Developing Practical Nursing Skills

Foundations for Nursing and Healthcare Students

Nicola Neale, Joanne Sale, Nicola Neale, Joanne Sale

• Publisher: Routledge
• Year: 2022
• ISBN:
  9781000528169
• Edition: 5
• Topic: Medicine
• Subtopic: Nursing

Developing Practical Nursing Skills helps you learn and perfect the practical skills required to become a qualified nurse. Adopting a patient-focused and caring approach, this essential text helps you integrate nursing values alongside physical skills in your daily practice.

Now in its fifth edition, the text takes into account the NMC standards of proficiency and is relevant to nurses across all fields. Key features of the book include: i) New chapters on mental health assessment and end-of-life care, along with expanded content on sleep, pain and medication management. ii) Full-colour text design with clear illustrations and clinical photographs to aid visual learning. iii) Reader-friendly style with learning outcomes, activities and reflection points to help you link theory to practice. iv) Scenarios from a range of settings, including community, mental health and learning disabilities nursing. v) A focus on adults and young people, and with 'pointers' on caring for children and pregnant women to promote a lifespan approach.

This is a complete clinical skills resource for all pre-registration nursing students. It is also a useful text for nursing associate and healthcare support workers.

1 Practical nursing skills: a caring approach

Lesley Baillie

DOI: 10.4324/9781003020660-1

Introduction

Nursing care should be delivered compassionately and competently in a way that promotes the dignity of the people being cared for. All student nurses need to learn to perform a range of practical skills safely, with a caring and person-centred approach (Nursing and Midwifery Council [NMC] 2018a). Healthcare support workers, assistant practitioners and nursing associates also need to develop practical skills, as they work within nursing teams. This book aims to assist readers in developing a caring and person-centred approach to a range of practical nursing skills, for application with people across different healthcare settings. Practical nursing skills comprise not only the hands-on (psychomotor) element but also an underpinning evidence-based knowledge, effective communication skills, an ethical approach, critical and reflective thinking, and an appropriate professional, caring attitude. These elements are considered throughout the chapters in this book.

This chapter discusses the nature and context of practical skills in nursing and how this book can help you in developing your nursing skills. There is an emphasis on developing and valuing these practical skills as holistic, caring skills that contribute to people’s healthcare experiences in a positive way, promote their dignity and support their comfort and well-being.

This chapter includes the following topics:

• The nature of practical nursing skills
• The context for practical nursing skills
• A person-centred approach to practical nursing skills
• A caring and compassionate approach to practical nursing skills
• Cultural competence and practical nursing skills
• Dignity and practical nursing skills
• Learning practical nursing skills

The nature of practical nursing skills

Nurses need to develop a range of competencies, including skills in practical nursing, communication and management. Practical nursing skills are the hands-on skills that nurses use in their care of people; some of these skills are performed by other professionals in caring roles too. Healthcare support workers, assistant practitioners and nursing associates carry out many of these skills, and hence, this book is relevant for them too. The NMC’s standards for registered nurses and nursing associates include detailed annexes of practical nursing skills (referred to as nursing procedures) (NMC 2018a, 2018b).

Practical nursing skills are used during assessment and interventions to promote comfort and maintain health for people who, due to acute or long-term physical or mental health conditions, cannot care for themselves independently or need help to maintain their health.

ACTIVITY

Box 1.1 Activity: healthy activities

Reflect on all the activities you carry out to keep yourself comfortable and healthy each day. What would happen if you could not carry out these activities?

You might have reflected that you carry out these activities, often referred to as ‘activities of daily living’ (Roper et al. 2000) with little thought much of the time: sleeping, eating and drinking, going to the toilet, moving about, and carrying out personal hygiene. You might take medication for one or more health conditions or if you have pain, take painkilling medicines or manage your pain another way. However, any mental or physical health condition can affect these self-care activities; without help, people would quickly become debilitated and uncomfortable, with their health and well-being at risk. There are around 6.5 million unpaid carers in the United Kingdom (UK) who help family, friends or neighbours with care due to health issues (Carers UK 2019). Many nurses are involved in supporting people and their carers at home, for example, teaching them to keep their skin healthy when they lack mobility; to manage medication; to cope with mental health issues; to deal with altered elimination, such as a urinary catheter; or to deliver care at end of life. When people are admitted to hospital, nursing teams must support the individual with activities that they cannot manage themselves as part of their holistic care.

Practical nursing skills are also carried out when assessing a person’s condition and delivering interventions to improve or maintain their health; these skills are carried out in acute situations, for people with long-term conditions and people with multiple health needs, in a range of settings. When we feel unwell, we self-assess; for example, we might measure our body temperature. Some people are unable to self-assess or communicate that they feel unwell, for example, a person with advanced dementia or a person with a severe learning disability. Nurses need to be highly skilled in using a range of assessment skills for people with different health needs, and they must be able to interpret and act on the results appropriately and often speedily. People who are acutely ill or who have long-term health conditions that fluctuate in severity, need careful and skilful monitoring. Nurses must also be able to use a wide range of practical skills to promote comfort, safety and well-being, including administration of medication.

ACTIVITY

Box 1.2 Activity: immunisations

Almost everyone has had an injection at some stage, and you may have had recent immunisations before starting your studies. You probably took it for granted that the skill would be performed competently. What are the different elements of carrying out this skill? List all you can think of.

You probably considered technical aspects such as preparing the correct medicine accurately and safely. You might have identified that the nurse required underlying knowledge of the drug’s actions and potential side effects and that the nurse should use a calm and friendly approach to relax you and relieve anxiety. This example illustrates that effective practical nursing skills require a skilled motor performance (the doing element) and a sound knowledge based on best evidence (the cognitive aspect), with both accompanied by an appropriate attitude (the affective aspect).

Oermann (1990) suggested that the motor (doing) element of a practical (psychomotor) skill is often emphasised to the exclusion of the cognitive and affective components. She highlighted the importance of the cognitive base (the scientific principles underlying the performance of the skill) and the affective domain, which reflects the nurse’s values and concern for the person while performing the skill. These three aspects are now explored further.

The affective domain

The affective domain is underpinned by values, which can be defined as ‘core beliefs that guide and motivate attitudes and actions’ (see https://www.ethics.org/resources/free-toolkit/definition-values/). Nurses bring their own personal values into nursing; these values are influenced by a range of factors (e.g. family, education) and hopefully include integrity, compassion, dignity and kindness. Nurses must also embrace professional values, directed by the National Health Service (NHS) and the NMC. Values are important as they influence attitudes and behaviour. For example, Nåden and Eriksson (2004) found that nurses who promoted dignity had a strong moral attitude, underpinned by values such as respect, honesty and responsibility; such nurses had a ‘genuine interest and desire to help patients’ (p. 90).

The cognitive domain

The cognitive domain reflects the thinking element behind the skill, including the application of best evidence in practice and problem-solving. Being able to adapt a skill in practice requires a sound underlying knowledge of why it is being performed and the rationale for each stage. For example, understanding the principles behind oxygen therapy enables nurses to choose an administration method that is safe and acceptable for people in specific healthcare situations. Practical skills should be based on best available evidence, which may be derived from research, but could be based on experience, and from reflection on practice (see the ‘Learning from experience and reflection’ section).

Nurses are accountable for their actions, so they must be able to explain the knowledge base underpinning their practice. Benner (1984) explored how expert nurses develop knowledge from their practice, learning to recognise, for example, subtle changes in people’s conditions. Not all nursing skills have a firm evidence base on which to implement practice, but in many areas research-based knowledge is available. Within this book, the authors have searched for up-to-date evidence to underpin practical skills, and they refer to evidence-based guidelines where available. These guidelines include the National Institute for Health and Care Excellence (NICE) evidence-based guidelines and quality standards (see www.nice.org.uk) and the Cochrane Library systematic reviews of research. Be aware: these guidelines are regularly reviewed, so check the websites for updates. Often, NHS Trusts and other healthcare organisations have their own clinical guidelines, based on best evidence, to assist nurses and other healthcare professionals to implement evidence-based practice in the local context. You should always work with your employer’s guidelines, if available.

The motor domain

Learning the motor dimension of a skill is important for an effective outcome as lack of a skilled motor performance jeopardises both safety and comfort. Knowing how to conduct a practical skill can be termed know-how type of knowledge – practical expertise and skill that is really acquired through practice and experience (Manley 1997). Nursing skills are performed in a changing clinical environment and varied settings, with people who respond and react in different ways. Therefore, nurses need to adapt skills accordingly, so practical nursing skills can never be wholly automatic in nature.

The importance of practical nursing skills for quality care

The importance of high-quality nursing care cannot be overstated, and the application of practical nursing skills is central to people’s experiences. The National Nursing Research...

Table of contents

• Cover
• Half Title Page
• Title Page
• Copyright Page
• Table Of Contents
• List of figures
• List of tables
• List of boxes
• List of contributors
• Foreword
• Preface
• Acknowledgements
• Glossary
• 1. Practical nursing skills: a caring approach
• 2. Communication: a person-centred approach
• 3. Fundamentals of mental health assessment for non–mental health practitioners
• 4. Measuring and monitoring vital signs
• 5. Meeting personal needs: hydration and nutrition
• 6. Meeting personal needs: elimination
• 7. Meeting personal needs: hygiene
• 8. Promoting comfort and sleep
• 9. Assessing and managing pain
• 10. Medicines management
• 11. Caring for people with impaired mobility
• 12. Infection prevention and control
• 13. Principles of wound care
• 14. Assessing and responding to sudden deterioration in the adult
• 15. Managing care at the end of life
• Appendices
• Index