, 237
face, expression and
communication, 19, 24
FACES scale for pain
assessment, 199–200, 217
faeces specimen, 439
falls, 90, 125, 130, 186, 328, 329,
409, 411, 419
family of patients
advising on communication
needs, 21
assessing children’s pain,
198–9, 204
assisting with last offices,
429
bereavement support, 425
family–centred care, 199
informing of bad news, 63
involved in children’s care,
33–4, 35, 41–2, 50, 204,
338, 342, 400–1, 404
patient’s response to, 189
wish to exclude, 34
family of healthcare
professionals, impact of
experience, 59
Family Law Reform Act (1969),
4 Glasgow coma scale (GCS),
finger pressure test, 191
finger probes, 177–8
first aid, 229, 343
basic life support for adults
390–8
basic life support for
children, 383–9
diabetic foot care, 229
Fitness for Practice, xxii
FLACC scale, 199
flexion, 190
flow meters, 378
fluid
assessing and managing
hydration, 235–44
balance chart, 125, 240–2,
252, 259
balance monitoring, 259–60
compartments, 247
extracellular, 247
feeds see enteral feeding,
milk, nutrition
hypertonic, 249, 253
hypotonic, 249
intake and output, 237–8
intake and output
measurement, 239–41
intracellular, 248
intravenous administration,
125, 242, 246, 253, 347
(see also intravenous
delivery) Hickman lines, 252, 346, 347
isotonic, 249 Hills, A., 9
Hodgen, L. A., 52
types of intravenous, 249 hoists, 82
see also urine, water Hollinworth, H., 340
Foley catheter, 115 Holmes, S., 413
Folkman, S., 38, 40 homeostasis, 247, 248
food see nutrition hope, need for, 63
foot hormones, stress, 40
care, 85, 127–37, 228–30 human immunodeficiency
characteristics of healthy, virus (HIV). 319, 359, 394
128–9 Human Rights Act (1998), 7,
common problems, 129 34, 401
diabetic foot assessment, humidification, 376–8
219–31 hydration see fluid
footwear, 129, 228, 230–1 hydrogel, 340
ischaemic, 221 hygiene, environmental, 323
Forshaw, M., 43 hygiene, patient, 79–86
Forssmann, Werner, 247 of feet, 131–2, 228–9
fractures, 20, 210, 378–9, 412, of hands see hand washing
419, 422 and hygiene
Franks, P. J., 340 with limb injuries, 410
of skeletal pin sites, 418
G see also eye care, mouth care
gastrostomy, 275–9 hygiene promotions, 323–4
Gavaghan, S., 61 hygiene, staff, 80
General Adaptation Model, 40 hyperaemia, 92
Gillick case on capacity to assessing skin for, 94
consent, 4–5, 403 hyperglycaemia, 181
hypertension, 170
186–9 hyperthermia, 155
Glasper, E. A., xxiii hypoglycaemia, 181
gloves, use of, 254, 294, 321–2 hypontraemia, 249–50
glucose levels, 180–4 hypotensium, 170
Guggenbuhl-Craig, A., 62 hypothermia, 155
guided imagery, 45 hypoxaemia, 173, 371, 379, 381
guilt, about smoking, 63 hypoxia, 175, 372, 381
H I
haemovigilance, 359 immobilisation, 401
hair, care of, 85, 144 immune antibodies, 360
halitosis, 109 Improving Working Lives, 23
hand washing and hygiene, incontinence, 240
294, 319–21, 336–7 and foot care, 132
Handoll, H. H. G., 418 lesions, 93
haptics, 24 nappy changing in infants,
Hardy, M., 401 140–1
head box, 375–6 infants
head injury, 186 basic life support for, 388
headaches, 208 care of, 138–49
health and safety, 6–7 definition of, 139
Healthcare Associated difficulties in enteral
Infections, 324 feeding, 272
see also infection enteral feeding routes, 264
healthcare sector, changes in, hydration in, 236–44
xxv–xxvi intravenous therapy for, 256
heart premature, 372
disease, 213 preparation of feeds, 281–9
rate, factors that affect, 159 scenarios involving, 129,
rate, regulation of, 159–61 236–8
hepatitis, 359 use of head box with, 375–6
see also children
infection
and catheters, 115, 120,
347–53
control and equipment,
132, 145, 157, 183, 223,
240, 256, 336–8 (see
also aseptic technique,
standard precautions)
control when a patient is
cut, 136
healthcare-associated, 319
and intravenous delivery,
257–9, 348, 352–3
and reuse of equipment, 132
risk with rescue breathing,
394
skeletal pin site, 417, 419
universal precautions
against, 318–25
in wounds, 343–4
infiltration, 259
information from clients, 237
information to clients
breaking significant news,
55–67
about catheterisation, 121,
349
and consent, 3
for diabetics, 228
enhancing coping skills,
42–3
first aid, 229
about patient-controlled
analgesia, 311–12
wearing casts, 416
withholding, 63
see also communication
infusion pumps, 256
injections, 297–303
pain-minimising technique,
302–3
see also needles
International Consensus
on Cardiopulmonary
Resuscitation
and Emergency
Cardiovascular Care
Science with Treatment
Recommendations
(CoSTR), 391
intermittent claudication, 221
intramuscular injection,
299–301
intraosseous infusion, 253
intravenous delivery, 245–61,
345–56
of blood transfusions, 363
care of patients with, 255–6
complications of, 255–9
dangers of errors, 264–5
 Index
of drugs, 246, 250, 264–5,
354–5
equipment for, 250–4, 364
flow rate calculations, 256–7
of fluids, 125, 242, 246, 347
long-term, 253
methods of infusion, 250
procedure, 253–5
types of fluid, 249
uses of, 247
see also catheters, enteral
nutrition
introjection, 64
intubation, 267–70
iron, dietary, 284, 367
ischaemia, 221
J immobility, risk of, 411
jaw angle pressure, 191
Joehnson, G. O., 40
Johnson, G. R., 425
Jung, C., 64
K linen, disposal/laundering of,
Kaitell, C. A., xxii, xxiii
Keen, M. F., 302
Kelly, J., 93
key skills, 18
of communication, 33
Khanna, S., 315
Kiger, A., 423
kinesics, 24
King, L., 302
Klasner, A. E., 269
Korotkoff sounds, 169
Kowanko, I., 8
L malnutrition universal
La Montagne, L., 39
laboratory request form, 433
Landsteiner, Karl, 358–9
language
for communication with
patients, 61, 62
culture, 32
development of, 29–30
and educational level, 32
other than English, 43, 61
sign language, 47–54
trends in usage, 32
Larcher, V., 5
Larson, E. B., 62
last offices, 422–8
latex allergy, 254
Lazarus, R. S., 38, 40
learning
approaches, xx–xxii
groups, xx, xxii, xxv
lifelong, xxv
process, xxiii–xxvi
learning difficulties/disabilities,
21, 48, 69
signing system for those
with, 50
legal issues
aggressive patients, 74
and death, 425–6
restraint, use of, 401–3
threats of legal action, 22
see also consent to
treatment
Levett, L. M., 49
life support procedures
for adults, 390–8
for children, 382–9
in hospital, 397–8
limbs
assessment of, 412
and motor response, 190
orthopaedic procedures,
407–23
strength and movement
assessment, 186, 193–4
322–3
listening skills, 33, 71, 215
location see environment
lockout period, 312–13
locus of control, 39–40
Long, T., 425
Love, C., 407, 420
Luke, D. A., 269
Lynch Jr, T. J., 60, 63
M see also clinical holding
Makaton, 49–51
malnutrition, 95, 263
screening tool see MUST
Management of Health
and Safety at Work
Regulations 1999, 6
manipulative behaviour, 22–3
Manthorpe, J., 9
manual handling see moving
and handling
mask, use of, 306, 374–5, 396
massage, 63, 214
McCaffery, M., 209–10, 211
McCreadie, C., 9
McEnry, T., 32
McGuinness, P., 403
McInnes, G. T., 170
McMaster University, xx
Medder, K. D., xxiii
medicine see drugs
Medicines and Healthcare
Products Regulatory
Agency (MHRA), 7, 359
meditation, 45
Mental Capacity Act (2005),
3, 4
Mental Health Act (1983), 4
mentors, consulting, 52–3, 60,
72, 242, 426–7
Mepilex, 340
Mepitel, 339
mercury, 167
Metheny, N. A., 271, 273
milk, for infants, 283–5
see also nutrition
mindfulness meditation, 45
mobile phones, 34
mobility and pressure ulcer
formation, 95
Moffatt, C. J., 340
Money-Kyrle, R., 65
monitoring
of blood transfusion, 363
circulation in injured limbs,
410–12
strategy, 39
monofilament, 224–5
Morales-Mann, E. T., xxii, xxiii
morgue, the, 429
motor response, 189, 190
mouth care, 108–13, 243
for infants, 146–8
mouthwashes, 112–13
movement of substances
within the body, 248–9
moving and handling, 7, 422,
425
effect on skin, 89
infants, 239
multiple sclerosis, 116
multiprofessional team
members of, 25
working, 25
MUST, 95
Myles, P. S., 314
N of the foot, 224–8
nail
anatomy terms, 133
care, 85
care of toenails, 131–6,
228–9
healthy toenails, 128
ingrowing toenails, 130
involuted toenails, 135
possible damage by painful
stimulus, 191
nappy
changing in infants, 140–1
measuring urine from, 240
rash, 141
narcotics, 197
see also drugs
nasal
administration of medicines,
445
295–6, 315
cannulae, 373–4
medications, 305–6
suctioning, 379–81
swabs, 435
nasogastric tube, 266–75
medicines administered via,
295–6
National Audit of Paediatric
Resuscitation, 385
National Blood Transfusion
Service, 359
National Confidential Enquiry
into Patient Outcome and
Death (NCEPOD), 175
National Institute for Clinical
Excellence (NICE), 90, 175,
263, 319, 337
National Patient Safety Agency
(NPSA), 264–5, 270–2,
392
National Service Framework
for Children and Young
People, 29, 34
naxolone, 316
nebulisers, 306–7
needle(s)
disposal of, 298
fear of, 41, 301
needle-free catherisation,
351
needlestick injuries, 255,
298, 303
and syringe infusion, 251
see also injections
Neocate, 285
neonates see infants
nervous system, 159
assessment of, 185–94
neurological assessment,
185–94
chart, 187–8
neuropathy, 220, 224
treatment of diabetic
peripheral, 228–31
types of, 224
neurothesiometer, 226
neurotip, 226
news, breaking significant,
55–67
Nightingale, Florence, xxi
non-aversive defensive
interventions, 68–75
non-blanching hyperaemia, 92
noradrenaline, 40
Norton score, 91
nose see nasal
noxious stimuli, 190–1
nurses
children’s, xxiii, 337–8
446 Index
training in intravenous
therapy, 253–4
nutrition support, 263
Nursing and Midwifery
Council (NMC), xxi, xxiii,
2, 3, 343
Code of Conduct, 6, 7, 20,
254
guidelines, 10, 256
nutrition
enteral feeding, 262–80
feeds for infants, 281–9
nutritional assessment, 95
and pressure ulcers, 95
weight loss and, 93
and wound healing, 343
O rest pains, 221
O’Keeffe, M., 9
obesity, xxv, 56
object-based communication,
52
occulesics, 24
occupational therapists, 242
oedema, 221
older people, 9
drinks for, 242–3
pain experiences, 209–10
scenarios involving, 26, 90,
109, 125, 131, 210–11,
236–8, 266–7, 419
olfactics, 24
omphalitis, 139
Ophorst, W. R., 295
ophthalmia, 145
opiods, effect of, 316
oral see mouth
oropharangeal suction, 378–81
orthopaedic procedures,
407–22
osmosis, 248
Overbeeke, P. W., 295
oximeters, 174–8
oximetry see pulse oximetry,
transcutaneous oximetry
oxygen
delivery methods, 373–6
in expired breath, 395
properties of, 371
requirements, 371
saturation level, 172–9, 239,
372, 393
therapy, 370–82, 396
P growth of infants, 283
Paget Gorman system, 49
pain
acute and chronic, 212–14
assessment in adults,
207–18
assessment in children,
195–206
assessment tools, 199–202,
216–17, 341
and catheters, 120
and dressing removal, 340–1
effects of, 196
frequency of experience, 208
history, 204
and injections, 301–3
and invasive procedures, 401
localisation to, 190
management of, 9, 196–7,
214–15, 310–17, 341
myths, 197
psychological, 196
relief, 20 (see also under
drugs)
stimuli, 186, 190–1
types of, 209, 213
palpation, 221
paracetamol, 156
paralanguage, 24
parental responsibility, 5
parents of patients see family
parenteral fluids, 252
Parker, M. J., 421
Pasero, C., 211
passive behaviour, 22
patient-controlled analgesia,
310–17
patient history, 328, 432
patients, difficult/unpopular,
212, 214
Payne, S., 423
Pearce, E., 431
Peate, I., 24
peer pressure, 33
Penson, R. T., 60, 63
percutaneous endoscopic
gastrostomy (PEG), 276
perineal care, 84–5
personality
and anxiety, 38
pH indication paper, 267
pharmaceuticals see drugs
phlebitis, 257, 258–9, 350
photophobia, 193
physiology/physiological
aspects of blood circulation,
165–6
aspects of bodily fluids,
247–9
effects of stress, 40
indicators of pain, 199
Picture Exchange
Communication System
(PECS), 49–50
pinch test, 238
plaster casts, 410–14
Platt, C., 338
play, therapeutic, 43
POAD, 221
podiatrics, 85, 127–37
port
for central venous catheters,
346, 351
for enteral feeding, 265
implantable, 347
for intravenous infusion,
252, 347
Portenoy, R. K., 210
position
for applying slings, 409, 410,
411
holding and stress points,
404
for an injection, 302
recovery, 385, 391, 394
for traction, 420–2
during venepuncture, 405
see also clinical holding,
restraint techniques
post-mortem, 426–7, 428
post-transfusion purpura
(PTP), 365
Poster, E. C., 44
posters, 23
Potter, J. F., 170
Potter, R G., 214
Poulter, N. R., 170
Powell. G., 51
power struggles, avoiding,
72–3
Pratt, R .J., 346, 348
pregnancy, 57, 65, 360
pressure area care, 87–99
pressure-relieving equipment,
94, 95–6
pressure ulcers, 88–98, 223,
327
assessment tools, 91–2, 94
definition, 88
grading of, 97–8
guidance on, 89–90
healing of, 98
incidence of, 89
risk assessment procedure,
93–4
privacy issues, 7–8, 81–4, 94,
329, 418
probes, 177–8
problem-based learning, xxii
problem-focused coping
strategies, 38, 41–2
proprioception, 227
Protecting Patients and Staff,
324
protective/disposable
clothing, 319, 322, 435
barriers for rescue breathing,
394–5
gloves see gloves
see also clothing; mask, use
of
proxemics, 24
psychotherapy, 63
Ptacek, J. T., 62
pulse, 159–61
normal rate, 159
oximetry, 172–9, 376
pedal, 220–3
rhythm and amplitude,
159–60
taking, 160–1, 387–9
pulseless electrical activity
(PEA), 385
pumps for infusion, 252–3, 368
PVD, 221
Q
QUESTT, 341
R
Randle, J., 267
reactive hyperaemia, 92
recovery position, 387, 393,
396
rectal administration of drugs,
296–7
referral
to police, 9
to social services, 9
reflective cycle, xxi
learning, 20
reflexes, testing of, 227–8
reflexology, 63, 214
Reik, T., 64
relaxation techniques, 44–5,
302
need to appear relaxed, 71
strategy to handle pain, 203,
217
religious issues, 9, 426–7
Rennie-Meyer, K., 255
rescue breaths, 385–7, 392–5
reluctance to perform, 394,
395–6
Resuscitation Council (UK),
386, 391
respiration
assessment of, 393
factors that affect, 161–2
normal rate, 161
problems and feeding, 264
regulation of, 371
respiratory arrest, 381, 384
respiratory distress, 352
taking measurements, 162,
239
restraint techniques, 69, 400–5
retinopathy, 372
 Index
Reynolds, L., 315
Rhem, J., xxii
rights, human
and consent, 2, 401
risk
of aggressive patients, 73
assessment and patient
safety, 6–7
assessment and staff safety,
81
assessment form, 7
in blood transfusion, 359
of central venous catheters,
348
of developing pressure
ulcers, 90–1, 93–4
five steps to assessment, 6–7
in handling corpses, 427
of oxygen therapy, 372–3
in rescue breathing, 392
and safety issues in
performing life support,
392–3
Robinson, S., 9
Roger, M. A., 302
Rotter, J. B., 39–40
Royal College of Nursing
(RCN)
campaigns, 324
code of professional
practice, 254
guidance, 89–90, 96, 321–2
Ryan-Wenger, N. M., 39
S see also hand washing,
SABRE, 359
safeguarding patients, 9–10
safety
of healthcare professionals,
73, 74
of patients, 6–7
in performing life support,
392
see also risk
Sainsbury Centre for Mental
Health, 73
saline, 249
Santy, J., 415
Scalzo, A. J., 269
Schenker, S., 263
Scholes, S., 9
SCRT, 221, 223
self-administration of
analgesia, 310–17
self-catheterisation,
intermittent, 116
self-esteem, 71, 72–3
self-harm, 30
self-reporting, 198, 204
self-talk, 45
Selye, H., 40
sensation, assessing, 194
sensory loss with diabetes,
224–5
Sever, P. S., 170
sharp and blunt discrimination
test, 226
shaving patients, 85–6
SHOT, 359, 364, 366
Siefert, M. L., 8
sign language, 47–54
Signalong, 49–50
skeletal pins, 416–19
skills
and competencies, xx
coping, 43
key, 18
transferable, 19
skin
care, 96
effect of forces on, 89
of feet, 129–30, 229
grafts, 339
hyperaemic response, 94
of infants, 140
infections, 277
inspection, 92–3
lesions, 93, 96
medication, 307–8
problems, 298 (see also
ulcers)
protection of, 272
traction, 419–22
and transdermal
medication, 315
wound
slings, 408–11
smoking, xxv, 63
Smythe, E. T. M., 348
social skills, xxiii
Society of Orthopaedic
Nursing, 412
socioeconomic issues, 32
sodium chloride, 113, 249
sodium levels in bodily fluid,
248
soya, 284–5
specimen collection, 431–40
speedshock, 258
sphygmomanometer, 166–8,
203
Spies, M., 273
spiritual needs, 9, 426–7
sputum specimen, 439
Sque, M., 423
stance, towards aggressors, 74
standard precautions, 294,
318–25, 433
state anxiety, 38
Steele, D. K., xxiii
sterilisation, 286, 337
sternal rub, 191
steroids, 343
stoma site, 276–7
stomach pains, 208
stress, xxv, 37–8
in adolescents, 30
in caring for the dying, 425
caused by invasive
procedures, 301
coping strategies, 38–9
definition of, 37
in frightening situations, 70
hormone, 40
immunisation techniques,
43–5
model of, 37–8
physical effects of, 40
response factors, 37
and taking in information,
60–1
stroke, 109
student-centred learning
(SCL), xx–xxiii
subcapillary plexus refill time
(SCRT), 221, 223
subcutaneous
influsion, 253
injections, 298–9
submissive behaviour, 31
suction therapy, 370–82
potential complications, 381
sugar see blood sugar
Sully, P., 22
superbugs, xxv
support, need for emotional,
71, 425–6
supra-orbital pressure, 191
swaddling infants, 141
symbols, use to communicate,
51
syringes, 265, 297
for blood samples, 354
design and colour, 265
driver, 364
for measuring liquid drugs,
275
size of, 267
technique, 302–3
syringe pumps, 252
T (TAGvHD), 365, 366
tachycardia, 159
tachypnea, 161
talcum powder, 145
tape damage, 96
teeth, cleaning, 110, 111–12
for infants, 146–8
telangectosis, 221
temperature
abnormal, 155
of baths, 228
447
for blood storage, 362, 431
bodily regulation of, 154–5
factors that affect, 156, 158
and pain relief, 214
for specimens, 433, 437
taking, 157–8, 239
testing of feet, 227
Temple, J., 415
tetanus, 328, 332
thermometers, 156–7
Thom, S., 170
thought-stopping, 39, 45
throat swab, 433
time
boundaries, setting, 61
of day and blood pressure,
170
of day and drug
administration, 295
of day and temperature, 158
needed to break significant
news, 58
needed to communicate,
20–1, 32, 48, 53, 58, 61
needed to show respect, 8
Tinker, A., 9
tissue donation, 427
titration, 312
total communication, 49
touch
communication via, 24, 65
testing of feet, 227
used in assessments, 94
tracheostomy, 376
traction, 417–20
training
in avoidance of personal
violence, 69–70
on blood transfusion, 366
on foot care, 131
on hygiene, 323–4
on nutrition, 263
transcutaneous oximetry, 224
transdermal patient-controlled
analgesia, 315
transfusion associated
circulatory overload
(TACO), 365
transfusion associated graft
versus host disease
transfusion related acute lung
injury (TRALI), 365, 366
transmucosal patient-
controlled analgesia, 315
trapezius muscle squeeze, 191
treatment options, 62
Trommelen, M., 295
tuning fork, 226
Turner, P., xxiii
448 Index
U verbal response, 188–90
ulcers
foot, 220, 223
pressure see pressure ulcers
types of, 327
ultrasonic gel, 221, 224
ultrasound, 346
umbilical cord, 139–40
care of, 143
undernutrition, 263
uniforms, wearing, 80
see also clothing
urimeter, 118
urinary tract infection, 115–16
urine
catheter specimen, 124, 436
measurement of, 240
specimens, 437–8
urinary catheter see catheter
see also fluid, nappy
universal precautions see
standard precautions
urticaria, 364
V patients and analgesia, 313
vaccination, 293
van den Bemt, P. M. L. A., 295
van Dooren, D., 295
vascular assessment, 220–4
venepuncture, 41, 254, 322,
405
venous ulcers, 327
vibration sensation testing,
225–6
vigilance, 39
Viscusi, E. R., 315
visual analogue scale, 200,
216–17
visual schedules, 52
vital signs, 153–63, 186, 191,
203, 239, 368
see also pulse, respiration,
temperature
vocabulary
of adolescents, 32
development of personal, 61
to describe pain, 202, 208,
216
for diabetic foot assessment,
221
vomiting and diarrhoea, 236
vulnerable
adults, 9, 239
children, 9, 239
dementia patients, 211, 239
Vuolo, J. C., 338
W World Health Organization,
Walker, J. A., 415
Walsh, K., 8
waste disposal, 81, 83, 84, 132,
142, 183–4, 298, 303, 322
water
for cleaning wounds, 338
humidification, 376–7
for making up infant feeds,
287
movement in the body, 248
percentage of bodily, 237
see also fluid
Waterlow score, 91–2
weaning, 288–9
WebCT, xxv
website, companion to book,
xxiv
weight units/conversions,
291–2
Welsh Assembly, 324
wheelchairs, 94
‘whoosh’ test, 271
Wiener, A. S., 358–9
Williams, B., 170
Winning Ways, 324
withdrawal, 190
Wondrak, R. F., 57
Wong and Baker pain scale,
200
Woogara, I., 8
word rating pain scale, 201
373
definitions, 29
wound
assessment, 98, 326–33, 338
assessment procedure,
329–30
care procedure, 342
closure and healing, 341–2
colour and odour, 330, 332
drains, 341
dressings, 338–41, 349–50
gastrostomy, 277
healing ability, 223–4, 331
healing phases, 331, 335–6
management, 98, 335–44
management problems,
342–4
measurement guides, 330
pin site, 418
swabs, 436
types of, 327
X
x-rays, 271
Y
young people see adolescents
Z
Z-track technique, 299, 301,
302