1. NUR 260 Supplementary Workbook September 2006 cohort KH/11/07/2008

2. This supplementary workbook has been developed by the NUR 260 module team. The aim of the workbook is to give the student learning activities relating to the clinical skills themes of the module. The aspects covered in the workbook include: 1. Pain management 2. Isolation nursing 3. Stoma care 4. Advanced wound management 5. Adjuncts to nutrition 6. Communication skills Please complete the questions, activities and reflections contained in the workbook. This will help to consolidate your knowledge and experience and thus aid discussion during forthcoming NUR 260 teaching sessions. Opportunities to complete the workbook have been allocated to you. These include the consolidation week, the reading weeks and time when your clinical skills group are not actively involved in clinical skills. Please investigate the topics by searching for the best available evidence. This could be from national or local guidelines, policies and procedures i.e. utilise your evidence-based practice skills. In the back of the supplementary workbook is a suggested reading list. PAIN MANAGEMENT KH/11/07/2008

3. A definition of pain 1.1 Review the Aetiology and pathophysiology of pain. Consider theories about pain i.e. Gate Control Theory. Construct your own definition of pain. 1.2 Differentiate between Types of pain Acute Chronic 1.3 Review the signs and symptoms of pain Acute Chronic KH/11/07/2008

4. Pain assessment 1.4 Examine the evidence relating to the effectiveness of various types of Pain Assessment Tools i.e. a. The PQRST method (Rahman 2004) b. The British Pain Society & Royal College of GPs method (2004) c. The visual analogue scale d. The numerical rating scale e. The verbal descriptor scale 1.5 Clinical Activity When next in clinical practice, ask your mentor about the pain assessment scale used in that placement. Compare and contrast it with other scales that you have found. Drug treatments 1.6 Investigate the Pain Relief / Analgesic Ladder devised by the World Health Organisation. Reflect back upon a patient you have cared for who: KH/11/07/2008

5. a. benefited from having their drug treatment linked to the principles of the analgesic ladder b. may have benefited from having their drug treatment linked to the principles of the analgesic ladder 1.7 List non-opioid analgesic drugs which can be used. Explain their effect, via which route they can be administered and what the undesired side effects may be. 1.8 List opioid analgesic drugs which can be used. Explain their effect, via which route they can be administered and what the undesired side effects may be. KH/11/07/2008

6. 1.9 Define what compound analgesics are? 1.10 Investigate types of non-steroidal anti-inflammatory drugs. Explain their effect, via which route they can be administered and what the undesired side effects may be. 1.11 What are tricyclics & anticonvulsants? Give some examples. What are their roles in pain management? Identify what their alternative use is. KH/11/07/2008

7. 1.12 Research Patient Controlled Analgesia. What is it? What are the main benefits and disadvantages of this type of analgesia? Cite your evidence or sources. 1.13 What is epidural analgesia? Investigate where the analgesia is administered. Discuss the specific nursing care associated with administering analgesia via this route. 1.14 Investigate non-pharmacological options for pain management. What is the evidence to show that the following types of therapies are effective? a. physical therapies b. cognitive & behavioural pain management c. complementary therapies d. TENS e. Patient Support Groups KH/11/07/2008

8. 1.15 Linking to available evidence, examine the benefits of a Pain Management Team within health organisations? 1.16 Clinical Activity When next in practice, explore the local guidelines and policies which relate to the drug management. Investigate from where they originated. ISOLATION NURSING 2.1 Your mentor informs you that Mr Smith has to be isolated & will require isolation nursing. a. Define what isolation nursing is KH/11/07/2008

9. b. Differentiate between protective & source isolation 2.2 Investigate some reasons why Mr Smith may be isolated 2.3 How will you explain to Mr Smith that isolation nursing is going to happen? KH/11/07/2008

10. 2.4 Clinical Activity - Review the isolation nursing policy in the clinical area where you are working. Outline the main aspects. 2.5 Investigate the psychological effects of isolation nursing for the individual. How can being isolate affect Mr Smith? Cite some of the evidence. 2.6 How will you aid Mr Smith if he develops psychological effects from being isolated? KH/11/07/2008

11. 2.7 Review the role of the Infection Control Nurse / Team. Investigate evidence to show the effectiveness of the team. List some of your sources. 2.8 Clinical Activity - Find a Patient Information Leaflet relating to isolation nursing. Appraise the leaflet and judge whether you feel it will be effective in informing the patient concerning what isolation nursing entails. STOMA CARE 3.1 Define what a colostomy is. Investigate reasons why a colostomy would be formed KH/11/07/2008

12. 3.2 Define what an ileostomy is. Investigate reasons why an ileostomy would be formed 3.3 Describe the faecal consistency from an ileostomy and from a colostomy. State why this occurs 3.4 Examine the pre-operative care of a patient having a stoma formation. Outline the role of a Stomatherapist. 3.5 Which sites on the abdomen should be chosen or avoided to facilitate the easy management of a stoma? KH/11/07/2008

13. 3.6 Examine the post operative care of a patient having a stoma formation 3.7 Discuss the post-operative stoma observations that should be undertaken. What is normal or abnormal? 3.8 Identify the appliances worn by patients with an ileostomy or a colostomy. Make a list of the differences, advantages and disadvantages associated with these appliances. KH/11/07/2008

14. 3.9 Identify the dietary information that is given to a patient who has recently had an ileostomy or colostomy formed 3.10 Clinical Activity - Reflect upon the care of a patient who you have nursed and who may have experienced an alteration of their body image. How did they react to this change? Identify how you think you can help patients to cope with this difficult experience in the future. ADVANCED WOUND MANAGEMENT 4.1 Revise the stages / phases of wound healing KH/11/07/2008

15. 4.2 Clinical Activity - What types of wound have you seen in practice? 4.3 What were the causes or contributing factors of these wounds? 4.4 List some examples of an acute wound 4.5 List some examples of a chronic wound KH/11/07/2008

16. 4.6 A wound is healing with primary intention. Explain what this is 4.7 A wound is healing with secondary intention. Explain what this is 4.8 A wound is healing with tertiary intention. Explain what this is 4.9 What factors can affect wound healing and why? KH/11/07/2008

17. 4.10You are caring for a patient with a wound. List some complications of: a. An acute wound. b. A chronic wound 4.11What is the optimum environment for wound healing? KH/11/07/2008

18. 4.12Clinical Activity - Review types of wound dressings in common usage and identify which types of wound they can be used 4.13You have been asked to assess a patients wound: a. Describe the holistic assessment of the patient b. Describe the assessment of the wound KH/11/07/2008

19. 4.14Clinical Activity - What Pressure Ulcer Risk Assessment Tools have been in use in your clinical areas? Review the effectiveness of these various tools. What has previously influenced your choice of tool? 4.15What are the causes of pressure ulcers? 4.16Clinical Activity - Explain how you have assessed a pressure ulcer / the pressure areas of a patient you have nursed. 4.17What evidence would you utilise in order to prevent pressure ulcer formation? KH/11/07/2008

20. ADJUNCTS TO NUTRITION 5.1 Who may make decisions relating to the requirement for nutritional support? 5.2 Explain what enteral feeding is? 5.3 Explain what parenteral feeding is? KH/11/07/2008

21. 5.4 What are the indications for naso-gastric feeding? 5.5 Investigate the correct method of naso-gastric feeding tube insertion 5.6 Identify the correct methods of ensuring the naso-gastric feeding tube is in the correct position. Cite an up-to-date source for this information. KH/11/07/2008

22. 5.7 Explore the types of feed which can be used for naso-gastric feeding 5.8 Describe the principles for the safe administration of the naso-gastric feed 5.9 When should naso-gastric administration sets be changed? KH/11/07/2008

23. 5.10What are the complications of naso-gastric feeding? 5.11Define what a PEG is 5.12What are the indications for PEG feeding? 5.13Explain how a PEG is inserted KH/11/07/2008

24. 5.14Describe the care of a patient with a newly formed PEG 5.15Discuss the psychological impact for the patient of having PEG 5.16Investigate the safe administration of drugs via a feeding tube KH/11/07/2008

25. COMMUNICATION SKILLS 6.1 What may cause aggression in an individual? 6.2 What may be some signs of anger in an individual? 6.3 Clinical Activity - Think back to a situation involving anger or aggression. Can you visualise the situation escalating? Did you recognise any of these reactions? KH/11/07/2008

26. 6.4 What skills are required to prevent and manage aggression in an individual? 6.5 What is de-escalation? 6.6 Define what bad news is KH/11/07/2008

27. 6.7 Clinical Activity - Write a reflection about: a. The last time you received bad news b. Who gave you the news? c. How did they break the news to you? d. What did they say to you? e. How did you feel? 6.8 Investigate the evidence relating to effective breaking of bad news 6.9 Who can be responsible for telling a patient they are dying? Further reading Pain management KH/11/07/2008

28. BNF (2008) British National Formulary London, BMJ Publishing Hogston, R Marjoram, B (eds) (2007) Foundations of nursing Practice Basingstoke, Palgrave Macmillan Mackintosh, C (2007) Assessment and management of patients with post operative pain Nursing Standard 22 (5): 49-55 Richardson, R (ed) (2008) Clinical skills for student nurses Exeter, Reflect Press Scottish Intercollegiate Guidelines Weetman, C Allison, W (2006) Use of epidural analgesia in post operative pain management Nursing Standard 20 (44): 54-64 WHO (1996) Cancer Pain Relief Geneva: WHO, www.anaesthesiauk.com www.action-on-pain.co.uk www.britishpainsociety.org www.nhs.uk/livewell/pain www.painconcern.org.uk www.painrelieffoundation.org.uk Isolation nursing Davies, H Rees, J (2000) Psychological effects of isolation nursing (1): mood disturbance Nursing Standard 14 (28): 35-8 Department of Health Madeo, M (2003) The psychological impact of isolation Nursing Times 99 (7): 54 Nursing Times Nursing Standard www.infectioncontrol.nhs.uk Stoma care Hogston, R Marjoram, B (eds) (2007) Foundations of nursing Practice Basingstoke: Palgrave Macmillan KH/11/07/2008

29. Vujnovich, A (2008) Pre and post operative assessment of patients with a stoma Nursing Standard 22 (19): 50-56 www.colostomyassociation.org.uk www.the-ia.org.uk (The Ileostomy & Internal Pouch Support Group) Advanced wound management www.cochranewounds.org www.epuap.com www.ewma.org www.medicaledu.com www.tus.org.uk www.woundcaresociety.org www.worldwidewounds.com Adjuncts to nutrition Brogden, B (2004) Clinical skills: importance of nutrition for acutely ill hospital patients British Journal of Nursing, 13 (15): 914-920 Bosonett, L (2002) Total parenteral nutrition: how to reduce the risks Nursing Times 28 May 98, 22, 40-3 Mallet, J Bailey, C (eds) (2006) Manual of clinical nursing procedures 4th edition Oxford: Blackwell Science. Pickering, K (2003) The administration of drugs via enteral feeding tubes Nursing Times 18 Nov 99, 46-9 www.bapen.org.uk www.nutrition.org.uk Communication skills Baile, WF Buckman, R Lenzi, R Glober, G Beale, G Kudelka, AP (2000) SPIKES a six step protocol for delivering bad news: application to the patient with cancer Oncologist, 5: 302-11 KH/11/07/2008

30. Chauhan, G Long, A (2000) Communication is the essence of nursing care1: breaking bad news British Journal of Nursing 9 (14): 931-8 Kubler-Ross, E Kessler, D (2005) On grief and grieving: finding the meaning of grief through the 5 stages of loss New York: Simon and Schuster KH/11/07/2008