bluuebunny/crossref_metadata_2025 huggingface dataset:
Professional concerns in wound care: a discussion of questionable practice recorded by nurses
Authors: Hollingworth Helen
Published: May 2014

Despite the growth of wound care as a specialty and the expansion of education in wound care to all grades of nurses, there is still evidence of outdated practice in both community and acute care settings. This article reports secondary data from a study into psychological support for patients with wounds (Hollinworth and Hawkins, 2002) that highlights examples of these poor practices. The professional implications of these practices are discussed, and suggestions made for improving practice.
Older people as health service consumers: background to a study
Authors: Bentley Jenny
Published: May 2014

User involvement in health care has received a high profile within the NHS Plan (Department of Health, 2000a), giving patients a greater say in their treatment and in the way that the NHS works. Older people, i.e. those over 65 years of age, as a group, are the highest users of hospital and community services (DH, 2001a). The national service framework (NSF) for older people (DH, 2001a) highlights highlighted the need to listen to older people, help them make informed choices and involve them in achieving a healthy lifestyle. While the NSF for older people rightly attempts to ensure fair and equitable access to health care services for older people, it is assumed that they want to be involved, and want to exercise their rights as users. This assumption needs to be tested. This study, presented as a series of four articles, sets out to explore if there is a consumerist ethic among older people in relation to health care. The first paper outlines some of the literature reviewed together with the methodology.
Agenda for Change, or recipe for confusion?
Authors: Pollard Tom
Published: May 2014

Health service workers have now had a few weeks to consider the implications of the interim announcement on Agenda for Change. A final announcement on the proposals is expected shortly, and it will then be up to nurses and their unions to decide whether to take or leave the package. If the response of community nurses gathered at our Primary Care Nursing Roadshow in Cardiff was any indication, they will take some convincing.
Stunts aside, hunger is a serious issue
Authors: Pollard Tom
Published: May 2014

The recent stunt by the American illusionist David Blaine – in which (in case you missed it) he spent 44 days suspended in a Perspex box near Tower Bridge in London, subsisting on water alone – won him many fans. Many were enthralled by the self-control required to starve himself for that long.
The public health roles of health visitors and school nurses: a survey
Authors: Jinks Annette , Smith Maureen , Ashdown-Lambert Joan
Published: May 2014

This article describes a qualitative study that examined the family-centred public health role of health visitors and the child-centred public health role of school nurses. A telephone survey of key health visitor and school nurse informants in the West Midlands was undertaken. Respondents to the survey were asked to give examples of practice that related to Holman’s (1992) public health typology. A wealth of data were obtained, which included 344 different examples of practice interventions. The majority of examples of practice given by the respondents were categorized as primary preventive interventions. The least represented concerned community empowerment and health protection. The findings of the survey give evidence of the current transitional nature health visitor and school nurse practice. Identified is some reorientation in practice and adoption of currently advocated models of public health, which have community participation, empowerment, and health protection as essential features.
Nurses are more than the sum of their parts
Authors: While Alison
Published: May 2014

The NHS Plan (Department of Health (DH), 2000) set out the blueprint for change in health-care delivery necessitated by the combination of rising public expectations, spiralling costs and perceived under-performance. The label of ‘modernization’ was adopted in an attempt to bring about widespread change in practice throughout the NHS with targets set to measure achievement of various goals in light of the taxpayers’ ‘investment’. The perverse incentive of targets has been noted previously (While, 2003) but equally important has been their ability to strengthen resistance among healthcare practitioners to any form of change regardless of its merit and likely improvement of patient outcome.
Health care and asylum seekers and refugees
Authors: While Alison
Published: May 2014

Increased global instability has population consequences. The United Nations High Commission for Refugees has estimated that globally nearly 27 million people are refugees and a further 25 – 30 million people are displaced within their own countries. This has inevitably meant that the UK, among other countries, receives increased numbers of applications for refuge – 85865 in 2002. Against this background the debate about asylum seekers and refugees has become more strident with the organization Migration Watch fuelling public anxiety.
Introducing the use of sterile maggots into a primary care trust: overcoming barriers
Authors: Fear Mair , Warrell Richard , Allum Lynn
Published: May 2014

Larval therapy has been available to patients in hospital where there has been a clinical need. Not all primary care trusts realize the clinical and cost effectiveness of this treatment, or if they do, are prepared to recognise funding to allow patients to receive this treatment in the privacy of their own home. Funding can be an issue as can instigating changes in practice, particularly when there are clinicians and managers who have an aversion to the therapy.
Introducing a health awareness day for the over-75s
Authors: Dobrzanska Linda , Dean Joanne , Graham Fiona
Published: May 2014

Working jointly, a community staff nurse from a district nursing team within North Bradford Primary Care Trust, and a health visitor (who has a remit to work with the elderly) audited their GP practice’s method of offering all over-75-year-olds a routine annual health check. They found that the method, level and nature of the assessments were not standardized and were organization-led rather than patient-led. This group of patients was not receiving the best service that could be offered. A more integrated approach was needed, and the idea of a ‘health awareness day’ was developed. Evaluation of the day showed that it was successful in raising health awareness and in increasing referrals to the GP for a variety of problems.
Letters
Authors: Baxter Tm
Published: May 2014

I read with interest the article by Drs Watson and Bowling on ‘Acid reflux and gastro-oesophageal reflux disease’ (Br J Community Nurs 9(8): 326-30). While the article is balanced and informative, in the section on over-the-counter treatment options it states that alginates can produce unwanted gastrointestinal side-effects such as diarrhoea or constipation.
Growing old in the UK
Authors: While Alison
Published: May 2014

The 60th anniversary in August of the D-Day landings provided a reminder that our older people are owed a debt of gratitude for their great efforts on the battlefield and on the home front. However, any belief that they will have a trouble free and pampered old age is constantly under threat from care shortcomings and financial worries.
Recruiting and retaining primary care nurses
Authors: While Alison
Published: May 2014

The increased location of chronic disease management in primary care presents threats and opportunities for the nursing workforce: threats from the impact of changing role boundaries and increasing workload; opportunities for role substitution, increased role flexibility, and skill accretion as nurses move into new fields of practice.
The Peristeen Anal Plug: a modern solution for an embarrassing problem
Authors: Doherty Willie
Published: May 2014

Faecal incontinence is a problem that affects over 500000 people on the UK, but unlike urinary incontinence is rarely spoken about or adequately addressed. The problem may arise from a range of causes, including obstetric trauma, surgery and neurological disorders. Like urinary incontinence, faecal incontinence can be managed. This article discusses one management option – the Peristeen Anal Plug – and illustrates with case histories the beneficial effect proper management of faecal incontinence can have on patients’ lives.
Hutton poses questions for all organizations
Authors: Pollard Tom
Published: May 2014

Whatever your political hue, I doubt you were oblivious to or totally disinterested in the outcome of the Hutton inquiry into the events surrounding the suicide of David Kelly. Of course it has been hard to escape the media coverage of the event (and I apologise that even here there will be no respite), but I have found it fascinating to watch government departments and ministers having to justify their actions.
Regardless of group, abuse is unacceptable
Authors: While Alison
Published: May 2014

No-one can fail to have been moved by tragic story of Soham, both as it was recorded by the media during the summer of 2002 and in the reports of the trial. However, without diminishing the awfulness of the calculated murders, nor the life-long grief that will be endured by the families and others in the Soham community, the profile given to this one case raises several questions.
Widening the choice of care for patients
Authors: While Alison
Published: May 2014

The publication Building on the Best (DH, 2003) outlines Government policy on choice, responsiveness and equity in the NHS, within the context of ongoing investment in new facilities and reforms. The paper suggests that while the NHS and its staff are highly regarded, public expectations have changed and users now want more control and flexibility over their experience of care. In addition the paper highlighted the imperative of finding new ways to tackle persisting inequalities in health-care provision.
Statins and secondary prevention of coronary heart disease
Authors: Ahmed Mehboub , Griffiths Peter
Published: May 2014

A mini-review (Griffiths, 2002) of double-blind randomized controlled trials (RCTs) was undertaken to assess the long-term effect of lipid-lowering treatments (statins versus placebo) in secondary prevention of myocardial infarction (MI). The population sample was adult patients with a history of MI, documented coronary heart disease or coronary artery disease. The Cochrane Library and the database Medline were searched and three RCTs appeared to possess all the stipulated inclusion and exclusion criteria. The trials all compared statins against a placebo; one trial was of simvastatin – the Scandinavian Simvastatin Survival Study (1994) – and the other two were of pravastatin – the Cholesterol and Recurrent Events Trial (CARE) (Sacks et al, 1996) and Long term Intervention with Provastatin Ischaemic Disease (LIPID) (Anon, 1998). The trials demonstrated that statins had a clear and consistent effect in significantly reducing the risk of MI. Overall an approximate decline of 30% in MI was produced from the three trials.
Medication errors should be avoided
Authors: While Alison
Published: May 2014

The publication of the National Care Standards Commission report (2004) on medication error in care homes made salutary reading. It seems that entry into supportive care environments does not guarantee adherence to universally high standards of care in this area. Medication errors have attracted interest because they can have serious consequences both for the patient and the care organization, and yet they can be avoided if proper procedures are adopted. Not surprisingly they are the priority for the newly-formed National Patient Safety Agency which is charged with meeting the Government target of reducing serious medication errors by 40%.
The new NICE guidelines on COPD
Authors: Smith Teresa
Published: May 2014

The National Institute for Clinical Excellence guidelines on chronic obstructive pulmonary disease, published in March this year, provide a new way of thinking about the management of the disease. This article highlights the key areas and recommendations made by the guidelines.
Time for a radical rethink of nurse education
Authors: While Alison
Published: May 2014

Fitness for Practice (UKCC, 1999) was meant to ensure that nurses did not qualify when their skills were inadequate for professional clinical practice. The problems it sought to tackle are UK-wide. Watson and Harris (1999) found that many mentors did not feel that it was their role to fail students, echoing Lanshear’s (1990) earlier observation regarding a failure to fail unsatisfactory students. So Duffy’s recent report (2004) has not really revealed anything new; rather, it has confirmed the continued malaise in the maintenance of professional standards of those entering the register.
Acid reflux and gastro-oesophageal reflux disease
Authors: Watson Alan R , Bowling Timothy E
Published: May 2014

Gastro-oesophageal reflux disease (GORD) is a common disease that is likely to increase in prevalence as the population becomes steadily more obese. Although generally benign reflux can, if untreated, lead to severe complications. This article describes the symptoms and diagnosis of acid reflux and GORD, and reviews currently available treatments ranging from lifestyle modification to surgery.
Pressure area care in primary care: issues in equipment provision
Authors: Henderson Val
Published: May 2014

The pressure area care needs of primary care patients are becoming more complexe due to changes in health care provision. Enabling patients to remain in their own home and allowing them some independence even though they are at high risk of developing pressure damage, relies on the nurse’s knowledge of prevention strategies and equipment provision locally. This article discusses the key issues in relation to the provision of pressure relieving equipment in a rural care trust in England, and how the trust has overcome the problem of equipment failure, especially out of hours and weekends.
Why the private sector must not rule the NHS
Authors: Pollard Tom
Published: May 2014

Recent revelations about the scale of Government plans to give private companies effective ‘ownership’ of NHS facilities and freedom to recruit NHS staff have caused a furore – and it’s not just traditional Labour voters who are kicking up a stink. Many people, even after 8 years of New Labour government, still instinctively reject private involvement in that most valued of public services – the NHS. Despite the enormous investment into the NHS seen in recent years, there is still a huge drive to involve the private sector in everything from building hospitals to providing staff to delivering services such as mobile CT scanners. Following a leak to a national newspaper, we have evidence of the full extent of the plans – £3 billion, and up to 15% of NHS elective care will be in private hands in the next couple of years. Add to this the plans for primary care, and we have what, from any angle, looks like a semi-private NHS.
Drug use and perceived health in recently hospitalized older people
Authors: Ulfvarson Johanna , Adami Johanna , Bardage Carola , von Bahr Christer , Wredling Regina
Published: May 2014

Older patients often have multiple diseases, resulting in treatment with many drugs. This may increase the risk for drug-related problems. This study aimed to analyse the congruence between the patient’s self-reported drug use and the medical record, and the relationship to perceived health among older patients recently discharged from hospital. A total of 200 patients over 65 years of age who were admitted to a medical ward and were treated with at least one drug participated in an interview study one week after discharge from the hospital. The patients provided information on their current drug therapy. This information was compared to the prescriptions documented in the medical record. Thirty per cent of the study population reported a drug use which was in congruence with the medical record, 28% used less drugs than prescribed, and 42% more. Statistical analysis showed a high probability of non-congruence with prescriptions among patients who reported poor health.
Keeping sight of the domestic ’flu threat
Authors: Pollard Tom
Published: May 2014

Somewhere deep in the heart of south-east Asia, a monster is taking shape. Small – very small – but perfectly formed, it will one day break out of its tropical fastness and spread scross the globe, killing millions of people as it goes…
Nurse prescribing: a delightful surprise
Authors: While Alison
Published: May 2014

While the reverberations of Commissioning a Patient-Led NHS (Department of Health (DH), 2005a) continue to be felt throughout community nursing, the announcement that nurses and pharmacists will be able to prescribe any licensed medication for any medical condition (except controlled drugs) (DH, 2005b) is cause for much celebration. The combination of these two policy initiatives provides community nurses with tremendous opportunities – if they can be seized.
Irritable bowel syndrome: diagnosis and symptom management
Authors: Watson Alan R , Bowling Timothy E
Published: May 2014

Irritable bowel syndrome (IBS) is a very common problem affecting 10% of the population at some time. Its cause and pathogenesis, however, remain poorly understood. Diagnosis is usually straightforward and detailed investigations are only required when the presentation is atypical. Treating IBS is always a challenge. The concerns and expectations of the patient must be met, along with any associated psychosocial issues. Medication on its own without addressing all of these issues is usually unsuccessful.
Crossing barriers to bring change to the inner city
Authors: Pollard Tom
Published: May 2014

Mary Clarke’s career to date has followed a route that will be quite familiar to many senior nurses. Raised in Hackney in east London, she trained in a west London hospital in the late 1970s and early 1980s, before her job moved back east and out into the community in 1986. She became a team manager, and then took a succession of increasingly senior posts until finally reaching the position she is in now, as the most senior nurse in City and Hackney Teaching PCT (tPCT). What surprises me, however, is the breadth of the work her current role encompasses. City and Hackney tPCT covers some of the richest and some of the poorest areas of the country. It is an area of huge economic and ethnic diversity. The challenges this presents are reflected in Mary’s work, which was recently recognized with a CBE.
New guidelines for transfer of catheterized patients
Authors: Seymour Coral
Published: May 2014

The nursing care of patients with bladder-related disorders is rarely, if ever, static. With a catheter in situ, such patients may be discharged from hospital into the community; they may require a series of outpatient appointments; they may be transferred from one hospital to another hospital; even within a hospital, from ward to ward.
Working in partnership with adult informal carers: policy and practice
Authors: Bliss Julie
Published: May 2014

In England and Wales alone, more than 5 million informal carers provide support to individuals who wish to remain within their own homes. However, research has identified that there is a limited understanding of the informal carer role among health professionals, and deficits in information sharing and the involvement of informal carers in decision making in relation to care packages. This article considers recent policy relating to this area, placing particular emphasis on the role of the district nurse in working in partnership with informal carers.
Longer lives must precede better deaths
Authors: While Alison
Published: May 2014

Improved health care and treatment advances have helped extend life expectancy. This has had many welcome benefits, but has also caused some disquiet. Longevity means that people have the time to think about what living means to them and what constitutes a bearable quality of life, as well as what they wish to be the circumstances of their death. The recent ruling of Mr Justice Hedley regarding the best interests of Charlotte Wyatt indicates that these concerns affect both the very young as well as the frail adult.
Changing indwelling urinary catheters using bladder infill
Authors: Robinson John
Published: May 2014

The most common method used changing indwelling urinary catheters, either urethral or supra-pubic, is to remove the catheter and proceed to re-catheterise. When removing the catheter with patients using drainage bags on continual drainage, the urinary bladder becomes empty of urine. Therefore, this may then leave the practitioner following re-catheterisation and often with no immediate drainage of urine, has the catheter has been safely inserted. A method which the author has used for many years and has experienced no problems is re-catheterisation using bladder infill. This article explains what is meant by bladder infill and how re-catheterisation can be undertaken safely using this method.
Domestic abuse: protection, intervention and the role of the law
Authors: Griffith Richard
Published: May 2014

District nursing sister Gwen Abbot suspects that one of her patients, a 35-year-old woman who lives with her partner in a rented one bedroom flat, is being abused. The woman is reluctant to explain the frequent bruising that is present around her arms and breasts when the district nurse visits. Sister Abbot wonders if she should get involved and if there were any legal measures the patient could take to protect herself from abuse.
How accurate are automated blood pressure monitors?
Authors: Beales Debbie
Published: May 2014

Increasingly, automated blood pressure devices are replacing mercury sphygmomanometers to monitor blood pressure in primary care settings. Practitioners have raised questions about the accuracy of these new devices, so a mini-review was undertaken to examine the evidence. A systematic search of the Medline database identified seven studies that were of sufficient quality. Eight devices were examined, all of which had passed validation procedures, achieving A or B grades according to current protocols. All were ‘recommended for clinical use’, despite the tendency of the devices to produce inaccurate measurements in high blood pressure ranges. The review demonstrates that ‘accuracy’ of the new devices does not equate to the accustomed accuracy of the mercury sphygmomanometer.
Public health 1: controlling infectious disease – the role of the law
Authors: Griffith Richard , Tengnah Cassam
Published: May 2014

District nurse Brenda Harrison is exasperated by the behaviour of one of her patients. John, a 43-year-old dairy farmer, has been diagnosed with respiratory tract tuberculosis. Generally amenable and polite, John is stubborn and inclined to want to do things his way. Brenda has explained that he must not milk his cows and to stay away from the dairy. John has also been told the importance of taking the range of antibiotics prescribed for the tuberculosis regularly for the full course over 6 months. Despite this advice and frequent monitoring he has only taken the treatment for short periods before forgetting or simply stopping the treatment when he feels better. As a result John’s wife, and now his brother, have also become infected. He continues to milk his dairy herd. Brenda is concerned that John’s continued reluctance to take a full course of treatment and to stop contact with milk will result in many more people becoming infected. She wonders if the law could be used to protect public health and force John to complete a course of treatment and stay away from his herd.
The new editor’s plans for the future
Authors: Timmons John
Published: May 2014

Welcome to my first Wound Care as Consultant Editor. I have taken over from the very capable hands of Louise Gibson, who is a friend and colleague, and whom I must thank for her excellent work over the past few years. I hope that she will continue to be a regular contributor to WoundCare.
A static-led approach to effective equipment management
Authors: Sale Jenny
Published: May 2014

Ashton, Leigh and Wigan Primary Care Trust has a static-led approach to the provision of pressure-relieving equipment in the community. This means that product selection must result from an individualized clinical assessment of the patients needs and not reliant on a blanket approach. The limitations of dynamics should be considered and the delivery of essential nursing care should be deemed paramount, rather than products. The emphasis within the PCT is on holistic assessment and informed clinical decision-making, combined with education of patients and carers in use of equipment. This article sets out the rationale for a static-led approach, and reports the results of a survey of district nurses which looked at their practice in this area.
Legal regulation of clinical waste in the community
Authors: Griffith Richard , Tengnah Cassam
Published: May 2014

The European Union has led the way in regulating the management of waste and has compelled member states, including the United Kingdom, to introduce legislation to ensure that risks to public health and the environment from waste is minimised. Waste management is now highly regulated and it is essential that district nurses comply with the regulations when disposing of waste produced in the course of treating patients. This article describes how the health and safety, waste and carriage legislation governs how district nurses handle clinical and hazardous waste in the community.
Assessing the needs of older burglary victims: a link nurse scheme
Authors: McGraw Caroline , Drennan Vari
Published: May 2014

Distraction burglary is a type of burglary where the method of entry is by a trick rather than the typical forced entry. Research suggests this type of event can contribute to a decline in health amongst victims aged over 65 years. This article describes a scheme that employed a district nurse to work in partnership with the police to address the health and social care needs of older victims of distraction burglary living in the London Borough of Islington.
Providing IV therapy education to community nurses
Authors: Depledge Jane , Gracie Fiona
Published: May 2014

The delivery of intravenous therapy (IVT) in the community has expanded considerably in the UK in the last 20 years. Although some primary care trust's are more actively engaged in providing intravenous services than others, whatever the degree of engagement, staff require knowledge and skills to practice safely. An education provider was commissioned by a group of trusts in West London to deliver education on the principles of IVT. Feedback suggested that this enabled nurses to challenge current intravenous practice in their areas and improve service delivery for the benefit of their patients. This article presents the basis of the curriculum delivered and experience of providing education in IVT to community nurses in West London.
Vision to reality: using patients’ voices to develop and improve services
Authors: Curry Rose
Published: May 2014

The NHS is being transformed into a patient led service requiring radical new ways of gathering patient's views. Sunderland Teaching Primary Care Trust (TPCT) demonstrated its commitment to this change by introducing an action research project in parallel to the introduction of a new nurse led urgent care team (UCT). The project used a qualitative methodology to collect views from initial UCT service users, patients with chronic obstructive pulmonary disease (COPD). Views were analysed using a thematic framework analysis. A multi-disciplinary action research group considered emerging themes and literature finding solutions and taking action to deliver service improvements. The research provides evidence of the quality of the new service and highlighted a service gap for housebound patients with chronic disease. This needs to be used positively to make improvements for patients in line with the NHS Improvement Plan and long-term conditions agenda.
Compulsory removal from home under the National Assistance Act 1948
Authors: Griffith Richard
Published: May 2014

District nurse Mary Thomas has had concerns about one of her older patients for some time. The lady, Miss Oates, is in her 80s and she lives alone in a bungalow with 30 cats. Her physical frailty is such that she is unable to care properly for herself or her cats. She has refused all offers of help from the social services authorities and only allows the district nurse in to dress an ulcer on her leg. The bungalow is filthy and stinks of urine. There is no heating or electricity. There is cat excrement and uneaten pet food everywhere. Today Sister Thomas has found her patient lying at the foot of her bed after falling the night before. She refuses to be helped into bed and seems determined to stay on the floor. Despite the urging of the district nurse and GP the patient has consistently refused to leave her bungalow.

Both sister Thomas and the GP accept that the patient has no signs of a mental disorder or of mental incapacity, nevertheless they both consider that care and attention in a care home, even for a short period to allow her bungalow to be cleaned, would be of great benefit and wonder if the law could be used to compel Miss Oates to move to a care home.
A new vision for care homes in the 21st century: My Home Life
Authors: Owen Tom
Published: May 2014

This article, brought to you in association with Help the Aged, raises some important issues for improving the lot of older people moving to and living in nursing and residential care homes.
Factors affecting choice of a healthy lifestyle: implications for nurses
Authors: Ochieng Bertha MN
Published: May 2014

Living a healthy lifestyle still remains a challenge to a wide section of the population. This article argues that since a healthy lifestyle is associated with other aspects of economic and social life, it should be examined within this context. This perspective suggests that participation in a healthy lifestyle, with its behavioural emphasis, which typically involves decisions about food, exercise, smoking, alcohol, drug use, risk of infection and accidents, is not necessarily up to the individual. Socioeconomic status, level of education, family, kin and social networks, gender, age and interpersonal influences all affect the choice of lifestyle. This has implications for community practitioners working in the field of health promotion, in particular to promote healthy lifestyle. A correlation model is presented that can be used by practitioners to identity factors that should be taken into consideration when working with clients to enable them to make a healthy lifestyle the easier option.
National research strategy: little for nurses
Authors: While Alison
Published: May 2014

The new health research strategy (Department of Health, 2006), it is claimed, will enable health research in England to be world-class and deliver evidence to improve health outcomes for the nation. Yet it is notable that it makes no direct mention of nurses.
Strategies to promote concordance within consultations
Authors: Hobden Alison
Published: May 2014

The first article considered definitions of concordance, highlighting the differences between concordance and non-compliance and non-adherence. This article will explore some of the reasons why patients and consultations are not concordant, drawing predominantly on the work of the Medicines Partnership. Four areas will be explored in detail: level of information given; concerns about side-effects; costs of medication; and effect on lifestyle. Suggestions are given as to how nurses can promote concordance within consultations.
Understanding and tackling fear of crime among older people
Authors: Burnett Alan
Published: May 2014

In this article, brought to you in association with Help the Aged, Alan Burnett examines the causes of fear of crime among older people, and proposes ways to reduce it.
Using case reports to aid reflective practice in wound care
Authors: Timmons John
Published: May 2014

Reflection is a widely-used tool in education and practice for giving individuals insight into events and incidents. Case reports, though lacking in rigour as a source of evidence, also provide an opportunity to reflect on and examine practice. They therefore provide a useful opportunity of examining practice in wound care, which is lacking in many nursing curricula. A case report is given here to illustrate some of the lessons that can be learned by reflection – even by an experienced nurse.
Cohesive short-stretch vs four-layer bandages for venous leg ulcers
Authors: Puffett Nick , Martin Lisa , Chow Meng Kiew
Published: May 2014

Nurses today are employing more and more evidence base within their practice. This must be carefully balanced with their ability to offer patients choice about treatment options for venous leg ulceration. Knowledge of only one particular compression bandage system is inadequate for nurses working within this area. This article aims to examine the evidence base for the use of compression bandaging in the treatment of leg ulceration. It explores results of current randomised controlled trials in this area pertaining to four-layer bandage (4LB) and cohesive short-stretch bandage (CSSB) systems. The advantages and disadvantages of the 4LB and CSSB are explored and application method of CSSB is explained. Concordance is an important issue that affects successful leg ulcer management (Moffatt, 2004a): if this can be achieved through offering patients choice of treatment bandages, then more successful treatment will be achieved for patients.
New security alarms for community nurses
Authors: Dawes Jonathan
Published: May 2014

Although it has its moments, one of the benefits of being an editor is that I no longer have to suffer abuse from angry patients or those that look after them. Within my practice I was unfortunate enough to witness a number of colleagues being sworn at, kicked and racially assaulted by a range of people—including one poor soul who was stabbed in the neck with a plastic fork.
Community matrons improve health: patients’ perspectives
Authors: Wright Kerri , Ryder Sherrie , Gousy Mamood
Published: May 2014

Community matrons are integral to the government’s plans to reduce hospital bed-use by people with long-term conditions. Community matrons have been given the role of case managing the very high intensity users in an attempt to reduce emergency bed days through preventing admissions and early discharge and through working closely with their patients to develop personalized plans of care and to support and encourage patients to take more control of their condition. To date there has been little research from the patients’ perspective into whether community matrons are achieving their aim. This series of two articles reports on an evaluation of a community matron service, which was initiated over 2 years ago, from the perspective of the patient. This second article reports on the patients’ perspective on how the community matron’s involvement has improved their health and what patients’ perceived to be important about the community matron service. The findings indicate that patients’ value the community matrons understanding of their individual experiences of long-term conditions; the clinical skills to address and give patients confidence that their conditions could be managed; and the availability of the community matrons to the patients. These aspects of the community matron’s role seemed to help the patients to feel safe and secure, improved their quality of life and ultimately increased the confidence and control they felt over their long-term conditions.
Delivering expert cardiac support in the community
Authors: Paynter Mike
Published: May 2014

This article outlines how cardiac problems can be assessed in the primary care environment, improving patient care and helping alleviate some of the operational and financial burdens on secondary and emergency care providers. It examines the approach that Bridgwater Community Hospital took in monitoring and managing cardiac conditions within primary care. By opting for a cardiac telemedicine service, clinicians get fast, expert interpretation of ECG results, enabling them to deliver timely and more effective, preventative care, as well as delivering clear cost benefits across the trust, and ensuring healthcare resources are optimized.
You never forget your first time
Authors: Dawes Jonathan
Published: May 2014

There aren’t many jobs which have saving a human being’s life written into their job description. The medical and nursing professions are stressful occupations where decision-making really can save or lose life. The field of medical ethics is a contestable minefield of tricky debate. Never is this more true than when dealing with resuscitation decisions.
Role of the law in ensuring work related road safety
Authors: Griffith Richard , Tengnah Cassam
Published: May 2014

Some 150 deaths and serious injuries are caused each week by people who were driving in the course of their work. The police, health and safety executive and government are seeking to improve this startling statistic by ensuring that organizations, including NHS Trusts, comply with health and safety law and fulfil their duty to carry out an assessment of risks associated with work related driving and implement a policy to minimize those risks. Failing to comply could result in prosecution by the police and health and safety executive.
Changes in primary care and their impact on nurses’ jobs
Authors: Nazarko Linda
Published: May 2014

The primary care landscape is changing. Primary care trusts are reconfiguring in an effort to reduce management costs by 15% and to divide services into purchaser and provider arms. These changes are affecting staff at all levels within PCTs and in some organizations hundreds of jobs are at risk. This article explains the process of reconfiguration and outlines your options if your post is at risk.
Show me the money
Authors: Dawes Jonathan
Published: May 2014

In a month of debate over where the future of Primary Care is heading, the Kings Fund, a leading health think-tank reported that overall productivity has diminished despite huge monetary spending in the NHS. Indeed, only 30p in every £1 has been earmarked for enhancing patient care. The massive sums pumped in to the service have been soaked up by increased doctors salaries and soaring costs of medical negligence cases. The report also implied that pharmaceutical giants take their share in the ever increasing prices of their products. Year after year since 1997 three years before I became a nurse a whopping £57bn has been spent on the NHS on average.
Assessing the impact of health policies on COPD
Authors: Berjon-Aparicio Sonia
Published: May 2014

COPD is a leading but under-recognized cause of morbidity and mortality worldwide. It is currently the fourth leading cause of death in the world. and the fifth commonest cause of death in England and Wales, accounting for nearly 28,000 deaths each year.

Methods: The author analyses systematically the national policies around chronic obstructive pulmonary disease such us the long term conditions NSF, the expert patient program, policies around smoking cessation and NICE and BTS recommendations on COPD.

Finding/Conclusion: The analysis of current national policies on chronic obstructive pulmonary disease leads to a discussion to justify the need for a National Service Framework on this chronic disease. The current and future impact on local implementation is also analysed.
Euthanasia: Is there a case for changing the law?
Authors: Griffith Richard
Published: May 2014

Calls for a change in the law to allow strictly controlled forms of voluntary euthanasia and assisted dying in the United Kingdom continue following two recent cases. In this article Richard Griffith reviews the current stance of the law on euthanasia and assisted dying and discusses attempts at reform made by Lord Joffe in the Assisted Dying for the Terminally Ill Bill 2005 [HL].
Termination of pregnancy: a case for a change in the law
Authors: Griffith Richard , Tengnah Cassam
Published: May 2014

In recent months there has been renewed public and parliamentary debate on whether the abortion law in the United Kingdom should be reformed. Parliament has debated the issue on three occasions and now the House of Commons Select Committee on Science and Technology are calling for evidence in support of their inquiry into reform of the Abortion Act 1967. The inquiry gives district nurses the opportunity to inform the debate and ensure that their voices are heard given that topics for reform include nurse-led abortions and home abortions.

In this article Richard Griffith and Cassam Tengnah review the development of the law relating to abortion and highlight the areas of reform to be considered by the select committee.
Blood glucose monitoring: reducing the cost, increasing the benefit
Authors: Holt Paula
Published: May 2014

The level of self blood glucose monitoring in patients who have diabetes has escalated over recent years following the results of two main research studies which identified a strong correlation between ‘tight’ blood glucose control and the reduction in diabetes related complications. This article analyses the effectiveness of self blood glucose monitoring for people with diabetes. Based on the research presented it goes on to discuss which patients should be encouraged to self blood glucose monitor and identify those for whom it may not be beneficial. Self blood glucose monitoring is discussed in relation to those receiving insulin therapy and those on diet and oral medication. Appropriate monitoring regimens are highlighted to ensure the effects of diet and medication on blood glucose level is assessed. Finally, strategies to look for patterns and trends in blood glucose levels are considered.
Motivational interviewing with clients with chronic leg ulceration
Authors: Morris Tania , White Geoff
Published: May 2014

In order to meet the holistic needs of the client with chronic illness, the nurse is required to adopt many different approaches to care. This article will explore one client-centred counselling approach that can be used by community practitioners to address behavioural change and improve concordance. The techniques are illustrated with an example of where motivational interviewing has been used to great success—in the ‘Look After Your Legs’ (LAYL) programme undertaken by West Gloucestershire primary care trust.

Interventions such as motivational interviewing have the potential to empower clients and so enhance care delivery.
Lymphorrhoea: ‘Leaky legs’ are not just the nurse’s problem
Authors: Renshaw Margaret
Published: May 2014

Lymphorrhoea, the weeping of lymph through the skin, is a complication of chronic oedemas, and is generally poorly known or understood by the majority of nurses and doctors. It can occur not just in the legs, but also in other parts of the body affected by lymphoedema such as arms and axilla, chest and genitals. Using a case study to illustrate the key messages, this article discusses the management of lymphorrhoea and highlights the need for all health professionals to be more aware of this unpleasant and disruptive condition.
Treatment options for pretibial lacerations
Authors: Henderson Valerie
Published: May 2014

Pretibial lacerations are a common occurrence in the older patient, however there is no clearly recognized protocol for the management of these wounds. This article aims to look at the published literature and identify what treatments are recommended and what work if any has been undertaken to develop protocols for the management of these wounds.
Does Allevyn foam’s management system improve wound healing?
Authors: Young Stephen
Published: May 2014

Four technically enhanced Allevyn dressings were used in this study. Patients were asked to evaluate these products and compare them to the performance of the original dressings. The dressings had been enhanced to increase the rate of fluid uptake and their rate of transpiration of the absorbed fluid, thereby radically increasing the overall fluid management profile of the dressings. The moisture vapour transmission rate (MVTR) had been enhanced by as much as 915% in two of the dressings. The results showed that 94% of the patients on the study rated the new dressings as being acceptable for the indication. When asked to rate appearance, conformability, dressing fixation, absorbency and wear time of the enhanced dressings against that of the users experience with the original Allevyn dressings, the results showed the enhanced dressings performed well. Patients were particularly impressed with the absorbency of the enhanced dressings with 72% rating it as better than the original. Improved absorbency meant that wear time, appearance, and fixation also scored highly in the ratings.
Panton-Valentine leukocidin: raising practitioner awareness
Authors: Beer Michelle , Fear Mair
Published: May 2014

Media reports have focused recently on methicillin resistant Staphylococcus aureus (MRSA). Panton-Valentine leukocidin is a toxin carried by MRSA. With reported increases in community acquired MRSA, This article seeks to raise practitioner awareness of this toxin and it’s effects on dermal tissue. A case study and anecdotal evidence is given.
Lymphoedema garment hosiery available on FP10 prescription
Authors: Hopkins Anita
Published: May 2014

This article aims to explore issues relating to European class compression garments now available on FP10 prescription. Highlighting the different strengths and styles currently available, the implications for practice are considered in light of training and competence to treat this patient group appropriately with these compression garments. There is a focus on particular products available from leading manufacturers and the products particular uses.
Restraint and the Mental Capacity Act 2005
Authors: Griffith Richard , Tengnah Cassam
Published: May 2014

In their latest article on Mental Capacity Act 2005 and district nurse practice, Richard Griffith and Cassam Tengnah discuss the requirements for the lawful use of restraint and examine when an action may lead to a deprivation of liberty under the Act.
Patient registries: a central component of the chronic care model
Authors: McEvoy Phil , Laxade Sylvain
Published: May 2014

Patient registries are a central component of the Chronic Care Model and research suggests that their use is associated with improved outcomes for patients with a range of chronic diseases. This article begins by outlining the case for using patient registries and it identifies some of the issues that need to be considered when setting up a registry. The second part of the article describes how a patient registry was used to support a newly established active case management service. The case study teases out some of the practical constraints and contextual factors that affected the development and implementation of patient registry. However it also highlights that the patient registry was highly valued by front line clinicians who used it, as it was an effective caseload and performance management tool.
The role of the district in the coronial process: the inquest 2
Authors: Griffith Richard , Tengnah Cassam
Published: May 2014

A coroner’s inquest is the most likely court a district nurse is going to be required to attend during the course of their career. Courts and inquests remain shrouded in the rituals and traditions of the legal system and appearing at an inquest can be a daunting experience. It is important that district nurses are aware of the role and function of an inquest including, the types of death that require an inquest, the conduct of an inquest and the role of witnesses before and during the inquest. In this way you will be better prepared to fulfil your role as a witness and contribute effectively to the coronial process.