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Some patients need to stop eating and drinking, to be nil by mouth, at certain points in their care pathway for their own safety; their care will vary, depending on individual needs. Nurses need adequate knowledge of NBM guidelines to know how to implement them and be able to educate patients. This article explains how to care for patients who are NBM during pre- or post-operative periods.

This article provides an insight into the experience of live donation from the donor and recipient perspectives from diagnosis until 18 months after transplantation. The lead author details the diagnosis of end-stage renal failure in her partner and their decision for her to donate a kidney.

An increase in minimal-stay surgery has reduced opportunities for nurses to discuss patients' anxieties about anaesthesia and the procedures that they will undergo. To allay patient anxieties and therefore promote a good recovery from surgery, nurses need to put in place a planned programme of information provision for patients. They are in a good position to promote patients' feelings of control and ability to cope, and help them to think positively.

Pre-operative preparation is vital to patient safety and a key nursing role. Careful preparation can minimise anxiety, and therefore physical effects, and ensure patients arrive in the operating department ready for surgery. This involves a range of procedures, including ensuring patients understand the operation, and are able to give informed consent, unless this is not possible due to age or mental capacity.

Patients face various possible complications after abdominal surgery. This article examines best practice in guiding and teaching them how to use an incentive spirometer to facilitate recovery and prevent respiratory complications.

Service-user involvement is a growing aspiration for health professionals and those involved in nursing education. This article describes one approach to integrating theory and practice through service-user involvement in a teaching setting. Gwen Carter, a student nurse, tells her story of becoming a patient and how reflecting on this experience affected her approach to patient care. By sharing her experience with peers and mentors, she was able to influence their approach to care, and made a difference to how mentors worked with students in practice.

Effective communication is the cornerstone of good healthcare. Poor communication can have serious consequences for patients and damage the nurse-patient relationship. This article explores how nurses can use communication tools with surgical patients to help relieve anxiety.

Management of postoperative pain is complex and multidimensionalandits effective management presents challenges to nurses. Failure to control pain can result in long term complications, including chronic post surgical pain. This first article, in a two part series, explores the physiological mechanism involved in the perception of pain and the role of psychological and environmental influences on how patients respond to it. Part 2, to be published next week, explores the principles of patient assessment and management of postoperative pain.

Part 1 of this two-part unit on haemophilia and inhibitors examined the condition of haemophilia, the problem of inhibitors and practical challenges nurses may face in surgical management. This second part examines a case study of a 58-year-old man with severe haemophilia and an inhibitor. Communication and involvement with the patient, caregivers, allied departments and the multidisciplinary team were integral to the procedure's success. This, in addition to detailed planning and continuity of care, is crucial for a successful outcome.

It is important to support the learning needs of newly qualified nurses to ensure their skills, knowledge and experience are developed rapidly for a demanding clinical environment. This article evaluates an 18-month surgical rotation programme to maximise experience and enhance recruitment and retention of surgical nurses.

The off duty or rostering system is an important part of managing any ward or department. This article looks at the issues that need to be considered when drawing up and managing off duty. It recommends standards for off-duty planning and shares the results of an audit carried out against some of these standards in one NHS trust.

The elective re-warming of patients immediately after cardiac surgery is a core nursing procedure. Various methods can be used to perform the procedure including forced air-warming systems and radiant lights. This article discusses the evidence regarding the most efficacious method.

The demands now placed upon the NHS to reduce waiting lists and cut costs mean that day surgery is being seen not only as a way forward for elective surgery, but also as a key factor for assisting in the bed management of acute services. This article focuses on the practical steps that health and social care professionals can take to improve discharge processes in their care settings.

Nurses play an essential role in preparing patients for surgical procedures, whether the operation is planned or an emergency. Part of this preparation may include administration of premedication. Government initiatives such as The NHS Plan (Department of Health, 2000) and Essence of Care (DoH, 2001) emphasise the need to get the fundamental aspects of nursing care right, and nurses have a professional responsibility to deliver evidence-based care (NMC, 2002). Additionally, the publication of Building a Safer NHS for Patients: Improving Medication Safety (DoH, 2004) aims to improve patient safety by reducing the incidence of drug errors. This article looks at why pharmacological intervention is no longer a routine preoperative preparation. It will discuss drugs that are used to aid anaesthesia and those used as prophylaxis to aid postoperative recovery, consider the ways in which premedication can now include psychological interventions, and look at the nurse's role.

Excellent communication skills, both verbal and nonverbal, are needed throughout the perioperative experience to educate patients undergoing surgery and so ease their anxiety. In addition, good communication with theatre colleagues, the multidisciplinary team, and other departments is vital to achieve technical excellence and individualised, holistic patient care. This article discusses the importance of effective communication and describes how it can be improved in the perioperative setting.

Patients on coronary artery bypass graft (CABG) waiting lists experience numerous emotional disturbances. This article reports on the introduction of a nurse-led presurgical intervention that comprises home visits and follow-up calls from a specialist cardiac nurse based at the hospital. An improvement in patients' anxiety and depression levels and modifiable coronary heart disease risk factors was observed following the intervention.

Supplementary prescribing is an exciting new development in nursing. After qualifying, the supplementary nurse prescriber may prescribe a range of medications as part of a clinical management plan. The rationale for the choice of medication for inclusion in a clinical management plan for use in elective surgery is described.

Orthopaedic pins and wires have been used to apply skeletal traction for many years, and there has been an increase in the use of external fixators (Santy, 2000; Sims and Saleh, 2000). Multiple pins are frequently used and, as such, create potential portals for infection. Infection rates for these pins are reported to be as high as 85 per cent (Sims and Saleh, 2000). However, pin-site management practices are diverse, contradictory and lack consistency.

Pre and postoperative fasting presents specific problems to patients with type 1 diabetes. Too much insulin can cause hypoglycaemia, whereas too little can lead to ketoacidosis. Simon Eaton explains how avoiding these complications requires use of appropriate treatment regimes and careful monitoring of glucose levels.

New roles that work across traditional professional boundaries are developing in response to the NHS modernization strategy. One trust has implemented a new health care assistant role to support junior doctors working in the surgical area. Evaluation shows that the role has had a positive impact on the working lives of junior doctors, enabling them to make more effective use of their time.

The role of a minor surgery nurse practitioner has been developed to benefit patients, the hospital trust and the nurse herself. An experienced theatre nurse was given intensive training by the surgical team, enabling her to provide a one-stop clinic for minor surgical procedures. Using local anaesthesia, the nurse removes common lesions such as moles, cysts and lipomas. Patients can bypass the wait for an outpatient appointment and subsequent day surgery. The success of the project has led to the introduction of a course in minor surgical skills for nurse practitioners in a range of specialties including dermatology, accident and emergency and primary care. The aim is to develop joint training for junior doctors and nursing staff.

Cardiac transplantation is recognised as an effective treatment option for severe heart failure in carefully selected recipients. This article emphasises the importance of a multidisciplinary team approach and focuses on the first 24-48 hours of postoperative care. It discusses organ rejection; pain control; infection; psychological implications and rehabilitation. Survival rates and a brief history of transplantation are also provided.

It could be argued that day surgery is seen as a poor relation to more exciting specialties, but the health secretary's campaign to expand day surgery has signalled a sea change in approach. A wide variety of procedures can be carried out in a day-surgery unit and nursing involvement is crucial. With the scope of day surgery increasing, it offers exciting opportunities and expanded roles for nurses.