1. NUR 260 Supplementary Workbook September 2006 cohort
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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
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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.
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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?
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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?
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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
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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
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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