bluuebunny/crossref_metadata_2025 huggingface dataset:
Evidence-based practice in primary care
Authors: Jones K , Wilson A , Russell I , Roberts A , O’Keeffe C , McAvoy B , Hutchinson A , Dowell A , Benech I
Published: May 2014

Evidence-based practice comprises four fundamental steps: the formulation of clear clinical questions from a patient’s perspective; searching the literature; critically appraising the evidence and incorporating into practice.

The Network for Evidence-Based Practice in Northern and Yorkshire (NEBPINY) seeks to establish a multi-disciplinary network of primary healthcare practitioners committed to evidence-based practice. Four interventions have been offered as part of an implementation programme: critical appraisal skills teaching; evidence-based guidelines; support for clinical audit and in-practice facilitation.

Currently, three main issues are emerging from the nursing perspective: access to the evidence; knowledge of and confidence in applying critical appraisal skills, and the importance of teamwork.

In-practice facilitation has encouraged meetings, for the common purpose of exploring the evidence-based guidelines and their potential impact upon practice. For some it has also been an opportunity to: discuss their own individual management of care with colleagues; to increase their awareness of the different roles played by each member and to exchange information and ideas.
Developing advanced nursing practice
Authors: Sams Debbie
Published: May 2014

What exactly is meant by advanced nursing practice, and what opportunities currently exist within community practice to develop it? This paper explores such questions by reflecting on attempts to develop advanced nursing practice within a community trust.

Transforming nursing practice does not occur overnight because change is inevitably a gradual process. In this paper, equal consideration is given to current challenges, pitfalls, stumbling blocks and – more positively – ways in which these can be overcome.
Reflections on the history of health visiting
Authors: Billingham Kate , Morrell Jane , Billingham Clive
Published: May 2014

1996 has been a year for celebrating the centenary of the Health Visitors Association. It has also been a time for reflecting on the history of the profession at a time of great uncertainty. This paper gives a historical account of the development of health visiting within an economic, political and social context. Drawing on original and contemporary texts the paper begins with the work of the early public health philanthropists and traces the development of health visiting through to the NHS reforms of the 1990s. Throughout the history of health visiting the voice of the user has been markedly absent, in particular the perspective of women.

The history of health visiting reveals a number of themes that have preoccupied the profession and its observers since its inception: social control, confusion in understanding the role and scope of health visiting, medical domination and the tension between individualism and population approaches to public health.

Today the profession has to fight to secure its position in a health service dominated by a bio-medical model. The challenge to prove their worth is one that the health visitors of today and tomorrow have to rise to if the profession is to survive in a world of resource constraint and evidence-based practice.
‘What happened to your face?’ Managing facial disfigurement
Authors: Clarke Alex
Published: May 2014

The emphasis that society places on physical appearance is an increasing challenge for those who have a facial disfigurement. Problems arise principally in the area of social interaction, with intrusions such as staring and comments commonplace. The resulting social anxiety and poor self esteem can often lead to outright avoidance of social situations. Medical and surgical solutions have their limits, and intervention is increasingly focusing on the behaviour of the individual and the development of the coping skills necessary to manage social situations. This paper briefly introduces some of these coping strategies and argues that nurses can be instrumental in raising awareness of the impact of facial disfigurement and the ways in which it can be managed.
Evaluating an initiative: clinical supervision in a community health trust
Authors: Draper Beverley , Koukos Christine , Fletcher Pam , Whitehead Anne , Reynolds Fiona , Coleman Mick , Rafferty Mic
Published: May 2014

This article describes the implementation and evaluation of a pilot project for clinical supervision in a Community Health Trust involving health visitors, district nurses and clinic nurses. The project represented collaboration between educationalists, clinicians and managers interested in establishing a working and sustainable culture of clinical supervision. The article provides an overview of a small scale study designed to chart the process of an innovation to implement clinical supervision in the practice setting. The findings demonstrate that despite some increase in negativity towards clinical supervision, overall, the participants felt that supervision was of benefit to them and their practice particularly in terms of its support function. The process of establishing clinical supervision is complex and requires careful and considered implementation.
Satisfactions and coping strategies of family carers
Authors: Nolan Mike , Lundh Ulla
Published: May 2014

With an increasingly ageing population, European countries are faced with developing strategies for maintaining community-based care. The major part of this care is provided by informal carers. The emphasis on the burden of caring and the concept of viewing carers as resources has led to a ‘pathological’ view of caring. The study reported in this article sought to establish the positive aspects of caring and coping strategies of informal carers in Sweden and the UK. The findings indicate that a high level of satisfaction is gained from care-giving. However, it is well recognized that the assistance offered to carers is generally inadequate. It is suggested that carer services should be more focused on the benefits of caring and that services should concentrate on maximizing them. Nurses working in the community have a key role to play in supporting family carers and it is important that they develop their skills in psychosocial interventions.
A review of the psychosocial aspects of multiple sclerosis
Authors: Williamson Kath
Published: May 2014

The psychosocial aspects of multiple sclerosis are far-reaching and may have devastating effects on individuals and carers alike. Issues such as the impact of uncertainty, the need to maintain hope and control, and a person’s ability to adjust his/her lifestyle to the disease progression are highlighted by recent research. The individualized nature of this chronic illness experience makes comprehensive and ongoing assessment crucial. Evidence from practice suggests that the district nurse’s contribution to psychosocial support is hindered by poor role definition. Similarly, while the literature acknowledges the benefits of empowerment, difficulties exist in practice. Collaboration between district nurses and clinical nurse specialists is advocated as a means of integrating best practice and clinical knowledge with community expertise. The need for improved research methodology is identified.
Pelvic floor reeducation for stress incontinence: comparing three methods
Authors: Laycock J , Brown J , Cusack C , Green S , Jerwood D , Mann K , Schofield A
Published: May 2014

Stress urinary incontinence is a common problem among women of all ages but may resolve with pelvic floor reeducation in many cases. Compliance to a regimen of pelvic floor muscle exercises is poor and many devices have been produced to make exercising these muscles more effective and interesting. This article describes a study in which two such devices - vaginal cones and pressure biofeedback - were compared with pelvic floor exercises alone. The results show that there is no statistically significant difference between the three modalities; all treatments produced significant improvement in symptoms and quality of life scores.
Cost effectiveness in leg ulcer management in the community
Authors: Quioc Victoria
Published: May 2014

Wound care and leg ulcer management account for the largest part of district nurses’ workload. This has major implications on prescribing budgets of primary care groups (PCGs). Ineffective care results in an expensive waste of financial resources and poor quality care for the patients involved. Two case studies of patients with venous leg ulcers are used as an example of how practice can vary within one PCG. Continuing support and training is needed for all community nurses to enable them to meet national and local standards and guidelines.
Assess, negotiate, treat: community prescribing for chronic wounds
Authors: Bentley Jenny
Published: May 2014

The cost of prescribing wound-care products in general practice in 1999 exceeded £95million (Department of Health (DoH), 1999a). However, there is a lack of randomized controlled trials to assess the effectiveness of wound-care products (National Prescribing Centre, 1999a) and there is evidence that non-effective treatments are being prescribed (DoH, 1999a). Use of the prescribing pyramid, as taught during nurse prescribing courses, may help community nurses justify their decisions and assess their wound-care practices. Wounds commonly encountered in the community include pressure sores, leg ulcers, fungating wounds and cavity wounds. The ideal choice of product is one that allows moist wound healing, is cost effective, clinically effective and acceptable to the patient.
Threadworms: a starting point for family hygiene
Authors: Ibarra Joanna
Published: May 2014

Owing to the embarassing anal itch caused by threadworm infection, some sufferers feel they cannot even mention the problem to their doctor. Community nurses, often regarded as a more approachable source of support, will also be able to prescribe medication if they have prescribing status. With an adequate understanding of the complaint, they can offer a choice of treatment options, mechanical removal or drugs, necessarily backed by the appropriate personal and environmental hygiene measures. The starting point for relevant hygiene is cheerful good practice in hand washing at home and school, which is also key to preventing the spread of many other more serious infections. Implementation is of basic importance and should form part of any of the current initiatives from Sure Start to Healthy Schools.
Hypodermoclysis for rehydration in the community
Authors: Moriarty Deirdre , Hudson Ellen
Published: May 2014

During 1999 and 2000 the practice development unit of Greater Glasgow Primary Care Trust received an increasing number of requests from community staff for guidance in caring for patients receiving subcutaneous fluids for rehydration. This article describes the process of developing guidelines in order to address the issue. Hypodermoclysis is a relatively safe, simple and cost-effective technique, suitable for use in the community with a range of client groups, e.g. older people or those recovering from recent cardiovascular accidents. Its use in palliative care, however, raises problems in terms of clinical evidence and ethical issues which need to be addressed. Various factors, i.e. products not being licensed for this specific use, staff requests for clinical guidance and the anticipated increasing use of hypodermoclysis for rehydration, all indicated the need for guidelines to be developed. The guidelines highlight the need for a collaborative approach, address the complexity of issues in the decision-making process and provide clinical guidance with the aim of improving nursing practice and patient outcomes.
The attitudes of GPs towards the nurse-practitioner role
Authors: Carr Jacqueline , Bethea Jane , Hancock Beverley
Published: May 2014

In recent years, nursing and health-care policy have promoted the advanced role of the nurse – that of nurse practitioner. But such a role has not been integrated widely into the primary health-care team. This study investigates the knowledge and attitudes of GPs who do not employ nurse practitioners to find out what prevents them doing so. Ten GPs who did not already employ a nurse practitioner took part in semi-structured interviews. Our findings show that GPs, although confused about the role, were generally supportive of advanced nursing practice. Skills identified with the role were prescribing, disease diagnosis and minor-illness management. GPs thought that protocols and guidelines should govern practice, which differs fundamentally from the Royal College of Nursing definition. None of the GPs had encountered the role in primary care, and the lack of professional regulation and role definition for practice nurses and nurse practitioners who work in primary care may have affected GPs’ perceptions.
The assessment and management of burns in the community
Authors: Dowsett Caroline
Published: May 2014

Each year many people seek medical advice or hospital treatment for burn or scald injuries. There is limited data on the number of burns patients seen in primary care, however a recent national survey suggested that there are 250000 presentations of burn injuries to primary care teams in the UK per year (National Burn Care Review, 2001). This article discusses the nursing management of burns in the community, outlining the initial assessment of the burns patient in terms of trauma management, and focusing primarily on those patients with non-complex burns. A full patient assessment incorporates the patient’s general condition, the type, cause, depth and extent of the burn and the effects on the individual patient. Good patient management is an essential element of care and the focus of this is the management of pain, prevention of infection, provision of evidence based wound care and onward referrals as appropriate. However not all patients can be managed solely in the community and the nurse needs to know when to refer and to whom to refer. The article outlines the recommendations from the National Burn Care Review in terms of patient referral.
Living with a pressure ulcer: a descriptive study of patients’ experiences
Authors: Fox Carolyn
Published: May 2014

This qualitative study explored the perceptions and feelings of patients with pressure ulcers. Five participants who had suffered from pressure ulcers extending into the subcutaneous tissue and deep fascia were interviewed. A semi-structured interview technique was used, in which participants were asked a series of open questions based on the reviewed literature and the author’s clinical experience. Content analysis was used to analyse the interview transcripts. The following themes emerged: pain, exudate levels, loss of independence, emotional factors, worry about healing, relationships, body image and social isolation.
Is modified cow’s milk formula effective in reducing the symptoms of infant colic?
Authors: Swadling Claire , Griffiths Peter
Published: May 2014

To determine the effectiveness of modified cow’s milk formulas on the symptoms of infant colic, a mini-review (Griffiths, 2002) of double-blind randomized controlled trials was undertaken. The population was infants diagnosed with colic and the outcome was a reduction in infant distress. Medline, Embase, CINAHL and the Cochrane Library were searched and seven clinical trials and two systematic reviews were identified. After applying inclusion criteria, two studies were examined in the review. One study compared the effects of a modified formula and a standard cow’s milk formula on bottlefed infants. The other examined the effects of a low-allergen diet on breastfed and bottle-fed infants. Results could only be retrieved from one study, which showed that hydrolysed formulas have a positive effect on reducing the symptoms of infant colic although sample sizes were small and the magnitude of benefit unclear. There is evidence to support advice to parents of bottle-fed infants with colic to consider changing to such formulas.
District nurses’ experiences and perceptions of cancer patient referrals
Authors: McHugh Gretl , Pateman Brian , Luker Karen
Published: May 2014

Traditionally palliative care of cancer patients has been seen as an important and defining aspect of district nursing. Care of the dying patient has been used to describe the ability and scope of the district nursing service to holistically provide for patient need. However health and social service changes in the last decade have refocused the district nurse’s role away from holistic delivery to more specialised care. There is also research evidence that there are several contradictions in referral processes to the district nursing service. We conducted a study to explore district nurses’ perceptions and experiences of referral of cancer patients to gain insight into these referral processes. We interviewed 20 nurses from three primary care trusts to explore the referral process of cancer patients to the district nursing service from the district nurses point of view. The nurses expressed concerns regarding completeness, accuracy and appropriateness of referral and suggested improvements that could be made.
Tielle* Plus fluid handling capacity can lead to cost savings
Authors: Trueman Paul , Boothman Stuart
Published: May 2014

The cost of care plays an increasing role in treatment decisions. As the costs of wound care are largely driven by the costs associated with nurse visits to change patients’ dressings, attempts to reduce the number of dressings used and thus the frequency of nurse visits should be welcomed. The acquisition cost of the dressing alone is a poor indicator of the total cost of care. Other factors – especially factors influencing the frequency of nurse visits, such as wear time – need to be considered when making treatment and formulary decisions. This paper assesses the theoretical wear time of a number of dressings based on laboratory data on their fluid-handling capacities. The monthly treatment cost associated with each dressing is based on the theoretical wear time. The results suggest that the superior fluid-handling capacity of TIELLE*a Plus hydropolymer adhesive dressing can reduce the costs associated with wound care.
So you want to do research? 6: Reporting research
Authors: Meadows Keith A
Published: May 2014

This last article of the series reviews some of the key issues that need to be considered when preparing your research findings for dissemination. Dissemination is an integral part of the research process and this article outlines some of the initial steps that need to be taken, including the establishment of agreements between authors. The importance of writing for a specific audience and how this determines the content of the report is then discussed. An overview together with guidelines on how to report qualitative and quantitative research is presented. General guidance on the choice of title, writing an abstract, listing references and acknowledgments are discussed. The article concludes with an outline of some of the key criteria editors use when reviewing a paper for publication.
Preventing falls in older people: evaluating a peer education approach
Authors: Allen Terry
Published: May 2014

Initiatives in falls prevention usually rely on the expertise of health professionals and are therefore limited in scope. In order to reach a wider audience, a peer education programme in Bradford gave one-off sessions to groups of older people providing information about falls prevention and demonstrating simple balance and strength building exercises. Although evaluation found the programme to be well received, it also revealed a high rate of undisclosed falls and a reluctance to inform, or seek advice from, health professionals. It was not clear how far this was to do with embarrassment or being seen as not coping, but suggests that a more appropriate role for health professionals may be one that is complementary and supportive within a broad educational and facilitative programme embodying peer education.
Self-assessment of health and social care needs by older people: a review
Authors: Griffiths Peter
Published: May 2014

This article explores the meaning and significance of ‘self-assessment’, a term that is increasingly being used in relation to developments affecting community practice. Self-assessment for health and social care needs has been used over a considerable period of time and for purposes as diverse as case finding for depression to assessment of housing options. Self-assessment has usually involved the use of short scales and questionnaires, but it can involve the use of physiological tests (such as testing urine for glucose) or complex, computerized decision-support systems. Although often explored as a simple means for extending the ‘reach’ of professional assessments (e.g. mass screening) and ensuring ‘appropriate’ use of health services (e.g. self-care algorithms), self-assessment is increasingly being advocated as a means of actively involving and empowering service users. However, a recent review of the topic (Griffiths et al, 2005) revealed the complexity of the topic and the pitfalls of a simplistic approach to self-assessment, which those engaged in developing the process should bear in mind.
Long-term conditions: making sense of the current policy agenda
Authors: Wilson Patricia M
Published: May 2014

This article is first of a series focusing on long-term conditions and aims to guide district nurses through the whole raft of policies that are currently emerging from the Department of Health for England and Wales. The article provides an overview of current policy by taking the reader through the initiatives, starting with population-wide prevention and concluding with policies focusing on clients with complex needs. The main triggers for government health strategies and the influence of models from the United States are discussed. The national service framework for long term conditions is explained and used as an example of the current emphasis on generic, rather than condition-specific, initiatives. The article concludes by drawing the initiatives together within the most recent model to come out of the Department of Health – the NHS and Social Care Model.
Caring for patients with COPD on long-term oxygen therapy
Authors: Edwards Margaret
Published: May 2014

Long-term oxygen therapy (LTOT) is becoming a mainstay of treatment for people with severe chronic obstructive pulmonary disease (COPD) in the community. This article provides an overview of the fundamental aspects of the therapy, measurement of blood gases and the equipment used in LTOT.
Long-term conditions. 2: supporting and enabling self-care
Authors: Wilson Patricia M , Mayor Vina
Published: May 2014

This article is the second of a series focusing on long-term conditions. It explores supported self-care identifying that this is the most appropriate approach to managing long-term conditions in 70-80% of patients with a chronic illness. The paper focuses on the Department of Health for England and Wales flagship initiative; the Expert Patient Programme. This lay-led self-management programme for people affected by a physical long-term condition is currently being rolled out by PCTs throughout the NHS and is seen as a key mechanism for empowering individuals and reducing resource demand in long-term conditions. The history, content, current and future models of the Expert Patient Programme will be described and the paper concludes by discussing future challenges for the programme as illuminated by two external evaluations.
Interprofessional education to improve pain management
Authors: Irajpour Alireza , Norman Ian , Griffiths Peter
Published: May 2014

Pain is a prevalent problem in community care and there is evidence that knowledge and understanding of pain management can be lacking among health professionals, leading to under-treatment. This mini-review aimed to assess the effectiveness of interprofessional education on health professionals’ pain documentation and on the pain intensity reported by patients. A search of key databases identified two randomized controlled trials and two quasi-experimental studies. Two studies assessed change in pain documentation following interprofessional education; one revealed a statistically significant improvement and another indicated 29% increase in documentation of pain assessments. Two studies demonstrated no significant changes in patient outcomes, while the other revealed significant improvements. However integration of the results was not possible because of the various methods of measurement used by the different researchers. Although broadly supportive of interprofessional education, the evidence is not helpful in determining the best way of improving pain management in the community.
Validation and usefulness of the Tamil version of the GHQ-12 in the community
Authors: John S , Vijaykumar C , Jayaseelan V , Jacob KS
Published: May 2014

The 12-item General Health Questionnaire (GHQ-12), increasingly used to screen for common mental disorders (CMD) in primary care, has been validated in different languages and cultures. However, the validity and usefulness of the Tamil version has not been established for use in the community.

This article reports a study to validate the Tamil version of the GHQ-12 in a rural setting in southern India. The research found that 16.5% of people interviewed satisfied international criteria for CMD. However, the predictive value of the tool as a tool for screening was found to differ from that found in studies undertaken in a hospital setting.

While screening instruments need to be validated in specific types of populations before being employed, such tests may be less useful in community surveys where the prevalence of common mental disorders is low. Strategies which artificially increase the prevalence of common mental disorders in the sample screened will improve the performance of the instrument.
Will health trainers reduce inequalities in health?
Authors: Netherwood Maggie
Published: May 2014

The Health Trainer initiative was a public policy initiative designed to tackle health inequalities. Despite considerable improvements in the health of the population in the United Kingdom, there continues to be a gap between the rich and the poor in terms of deaths from cancer, stroke and coronary heart disease. There is a relationship between these health problems and lifestyle behaviours such as smoking, physical inactivity and poor diet. The Health Trainer initiative was created as part of the white paper Choosing Health. Following initial implementation across targeted Primary Care Trusts (The Spearhead Group), a rigorous evaluation of the initiative is taking place prior to a national roll out. This paper uses Whitehead’s framework to examine the decision to implement health trainers as a stated aim of tackling health inequalities. The four purposes of health policy as identified by Whitehead (1995) and the categories of healthy living initiatives (Visram and Drinkwater 2005) are examined and applied to the health trainer initiative and its potential for reducing health inequality.
Introducing: Telehealth and Telecare
Authors: Cook Rosemary
Published: May 2014

In May 2007, the Government announced a series of pilots of ‘hi-tech home healthcare’. These aim to keep older people, and those with long-term conditions, out of hospital and leading more independent lives, by using remote monitoring devices to help them manage their condition. The pilots also explicitly aim to reduce the number of prescriptions dispensed, and reduce admissions to residential and nursing homes, as well as reducing hospital admissions and Accident and Emergency attendances.
Care pathways: a legal sword or shield?
Authors: Griffith Richard
Published: May 2014

District nurses use care pathways to ensure the efficient delivery of evidence-based high quality care. However, many health professionals, including district nurses have expressed concern that comparing the actual care delivered with a care pathway makes them more susceptible to litigation should the patient suffer harm during the course of treatment. In this article Richard Griffith considers the legal implications of care pathways.
‘Look After Your Legs’: patients’ experience of an assessment clinic
Authors: Freeman Elaine , Gibbins Annabel , Walker Mark , Hapeshi Julie
Published: May 2014

Venous leg ulcers are a chronic, recurring condition and a major cause of morbidity, especially in older people. Two inner city district nursing teams initiated a weekly, nurse-led, leg ulcer assessment clinic, and a monthly support group for patients with healed or almost healed leg ulcers. The group supports and empowers patients with self-care ‘look after your legs’ health promotion messages. The support group uses a similar model to the expert patient programme (Department fo Health, 2001). Patients in the group coined the unique name ‘patient ambassador’. Patient ambassadors, with nursing support, are used to promote self care and lifestyle changes to members of the group to prevent recurrence of leg ulceration.

The aim of the research reported here was to evaluate the ‘Look after Your Legs’ (LAYL) service and the benefit to others of the patient ambassador role.
Review of personal protection equipment used in practice
Authors: Hinkin Jon , Gammon John , Cutter Jayne
Published: May 2014

Standard precautions offer a consistent approach to infection control that does not rely on knowledge or suspicion of infection, and contributes to staff and patient safety by reducing the risk of exposure to potentially infectious material. One of the cornerstones of standard precautions is the appropriate use of personal protective equipment (PPE) whenever contact with blood or body fluids is anticipated. However, evidence suggests that compliance with standard precautions including correct use of PPE is inadequate. Demographic and epidemiological changes in the UK, and the drive to provide more complex patient care outside acute hospitals may lead to increased infection risks for both patients and community healthcare workers. This review examines the importance and use of PPE by community nurses and discusses the implications for practice of poor compliance with standard precautions. Recommendations for practice will be made aimed at improving compliance with this important element of standard precautions.
Survey to investigate the role of the community stroke care coordinator
Authors: Murray Jenny , Forster Anne , Young John
Published: May 2014

The National Service Framework for older people recommends that patients recovering from a stroke should have access to a stroke care coordinator (SCC) to support their longer-term recovery. However, the knowledge base, skills and procedures for the role are poorly defined. We have therefore conducted a survey to examine the development and responsibilities of SCCs with a remit for longer-term support. We identified 39 SCCs, most of whom were nurses. Three role types were observed: enhanced community follow-up (n=22); hybrid (n=15); and hospital outpatient (n=2). However, there was overlap between the roles reflecting a wide variation in practice in respect of timing and frequency of patient contacts, and methods for assessing patients’ needs. Workload and knowledge of the evidence-base were identified as the main challenges to delivering care. Meeting patients’ needs was impeded by limited access to psychology and physical therapies. A more robust evidence-base to support longer-term stroke care, combined with routine clinical governance systems for monitoring care provision could enhance the development of the SCC role.
Kidney Research UK’s: A better life through education and empowerment
Authors: Jain Neerja
Published: May 2014

Over 3 million people are affected by chronic kidney disease (CKD). Kidney Research UK, a national charity dedicated to research that will lead to better treatment and cures for kidney disease has developed the innovative and successful ‘A better life through education and empowerment’ (ABLE) programme which researches and raises awareness of the issues among ‘at risk’ groups and helps prevent or slow its progression. Initially the programme focused on the black and minority ethnic (BME) communities who are up to 5 times more likely to develop kidney failure than white caucasians. This is largely due to hypertension and type 2 diabetes.

Recently the scope of the programme was broadened to encompass all those at risk and the useful lessons learned from the 7 initial projects are being used to inform the future of ABLE and other CKD projects. The programme has been funded by a cross section of organizations including the Department of Health and the Big Lottery Fund. Outcomes from the first two completed projects as well as an update on the other ABLE work are summarized.
Leg ulcer management with topical medical honey
Authors: Leigh Sare Janice
Published: May 2014

Three case studies of patients with leg ulceration are used to illustrate the effectiveness of Medihoney™ antibacterial wound gel (Medical honey) in wound healing via wound bed preparation. The aim was to improve the patient’s quality of life, during the healing process, through provision of comfort, reduction in pain and protection from infection. Three patients with chronic leg ulceration were assessed as potentially benefiting from the action of medical honey to achieve wound healing. Patient selection was based on structured leg ulcer assessment. The aetiology of ulceration in patient 1 was mixed arterial and venous, and in patient 2 and 3, venous. All had several years’ history of reoccurrence. Promotion of healing occurred in all instances with a reduction in the incidence of infection, reduction in pain and the provision of comfort. Antibacterial medical honey should therefore be considered as a dressing option when assessing and managing chronic wounds.
Dietary factors and depression in older people
Authors: Williamson Claire
Published: May 2014

Depression is one of the most prevalent mental health conditions and can affect people of all ages, but it is becoming more common among the older population with increasing life expectancy. Observational studies have found poor micronutrient status (particularly folate and vitamin B12) to be associated with an increased risk of depression in older people. Supplementation with folic acid has been shown to enhance anti-depressant drug treatment and there is preliminary evidence that supplementation with certain micronutrients may help improve depressive symptoms in older patients. There has also been a lot of interest in the role of long-chain omega-3 fatty acids in depression. However, the evidence from randomized controlled trials is limited and difficult to evaluate owing to considerable variability between studies. The research highlights the importance of a healthy diet and lifestyle to help maintain good mental health into old age and health professionals should try to support older people in trying to achieve this.
A community nurse clinical competency framework
Authors: Glanville Geake Bev , Ryder Rebecca
Published: May 2014

This article describes a dynamic initiative in community nursing education across the South West Peninsula. A group of educationalists from three community health services have written a framework of clinical competences to support community nurses in their professional development, providing career progression. The framework comprises of three sections: a preceptorship for nurses novice to community nursing; a section where experienced community nurses record their achieved knowledge, skills and competences, complemented by a validated, academic, 40 credit, degree module; and a developmental role (identified as a ‘band 5+’) in which the nurse demonstrates a range of knowledge and competences in order to progress onto a higher band such as a team leader. This framework is currently being piloted in four NHS community health services/trusts and it is expected that an evaluation will be undertaken within 12 months of implementation.
Functional foods: what are the benefits?
Authors: Williamson Claire
Published: May 2014

Functional foods and drinks are products that have been enriched with added nutrients or other substances that are considered to have a positive influence on health. Examples include probiotic yogurts, cholesterol-lowering spreads and foods with added nutrients, such as omega-3 fatty acids. This article considers a number of the more popular functional foods currently on the market, looking at how they may benefit our health and the evidence behind some of the claims being made about them. There is good evidence for the efficacy of some functional food products, for example cholesterol-lowering spreads have been proven to be effective in human trials. However, there is currently little evidence that foods with added omega-3 fatty acids can help improve brain function in ‘normal’ individuals. Other important factors, such as the amount of functional food that must be consumed to provide a health benefit, are also considered.
Satiety and the anorexia of ageing
Authors: Benelam Bridget
Published: May 2014

The ‘anorexia of aging’ refers to reduced appetite and energy intakes observed in some older adults. Satiation (the process that leads to the termination of eating, which may be accompanied by a feeling of satisfaction) and satiety (the feeling of fullness that persists after eating, potentially suppressing further energy intake until hunger returns) are important factors in the control of appetite and energy intake, and there is evidence that some aspects of satiation and satiety are altered in older adults. Factors affected include gastric emptying, which could affect satiation, and levels of gut hormones which could affect satiety. Sensory specific satiety also appears to be reduced in older subjects. This might be important in the anorexia of aging and dietary strategies could be used to reduce satiety and encourage an increased energy intake. However, many other factors may affect the anorexia of aging and it is important to understand these in order to help those at risk of malnutrition.
Stoma care nursing management: cost implications in community care
Authors: Black Pat
Published: May 2014

Successfully rehabilitating the stoma patient in the community means continuing the care provided by the hospital and preparing the patient for this new phase of life. It is well documented that this transition from hospital to home can often be a difficult time for the stoma patient and that home visits and ongoing support from the district nursing team are needed for many patients in the long term. This article aims to help community nurses understand the needs of the stoma patient in their homes and looks at the current situation, including costs, of supplying stoma appliances in the community.
Topical antimicrobial agents for the treatment of chronic wounds
Authors: Ousey Karen , McIntosh Caroline
Published: May 2014

Chronic wounds are commonly observed in acute and community settings. The management of chronic wounds represents a significant proportion of health-care resources and makes up a substantial amount of contact time with community-based nurses spending approximately 25% to 50% of their time treating wounds. Chronic wounds often exhibit increased bacterial burden that can negatively impact upon patients, reduce their quality of life and substantially increase treatment costs for health care providers. Antibiotic resistance has become a major medical and public health problem, and interest has been generated in the use of topical therapies to manage wound infection. This article presents an overview of the historical use of honey, silver and iodine for the treatment of infected wounds progressing through to modern day use and the current evidence base for the use of these antimicrobial agents in the management of infected wounds.
Liberating new talents: an innovative pre-registration community-focused adult nursing programme
Authors: Arnott Jane
Published: May 2014

The drive for a more community-focused approach to pre-registration nursing education as identified in Modernising Nursing Careers, (Department of Health, 2006a) has continued to gather momentum. The research literature identifies that the community context impacts significantly on care delivery, with student nurses often missing the underlying complexities of working in this context; focusing on the task in hand rather than the broader landscape of care (Carr, 2004). In 2008, a community focused pre-registration adult nursing degree pathway was started at Canterbury Christ Church University (CCCU), to prepare a cohort of 16nursing students to work in the community and general practice setting at the point of registration.

Placement learning has been focused within general practice and community through a hub and spoke approach to enable students to develop a deep understanding of the complexities of care in this setting with particular reference to the management of risk and unpredictability.

The pilot is being formally evaluated with a particular emphasis on the meaning and relevance of practice learning within these settings. The emerging data will not only provide evidence to promote the community and general practice agenda within pre-registration curricula, but help to clarify the essential skills and knowledge required to prepare students nurses for working in these settings.
The Silver Song Club Project: singing to promote the health of older people
Authors: Skingley Ann , Bungay Hilary
Published: May 2014

Attention has recently been drawn to the contribution of the arts, and of singing in particular, to health and wellbeing. This article describes a qualitative research project which aimed to gain participants’ views of taking part in Silver Song Clubs – community-based singing groups for older people. Seventeen individuals aged 60-plus from six clubs were interviewed and a number of benefits were identified. These included: enjoyment; better mental health and wellbeing; increased social interaction; improvements in physical health; cognitive stimulation and learning; and improved memory and recall. It is suggested that such benefits sit well within a model of health relevant to older people themselves. Community nurses working with this age group might consider including an assessment for interest in musical and related activities, and also should be aware of any local initiatives into which individuals can be referred.
Skin care as a tool in the prevention of health care-associated infection
Authors: Bissett Linda
Published: May 2014

Keeping skin healthy is particularly important for patients and all health-care personnel as any break in the skin can potentially harbour bacteria that may become a cross-infection risk to patients. When skin is damaged it is more difficult to remove microrganisms even when staff follow the recommended technique for hand washing (Royal College of Nursing, 2000). Broken skin on patients increases the risk of developing a healthcare-associated infection (HAI) as microorganisms can penetrate the surface of broken skin and cause anything from boils to bacteraemia. The aim of this article is to discuss skin as a barrier to infection, and examine ways to maintain the integrity of both staff and patients’ skin. It will also look at the effect damaged skin can have on hand hygiene compliance and how it can increase the need for intervention in patients with broken areas of skin if these areas then become infected.
Manual lymphatic drainage: exploring the history and evidence base
Authors: Williams Anne
Published: May 2014

Manual lymph drainage (MLD) is an integral part of lymphoedema treatment but there is limited evidence to guide clinical practice. This paper outlines the historical background to MLD and provides insights into the evidence relating to the effect and efficacy of manual lymph drainage, highlighting considerations for lymphoedema practitioners
Achieving effective outcomes: monitoring the effectiveness of the Softform Premier Active (TM) mattress
Authors: Stephen-Haynes Jackie
Published: May 2014

The identification of pressure-relieving mattresses to achieve positive clinical outcomes for patients and financial considerations for organizations is a challenge for health-care staff. This article reports on an audit undertaken within a primary care trust to determine the clinical and cost effectiveness of the Softform® Premier Active mattress. Preliminary results have been previously published (Stephen-Haynes, 2009) and are presented here in full.
Microfine glove and toe caps and their use in lymphoedema management
Authors: Close Gail
Published: May 2014

Lymphoedema garments have progressed in the last 10 years, so gone are the days when only one colour is available (that lovely beige!). How many patients would have to be persuaded to wear their compression hosiery in that desirable colour? Not just have the colours become more acceptable, so have the fabrics. There are a wide range of compression gloves available to the lymphoedema specialist to fit on the patient but that cannot be said of toe caps. The Microfine toe cap is the only one available as an off-the-shelf garment, and when the lymphoedema is deemed to be manageable in these garments, it offers an alternative to flat knit. The Microfine glove and Microfine toe cap are adaptable and can offer colour options and a fabric that is less bulky and fine. It also allows therapists to trim the length of each digit for a better fit without reducing compression. The author will present three case studies of patients that are using.
Nurses' knowledge of the provision of oral care for patients with dysphagia
Authors: Durgude Yuwrajh , Cocks Naomi
Published: May 2014

There has been little research on the provision and adaptation of oral care for patients with dysphagia in nursing homes. This study collected data via a questionnaire specifically on the knowledge of oral hygiene and the current oral care practices for patients with dysphagia. Fifty-three registered nurses (RNs) completed the questionnaires. The results of the questionnaire indicated that although RNs gave more oral care daily to their patients with dysphagia than to their patients without dysphagia, they had limited knowledge of drugs that affect oral care and of medical conditions associated with poor oral hygiene. Of particular concern was the limited knowledge of the link between dysphagia, oral hygiene and pneumonia and that some of the current oral care practices may be putting patients who have dysphagia at increased risk of developing pneumonia. These results are discussed in light of previous research on the topic and recommendations are made with regards to oral care training.
Advanced physical assessment skills: implementation of a module
Authors: Aldridge-Bent Sharon
Published: May 2014

This article aims to explore and examine advanced physical assessment skills and the role of the district nurse. It will particularly highlight district nurses' perceptions of how they may implement skills learnt on a new module introduced into the Community Health Care Nursing degree at a university in London. Physical assessment skills have traditionally been viewed as part of a doctor's role; however, with the advancement of nursing roles, it is argued that it has become a key nursing skill. As Government policy continues to expect health professionals to keep patients in the community who have complex health and social care needs, the role of the district nurse presents as ‘best placed’ to take on this challenge ( Department of Health (DH), 2005a ; 2005b ).

Evaluation of the district nurses' perceptions of their practice is shared here, highlighting some of the challenges that they face. The article will address the complexity of developing a curriculum in response to the DH initiatives and the importance of listening to students on courses.