Search

Why you should read this article: • To understand the causes of peripheral neuropathic pain and its effects on patients’ quality of life • To be aware of the non-pharmacological interventions that may be used to manage peripheral neuropathic pain • To consider how you could support patients to self-manage their peripheral neuropathic pain. Peripheral neuropathic pain is a complex condition that can adversely affect people’s quality of life. Alongside pharmacological interventions, nurses can support patients to self-manage their pain using non-pharmacological interventions such as lifestyle changes and exercise. To do this effectively, nurses should be able to recognise the signs and symptoms of peripheral neuropathic pain and be able to educate patients on appropriate self-management approaches. It is important that nurses provide education, advice and information in a way that patients can understand and check this understanding. This article provides an overview of how nurses can support patients to self-manage peripheral neuropathic pain by using various non-pharmacological interventions. [ABSTRACT FROM AUTHOR]

Why you should read this article: • To refresh your knowledge of various elements of communication • To recognise the skills required to communicate effectively and provide person-centred care • To learn about different communication models to support effective non-verbal and verbal communication. Communication is a process of sharing information and developing relationships through interaction. It is essential for nursing care, providing a basis for nurses to establish therapeutic relationships and trust with patients and their families. It is often assumed that nurses can intuitively communicate well; as a result, traditionally there has been a lack of formal training in this area. However, communication is a skill that can be developed and enhanced. This article explains the elements of communication and discusses the skills required by nurses to communicate effectively and provide compassionate, person-centred care. The author outlines two communication models to demonstrate how nurses can use these skills to deliver bad news and support people in distress. [ABSTRACT FROM AUTHOR]

On her first nursing placement two decades ago, Caroline Whitton met a patient on a surgical ward who had cystic fibrosis. She cared for him again on her emergency department placement, and then on the respiratory ward. She later cared for the man as an outpatient in her capacity as cystic fibrosis nurse at University Hospitals Plymouth NHS Trust until he died. [ABSTRACT FROM AUTHOR]

Why you should read this article: • To familiarise yourself with the basic principles of person-centred care • To enhance your knowledge of the benefits and barriers to providing person-centred care at the end of life • To contribute towards revalidation as part of your 35 hours of CPD (UK readers) • To contribute towards your professional development and local registration renewal requirements (non-UK readers) Providing person-centred care that takes into account each patient's individual needs and priorities is crucial at the end of life. Nurses need to be aware of the main aspects of person-centred care, such as supporting shared decision-making, developing therapeutic nurse-patient relationships, and considering the patient's physical, psychological, social and spiritual needs. This article discusses the concept of person-centred care in the context of providing end of life care to patients and their families. It explains the benefits and barriers to providing person-centred end of life care, and outlines some of the areas that nurses and other healthcare professionals need to consider to promote effective care. [ABSTRACT FROM AUTHOR]

Why you should read this article: • To recognise the role of nurses in the prevention of non-communicable diseases • To enhance your ability to initiate and engage in effective healthy conversations with service users • To be aware that training can provide nurses with the knowledge, skills and confidence to discuss health with service users, and that it is available to all NHS staff Nurses in all settings have an important role in preventing non-communicable diseases such as cardiovascular disease, cancer, respiratory disease and diabetes mellitus. They have multiple daily opportunities in their practice to discuss health with people, with the aim of supporting behaviour changes that reduce the risk of non-communicable diseases and the associated health-related and economic challenges. Incorporating the principles of healthy conversations into all daily interactions provides opportunities for nurses collectively to promote health on an individual basis to millions of people. However, many nurses have not received training in such behaviour change interventions. This article explains the principles and potential benefits of healthy conversations, and emphasises the importance of training to promote nurses' knowledge, skills, confidence and motivation to engage in such conversations. [ABSTRACT FROM AUTHOR]

Communication is key to building a therapeutic relationship between nurse and patient. [ABSTRACT FROM AUTHOR]

Why you should read this article: • To recognise the importance of embedding cultural competence in healthcare • To understand how cultural competence may apply to people with a diagnosis of a mental health condition • To identify strategies for providing effective and inclusive care to patients with mental health conditions As cultural competence becomes embedded in healthcare, it is important to consider this concept in the context of caring for patients with mental health conditions in general hospital settings. Adult nurses are likely to encounter patients with such conditions who are experiencing a mental health crisis in their practice. However, a lack of opportunity to develop the skills required to engage with patients whose behaviours may be unfamiliar or perceived as challenging can result in suboptimal experiences of care. Developing cultural competence can enhance adult nurses' ability to deliver effective and inclusive care to patients with mental health conditions. This article discusses various aspects of cultural competence in relation to mental health and provides examples of verbal and non-verbal communication techniques that can support adult nurses to engage effectively with patients experiencing a mental health crisis. [ABSTRACT FROM AUTHOR]

Why you should read this article: • To understand the importance of effective communication in end of life care • To appreciate the challenges for healthcare professionals in engaging in end of life discussions with patients and families • To recognise ways in which end of life communication skills can be enhanced among healthcare professionals Skilled and compassionate communication with patients and their families is a priority in all areas of clinical practice. This is particularly important in palliative and end of life care, where people may feel frightened and vulnerable and require clear, honest and compassionate communication from healthcare professionals. However, many patients and families have reported dissatisfaction with their interactions with healthcare professionals in end of life care, including a lack of compassion and understanding of their emotional well-being. This article explores the literature on end of life communication with patients and families and discusses how improvements can be made in this area of practice. [ABSTRACT FROM AUTHOR]

Why you should read this article: • To learn about the principles and types of brief behaviour change interventions • To recognise the importance of motivational interviewing in supporting behaviour change • To identify various tools and techniques that you could use in your practice to deliver brief interventions Nurses are well placed to deliver brief opportunistic health promotion interventions during routine encounters with patients. Brief interventions have been shown to be effective in prompting behaviour change among people who engage in harmful drinking or substance misuse. Nurses can use their communication, relationship-building and partnership-working skills to support people to consider behaviour change. This article explains the concepts that underlie brief behaviour change interventions, which include motivational interviewing and the transtheoretical model of behaviour change. The article also describes practical tools and techniques that nurses can use to deliver such interventions. [ABSTRACT FROM AUTHOR]

Research suggests that most patients have withheld medically relevant information from healthcare professionals, including nurses. [ABSTRACT FROM AUTHOR]

It is seven years since #hellomynameis founder Kate Granger died, but as the campaign for a friendlier health service that she instigated ten years ago continues to thrive, her widower believes she is 'smiling down'. [ABSTRACT FROM AUTHOR]

The article discusses some of the barriers to breaking bad news effectively to patients and the communication skills needed to engage in challenging conversations. Topics include communication skills required to engage in challenging conversations, process involved in breaking bad news, and mnemonic protocols that can be used to structure challenging conversations with patients face to face and over the phone.

The issues patients from minority ethic backgrounds experience when seeking healthcare – like lack of empathy, discrimination, and poor outcomes – are well documented. [ABSTRACT FROM AUTHOR]

Why you should read this article: • To understand how trans and non-binary patients may have a negative experience when accessing healthcare • To learn how enhanced communication can result in a positive healthcare experience for trans and non-binary patients • To count towards revalidation as part of your 35 hours of CPD, or you may wish to write a reflective account (UK readers) • To contribute towards your professional development and local registration renewal requirements (non-UK readers) There is increasing evidence to suggest that transgender (trans) and non-binary people encounter significant societal discrimination, stereotypical and misleading representation in the media, and frequent misgendering. They may also experience several barriers to accessing healthcare, as well as discrimination from staff and other patients. This article explores how and why trans and non-binary people experience discrimination, and discusses how healthcare professionals, including nurses, can enhance the care experience for these patients, with a particular emphasis on language and communication. [ABSTRACT FROM AUTHOR]

Why you should read this article: • To understand the requirement for telephone assessments during the coronavirus 2019 (COVID-19) pandemic • To familiarise yourself with the skills required to undertake telephone assessments • To enhance your knowledge of specific techniques such as active listening The coronavirus 2019 (COVID-19) pandemic has led to an increase in the number of healthcare consultations being undertaken remotely rather than face to face, including telephone assessments with patients. When undertaking telephone assessments, the communication and clinical skills used in face-to-face consultations must be adapted to compensate for the loss of visual contact between the patient and the nurse. Specific techniques such as visualisation and managing silence can enable the nurse to develop trust and rapport with the patient, and contribute to effective telephone assessments. [ABSTRACT FROM AUTHOR]

Body language is an important part of communication as a nurse. On a busy shift, it can be easy to inadvertently give out the wrong message via non-verbal communication. But being aware of a few key ways in which body language matters can make a huge difference. [ABSTRACT FROM AUTHOR]

When communicating information to patients, the words you choose can be as important as the message itself. A nurse's choices of language can affect how patients view their health. Clumsy use of language can make a person feel stigmatised and distressed, which, experts argue, can lead to adverse health outcomes. And there are many ways nurses can unconsciously perpetuate unhelpful and incorrect views about various health conditions, in addition to longstanding societal stigmas, such as those around race, gender and sexuality. [ABSTRACT FROM AUTHOR]

When speaking to patients and colleagues, it is vital that nurses can communicate information clearly – but taking in other people's responses is just as important. [ABSTRACT FROM AUTHOR]

Why you should read this article: • To enhance your awareness of the barriers that may prevent you from recognising acute pain in patients • To recognise how you can overcome the barriers that prevent the recognition of pain • To understand the components of a comprehensive pain assessment This article considers two areas of practice that are fundamental to the provision of high-quality nursing care for people experiencing acute pain: the initial recognition of pain, and the formal assessment of pain. The initial recognition of a patient's pain is a subject that is frequently overlooked in the literature. However, if nurses are unable to identify that a patient is experiencing pain, then a formal pain assessment may not take place, which in turn negatively affects the quality of any subsequent pain management. This article explores some of the barriers to the initial recognition of pain and examines how a formal pain assessment can support optimal patient care. [ABSTRACT FROM AUTHOR]

Around 43,000 people are diagnosed with bowel cancer in the UK each year and it is the country's fourth most common cancer. [ABSTRACT FROM AUTHOR]

I have been a general practice nurse for 16 years and an advanced nurse practitioner for the past four. One of my major concerns has always been seeing patients with mental health issues – I felt I wasn't the right person to help so would refer the patient to their GP. [ABSTRACT FROM AUTHOR]

Bowel care is of great importance for a patient's quality of life, yet many people are too embarrassed to discuss the subject. It's a conversation that arguably needs to be had whatever the clinical setting: £168 million was spent by NHS England on treating constipation in 2018-19, the equivalent of funding 7,304 newly qualified nurses for a year. [ABSTRACT FROM AUTHOR]

AUTH Why you should read this article: • To identify the range of individual personality types • To understand how knowledge of personality types can improve your communication with colleagues and patients • To count towards revalidation as part of your 35 hours of CPD, or you may wish to write a reflective account (UK readers) • To contribute towards your professional development and local registration renewal requirements (non-UK readers) Understanding personality types can assist nurses in enhancing their understanding of themselves and their colleagues, which in turn can support effective communication. This article outlines the principles of the Myers-Briggs Type Indicator (MBTI) – a personality inventory that aims to improve the understanding of psychological types – and details the characteristics of the MBTI's 16 different personality types. The article explores how these 16 personality types can influence communication within healthcare teams and between healthcare professionals. It also discusses how these personality types affect styles of nurse leadership and how an understanding of personality types can improve nurses' communication with patients. [ABSTRACT FROM AUTHOR]

AUTH Why you should read this article: • To recognise the importance of communicating effectively with patients to optimise their outcomes and enhance their experience • To enhance your knowledge of the principles and methods that you can use to inform your approach to communicating effectively with patients • To count towards revalidation as part of your 35 hours of CPD, or you may wish to write a reflective account (UK readers) • To contribute towards your professional development and local registration renewal requirements (non-UK readers) Communication between a nurse and a patient may seem intuitive. However, communicating effectively with patients while applying the principles of person-centred care can be challenging. Patients' perceptions of suboptimal care and healthcare services may be influenced by how nurses communicate with them, since communication may be used as a quality indicator, as well as an indicator of patient experience. This article considers how nurses can communicate effectively with patients to optimise care. It explores the theoretical principles of interpersonal and professional communication, and discusses practical methods of listening and speaking to patients that nurses can apply in their clinical practice. [ABSTRACT FROM AUTHOR]

AUTH Why you should read this article: • To recognise the definition of lesbian, gay, bisexual, transgender, queer or questioning, and intersex (LGBTQI+) people, and what these terms mean • To understand the health inequalities that affect LGBTQI+ patients • To remain aware of areas where the nursing care of LGBTQI+ patients may require a personalised response such as Evidence demonstrates that subconscious and intentional discrimination against lesbian, gay, bisexual, transgender, queer or questioning, and intersex (LGBTQI+) people continues to exist in the UK healthcare system. Surveys have indicated significant health inequalities in LGBTQI+ populations, including high rates of mental health issues and suboptimal healthcare experiences. This article explores these issues and encourages nurses to reflect on their unique and privileged position to champion the rights of vulnerable people, as well as their role in improving the healthcare experience of LGBTQI+ patients in the future. It also discusses safety issues and special considerations for LGBTQI+ patients, including those related to sexual health, mental health and intellectual disabilities. [ABSTRACT FROM AUTHOR]

The article analyzes the impact of Great Britain's exit from the European Union (EU) on the supply of medicines and other supplies. Nurses have expressed concerns that Brexit will result in issues such as drug or product substitutions and stockpiling by patients. The Royal College of Nursing (RCN) has warned about added workload for nurses and the effect of Brexit on the National Health Service (NHS).

Why you should read this article: • To recognise the symptoms and causes of various mental health conditions • To enhance patient safety by being aware of the risks associated with mental health conditions, such as suicide and self-harm • To understand the communication skills that can be used to improve care and support for people with mental health conditions Nurses often care for people with mental health conditions in general clinical settings. In these situations, they have a responsibility to ensure that the individual's physical, social and psychological needs are assessed and met. Nurses practising in general clinical settings should be familiar with the skills and knowledge required to meet the needs of people with mental health conditions. This article aims to provide nurses practising in general clinical settings with an understanding of such conditions and the associated effects on an individual's physical health. It also details the signs and symptoms of various mental health conditions, and outlines the communication skills that nurses can use when caring for people with these conditions in general clinical settings. [ABSTRACT FROM AUTHOR]

As a result of global migration, nurses are caring for patients in increasingly diverse cultural and linguistic settings. Intercultural nursing requires nurses to care for patients as unique individuals while considering their cultural needs. Being able to communicate effectively with patients from various cultures is crucial for understanding and for optimal delivery of patient care. Communication must be considered in the context of overall care; therefore, this article describes important concepts underpinning appropriate intercultural care. It provides a guide to effective intercultural communication by discussing three main areas: cultural knowledge, attitudes and feelings, and communication skills. These are the essential areas that nurses can reflect on, and develop and apply in intercultural communication with patients and their families. [ABSTRACT FROM AUTHOR]

Nurses require effective communication and interpersonal skills to provide optimal care, and to ensure that patients and their families and carers have a positive experience of receiving care. The new Nursing and Midwifery Council standards of proficiency for registered nurses, and for nurse education and training, published in May 2018, recognise that future nurses will be practising in increasingly complex roles and environments. This article identifies the essential communication skills that will be required by nurses in the future, summarising the characteristics of a modern nurse communicator. It also suggests various approaches that nurses can use to develop their communication skills. [ABSTRACT FROM AUTHOR]

Lesley Mills is comfortable talking about sex. [ABSTRACT FROM AUTHOR]

Compassionate communication is fundamental to nursing. Yet when it comes to breaking bad news or talking through potentially life-changing results with patients and their families, it is common for nurses to feel ill-equipped. [ABSTRACT FROM AUTHOR]

Effective communication is essential to maintain mental health and resilience. Communication can be challenging for people who experience serious mental illness (SMI), which can be a barrier to social, employment and educational opportunities, as well as increasing their risk of experiencing abuse. Therefore, it is important that nurses who work with individuals experiencing SMI understand the assessment and management of specific communication, speech and language needs. This article focuses on five areas of communication, speech and language - receptive language, expressive language, speech, social communication and swallowing - to increase nurses' confidence in assessing communication needs and making appropriate referrals to speech and language therapy services. The authors also suggest therapeutic interventions that nurses can use to reduce the effects of speech and language difficulties among people with SMI. [ABSTRACT FROM AUTHOR]

Advanced nurse practitioners, and nurses aspiring to this role, are required to understand how to communicate effectively and on a collaborative basis with patients and carers during consultations, with the aim of enhancing patient outcomes such as improved patient satisfaction, ability to self-manage healthcare needs and adherence to care plans. This article explores collaborative communication in consultations and how best to achieve this, using the author's doctoral observational research based on the findings of a mixed methods observational study of communication in advanced clinical practice patient consultations. [ABSTRACT FROM AUTHOR]

Communication is an essential aspect of life, yet it can be taken for granted. Its centrality to being in the world and in professional practice often becomes evident when nurses and older adults encounter communication difficulties. The factors that can affect nurses' communication with older adults relate to the older adult, the nurse, sociocultural considerations and the environment, and the interactions between these factors. In adopting a person-centred approach to communicating with older adults, it is necessary to get to know the person as an individual and ensure communication meets their needs and abilities. Effective communication is essential in nursing practice and requires professional competence and engagement. This article can be used by nurses to support effective communication with older adults across the continuum of care. [ABSTRACT FROM AUTHOR]

Modern healthcare environments are becoming increasingly complex. Delivering high-quality fundamental care in these environments is challenging for nurses and has been the focus of recent media, policy, academic and public scrutiny. Much of this attention arises from evidence that fundamental care is being neglected or delivered inadequately. There are an increasing number of standards and approaches to the delivery of fundamental care, which may result in confusion and additional documentation for nurses to complete. This article provides nurses with an approach to reframe their thinking about fundamental care, to ensure they meet patients' care needs and deliver holistic, person-centred care. [ABSTRACT FROM AUTHOR]

Assessing spirituality and the spiritual needs of patients is fundamental to providing effective spiritual care. This article, the second in a series of three, discusses the assessment of patients' spirituality and spiritual needs in healthcare settings. Several formal spiritual assessment tools are available to assist nurses to identify patients' spiritual needs and to determine whether they are experiencing spiritual distress. However, it may be more appropriate to assess patients' spirituality informally, by asking open questions about their spiritual beliefs and needs. It is important for nurses to be aware of the limits of their competence in undertaking spiritual assessment and providing spiritual care, and to refer patients to the healthcare chaplain or other spiritual support personnel where necessary. The third and final article in this series will discuss spiritual care nursing interventions. [ABSTRACT FROM AUTHOR]

Establishing positive and trusting therapeutic relationships with patients has long been recognised as an essential component of nursing practice and is important for effective care. There are various challenges in clinical practice that make it increasingly difficult to deliver effective care centred on such relationships. Understanding and addressing these challenges is crucial to ensure a positive experience of care for patients, families, carers and nurses. This article outlines how nurses can use a framework to develop therapeutic relationships with patients and use the best available evidence to deliver effective care. It also explores the challenges in developing effective therapeutic relationships with patients at the healthcare system level, and considers how these challenges can be addressed. [ABSTRACT FROM AUTHOR]

Spirituality is a complex concept that has different meanings for different people. Spiritual care is a fundamental aspect of nursing and attending to the spiritual needs of patients may improve their health outcomes. This article, the first in a series of three, explores various definitions of spirituality, and the importance of spirituality and spiritual care in healthcare settings. The second article of this series provides an in-depth exploration of the assessment of patients' spiritual care needs, and the third and final article in this short series discusses spiritual care nursing interventions. [ABSTRACT FROM AUTHOR]

Health policy and healthcare professional guidelines promote patient and carer involvement, which includes working in partnership with service users in all aspects of healthcare provision, research and education. This article explores the expectations for nurses to work in partnership with patients and carers, examines the definitions and theories of working in partnership and related concepts, as well as considering examples of partnership working in nursing practice. [ABSTRACT FROM AUTHOR]

As the population ages and the incidence of chronic diseases and lifestyle-related conditions rises, nurses are increasingly required to provide care for people with a range of chronic (long-term) conditions. The healthcare needs of patients are often complicated by comorbid conditions. Nurses deliver healthcare in the context of the patient's medical conditions, treatment regimens, the healthcare system, and the individual's socioeconomic, personal and family factors, which may include the challenges of social isolation and geographic distance. In such complex circumstances, patients may be perceived as 'difficult' or 'challenging', however, the challenge is not the patient themselves, but the relationship between the nurse and the patient. Communication difficulties can occur between nurses and patients, which may affect the therapeutic relationship and the quality of care provided. This article discusses the communication skills that nurses require to interact effectively with patients who have complex and chronic comorbid conditions. It focuses on therapeutic communication strategies and the nurse-patient relationship, while emphasising the need for nurses to be self-aware when caring for patients with complex healthcare needs. [ABSTRACT FROM AUTHOR]

The article discusses how nurses can support patients to consider options for their treatment and care through shared decision-making. Topics include description made by the British National Institute for Health and Care Excellence on shared decision-making, key component of shared decision-making, and views of Julian Barratt, head of postregistration education at Wolverhampton University's Institute of Health, on shared decision-making.

The article features Catherine Hind, a nursing student who developed an approach for nurses on all settings on how to provide emotional support for people at risk of self-harm or suicide. It provides information on the Student Quality Ambassador project, wherein Hind uses her experience as a Samaritans volunteer. It discusses the importance of hospital staff being able to talk to patients with any kind of emotional health problem.

The article discusses the importance of improving handovers in nursing practice to improve care and optimising patient outcomes. Royal College of Nursing head of nursing practice Wendy Preston argues that handovers need the robust governance that is characteristic of other elements of nursing practice. Clinical research manager Jane Bruton said that improving communication makes nurses' working lives easier. Challenges presented by handovers in the community are mentioned.

The article offers step-by-step instructions for conducting remote consultations with patients.

This article, the second of two, provides healthcare practitioners with an overview of best practice in palliative and end-of-life care, including nutrition, hydration, oral hygiene and pain management. Communication and spiritual care are discussed, as well as care after death. Providing support and education for families is an important aspect of palliative and end-of-life care. Care home nurses should ensure that the person living with dementia is at the centre of decision making, and provide care that is inclusive of their needs and wishes. The article is framed in a care home context; there is little research about how to optimise palliative care for people living with dementia in care homes. [ABSTRACT FROM AUTHOR]

The terms palliative and end of life care are often used interchangeably and healthcare practitioners may perceive that palliative care is only appropriate during the terminal stages of an illness. This article, the first of two parts, provides healthcare practitioners with an overview of the concept of palliative care. It explains how this can be differentiated from end of life care and how it should be commenced in a timely manner, so that people who are living with dementia can contribute to the planning of their future care and death. The policies and tools used in the provision of palliative and end of life care are discussed, including advance care planning and The Gold Standards Framework. The article is framed in a care home context; there is little research about how to optimise palliative care for people living with dementia in care homes. The second part of this article will discuss end of life care and the best practices for providing end of life care, including nutrition and hydration, oral hygiene, pain management and spiritual care. [ABSTRACT FROM AUTHOR]

Complaints and their management are an important indicator of the quality of care. Therefore, effective management of complaints is central to improve services and prioritise an open, honest and transparent health service. However, there is scope for NHS organisations to improve their response to complaints. This article outlines the NHS complaints procedure, focusing on how nurses can develop essential skills to help them to improve their management of any complaints that arise in their clinical area. It provides a structured framework, identifying useful communication skills, and explores how managing complaints relates to a nurse's statutory duty of candour. [ABSTRACT FROM AUTHOR]

Diabetes is an increasingly common life-long condition, which has significant physical, psychological and behavioural implications for individuals. Self-management of type 1 and type 2 diabetes can be complex and challenging. A collaborative approach to care, between healthcare professionals and patients, is essential to promote self-management skills and knowledge to help patients engage in shared decision making and manage any difficulties associated with a diagnosis of diabetes. [ABSTRACT FROM AUTHOR]

Communication involves the exchange of information between at least two people, a giver and a receiver. If left unaddressed, communication difficulties may have a profound effect on quality of life and quality of care. Poor communication may result in high levels of anxiety and depression for the person living with dementia. Communication breakdown contributes to high rates of depression in spouses of people living with dementia and is a major problem for family and carers. Positive and supportive communication is essential to ensure good quality dementia care. A person-centred approach focuses on supporting a person to use and retain their skills and abilities. Person-centred communication involves a commitment to including the perspective of the person living with dementia, and an understanding of who the person is, their life history and preferences. [ABSTRACT FROM AUTHOR]

The Jones Dependency Tool can be used in emergency departments to improve patient care and identify the required staffing and skill mix. Using the tool, the nurse can accurately identify a patient's specific nursing needs. The dependency tool is used to evaluate patients' needs in six areas: communication; airway, breathing and circulation; mobility; eating, drinking, elimination and personal care; environmental safety, health and social needs; and triage. Appropriate nursing care can be tailored to the dependency level, depending on whether the dependency level is low, moderate, high or total dependency. [ABSTRACT FROM AUTHOR]