Falls are the most commonly reported patient safety incident in hospitals in the UK, and a major cause of patient harm. Older adults with cognitive impairment, such as dementia or delirium, are at particular risk of falls in acute settings due, for example, to attempting to mobilise without support, inability to communicate their needs or misjudging danger. Nurses have a central role in falls prevention, balancing patient safety with preserving individuals' dignity and autonomy to ensure that practice is consistent, compassionate and ethically sound. This article explores strategies for reducing the risk of falls in older adults with cognitive impairment in acute settings. The authors discuss patient safety interventions, including the use of enhanced observation and technological devices such as pressure-sensitive mats and bed-exit alarms, and consider the ethical implications of using such interventions. The authors also discuss the importance of multidisciplinary assessment and rehabilitation, as well as education for staff, patients and families, in effective falls prevention practice.

Non-medical prescribing has expanded significantly in the UK since its introduction in the early 1990s, bringing increased responsibilities and accountability for non-medical prescribers (NMPs). It is essential that NMPs are equipped to maintain high standards of prescribing practice. This article discusses crucial factors for NMPs to consider when making prescribing decisions, focusing on effectiveness, appropriateness, safety and cost-effectiveness. The author highlights the importance of referring to guidance and research, consulting local policy and drug formularies, thorough patient assessment and history-taking, accurate and objective patient education, and shared decision-making and person-centred prescribing. To remain competent and confident, NMPs must be provided with continuing professional development and opportunities for reflective practice.

Early recognition and management of acute deterioration is essential to reduce the risk of patients experiencing catastrophic events, such as cardiac arrest, and to prevent potentially avoidable deaths. Common signs and symptoms of acute deterioration include increased respiratory rate, alteration in skin temperature, increased heart rate, hypotension, reduced urine output and acute onset confusion. Nurses undertake clinical monitoring and observation of patients in acute care settings and are therefore ideally placed to recognise and act on these signs and symptoms. This article explores the pathophysiology of common signs and symptoms of acute deterioration in relation to body systems, aligned with the airway, breathing, circulation, disability and exposure (ABCDE) approach and with reference to the National Early Warning Score (NEWS) 2 'track and trigger' tool. The author also considers the contribution of clinical intuition, clinical judgement and effective communication in the management of the deteriorating patient.

This 'How to' article explains how to perform a thorough and legal mental capacity assessment for adults in a safe, effective and supportive manner. Nurses undertaking this assessment must ensure they have the appropriate knowledge and skills, and must work within the limits of their competence. • Nurses should ensure they fully understand the definition of the phrase 'lacks capacity'. • A person must be assumed to have capacity unless it is established that they lack capacity. • A person must not be treated as unable to make a decision unless all practicable steps to help them do so have been taken without success. REFLECTIVE ACTIVITY: 'How to' articles can help to update your practice and ensure it remains evidence-based. Apply this article to your practice. Reflect on and write a short account of: • How this article might improve your practice when undertaking a mental capacity assessment. • How you could use this information to educate nursing students or your colleagues on what constitutes a thorough and legal mental capacity assessment.

Syphilis is a preventable and curable sexually transmitted infection that remains a significant public health challenge despite the availability of effective antibiotic treatment. Following a decline in the late 20th century, syphilis has re-emerged globally, with rising rates across diverse populations and a particularly concerning increase in congenital infection. The varied and often subtle presentations of syphilis, alongside its asymptomatic stages, can contribute to delayed diagnosis and ongoing transmission. Since many cases are now identified outside specialist sexual health services, nurses have a central role in the early recognition, initial testing, patient education and prevention of the condition. This article outlines the epidemiology, clinical features, diagnosis and treatment of syphilis. It examines prevention strategies including partner notification, emerging biomedical interventions and community-engaged health promotion, highlighting key implications for nursing practice and public health.

Palliative care is undergoing a significant transformation, driven by a global ageing population, a corresponding rise in chronic conditions and a growing need for integration across health and social care settings. Nurses are considered the primary providers of palliative care, supporting people with life-limiting illnesses in the home, hospital, care home and hospice environments. This article explores two domains that support a person-centred approach to palliative care: developing knowledge and skills; and leading and influencing care. The author identifies ways to develop and strengthen nurses' capabilities through education, reflection and mentorship, supported by leadership that advocates a person-centred approach, and organisational systems that enable compassionate care aligned with what matters to the individual. By identifying actionable initiatives across knowledge development and leadership, this article aims to prepare nurses for the challenges and opportunities of an evolving palliative care landscape.

Safe and effective medicine administration and dosage calculation are fundamental nursing proficiencies. Medicine dosage calculations must be undertaken with utmost care to ensure patients' safety and that they gain maximum benefit from the prescribed medicine. It is essential, therefore, that nurses can undertake medicine dosage calculations accurately. Nurses undertaking this activity must ensure they have the knowledge and skills to do so and work within their competence level. • Inaccurate medicine dosage calculations are a significant causative factor in medication errors. • Wrong dose medication errors are frequently reported in both adult and children's healthcare settings, with higher rates of overdosing errors compared with underdosing errors. • Causative factors of inaccurate drug calculations include mathematical-related errors, such as inadequate understanding of basic mathematics, and conceptual errors, where the nurse does not evaluate whether the final calculated dosage makes sense or is a safe and realistic amount for the patient within the context of their health status. • Technology-enhanced simulation training, independent double checking, use of calculators, and use of generative artificial intelligence (AI) as an additional verification layer, have been identified as strategies that may reduce medicine dosage calculation errors. REFLECTIVE ACTIVITY: 'How to' articles can help to update your practice and ensure it remains evidence-based. Apply this article to your practice. Reflect on and write a short account of: • How this article might enhance your practice when undertaking oral medicine dosage calculations. • How you could use this information to educate nursing students or your colleagues on the correct methods to achieve accurate medicine dosage calculations.

In healthcare, the terms 'fasting' or 'nil by mouth' usually refer to a patient who is not allowed to have any form of food, drink or medicines orally for a specific time. Fasting is a contentious issue in perioperative care, and differing guidelines in this practice can cause confusion and pose unnecessary risks to patients. Prolonged fasting may lead to discomfort and increased risk of surgical complications, while studies have shown that shorter fasting periods can enhance patient outcomes. Evidence supports allowing patients to have sips of clear fluids preoperatively, as demonstrated by the SipTilSend protocol, which may reduce fasting times without increasing the risk of complications. This article explores and promotes evidence-based fasting protocols that could improve perioperative care and enhance the patient experience.

Nutrition is fundamental to human life and a comprehensive knowledge of the body's nutritional needs is crucial for enhancing health and promoting recovery. This article outlines principles of optimal nutrition relevant to nurses working with adults in acute care settings. It provides an overview of metabolism, energy expenditure, nutrients and malnutrition, discusses nutritional screening and explores nutrition impact symptoms commonly experienced by acute patients. The article also outlines the responsibilities of nurses in preventing or managing malnutrition in patients.

Heart failure is a complex cardiac syndrome that has high mortality and morbidity rates, and is associated with high healthcare costs. Without prompt diagnosis and administration of key prognostic medicines, heart failure can have significant adverse effects on patients' quality of life. Patients with heart failure are commonly encountered in all healthcare settings, so it is likely that most nurses will care for them at some point in their practice. Therefore, it is important that all nurses are aware of the latest developments in the management of heart failure and the terminology used in relation to the condition. This article outlines the epidemiology, diagnosis and treatment of heart failure to update nurses' knowledge, thereby supporting them to identify the signs and symptoms, provide patient education and enhance outcomes.