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Clinical reasoning and effective communication are fundamental skills for nurses working at an advanced level of practice. Clinical reasoning processes are designed to enable the nurse to establish the nature of a patient's presenting condition before focusing on problem-solving techniques that can guide the appropriate course of treatment. This article explores the concept of clinical reasoning in advanced practice and outlines the various approaches that nurses can take. It also details the role of effective communication in advanced practice. A case study is used to demonstrate the specific stages involved in clinical reasoning. [ABSTRACT FROM AUTHOR]

The author discusses some studies and insights from professionals about the spiritual need of patients. A 2011 Royal College of Nursing poll showed a high level of uncertainty on spirituality and nursing. A 2016 investigation by the Royal College of Physicians found that 15 percent of people dying in acute hospitals in England had discussions on their spiritual needs documented. Guidelines have been set out by the National Institute for Health and Care Excellence on the care of dying people.

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]

Healthcare-associated infections and antimicrobial resistance are significant threats to public health. As resistant organisms continue to emerge and evolve, and antimicrobial agents become less effective, infection prevention and control remains a vital aspect of maintaining public health, particularly among vulnerable patient groups such as older people and young children. Because of the increasing complexity of healthcare treatments and interventions, patients are becoming increasingly susceptible to healthcare-associated infections and resistant organisms. This article outlines some of the challenges that nurses may [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]

The year was 2011 and I had returned to work in my home city of Melbourne, Australia, after a stint nursing in the UK. A child had been medically reviewed after presenting to the emergency department with a mild head injury and was deemed safe for discharge home. I can't remember why, but I thought this patient should stay in hospital for observation. [ABSTRACT FROM AUTHOR]

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

As the pandemic continues, nurses may feel they have less time than ever to reflect. But with many assuming different roles, in different ways, and in stressful circumstances, reflective practice is more important than ever. [ABSTRACT FROM AUTHOR]

How do you describe what you do? Do you present a clear image of your role, its complexity, the fact that it's pivotal to patient care? Or do you say you are 'just a nurse'? [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]

The article discusses the nursing proficiency standards introduced by the British Nursing and Midwifery Council (NMC) which focused on how nurses may promote diet and a healthier lifestyle to overweight patients. Topics explored include the need to educate concerned patients on the health impact of poor nutrition, the motivational interviewing technique which may be employed to support behaviour change, and the way these standards can help increase health awareness of patients.

Urinary incontinence is a common and usually hidden issue that can affect women of all ages. It is often ignored by the patient because of their misconception that incontinence is an inevitable consequence of ageing and their low expectations of successful treatment. There are various types of incontinence, with symptoms that can significantly affect patients' quality of life. This article aims to enhance nurses' understanding of the types of urinary incontinence affecting women, associated risk factors and continence assessment, as well as the initial investigations and conservative treatments that can be instigated by general nurses. It also discusses some of the advanced treatments offered by specialist services. The article emphasises the importance of undertaking a holistic continence assessment to ensure appropriate continence care is provided, and how tailoring this care to the individual can improve adherence to treatment plans. [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]

Patients exhibiting challenging behaviour, which includes any non-verbal, verbal or physical behaviour, is a significant issue in healthcare settings. Preventing such behaviour and the harm it can cause is important for healthcare organisations and individuals, and involves following a public health model comprised of three tiers: primary, secondary and tertiary prevention. Primary prevention aims to reduce the risk of challenging behaviour occurring in the first instance; secondary prevention involves reducing the risk associated with imminent challenging behaviour and its potential escalation; and tertiary prevention focuses on minimising the physical and emotional harm caused by challenging behaviours, during and after an event. De-escalation should be the first-line response to challenging behaviour, and healthcare staff should use a range of techniques - maintaining safety, self-regulation, effective communication, and assessment and actions - to reduce the incidence of challenging behaviour. In some situations, physical interventions may be required to protect the safety of the individual, healthcare staff and other individuals involved, and healthcare staff should be aware of local policies and procedures for this. Following a serious incident, where there was potential or actual harm to patients and healthcare staff, healthcare organisations should use post-incident reviews to learn from the situation, while healthcare staff should be offered the opportunity for debriefing. Positive responses to challenging behaviour at an organisational and individual level can lead to improved work environments for healthcare staff and optimal patient care and outcomes. [ABSTRACT FROM AUTHOR]

The use of interprofessional simulation training to enhance nursing students' performance of technical and non-technical clinical skills is becoming increasingly common. Simulation training can involve the use of role play, virtual reality or patient simulator manikins to replicate clinical scenarios and assess the nursing student's ability to, for example, undertake clinical observations or work as part of a team. Simulation training enables nursing students to practise clinical skills in a safe environment. Effective simulation training requires extensive preparation, and debriefing is necessary following a simulated training session to review any positive or negative aspects of the learning experience. This article discusses a high-fidelity simulated training session that was used to assess a group of third-year nursing students and foundation level 1 medical students. This involved the use of a patient simulator manikin in a scenario that required the collaborative management of a deteriorating patient. [ABSTRACT FROM AUTHOR]

The conflicting tasks of treating or managing disease and preparing patients and their families for the end of life are well documented in haematology and palliative care settings. This article is a reflection on practice by a nursing student who was in the fourth year of an internship, and discusses a case study involving a woman at the end of life. It considers the approach to palliative and end of life care adopted in an oncology and haematology ward where there was a reluctance to be realistic about the limitations of treatments among some healthcare practitioners, who did not want to dispel unrealistic expectations of the patient's recovery as a result of continuing treatment. This reflection focuses on the care of a patient at the end of life and the frustration experienced by the nursing student at their inability to alter the direction of treatment from curative treatment to the palliation of symptoms. [ABSTRACT FROM AUTHOR]

Patients who deteriorate without recognition or timely interventions are at risk of critical care admission and increased morbidity or mortality. This article outlines the systematic ABCDE (airway, breathing, circulation, disability, exposure) approach to patient assessment, which enables healthcare practitioners to identify and respond to life-threatening conditions in order of priority. The patient's vital signs should be measured as part of the ABCDE assessment and recorded using a track and trigger tool to enhance recognition of physiological abnormalities that signal deterioration. To optimise communication and escalation of deteriorating patients, healthcare practitioners should report ABCDE assessment findings using a structured communication tool. [ABSTRACT FROM AUTHOR]

Effective management of the deteriorating patient requires early recognition of the signs of deterioration, timely review and appropriate interventions. However, this does not always occur. Errors in the recognition and management of a deteriorating patient are rarely related to a single factor; rather they are a complex interaction of system and human factors. This article presents a case study focusing on understanding the factors that led to errors resulting in the death of a patient. Understanding the complex interaction of system and human factors enables the identification of strategies that could be used to decrease the likelihood of a similar incident occurring. [ABSTRACT FROM AUTHOR]

The transfer of patients from the intensive care unit (ICU) to a general ward can present several challenges for nurses. Such patients are at high risk of adverse outcomes, including readmission to the ICU, and increased nosocomial infections and mortality, with a resultant increase in hospital costs. This article explores the challenges of transferring patients from the ICU and uses evidence to examine ways to address them to ensure optimal care for a complex patient group. Transfer time, factors affecting general ward care, handover processes, recognition of deterioration and education, intensive care outreach, and the psychological factors affecting these patients are examined. [ABSTRACT FROM AUTHOR]

Aim To explore the views, perceptions and experiences of older people with dementia of person-centred care, and how these might affect practice. Method This was a qualitative literature review. A literature search was undertaken, which involved searching databases, reference-checking, and hand-searching of academic journals, national policies and nursing organisation websites, from 1999 to 2017. The author undertook data extraction and a meta-synthesis independently to identify themes from the articles. Findings A total of 12 articles were included in the literature review. Few articles pertaining to the views, perceptions and experiences of older people with dementia receiving person-centred care were identified, with most of the literature based in settings outside the UK. Four main themes were identified: shared decision-making; promoting individuality, independence and autonomy; person-centred care; and communication and giving voice to people with dementia. Conclusion Knowledge of the lived experience of people with dementia is important to ensure they receive care that enhances their quality of life. It is essential to consider the views and experiences of older people with dementia to provide effective person-centred care and undertake appropriate research. Further research is required to evaluate the experiences of older people with dementia receiving care to inform practice. [ABSTRACT FROM AUTHOR]

Families ('family' will be used in this article to refer to anyone the patient considers significant, whether they are an actual family member or not) of patients who are critically ill have heightened communication needs. Nurses are an important source of information, particularly about day-to-day patient events and progress. Intensive care unit (ICU) nurses are valued by families because they provide clear, jargon-free information about the patient and their condition. However, they have sometimes been criticised for focusing on short-term issues while avoiding potentially difficult conversations about long-term outcomes and prognosis. A family conference or meeting is held when bad news has to be communicated to families, prognosis discussed or major decisions made, particularly about treatment withdrawal or resuscitation. These meetings should involve physicians and ICU nurses. Despite family conferences, family members' understanding of patient prognosis, diagnosis and treatment is often suboptimal. A planned and structured approach for these meetings, using quantitative statements for prognostic information, recording and communicating what has been said, and supporting meetings with written information, can improve their effectiveness. These supportive strategies increase understanding and consensus, and prevent the provision of conflicting information. It is important for nurses to be willing to follow up these meetings by supporting families to clarify their understanding and encouraging them to raise concerns and ask questions. [ABSTRACT FROM AUTHOR]

Nurses at Central and North West London (CNWL) NHS Foundation Trust were given just two weeks' notice that their home-working arrangements were to be scrapped last month. [ABSTRACT FROM AUTHOR]

Senior addiction nurses deliver evidence-based treatment and care to those experiencing alcohol and drug misuse issues. [ABSTRACT FROM AUTHOR]

The British Pain Society (BPS) defines pain as 'an unpleasant sensory and emotional experience associated with actual or potential tissue damage or described in terms of such damage'. [ABSTRACT FROM AUTHOR]

The healthcare workplace is a 'fertile breeding ground for conflicts' – so says Health Education England (HEE) in an online learning programme about managing conflict at work. [ABSTRACT FROM AUTHOR]

Seven years ago, following what should have been a routine hospital procedure, Katie Dutton contracted sepsis. Now, she is using her experience to teach others how to spot and manage patients who are deteriorating. [ABSTRACT FROM AUTHOR]

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

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]

The care paradigm for patients with human immunodeficiency virus (HIV) has changed from managing an infectious condition with a suboptimal prognosis, to managing a long-term chronic disease. The wellness thermometer is a tool that was developed to assist with monitoring the biological, psychological, social and spiritual well-being of patients with HIV. Aim To evaluate the effectiveness of using the wellness thermometer in healthcare consultations with patients with HIV. Method This was a service evaluation that was undertaken in three UK HIV clinics in 2014. After using the wellness thermometer, patients and healthcare professionals completed a survey to indicate whether they felt the tool improved their consultations. Results A total of 231 patients completed the survey. It was found that 80% (n=185) of patients felt the wellness thermometer helped to identify their concerns, while 79% (n=182) of patients felt the wellness thermometer improved their conversation with the healthcare professional. Of the 12 healthcare professionals who completed the survey, most felt that the tool helped patients to identify their concerns (n=10) and that it was easy to use (n=11). Conclusion There are several benefits associated with using the wellness thermometer in healthcare consultations, and it may support patients with HIV to report any concerns they have in relation to their treatment and quality of life. The authors envisage that the tool will become a routine part of the care of these patients. [ABSTRACT FROM AUTHOR]

Aim To increase awareness of the needs of patients with dementia in the trauma and orthopaedics unit of one acute hospital, and to collaborate with staff on the unit to identify ways of improving the care experienced by these patients and their families. Method An action research approach was used and three action research cycles were completed. Data were obtained retrospectively for 20 patients with dementia who were admitted to the unit for treatment. Deficiencies in the care of these patients were identified and related to communication, pain management and the recognition of delirium. In response, a dementia toolkit was developed by nurses and implemented on the unit to improve the care of patients with dementia. Findings Comparison of pre-implementation and post-implementation audit results indicated a significant improvement in all aspects of care for patients with dementia in the trauma and orthopaedics unit, as a result of the implementation of the dementia toolkit. Education and training were provided to staff on the ward to ensure the toolkit was implemented appropriately. Conclusion It is important to consider the specific needs of patients with dementia in acute care settings, not only the primary reason for their admission. The involvement and inclusion of staff in determining what change was needed on the unit, how change would be undertaken and the positive effects of change, demonstrates how action research can inform and improve clinical practice. [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]

Background People with learning disabilities experience significant inequalities in accessing healthcare. Legal frameworks, such as the Equality Act 2010, are intended to reduce such disparities in care, and require organisations to make 'reasonable adjustments' for people with disabilities, including learning disabilities. However, reasonable adjustments are often not clearly defined or adequately implemented in clinical practice. Aim To examine and synthesise the challenges in caring for people with learning disabilities to develop a framework for making reasonable adjustments for people with learning disabilities in hospital. This framework would assist ward staff in identifying and managing the challenges of delivering person-centred, safe and effective healthcare to people with learning disabilities in this setting. Method Fourth-generation evaluation, collaborative thematic analysis, reflection and a secondary analysis were used to develop a framework for making reasonable adjustments in the hospital setting. The authors attended ward manager and matron group meetings to collect their claims, concerns and issues, then conducted a collaborative thematic analysis with the group members to identify the main themes. Findings Four main themes were identified from the ward manager and matron group meetings: communication, choice-making, collaboration and coordination. These were used to develop the 4C framework for making reasonable adjustments for people with learning disabilities in hospital. Discussion The 4C framework has provided a basis for delivering person-centred care for people with learning disabilities. It has been used to inform training needs analyses, develop audit tools to review delivery of care that is adjusted appropriately to the individual patient; and to develop competencies for learning disability champions. The most significant benefit of the AC framework has been in helping to evaluate and resolve practice-based scenarios. Conclusion Use of the4C framework may enhance the care of people with learning disabilities in hospital, by enabling reasonable adjustments to be made in these settings. [ABSTRACT FROM AUTHOR]

Communication skills training can be a valuable means of supporting professional and family carers of people with dementia. Most communication skills training programmes for those caring for people with dementia focus on dementia awareness and the technical aspects of communication, such as the pace and volume of the carer's speech. However, it is also important to examine what is conveyed about a carer's internal experience in their non-verbal interactions with people living with dementia. This article explores how drawings can be used to help carers to reflect on what is communicated and question any hidden assumptions. It discusses three case studies to demonstrate the complex dynamics that may be involved in interactions with people with dementia: the loss of shared memories, facing towards someone with dementia rather than away from them, and talking about issues that may be upseting. Drawings provide a means for carers to access their unspoken thoughts and emotions, and can help them to improve their understanding of non-verbal interactions with people who have dementia. [ABSTRACT FROM AUTHOR]

Aim: To facilitate a multidisciplinary collaborative approach to developing person-centred practice in hip fracture care for older people. Method: Collaborative inquiry, a form of action research, was used to collect data for this study. It involved exploration of dilemmas, questions and problems that are part of human experience. Clinical leaders from different disciplines (n=16), who work with older people with hip fractures at different stages of the care pathway, participated in a series of facilitated action meetings. The practice development techniques used in this study included: identifying the strengths and limitations of the current service, values clarification, creating a shared vision, sharing clinical stories, reviewing case records, and reflecting on the experiences of three older people and two caregivers. Findings: Hip fracture care was based on meeting service targets, national guidelines and audits. Care was fragmented across different service delivery units, with professional groups working independently. This resulted in suboptimal communication between members of the multidisciplinary group of clinical leaders and care that was process-driven rather than person-centred. Spending time away from clinical practice enabled the multidisciplinary group to collaborate to understand care from the patients' and caregivers' perspectives, and to reflect critically on the care experience as a whole. Conclusion: To develop a person-centred workplace culture, the multidisciplinary team requires facilitated time for reflection. Ongoing facilitative leadership would enable the multidisciplinary team to collaborate effectively to deliver safe, effective person-centred practice in hip fracture care for older people. [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]

Aim: To assess family satisfaction with care provided to patients in critical care units in Islamabad. Method: care units at two private hospitals in Islamabad, Pakistan. The purposive sample consisted of 3 A descriptive cross-sectional study was conducted in 11 medical and surgical critical 23 immediate family members and other relatives and friends (referred to as family members in this article) of 323 patients admitted to the critical care units for at least 24 hours. The revised Critical Care Family Satisfaction Survey was used for data collection. Descriptive statistics were used for data analysis. Findings: A total of 149/323 (46%) family members were 'very satisfied' with the honesty (openness) of staff in explaining the patient's condition, and 137/323 (42%) family members were 'very satisfied' with the nurses' availability to speak to them. A total of 143/323 (44%) family members were 'satisfied' with the honesty (openness) of staff in explaining the patient's condition, and 131/323 (41%) were 'satisfied' with the nurses' availability to speak to them. A few family members (21/323, 6%) were 'very dissatisfied' with the flexibility of the visiting hours and a few (20/323, 6%) were 'very dissatisfied' with the noise level in the critical care units. Some family members (38/323, 12%) were 'not satisfied' with the flexibility of the visiting hours, and some (18/323, 6%) were 'not satisfied' with the noise level in the critical care units. Conclusion: The majority of family members (244/323, 75%) were 'satisfied' or 'very satisfied' that their relatives' needs were being met in the critical care units. However, qualitative data indicate that most family members wanted greater involvement in decision making. These findings should be considered by staff working in critical care settings to ensure high-quality patient care. [ABSTRACT FROM AUTHOR]

The article discusses how nurses can use the microblogging website Twitter to engage in professional discussions and share information related to patient care. Topics covered include the procedure for creating a Twitter account, the opportunity for professional networking offered by the TweetChats feature, and the opportunity for patients and carers to share their opinions on Twitter. Also mentioned is the use of Twitter by nurses to update their knowledge and skills.

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]

Aim To use qualitative data collection approaches to enhance insight and understanding of the NHS England Youth Forum, including its role, value and potential effects. Method A qualitative evaluation research approach was used. Two focus groups were conducted: one with five young people from the NHS England Youth Forum and another with five members of the Adult Reference Group that supports the forum's work. Individual semi-structured interviews were undertaken with four employees of NHS England and the British Youth Council who had a central role in the development and implementation of the forum. Findings The members of the NHS England Youth Forum were participating in an extensive range of activities, and their work is having a direct and positive influence on the provision of healthcare services. The day-to-day management of the forum, in terms of personnel, time and commitment, should be acknowledged. Conclusion Young people are not only highly capable of participating in decision making related to healthcare, but also want to be involved and value the opportunity. [ABSTRACT FROM AUTHOR]

Cohesive interprofessional teamwork is essential to successful healthcare services. Interprofessional teamwork is the means by which different healthcare professionals -- with diverse knowledge, skills and talents -- collaborate to achieve a common goal. Several interventions are available to improve teamwork in the healthcare setting. This article explores the role of care pathways in improving interprofessional teamwork. Care pathways enhance teamwork by promoting coordination, collaboration, communication and decision making to achieve optimal healthcare outcomes. They result in improved staff knowledge, communication, documentation and interprofessional relations. Care pathways also contribute to patient-centred care and increase patient satisfaction. [ABSTRACT FROM AUTHOR]

What do not attempt cardiopulmonary resuscitation (DNACPR) notices are and how they are made is an area where some misunderstanding and confusion persists. [ABSTRACT FROM AUTHOR]

A personal narrative is presented which explores the author's experiences of as a first-time father and how stigma can make it hard for men to ask for health.

The article advises nurses and midwives about the importance for them to engage in a reflective discussion (RD) with a fellow Nursing and Midwifery Council (NMC) registrant during the NMC revalidation process. Topics mentioned include the important role of employers in the success of revalidation, the benefits of RD including the improvement in practice and services and the achievement of work-life balance, and the approaches to RD including incident debriefing.

The article offers information on assessing an individual's experience of pain. Topics discussed include the role of nurses in the management of pain, tools that healthcare professionals can use to help patients express their level of pain, and medicines used in pain relief. An advice from advanced pharmacist practitioner Emma Davies to ask how the person manages with their drugs and whether they affect their normal daily activities is also mentioned.

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 evaluates the National Early Warning Score (NEWS) system, a tool to assess patients in the community, launched by the Royal College of Physicians (RCP).

The article deals with the use of the ReSPECT scheme to help patients plan for a potential health crisis. It explores the use of advance discussions by the scheme to make care choices for a future emergency. The importance of immediate decision-making by professionals responding to a crisis is discussed, as well as the support given by the Royal College of Nursing (RCN) to the ReSPECT process.