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Why you should read this article: • To refresh your knowledge of the anatomy of forearm bones and the pathophysiology of bowing fractures • To increase your awareness of the diagnostic challenges and complications associated with bowing fractures • To enhance your understanding of the management of children with bowing fractures. Bowing fractures of the forearm are characterised by numerous micro-fractures on the concave surface of the affected bone(s), usually caused by a fall on an outstretched arm. Children are more susceptible to this type of injury than adults because their long bones have more elasticity. Bowing fractures of the forearm are challenging to diagnose because there are no obvious cortical defects, which can lead to inappropriate management and associated complications, including loss of movement range and loss of function. This article discusses bowing fractures of the forearm in children, including their pathophysiology, diagnosis and management. It aims to enhance emergency nurses’ awareness and knowledge of this type of injury in children and of the challenges surrounding diagnosis and management. [ABSTRACT FROM AUTHOR]

Why you should read this article: • To increase your awareness of craniopagus, a rare condition in which identical twins are joined at the head • To identify the multidisciplinary skills and expertise required for successful separation of craniopagus twins • To explore the pivotal role of nurses in the management and care of craniopagus twins in hospital. Craniopagus is a rare condition in which the skulls of conjoined twins, and the neurovascular structures in their skulls, are incompletely separated. Separation surgery is complex and requires a range of skills and expertise, including from all the nursing teams involved. A multidisciplinary group of professionals in a tertiary paediatric care setting in Italy developed a comprehensive protocol for the nursing care of craniopagus twins in hospital, informed by the findings of a literature review and the expertise of its members. The protocol was applied to the management of a pair of craniopagus twins who successfully underwent separation surgery at the authors’ hospital. The protocol describes the crucial role of nurses in the care of craniopagus twins and their families before, during and after separation surgery. [ABSTRACT FROM AUTHOR]

Why you should read this article: • To appreciate the importance of effective management of service users’ discharge from inpatient settings • To understand the factors that can enhance service users’ experience of transition from inpatient rehabilitation settings to the community • To learn about what elements of the discharge process could be improved to enhance service users’ experience. Discharge from inpatient rehabilitation settings can be a stressful experience for service users and mismanagement of the transition process can have negative outcomes, such as early readmission. This service evaluation explored the experience of people transitioning from inpatient rehabilitation settings to the community to identify what works well in the rehabilitation pathway discharge process and areas for improvement. Eight service users participated. All eight completed a bespoke questionnaire, six of whom took part in a subsequent semi-structured interview. Findings suggest that, overall, participants had a positive experience of transition, particularly in relation to practical and emotional support from inpatient and community rehabilitation services. Areas identified for improvement include increased involvement of family and carers during the discharge process and greater clarity about the role of the various professionals and teams involved in service users’ care once they are discharged to the community. [ABSTRACT FROM AUTHOR]

Delayed discharges have been a persistent problem in UK hospitals for the past decade. One in eight hospital beds in England is occupied by patients who are medically fit to leave, but cannot be discharged, data from NHS England show. [ABSTRACT FROM AUTHOR]

Why you should read this article: • To enhance your knowledge of the use of canine-assisted therapy in healthcare settings • To learn about a project that involved introducing a therapy dog to anxiety management groups for young people • To consider the effects that the presence of a therapy dog may have on young people Research suggests that the inclusion of dogs in the delivery of psychotherapy for adolescents may have a positive effect on outcomes. This article details an evaluation that explored the effect of introducing a dog to cognitive behavioural therapy-based anxiety management groups for young people aged between 11 years and 14 years. A total of 35 young people attended these groups, which ran either with or without a dog present. The results suggest that the presence of a therapy dog significantly reduced young people's anxiety ratings in five of the six sessions and contributed to a higher discharge rate after completing the group therapy (44% in the groups with the dog versus 28% in the groups without the dog). Qualitative feedback indicates that the presence of a therapy dog improved the young people's experiences by enabling them to feel increasingly relaxed and confident in the group. These findings suggest that a therapy dog can enhance young people's experiences in group therapy, particularly in the early stages, and increase discharge rates. [ABSTRACT FROM AUTHOR]

Head injury is the most common cause of death and disability in people aged one to 40 in the UK, and accounts for around 1.4 million attendances at emergency departments (EDs) in England and Wales each year. [ABSTRACT FROM AUTHOR]

More than one in ten people aged over 65 and up to half of people over 85 live with frailty. This age group is more likely than others to need health and care services – often presenting as emergency admissions because their needs have not been met by other parts of the system. [ABSTRACT FROM AUTHOR]

Why you should read this article: • To recognise the importance of providing person-centred care to patients and their families • To learn about how one hospital maintained and developed person-centred care practices during the coronavirus disease 2019 (COVID-19) pandemic • To consider strategies you could use in your area of practice to support communication and collaboration between patients, families and the healthcare team Providing person-centred care to hospitalised patients and their families can be challenging in the context of restrictions on visiting, such as those widely implemented in healthcare settings during the coronavirus disease 2019 (COVID-19) pandemic. In the US, several strategies have been deployed to work around the restrictions on family presence in hospitals, most of which focused on communication between the patient and family, and collaboration between the family and the healthcare team. Sharp Memorial Hospital, an acute care hospital in San Diego California, US, was determined to maintain its person-centred care practices during the pandemic. A Family Resource Centre started operating in March 2020 with the aim of enabling hospitalised patients and their families to connect in a safe manner. This article describes this innovative approach to maintaining person-centred care in hospital during restrictions on family presence. [ABSTRACT FROM AUTHOR]

When designing the day surgery unit in our new children’s day treatment centre at Evelina London Children’s Hospital, families wanted to know why – regardless of the type of procedure – their children had to wait four hours after general anaesthetic before discharge. [ABSTRACT FROM AUTHOR]

Why you should read this article: • To increase your awareness of the complications experienced by older people undergoing emergency surgery • To learn about strategies for managing post-surgical challenges in older people • To remind yourself of optimal discharge planning for older people post-surgery The number of older people undergoing surgery in the UK is increasing, partly due to an ageing population and advances in surgical techniques. However, outcomes for older patients who have undergone surgery are suboptimal when compared with younger people, especially following emergency surgery. To minimise the risk of adverse events affecting older people following surgery, it is essential that nurses understand how to manage common challenges for this patient group such as delirium, pain, reduced mobility and inadequate hydration. [ABSTRACT FROM AUTHOR]

Reducing long-term segregation for patients with a learning disability or people with autism has been highlighted as a priority by the NHS in recent years, but what progress is being made? [ABSTRACT FROM AUTHOR]

Why you should read this article: • To learn about the differences between psychiatric intensive care, low secure and locked rehabilitation units • To understand how service provision in psychiatric intensive care, low secure and locked rehabilitation units has changed since 2006 • To gather information on the types of interventions offered by the different psychiatric intensive care facilities Psychiatric intensive care can take place in a variety of settings, including psychiatric intensive care units (PICUs), low secure units (LSUs) and locked rehabilitation units (LRUs). These units have a range of referral, admission and discharge care pathways, staffing profiles and core interventions. The aim of this service evaluation was to compare present provision in PICUs and LSUs with results from the first national survey of PICUs and LSUs in 2006. The service evaluation also aimed to define the role of LRUs. The authors used a cross-sectional, 'census day' questionnaire with six-month follow-up design. Overall, 111 NHS units participated in the evaluation. Results included that PICUs were smaller and usually had a mixed-sex distribution of service users; LSUs mostly comprised single-sex facilities; and LRUs mostly comprised single-sex units with a significantly longer mean length of stay than the other types of unit. PICUs primarily cared for service users exhibiting acute behavioural disturbance, first-episode psychosis or psychotic crisis and, compared with the other types of unit, more often used high-dose medication and electroconvulsive therapy. [ABSTRACT FROM AUTHOR]

Emergency departments (EDs) are high-volume requestors of pathology and radiology testing and new advice from the Royal College of Emergency Medicine (RCEM) gives guidance for ED staff on how to manage the results. [ABSTRACT FROM AUTHOR]

Patients with colorectal cancer may require colorectal surgery as part of their treatment. Enhanced recovery after surgery (ERAS) is an evidence-based multimodal pathway that improves patients' outcomes by attending to specific aspects of patients' needs from pre-admission to post-discharge. This article reports findings of a non-systematic review of the literature on ERAS in the context of patients undergoing colorectal surgery. Evidence suggests that ERAS improves patients' outcomes by decreasing post-surgical complications and therefore reducing length of stay in hospital. The article also discusses how nurses are fundamental to the implementation of an ERAS pathway. [ABSTRACT FROM AUTHOR]

Homelessness is on the rise in the UK and, over the past few years, there has been a significant increase in the number of emergency department (ED) attendances and admissions by homeless people. Those attending the ED will often have multiple unmet health, housing and social care needs. While it is not possible to meet all these needs in the ED, emergency nurses should be equipped with the knowledge and skills required to communicate with, refer and signpost patients who are homeless. Under the Homelessness Reduction Act 2017, ED staff have a duty to refer homeless people, with their consent, to local authorities for assistance. This article details the barriers that homeless people may experience when accessing healthcare services and explains how these can be addressed. It also outlines the actions that emergency nurses can take to improve the care of homeless people in the ED at an individual and a systems level. [ABSTRACT FROM AUTHOR]

Background: Sleep disturbance, often arising from the way parents manage their child's sleep, affects 40% of children and leads to increased demand on clinical services. Children and young people with significant sleep issues can be treated effectively with a supportive approach but are often prescribed the hormone melatonin because of a lack of available support services. Aim: To understand the effect and clinical implications of a nurse-led sleep support clinic on melatonin prescribing in children and young people. Method: A retrospective case note evaluation was undertaken of a nurse-led sleep support service delivering a bespoke programme and follow-up support to a patient group of 124 children and young people, 104 of whom had co-morbidities. Results: A total of 78 (63%) patients were successfully discharged without melatonin prescriptions after a median of two face-to-face clinic visits and three telephone calls. Eleven out of 12 patients had not restarted melatonin after 12 months. Conclusion: A nurse-led, non-pharmacological approach to sleep support in children and young people can provide an effective, sustainable alternative to melatonin prescribing. The authors recommend that appropriate sleep support should be administered and the response reviewed before melatonin is prescribed. Investment in sleep services to support this approach is important. [ABSTRACT FROM AUTHOR]

The Transforming Care programme was devised by NHS England in 2015 with the aim of supporting people with a learning disability and/or autism who exhibit behaviour that challenges, including those with a mental health condition, to move out of long-stay hospitals and live in the community. The driving factor behind the programme was abuse and neglect experienced by people in long-stay settings, including those living at Winterbourne View, a private hospital near Bristol that was closed in 2011 after revelations that patients had been ill-treated. By March 2019, when the programme ended, the target to reduce inpatient bed capacity by 50% had not been met. This article discusses the author's experience as a dual-qualified social worker and mental health nurse employed by a Transforming Care Partnership. In this role, the author coordinated the discharge process for five people with learning disabilities and/or autism, often with co-morbid mental health issues, who had lived in hospital for 7-21 years. The complex multiagency work that enabled these successful discharges is explored and the article considers how this work can be built on in future to ensure more people with learning disabilities are able to live in their own homes. [ABSTRACT FROM AUTHOR]

AUTH Why you should read this article: • To be aware of the common types of prescribing errors that can occur in emergency departments (EDs) • To enhance your knowledge of the information required on prescribing forms for a medicine to be dispensed • To identify methods of reducing the rate of prescribing errors in the ED Background: Prescribing errors are a subset of medication errors that occur on the forms used to prescribe medicines for patients. On their discharge from the emergency department (ED), many patients are given a prescription form to obtain medicines from their local community pharmacist. On the identification of a prescribing error, the patient is sent back to the ED because the medicine cannot be dispensed. Aim: To identify the most common prescribing errors on prescriptions returned to one large inner-city ED in South Wales from community pharmacies. Method: Prescriptions that were returned to the ED over a six-week period from September and October 2016 were analysed to determine the types of prescribing errors that occurred and their frequency. Results: A total of 10,218 patients attended the ED over the six-week period, of which 7,731 patients were seen by a clinician and discharged home. Of these, 322 patients were discharged with a prescription, and 20 (6%) of these patients returned to the ED with a prescribing error that prevented the pharmacist from dispensing the medicines. The most common prescribing error was incorrect or missing prescriber information. Conclusion: This study identified that there was a low rate of prescribing errors in the ED, and this was comparable with the rate of prescribing errors identified in the literature. Common prescribing errors could be mitigated through the introduction of electronic prescribing in the ED. [ABSTRACT FROM AUTHOR]

Despite recent attention to pain assessment and management, cancer pain remains a significant clinical problem worldwide. A total of 38% of cancer patients experience moderate to severe pain that is unresponsive to conventional analgesia and may benefit from additional pain interventions. With expert management, for most people with cancer, pain can be treated effectively with conventional pharmacological approaches, however a minority find either that analgesic management strategies provide suboptimal pain relief or cause excessive side effects. This article describes how collaborative working between a specialist palliative care team and acute pain service can help provide the most effective pain relief for this group of patients. The article uses a case study to describe how the teams work with the wider multidisciplinary cancer team to provide coordinated support and pain management for patients and their families. [ABSTRACT FROM AUTHOR]

AUTH Why you should read this article: • To enhance your awareness and appreciation of the experiences of parents caring for a child with complex needs who is undergoing transition from hospital to home • To consider your role in supporting parents and families undergoing transition from hospital to home • To be aware of the emotional challenges faced by parents and families caring for a child who is ventilator dependent at home The number of children who are ventilator dependent and being cared for at home by their families has risen dramatically in recent years. Parents' roles are often taken for granted, with little recognition of the effect of the shift from parent to carer on families. The aim of this literature review was to explore parents' perceptions of the burden of care placed on them during the transition of their child who depends on a ventilator from hospital to home, the support they received during discharge and any gaps in continuity of care. An electronic database search was undertaken of PubMed, Cumulative Index to Nursing and Allied Health Literature and PsycINFO. After exclusion a total of 14 studies were reviewed and critiqued. The main themes identified were: transition: preparing for discharge; feelings of isolation on transitioning home; and the strive for normality or a sense of control felt by parents and family members. Where facilitated, families are more than capable of providing skilled, competent care at home to a child who is ventilator dependent. The long-term effects of this arrangement are largely unknown so far, but the literature shows that it has a substantial psychosocial effect on families. More information and education for healthcare professionals is required about the experiences of these families to appreciate the struggles they face after discharge. This may have a positive effect on how nurses and other professionals support parents during the discharge process. [ABSTRACT FROM AUTHOR]

More than 100,000 children and young people are estimated to be living with serious and complex health needs across the UK. Many spend months or even years in hospital because there is no support for them to leave. [ABSTRACT FROM AUTHOR]

Schizophrenia affects the mental well-being of service users but also their physical and social well-being. This article explores the causes of schizophrenia and how the illness can contribute to self-neglect. The interaction of mental and physical health in people with schizophrenia is explored and how mental health nurses might work with colleagues to help service users to cope. A case study is used to illustrate how healthcare professionals from different backgrounds worked with a service user and his family to help manage his self-care and improve his well-being. This is the third article in a series on well-being, physical and mental health. [ABSTRACT FROM AUTHOR]

In 2016, the urgent and ambulatory care service in Oxfordshire formed part of a cross- organisational partnership working group. The group consisted of Oxford Health NHS Foundation Trust community minor injury units (MIUs) at Abingdon and Witney, and Oxford University Hospitals NHS Foundation Trust (OUH) trauma and orthopaedic specialties and emergency department (ED). The aim was to redesign fracture management pathways and delivery of definitive care at patients' first point of contact with the NHS. This article discusses the implementation of the trauma pathways in two of Oxfordshire's community MIUs. In total, a range of seven common fracture pathways seen in the ED and community MIUs were redesigned so that patients were treated definitively at the first point of contact and discharged with a safety net supported by leaflets; a direct contact facility to OUH trauma specialties was part of the safety net allowing patients to self-refer to the trauma clinic if they had any concerns. In total, 513 patients were treated and discharged on see, treat and discharge fracture pathways in the first year of pathway operation, which represented a 21% decrease in patient referral rates to the trauma clinic at OUH compared with the previous year. [ABSTRACT FROM AUTHOR]

Aim To explore the experiences of women with breast cancer undergoing a mastectomy and discharge from hospital within 23 hours of their stay. Method A qualitative phenomenological hermeneutic approach using semi-structured interviews. A purposive sample of ten women were recruited from the breast unit in a single centre over five months identified by the breast care team. Findings Six patients discharged within 23 hours had a positive experience of the pathway. However, four did not complete the pathway and had a negative experience. Main themes were initial reactions to the 23-hour pathway, surgery and inpatient experiences, experiences across the whole pathway, coping and the effect of the support network. Conclusion Although the 23-hour pathway is safe and effective it may not meet the individual needs of all patients and does not offer a person-centred care approach. It may be possible to identify patients prospectively who are likely to have a negative experience and target support or amend the pathway to improve their experience. [ABSTRACT FROM AUTHOR]

Childhood asthma is a complex disease which may be resistant to treatment and varies in its clinical presentation. The number of children admitted to emergency departments (EDs) with acute exacerbation of asthma is high and many are managed solely in the department. The correct assessment of the severity of an exacerbation can be achieved through competent history taking, examination and accurate recording of observations. Nurses working in EDs should be able to recognise the clinical signs and symptoms of acute asthma, assess severity and advise on appropriate management. Nurses should have some knowledge of first-line management and how and when to help deliver these therapies. They should also be able to guide patients in discharge and follow-up care, develop a rapport with families and educate them on topics such as trigger avoidance. The assessment and management of these patients as outlined in this article is based on the British Thoracic Society/Scottish Intercollegiate Guidelines Network (2016). [ABSTRACT FROM AUTHOR]

The aim of ambulatory emergency care (AEC) is to provide patients with ambulatory care-sensitive conditions with safe and appropriate emergency care on the day they attend hospital. It is achieved without admitting patients to a hospital bed and is therefore an admissions-avoidance service. Gloucestershire Hospitals NHS Foundation Trust has been running AEC at its two acute sites since May 2014. This article reports findings from a service review that looked at whether there were improvements in health outcomes for patients accessing AEC compared with those for patients who had presented to emergency care before the service was set up. The article describes how a review of patient notes found that patients managed through AEC had fewer diagnostic procedures performed and were more likely to be discharged to their normal place of residence. [ABSTRACT FROM AUTHOR]

As health and social care services aim to return to a 'new normal' what does this mean for children's services heading into the autumn? While severe cases of COVID-19 in children have been thankfully rare – there were reported to have been more than 70 intensive care admissions by mid-June – children's services have been hit hard. [ABSTRACT FROM AUTHOR]

Aim To explore the collaboration challenges faced by neonatal intensive care unit (NICU) nurses and public health nurses when preparing premature infants for transition home and to explore the culture of cooperation between the two professional groups. Method Qualitative individual interviews were undertaken with two NICU nurses and two public health nurses. A qualitative content analysis was used to analyse the data. Findings Three main themes were identified: different expectations and lack of communication between NICU nurses and public health nurses; responsibilities and interactions between the two professional groups were not clearly defined; and the public health nurses' competence was not recognised by the NICU nurses and parents. Conclusion There is a need of clear guidelines about the discharge process from the NICU. This issue must be given further attention. [ABSTRACT FROM AUTHOR]

Concussion in sport is a common presentation in urgent and emergency care settings, so it is essential that nurses have a full understanding of the condition. Most patients who attend an emergency department with concussion are discharged and discharge advice must be well-informed and evidence based. This article outlines the normal anatomy of the brain and the pathophysiology of concussion, and discusses the guidelines on returning to sport following this injury. [ABSTRACT FROM AUTHOR]

A postgraduate mental health nursing student refers to an incident in practice to reflect on psychiatric diagnosis and the diagnosis of personality disorder. She also discusses the care programme approach as a forum for person-centred practice and shared decision making in mental health care. Mental health practitioners need to pay more attention to their own motivations and behaviour, and listen more intently to the person they are working with. Using the open dialogue model of practice, which relies on transparency between staff, service users and significant others, could improve communication with people diagnosed with a personality disorder. [ABSTRACT FROM AUTHOR]

Parkinson's disease (PD) is a common progressive neurological condition. There are 127,000 people with the disease in the UK, that is, one in every 500 of the population. In 2014-15 there were 14,000 hospital admissions of people with PD in England. However, PD is often not the primary cause of admission. Urinary tract infections and pneumonia, for example, are frequent causes of hospital admission for people with PD. Therefore, nurses on general medical and surgical wards will often care for people with PD. This article aims to provide an update on PD and explore the nurse's role in assessment and provision of safe and effective care for patients with PD in acute hospital settings. [ABSTRACT FROM AUTHOR]

Aim This article describes the modification and testing of a triage tool, the patient pathway assessment score (PPAS), which could be used by all grades of nursing staff to triage patients in a medical assessment area (MAA). The aim was to increase patient satisfaction and reduce waiting times. Method Staff scored all patients using PPAS, but used the existing triage process to assign patients to one of the MAA's two pathways. Two researchers reviewed patients' notes retrospectively to determine which pathway they should have followed and compared this to the outcome that would have occurred if the PPAS score had been used. Results Full, rather than theoretical, use of the PPAS tool could have reduced patient waiting times, as 55 (24%) out of 231 patients would have been allocated to the correct pathway. Conclusion The tool could improve patients' journeys through the MAA by ensuring they are allocated to the correct pathway. It is now implemented in practice. [ABSTRACT FROM AUTHOR]

The move towards healthcare being delivered predominantly in people's own homes has been seen as creating more choice and giving patients better access to care. How this is being delivered in practice is under question as district nursing teams endeavour to meet a range of needs and coordinate the transfer of care from hospital to home. The research project outlined here explored the views of district nurses on what are the 'enablers' and 'barriers' to the transfer of care from hospital to home. It also asked what the nurses felt were important issues in coordinating the discharges process on a daily basis. District nurses' views are outlined and recommendations for future practice made. This study shows that the most important issue in the smooth transfer of care from hospital to the community is communication. Although other factors were identified, the research highlighted the importance of good communication between primary and secondary care providers. This article provides practical methods for translating these findings into daily practice. [ABSTRACT FROM AUTHOR]

The readiness of a child or young person for discharge includes patient safety, the family's ability to care for the child at home and the ongoing treatment they will need, which has a direct influence on their health outcomes and future readmissions to hospital. There are no standard criteria for discharge practice and registered nurses have reported concerns about their ability to provide education and discharge planning to meet the needs of the patient and their family. A literature review was carried out to ascertain the current discharge principles adhered to in practice and the implemented tools used. The problems faced by registered nurses include ineffective communication, poorly defined role in discharge planning and lack of agreement with the multidisciplinary team. The standardisation of discharge procedures may reduce the risk of readmission and health deterioration of the patient and ensure positive health outcomes, improve family health literacy and continuity of care. [ABSTRACT FROM AUTHOR]

The article discusses the development of a pathway for people at the end of life by a team of nurses at the Northern General Hospital in Sheffield, England. The pathway includes guidance for the multidisciplinary team. It was developed based on the expertise of nurses in palliative and primary care. Members of the team include John Gillett, Angela Harris, Andreas Crede and Jayne Dransfield.

Head injury is the most common cause of injury-related death and permanent disability in children. Minor head trauma is common in childhood and does not require any medical treatment. Although deficits can occur even after mild to moderate head injury, they are markedly greater and become clinically evident following severe head injury. It is important that emergency department clinicians are aware of the signs and symptoms that indicate severe traumatic brain injury and triage for urgent intervention in those children who present with these signs and symptoms. Clinicians also need to know when children can be sent home with reassurance and information, and when they require admission or transfer to a neurosurgical unit. This article examines the literature on head injuries in children, describes assessment, management and treatment, and provides a simple management algorithm. [ABSTRACT FROM AUTHOR]

Admitting children to emergency departments (EDs) often places them in an environment better suited to the treatment of adult patients. These children are often triaged and treated as adults, resulting in children being given the wrong triage categories and having their treatment delayed. EDs have problems giving drugs to children, staff are unfamiliar with children's emergency care, and children find EDs frightening. A paediatric emergency short stay unit (PESSU) was opened at Caboolture Hospital, Queensland, Australia, in January 2014. Admission to the PESSU has significantly reduced waiting times for children arriving at the ED and enabled specialist nursing and medical care to be provided quickly. This has been supported by the development of the paediatric flow nurse role (Gray et al 2016). [ABSTRACT FROM AUTHOR]

This is the third in a short series that presents case study examples of the application of comprehensive geriatric assessment (CGA) in different clinical settings. CGA is a holistic assessment model, which is designed to determine a frail older person's medical and mental health status, as well as functional, social and environmental issues. When undertaken by nurses, it can enable individualised care planning. The case study presented explores the application of CGA with an 89-year-old patient with complex health and social care needs. It demonstrates how a hospital admission was avoided and the patient's health outcomes improved, by using a nurse-led systematic approach to assessment and by careful consideration of CGA domains. [ABSTRACT FROM AUTHOR]

Children admitted to emergency departments (EDs) in Australia are often placed in an environment better suited to the treatment of adult patients. This can lead to problems because ED staff are unfamiliar with specialist paediatric care and children often find adult EDs frightening. The development of the paediatric flow nurse (PFN) role at Caboolture Hospital has meant children are treated and supported by a trained paediatric nurse and triaged and treated quickly and effectively. The PFN team collaborates with ED nursing and medical staff to start treating patients and to help move children from the ED to the paediatric emergency short stay unit or inpatient paediatric beds. Each week, the PFN team sees about 30-50 children, many of whom are cared for and discharged directly from the ED. [ABSTRACT FROM AUTHOR]

January 2016 was one of the most difficult months for emergency departments since the four-hour waiting time standard was introduced by the government in 2004. Patient demand was high and the percentages of people admitted or discharged within four hours fell to some of its lowest levels in all UK countries. This article gives an overview of the situation across the four nations and explores the reasons behind the statistics. It also outlines what hospitals and local authorities are doing to relieve pressures and cope with unprecedented demand. [ABSTRACT FROM AUTHOR]

Timely and well-planned discharge improves the patient's experience, contributes to patient safety and reduces the length of hospital stays. The role of orthopaedic discharge sister was developed at James Cook University Hospital in 2007 to provide safe, timely and efficient discharge for patients from the trauma and theatre centre, and to improve patient experience and flow. This article gives an overview of the role and describes how the sister works with colleagues to plan patient discharges from pre-assessment and emergency department admission through their hospital stay until their departure. [ABSTRACT FROM AUTHOR]

The recent outbreak of Ebola virus disease killed more than 11,000 people in the West African countries of Sierra Leone, Guinea and Liberia. As the death toll in West Africa but also elsewhere rose, it became apparent that potentially infected patients could present to emergency departments across the world. An international response was needed to contain the disease and prevent its rapid spread. This article describes a British military-run treatment centre in Kerry Town, Sierra Leone, and discusses how standard nursing practices were adapted to manage this high-risk situation. It also highlights the difficulties of nursing patients with a contagious disease that has no licensed cure or vaccine. [ABSTRACT FROM AUTHOR]

This article describes the role of the community neonatal nurse in the discharge of infants with chronic lung disease (CLD), or bronchopulmonary dysplasia. It also explores the use of a common assessment framework in the assessment of such children and development of a nursing care plan. The article includes a case study to illustrate the link between CLD and other diseases, and emphasises the importance of focusing on holistic care from admission, in the neonatal unit and at discharge. [ABSTRACT FROM AUTHOR]

Adrenal insufficiency is an endocrine condition defined as the inadequate production or action of glucocorticoids, principally a steroid hormone called cortisol. While rare in childhood, it carries the risk of adrenal crisis in the event of a child becoming unwell as a result of intercurrent illness, injury or surgery. Children's nurses must be vigilant in caring for a child with adrenal insufficiency and have a clear understanding and awareness of the principles of emergency management at home and in hospital. [ABSTRACT FROM AUTHOR]

Patient care visibility technology systems provide real-time information about patient admissions, discharges, transport, clinical activities and housekeeping services, in order to enhance patient care and flow. This article reports the results of a descriptive study that explored healthcare professionals' perceptions of and attitudes to a patient care visibility technology system in an acute care setting. The results indicate that staff find the system user friendly, and are positive about its staff- and patient-focused characteristics. Overall, positive staff perceptions and acceptance imply positive use of the system. This study forms the basis for further research on the effects on the patient-care outcomes of healthcare professionals' use of these systems. [ABSTRACT FROM AUTHOR]

The nearest relative role is a statutory safeguard for people who may be subject to the formal powers of the Mental Health Act 1983 in England and Wales. It survived the amendment in 2007, despite a wide consensus that the role should be replaced by a 'nominated person'. This article reviews the nearest relative role and argues it is consistent with contemporary policy with regard to carers. It challenges practitioners to dispense with any lingering ambivalence about the role and to facilitate the nearest relatives' legal rights to support people with mental health needs and their carers. [ABSTRACT FROM AUTHOR]

Practitioners need to work collaboratively to enable people experiencing homelessness to achieve a good standard of care whenever they have a ‘transition of care’ between hospital and community services. The Queen’s Nursing Institute, in partnership with other organisations, is sharing best practice with a network of more than 850 health professionals who specialise in working with homeless and vulnerable people. This article outlines the role primary health professionals should play in preventing homelessness and supporting people with ongoing care. [ABSTRACT FROM AUTHOR]

Overcrowding due to poor patient flow increases risk for more than 500,000 patients a year (College of Emergency Medicine (CEM) 2014) and is linked to increased mortality (Geelhoed and de Klerk 2012). CEM (2014) has called for urgent action to address ‘exit block’ in UK emergency departments (EDs). In October last year, Croydon Health Services NHS Trust designed and implemented a site practitioner early warning system (SPEWS) to alert staff to capacity and flow pressures in the ED, and to initiate escalation to a nurse-led, protocol-driven response. Under pressurised and time-critical conditions, SPEWS ensures rigour and conformity in exchanges between clinical emergency care staff and managers. The result is closer collaboration between clinicians and managers, optimised patient flow and mitigated risk from exit block. [ABSTRACT FROM AUTHOR]

Service users, staff and carers have long expressed dissatisfaction with the quality of acute mental health inpatient care, particularly with perceived staff inaccessibility and poor environments. Recovery-orientated organisational policies and staff training and practice have been shown to improve the situation. These have centred on integration with other services and collaboration with service users and their families. Whereas on wards, good risk management, therapeutic relationships, meaningful activities, attention to physical health and social inclusion all promote recovery and are cost-effective. [ABSTRACT FROM AUTHOR]