A guide to removing surgical staples.

This article provides a comprehensive overview of the wound healing process, emphasising the critical role of surgical staples in primary intention healing. It outlines the four distinct phases of wound healing including haemostasis, inflammation, proliferation, and maturation - and discusses the mechanisms by which surgical staples enhance this natural biological process. Special focus is given to the aseptic non-touch technique (ANTT), which is crucial in preventing infections during the staple removal procedure. The article further explores the procedural steps involved in the removal of surgical staples and highlights the holistic aspects of patient care that need to be considered. This includes strategies for effective pain management, ensuring informed consent, and maintaining a sterile environment. By integrating clinical skills with a thorough understanding of wound care, this article aims to improve nursing practices in surgical settings, promoting better patient outcomes and recovery.

A study of factors affecting pass rates of level 5 written assessments for undergraduate adult nursing students.

Nursing programmes were flexible during the COVID-19 pandemic, offering simulation to replace clinical hours and adjusting supervision and assessment. However, second-year students in two modules had lower results despite no changes to the material, team or delivery. OBJECTIVES: A retrospective cohort study was conducted, on second-year adult nursing students who submitted written assignments, to analyse recurring patterns that could explain the failure rate. METHOD: Data were analysed from 265 university students to identify patterns of association in demographics, module results and student engagement indicators. RESULTS: A positive correlation was found between age and assignment results, with older students achieving higher grades. Clustering identified three patterns of student engagement. Students demonstrating engagement with all aspects of the course (30.2%) performed significantly better than those in other clusters (P<0.001). Students with disabled student support recommendations performed notably worse than those without. All sizeable differences were resolved following the return to campus and the implementation of additional writing support. DISCUSSION: Age, cross-medium engagement and preparation were all shown to have an impact on marks. These findings can influence how higher education institutions drive and monitor engagement, as this study suggests that all parts of a blended learning approach are equally important.

A guide to pain assessment and management in adults.

Pain is universally experienced and extremely complex, involving the mind as well as the body. It is activated by a variety of stimuli, including biological, physical and psychological. This article seeks to provide a deeper understanding of the physiology of pain and the various classifications used in clinical practice. It also aims to raise awareness of the skills that nurses require for the assessment and management of an individual patient's pain. It explores the tools available to assist with the assessment of pain and provides an introduction to some of the management strategies that can be used to manage pain. Some of the barriers to effective pain assessment and management are also examined.

At a glance: a guide to venepuncture in adults.

This article will provide clinical guidance on carrying out venepuncture on an adult. It will discuss site, equipment selection and aseptic non-touch technique. The aims are to increase knowledge of the anatomical structures associated with venepuncture, demonstrate the clinical procedural technique of venepuncture, and provide an awareness of the dangers and complications of this invasive technique.

A guide to cannulation in adults.

This article provides clinical guidance on performing cannulation on an adult. The site, equipment selection and aseptic non-touch technique will be discussed. The clinical procedural technique of cannulation will be explained and the article will also provide an awareness of the dangers and complications of this invasive technique for both the patient and the health professional.

An overview of the female reproductive system.

This is the first of two articles providing an overview of the female reproductive system. This article looks at the internal organs associated with the female reproductive system, as well as the vulva. The author describes the relevant pathophysiology and provides an outline of disorders associated with these reproductive organs. The role of health professionals in managing and treating these disorders is discussed, and the importance of providing women-centred care highlighted. A case study and care plan is used to illustrate the importance of individualised care, including history taking, assessment of the presenting symptoms, treatment strategies, health education and advice on follow-up actions. A second article will provide an overview of breasts.

Genomes of two Extinct-in-the-Wild reptiles from Christmas Island reveal distinct evolutionary histories and conservation insights.

Genomics can play important roles in biodiversity conservation, especially for Extinct-in-the-Wild species where genetic factors greatly influence risk of total extinction and probability of successful reintroductions. The Christmas Island blue-tailed skink (Cryptoblepharus egeriae) and Lister's gecko (Lepidodactylus listeri) are two endemic reptile species that went extinct in the wild shortly after the introduction of a predatory snake. After a decade of management, captive populations have expanded from 66 skinks and 43 geckos to several thousand individuals; however, little is known about patterns of genetic variation in these species. Here, we use PacBio HiFi long-read and Hi-C sequencing to generate highly contiguous reference genomes for both reptiles, including the XY chromosome pair in the skink. We then analyse patterns of genetic diversity to infer ancient demography and more recent histories of inbreeding. We observe high genome-wide heterozygosity in the skink (0.007 heterozygous sites per base-pair) and gecko (0.005), consistent with large historical population sizes. However, nearly 10% of the blue-tailed skink reference genome falls within long (>1 Mb) runs of homozygosity (ROH), resulting in homozygosity at all major histocompatibility complex (MHC) loci. In contrast, we detect a single ROH in Lister's gecko. We infer from the ROH lengths that related skinks may have established the captive populations. Despite a shared recent extinction in the wild, our results suggest important differences in these species' histories and implications for management. We show how reference genomes can contribute evolutionary and conservation insights, and we provide resources for future population-level and comparative genomic studies in reptiles.

Implementation of a Nurse-Driven Medication Ordering Protocol to Improve Clinician and Nursing Experiences.

ABSTRACT: Paging and text messaging to request new orders remain common means of communication between clinicians and nurses in the hospital setting. However, sending and triaging multiple pages can lead to interruptions in other clinical duties. A medication order delegation protocol allowing for nurse-driven ordering of low-risk medications was developed with an objective of decreasing potentially avoidable pages. The aim of this study was to evaluate the impact of implementing this protocol on nurse and clinician perceptions of clerical burden and satisfaction. A survey assessing satisfaction with the process of obtaining medications in this protocol and the perception of clerical burden associated with ordering them before and after delegation protocol implementation was completed by over 160 clinicians and nurses. Survey respondents reported increased satisfaction and decreased clerical burden associated with the implementation of the delegation protocol. These results suggest the potential for delegation protocols to limit clerical burden associated with paging.

A guide to undertaking and understanding blood pressure measurement.

This article aims to provide background information on blood pressure. It outlines the anatomy and physiology associated with the skill of blood pressure measurement, and the varying techniques for taking blood pressure readings, both invasively and non-invasively. It further explains the steps for taking a manual blood pressure and provides top tips for carrying out this procedure in clinical practice.

Recruitment and retention of older adults in Assisted Living Facilities to a clinical trial using technology for falls prevention: A qualitative case study of barriers and facilitators.

Older adults often have health complexities and higher levels of attrition. Even though they are the main users of healthcare, they are often not included in health research because the health research may not be well designed to accommodate their evolving health needs. One research area in which participation of older adults is essential focuses on improving physical function. In this field, there are many innovations and new technologies developed. Barriers and facilitators to recruit older adults to research that improves physical function by using technology are not well explored yet. This study aims to explore barriers and facilitators regarding recruitment and retention of older adults living in Assisted Living Facilities to a randomised controlled trial study that aimed to improve physical function by using technology. Nine semi-structured interviews were conducted with four Scheme Managers, three therapists and two researchers. The interviews were transcribed. After open, axial and selective coding, the codes were thematic analysed in ATLAS.ti. Scheme Managers, therapists, researchers and older adults' peers appear to play an important role in the recruitment and retention of older adults living in Assisted Living Facilities. Additionally, the technology itself and the presentation of the research appear to influence recruitment. Creating a social setting, inviting people face-to-face, demonstrating the technology, showing the benefits by presenting results from a pilot study and alleviating people's fears were experienced as important factors for recruitment. The results from this study can help other researcher to improve recruitment and retention strategies so evidence-based practice in care for older adults can be improved to enhance quality of life of older adults.

Care of the surgical patient-part 2: oral anticoagulants.

Part two of this series on the care of the surgical patient introduces readers to some of the additional risks associated with patients who are undergoing surgery and taking oral anticoagulants. It explores the use of vitamin K antagonists and heparin. Some of the management strategies and additional considerations that need to be addressed during the perioperative care continuum will also be discussed.

Smartphone Apps to Support Falls Rehabilitation Exercise: App Development and Usability and Acceptability Study.

BACKGROUND: Falls have implications for older adults' health and well-being. Strength and balance interventions significantly reduce the risk of falls. However, patients do not always perform the unsupervised home exercise needed for fall reduction. OBJECTIVE: This study aims to develop motivational smartphone apps co-designed with health professionals and older adults to support patients to perform exercise proven to aid fall reduction and to explore the apps' usability and acceptability with both health professionals and patients. METHODS: There were 3 phases of app development that included analysis, design, and implementation. For analysis, we examined the literature to establish key app components and had a consultation with 12 older adults attending a strength and balance class, exercise instructors, and 3 fall services. For design, we created prototype apps and conducted 2 patient and public involvement workshops, one with 5 health professionals and the second with 8 older adults from an exercise group. The apps were revised based on the feedback. For implementation, we tested them with one fall service and their patients for 3 weeks. Participatory evaluation was used through testing, semistructured interviews, and focus groups to explore acceptability and usability. Focus groups were conducted with the service that tested the apps and two other services. Qualitative data were analyzed using the framework approach. RESULTS: On the basis of findings from the literature and consultations in the analysis phase, we selected Behavior Change Techniques, such as goal setting, action planning, and feedback on behavior, to be key parts of the app. We developed goals using familiar icons for patients to select and add while self-reporting exercise and decided to develop 2 apps, one for patients (My Activity Programme) and one for health professionals (Motivate Me). This enabled health professionals to guide patients through the goal-setting process, making it more accessible to nontechnology users. Storyboards were created during the design phase, leading to prototypes of "Motivate Me" and "My Activity Programme." Key changes from the workshops included being able to add more details about the patients' exercise program and a wider selection of goals within "Motivate Me." The overall app design was acceptable to health professionals and older adults. In total, 7 patients and 3 health professionals participated in testing in the implementation phase, with interviews conducted with 6 patients and focus groups, with 3 teams (11 health professionals). Barriers, facilitators, and further functionality were identified for both apps, with 2 cross-cutting themes around phone usability and confidence. CONCLUSIONS: The motivational apps were found to be acceptable for older adults taking part in the design stage and patients and health professionals testing the apps in a clinical setting. User-led design is important to ensure that the apps are usable and acceptable.

Care of the surgical patient: part 1.

This article provides clinical guidance on the care of a patient undergoing an elective surgical procedure. It discusses preoperative care and the preparation of the patient. It aims to provide an awareness of the complications associated with perioperative care. Through the use of a patient case study, the authors demonstrate the care required across the full perioperative journey from diagnosis to discharge.

Adult pain assessment and management.

Claire Ford, Lecturer, Adult Nursing, Northumbria University, Newcastle upon Tyne ( claire.ford@northumbria.ac.uk ) outlines the skills and tools health professionals use to help patients manage pain.