Understanding and investigating potential problematic behaviour towards colleagues.

Behaviour towards colleagues within the nursing team that undermines teamwork and conflicts with standards and policies can be described as problematic. It is important that nurse managers understand and investigate potential problematic behaviour towards colleagues, particularly in today's healthcare environment where team cohesion and morale are constantly under threat. In this article, the author highlights the challenges for nurse managers and describes the sensitive and respectful exploratory process they need to undertake. Nurses' behaviours are underpinned by beliefs, values and attitudes so investigating potential problematic behaviour warrants an exploration of these aspects with individual nurses and with the nursing team. Therefore, the author also suggests a way for nurse managers to conduct a collective exploration of the team's values.

Optimising professional communication with patients.

Communication between a nurse and a patient may seem intuitive. However, communicating effectively with patients while applying the principles of person-centred care can be challenging. Patients' perceptions of suboptimal care and healthcare services may be influenced by how nurses communicate with them, since communication may be used as a quality indicator, as well as an indicator of patient experience. This article considers how nurses can communicate effectively with patients to optimise care. It explores the theoretical principles of interpersonal and professional communication, and discusses practical methods of listening and speaking to patients that nurses can apply in their clinical practice.

Improving nursing students' experience of clinical placements.

Clinical placements can present a significant challenge for nursing students, since the learning environment differs from that of the classroom, involving potential risks and complicated interpersonal and interprofessional relationships. The array of decisions required on clinical placements can be confusing for nursing students, which can cause them to doubt their skills and knowledge. This article describes the challenges involved in clinical placements, and discusses the importance of person-centred care and techniques such as reasoning and reflection that can improve nursing students' learning in practice. It uses two case studies to illustrate how clinical supervisors and mentors can design clinical placements that enable nursing students to develop their skills, knowledge and self-confidence.

Developing patient rapport, trust and therapeutic relationships.

Rapport is established at the first meeting between the patient and nurse, and is developed throughout the therapeutic relationship. However, challenges can arise during this process. Initially, nurses can establish trust with the patient through the questions they ask, however, as care progresses, the nurse will be required to demonstrate a commitment to maintaining the patient's psychological well-being. When the therapeutic relationship ends, the nurse should assist the patient to assess progress and plan the next stage of recovery. This article provides three reflective exercises using case study examples to demonstrate how rapport is developed and sustained. Evidence is provided to identify why challenges arise in the therapeutic relationship and how the nurse can ensure they provide care that the patient regards as genuine.

Improving nurses' level of reflection.

Reflecting on practice is an important aspect of nursing. There is widespread acknowledgement of the value of reflective practice and it has a significant role in coursework assessment and revalidation requirements. However, less attention has been given to the various levels of reflection and what constitutes a higher or lower level of reflection. This article aims to assist nurses to understand how identifying the various levels of reflection can improve their practice. A case study example is used to demonstrate how mentors might support nurses in incorporating reflection into their practice.

Managing patients' anxiety about planned medical interventions.

Patients are often anxious about planned medical interventions, and those experiencing anxiety are less likely to have the confidence to collaborate with healthcare professionals on their plan of care, and make decisions about consent. They may also find it challenging to follow rehabilitation guidelines, which can affect their long-term recovery. As part of their professional duty, nurses are required to recognise when people are anxious or in distress and respond compassionately, and while acquiring valid consent for any planned medical intervention requires the nurse to explain any risks, they should also attempt to reassure patients. The anxiety that precedes a planned medical intervention has been described as state anxiety; this refers to feelings of discomfort and uncertainty that accompany a situation such as an operation or a diagnostic procedure. Nurses can attempt to reduce any anxiety that patients experience by explaining the planned medical intervention and providing accurate information at the optimum time. This article outlines some of the coping theories that nurses can use to support patients in managing their anxiety about planned medical interventions.

Discussing risk with patients.

Nurses support patients to make decisions about risk on a regular basis. They aim to offer patients evidence regarding the choices available. However, it is necessary for patients to understand the components of risk and associated decisions, before shared decision-making can be realised. This article provides a straightforward explanation of risk and risk decision-making to enable nurses to support patients through the risk-assessment process. Consideration is given to the patient's predisposition towards risk, whether positive or negative, and the necessity of reviewing the patient's understanding of the risks involved. A model of risk assessment is presented, that considers the likelihood of a risk occurring and its possible effects on the patient. The article emphasises the importance of considering risk decisions in the long term, including the opportunities that are realised with each decision made. Case studies are used to consider these principles in practice.

Enabling patients to manage altered body image.

The author presented a model in the 1990s to explain altered body image, which has been used to characterise the difficulties encountered by patients who experience body change as a result of illness, injury or disability. However, it remains a challenge for nurses to establish care plans that can assist patients to manage the psychological adjustments associated with disfigurement. This article presents some simple questions to help patients narrate their psychological experiences and needs, and proposes a model of psychological change, based on the work of Kübler-Ross, to enable nurses to anticipate patient requirements that might arise at different stages of the individual's recovery and rehabilitation. Body-image rehabilitation may be protracted. Therefore, it is essential for nurses to understand what the patient is thinking and feeling throughout the rehabilitation process and which stage of psychological change the patient is working through.

Promoting healthy sleep.

Nurses are accustomed to helping others with their sleep problems and dealing with issues such as pain that may delay or interrupt sleep. However, they may be less familiar with what constitutes a healthy night's sleep. This article examines what is known about the process and purpose of sleep, and examines the ways in which factors that promote wakefulness and sleep combine to help establish a normal circadian rhythm. Theories relating to the function of sleep are discussed and research is considered that suggests that sleep deficit may lead to metabolic risks, including heart disease, obesity, type 2 diabetes mellitus and several types of cancer.

Hallucinations: insights and supportive first care.

Nurses working in a range of clinical settings may encounter patients who report experiencing hallucinations, whether auditory, visual or any other form. This article, which has been written for nurses working in general practice rather than mental health practice, clarifies the differences between hallucinations and delusions and explains that both symptoms are often experienced together in mental illness. The possible causes of hallucinations are summarised and the advice that should be given to patients is discussed. Although patients might manage their hallucinations by creating narratives to explain what is happening to them and to find ways of representing their experience to others, diagnosis and treatment of underlying conditions are important too. The article outlines precepts that can guide the nurse's response to a patient presenting with hallucinations for the first time.

Understanding attitudes and their effects on nursing practice.

Attitudes are of crucial importance in nursing. Attitudes help us to understand how people perceive issues and processes in care and determine what they deem important, good, relevant and appropriate. We should understand attitudes if we are to provide collaborative, patient-centred care; however, they are poorly understood. This article enables the reader to examine attitudes and their constituent beliefs and values. It explores the function of attitudes, considers how they are formed and reflects on the process of attitude change, examining how persuasion can be used to enable individuals to revisit behaviours that seem problematic or less effective.

Helping patients to learn about self-management.

Nurses are often urged to help patients learn about their illness and the self-management measures that may enable them to achieve a degree of independence after they have left hospital. However, little has been written about the practical process of facilitating patient learning while the patient makes sense of their circumstances and considers what they can do to manage any necessary lifestyle changes. Educational articles tend to focus on programmed learning, such as educational courses delivered to groups of patients with similar conditions. This article assists the nurse in reviewing what learning might entail for a patient and to explore why this type of learning is different to learning in other circumstances.

Approaches to counter loneliness and social isolation.

Social isolation and loneliness are significant threats for older people and may be associated with mental and physical health problems. This article revisits what is meant by social isolation and loneliness and explores the way in which social change can trigger both problems. Social networks are discussed as the means by which older people can mediate the stresses of change around them. The article summarises some of the health consequences of loneliness, indicates some simple measures nurses can use to limit the risk of institutional loneliness and then examines how collaborative community ventures, mentoring and befriending schemes can help older people to access and rebuild social networks that may assist them to sustain wellbeing. Case study material is used to highlight contrasting profiles of older people who may be either more or less at risk of social isolation.

Applying critical thinking to nursing.

Critical thinking and writing are skills that are not easy to acquire. The term 'critical' is used differently in social and clinical contexts. Nursing students need time to master the inquisitive and ruminative aspects of critical thinking that are required in academic environments. This article outlines what is meant by critical thinking in academic settings, in relation to both theory and reflective practice. It explains how the focus of a question affects the sort of critical thinking required and offers two taxonomies of learning, to which students can refer when analysing essay requirements. The article concludes with examples of analytical writing in reference to theory and reflective practice.

Writing up research for publication.

This article describes the process of preparing a research article for publication in a nursing journal. It is aimed at nurses who wish to share their research results with other health professionals and is designed to help the researcher who is new to publishing. In writing a research article, the author describes what he or she has learned. This may enable others to replicate or develop the research, or improve their clinical practice. Published research should represent the research clearly and accurately, present the findings or results, and provide reasoned conclusions about what has been discovered.

Respecting patient confidentiality.

Nurses face a particular challenge in respecting the confidentiality of patients in a world where information is quickly shared and where information about illness can be sensitive. We have a duty of care towards patients. That duty includes maintaining privacy (protecting them from undue intrusion), and confidentiality (by the discreet management of information about themselves that they share with us). Legislation on confidentiality comes from different sources and should be interpreted in the clinical setting. This article summarises the principal requirements set out in the legislation and directs readers to questions and tools designed to help them explore the extent to which patient confidentiality is respected where they work.

Preparing a successful, role-specific curriculum vitae.

An internet search reveals just how many articles there are on preparing a curriculum vitae (CV). The preparation of a CV should not be regarded as a 'one-off' event, to be updated periodically. A successful CV requires thoughtful preparation to ensure it is directed towards a specific post and should consider two important perspectives. First, an understanding of what is required of the practitioner in the nursing post (demand), and second, what the nurse can offer in terms of his or her skills, experience, qualities and qualifications (supply). The demands of the post will also include meeting professional standards, such as those that have emerged following consideration of the Report of the Mid Staffordshire NHS Foundation Trust Public Inquiry (Francis 2013). This article explores how to prepare a successful CV for a specific role, using a demand and supply perspective--where a nurse seeks to match the specific requirements of the post by summarising what he or she has to offer.

Improving your journal article using feedback from peer review.

While preparation of a journal article for submission may often include informal review by colleagues, an article is not accepted for publication until it has been formally peer reviewed. Peer review is the process whereby journal editors ask expert reviewers to examine the work submitted and prepare a report on its suitability for publication. Two or more revisions of the article may be required following peer review, with the author reworking the article in the light of feedback received on each occasion. This can be challenging for some authors, but used well, it offers a chance to improve the work to the required standard of the journal, and help the author present a more precise and coherent account of the arguments. The extent to which the author responds to the critical commentary of peer reviewers is important, because this may determine whether or not the article is published. This article explores the aims of peer reviewers and recommends ways in which authors can respond to the feedback provided.

Writing a continuing professional development article for publication.

Writing for journal publication is a worthwhile but challenging activity that requires clear motives, purpose, planning and execution. Continuing professional development (CPD) articles are designed to be informative and educative, with the aim of enhancing the reader's understanding of a particular subject. This article provides an overview of how to approach and plan the writing of a CPD article to enhance the success of its acceptance for publication in a professional journal.