bluuebunny/crossref_metadata_2025 huggingface dataset:
Current practice and recent advances in catheter ablation
Authors: Lee Justin , Bugden Hilary , Grace Andrew
Published: May 2014

The use of invasive cardiac electrophysiology and radiofrequency catheter ablation in the diagnosis and treatment of arrhythmias has become a part of mainstream cardiology practice. Atrial flutter and supraventricular tachycardias can be cured with a high rate of success and low risks of complications. The treatment of paroxysmal atrial fibrillation (AF) by catheter ablation is generally thought effective and improvements are occurring in the treatment of persistent AF. Ventricular tachycardia is also increasingly amenable to treatment. As technology and understanding of arrhythmia mechanisms both continue to evolve, then the safety and efficacy of these procedures are likely to increase.
ECG of the month
Authors: Regan Claire , Regan Martin
Published: May 2014

Claire Regan and Martin Regan present two ECGs for you to analyse. Answers are given on page 319
Making care safer: reducing avoidable harm and death
Authors: Shuldham Caroline
Published: May 2014

Caroline Shuldham considers the implications for practice of the National Advisory Group paper on improving safety in the NHS and the American Heart Association paper on safety in the theatre
NICE Quality Standard: familial hypercholesterolaemia
Authors: Linden Belinda
Published: May 2014

Belinda Linden discusses the National Institute for Health and Care Excellence Quality Standard QS41 on familial hypercholesterolaemia, issued in August 2013.
Wilful neglect and failure to initiate CPR
Authors: Griffifth Richard
Published: May 2014

In a previous article in the British Journal of Cardiac Nursing, Richard Griffith (2013) reviewed the lawfulness of do not attempt resuscitation (DNAR) orders in relation to the Supreme Court decision on futile treatment in Aintree University Hospitals Foundation Trust v James [2013] . In this article, he considers recent cases of wilful neglect to come before the Court of Appeal, and argues that rather a failure to provide cardiac pulmonary resuscitation (CPR) when required to do so is likely to result in prosecution for wilful neglect.
JBS3: Making decisions about lifestyle and drug treatment using a web-based tool
Authors: Linden Belinda
Published: May 2014

Belinda Linden outlines the recommendations made by the Joint British Societies on the prevention of cardiovascular disease (JBS3) launched in March 2014
The BHF cardiac healthcare assistant pilot scheme
Authors: Annus Christopher
Published: May 2014

Christopher Annus gives an overview of a pilot scheme which explored the benefits of introducing health-care assistants into heart failure services
Public health doctors and general practitioners: Poles apart?
Authors: Dilloway Mark
Published: May 2014

On 1 April 1996, the new health authorities will be created. This organisational change will be accompanied by a wider remit for public health doctors than the traditional definition of public health. The future public health roles and responsibilities will include ensuring that public health considerations drive the authority's purchasing and commissioning activities, the monitoring of health outcomes of interventions, and improving the effectiveness and value for money of clinical and non-clinical interventions. Public health doctors, in particular Directors of Public Health, will have a strong influential role in the corporate management team. As a result there is a possibility that general practitioners may feel threatened by what they see as a “top down” approach to the provision of health care, erosion of their clinical freedom and the doctor-patient relationship.

Although their perspectives may differ, there is considerable common gorund between public health doctors and general practitioners. Collaboration in the undergraduate curriculum and representation in the annual public health reports are just two ways in which liaison may be encouraged.

Developing and sustaining an effective relationship will depend on both parties. General practitioners need to overcome their mistrust of the corporate role of public health doctors, while the latter could meet this criticism by showing an independent spirit through their annual reports and support for equity.
Public health in the workplace
Authors: Bamford Margaret
Published: May 2014

This paper reviews the opportunities for occupational health to be seen as an element of public health. It reviews the international and national perspectives on provision of health care in the workplace, and considers the tension between private provision of that care, and the interface with the NHS. There is a brief description of the statutory arrangements for occupational health together with the possible range of people involved in providing care. It concludes with suggestions for the more positive inclusion of occupational health into public health for the benefit of the community.
The potential of clinical supervision for community nurses
Authors: Butterworth Tony
Published: May 2014

The development of clinical supervision in British nursing has been truly spectacular. From tentative beginnings 10 years ago its implementation and the debate it engenders has reached a peak over the last year. Can this momentum be sustained, and is there sufficient academic strength and practical utility in clinical supervision to offer tangible advantage to both the profession and the patients and families it cares for? The easy answer must be a classic compromise of yes and no. It certainly appears to appeal to those who occupy both ends of the ideological spectrum which characterizes British nursing.
Community hospital nurses: raising the profile
Authors: Antrobus Mollie
Published: May 2014

Community hospitals, and the staff who work in them, tend to wax and wane in political attention and interest. Mr Dorrell, in his millennium speech, currently has them high on his agenda, as he recognises the value of an interim provision between hi-tech hospital facilities and primary and community health care services. Those who live in the locality and receive the benefits of local health care provision will always value community hospitals and their staff. Local support is one feature of their survival – especially from a financial perspective. Community hospitals may:

●Be a part of a community trust, as in Devon.

●Be a part of an integrated acute and community trust, as in Salisbury.

●Form an individual trust, as in Andover and Teddington.
Setting health care priorities
Authors: David Ami
Published: May 2014

Any discussion of setting health care priorities – popularly referred to as ‘rationing’ – rouses emotions, with the implication that the public will be losing rights of access that they – and we as professionals – have come to expect. The process of setting priorities in the NHS is a creeping development we can no longer ignore.
Equality of opportunity for black and minority ethnic older people
Authors: Chevannes Mel
Published: May 2014

This paper seeks to clarify the uneven way in which the concept of equality of opportunity has been introduced to the current community care debate. Analysis of the concept indicates the transformation in services provided for black and minority ethnic older people, and indeed in their access to health services generally. It is argued that the emphasis on the entry of words such as ‘black’ and ‘minority ethnic’ into community care reports serves only to expose the lack of any fundamental shift in the dominant political and ideological framework of community care. An interactive equality of opportunity model is constructed to analyse three levels at which black and minority ethnic older people, nurses, health and social care professionals can enhance access to services, appropriate care, and satisfaction with the outcomes. This model also incorporates users’ views into the process of assessing needs for care and providing services.
Psychiatric patient violence: assessment and management of risk
Authors: Keirle Peter
Published: May 2014

The relationship between violent behaviour and mental illness is both complex and contentious. In recent years, public attention has focused on what may be considered tragic failures of care in the community.

Partly in response to subsequent enquiries, new government guidance and legislation have emerged which seek to reinforce the role of the mental health practitioner in assessing and managing the risk of psychiatric patient violence.

This paper describes the development of a risk assessment framework in relation to psychiatric patient violence. The framework focuses on the evaluation of past behaviour as a key element of risk assessment, and offers guidance on appropriate areas of enquiry. The central aim of assessment is to identify in what circumstances the risk of violence may be increased, and to plan care accordingly. This approach reflects an emphasis on the situational factors that may surround violent behaviour and in doing so, moves away from viewing risk assessment as a one-off decision that can somehow distinguish the safe from the dangerous.
Elder abuse: the role of risk management
Authors: Kingston Paul , Penhale Bridget
Published: May 2014

In recent years there has been an increased emphasis on violence across the life course, with a re-emerging focus on the abuse and neglect of older people. Risk taking, risk assessment and risk management are also emerging as necessary methods of managing health and welfare interventions. A critical analysis of both topics would facilitate an assessment of the contribution that effective risk management can provide within intervention strategies in situations of elder abuse and neglect.
The search for constancy in community health nursing
Authors: Sines David
Published: May 2014

During the past decade the future of community health care nursing has been established as the focus for the promotion of health gain for the population and its constituent neighbourhoods. Government investment in the design of a new infrastructure to support ‘care in the community’ initiatives has further strengthened the need for the community health care nursing and health visiting professions to review the standard and content of the education and practice base of community health care nursing. A further challenge has been the entry of pre and post-qualifying nurse education into the higher education sector with its demand for further rigour in quality control and academic compliance.
Health visitors' ideologies regarding health promotion for men
Authors: Williams Robert
Published: May 2014

‘Is there scope within health visiting practice for health promotion with men?’ This research question and the specific objectives employed to develop the project were pursued using a qualitative and descriptive methodology. Fieldwork with participant managers and health visitors, within a community NHS trust, was undertaken in December 1995 and January 1996.

Findings suggest that although a range of diverse perspectives is present, there are nevertheless dominant individual and organisational ideologies that encourage marginalization of men’s health. There are certainly ideas, experiences, and practices reported by participants within the project which identify work with men taking place, and also indicate potential for service development. However, to address health promotion with men within health visiting effectively, recommendations for individual and organisational change are produced and outlined.
Practical stoma care: a community approach
Authors: Black Patricia K
Published: May 2014

Successful rehabilitation of the stoma patient in the community depends on several factors: understanding the type of stoma constructed and whether it is temporary or permanent; understanding which type of appliance is the correct one to use; having a knowledge of alternative appliances if the original is found to be difficult to use or causing skin problems; and trouble shooting for the common problems sometimes seen after stoma surgery.

Obviously, a new stoma patient with no previous experience of a stoma or appliances will rely totally on the stoma care specialist or the community nurse. In many areas of the UK new stoma patients are often referred to the community nurse for follow up after hospital discharge, However, community nurses may easily come across ‘lost ostomists’ and need to give help and advice on problems or new appliances. Once a stoma patient is discharged from hospital, community nurses have a valuable role to play in the patient’s rehabilitation and return to a normal and productive life.
Menopause Information Service: facilitating health enhancement
Authors: Griffiths Mary L.
Published: May 2014

Significant numbers of women suffer unpleasant symptoms of the menopause. This article describes an information and support service run by health visitors and practice nurses in Wolverhampton, using a resource package developed by a pharmaceutical company. It describes the potential health gain for women and the use of various evaluative procedures which may influence health care planning and decision making.
Continence clinic: positive outcomes difficulties encountered
Authors: Nolan Caroline
Published: May 2014

This paper outlines the work of a community nursing development unit in relation to their role in health promotion and those patients suffering incontinence. The role of the nurse in health promotion has become fundamental in the new NHS in achieving the government health targets. It is well documented that incontinence is a huge problem that affects both men and women and unless a comprehensive package of care is made available many sufferers will go untreated. The underlying principles of many health promotion strategies involves changing behaviour, it is with this particular focus that district nurses at Yardley Green Nursing Development unit have attempted to understand why some patients’ progress with treatment better than others in terms of behaviour change. Patients attending a continence clinic demonstrated considerable improvement in their condition, however, the process of change is multifactoral and an increasingly complex problem providing a challenge for those involved.
Management of fungating wounds
Authors: Williams Clare
Published: May 2014

Patients suffering with fungating wounds present a major challenge to nursing care. The quality of care given to such patients may be the most important factor in determining the quality of life. Symptoms of these wounds can be psychological as well as physical. A holistic and multidisciplinary approach to treatment is of paramount importance. This paper outlines key factors in the management of fungating wounds, including dressing selection, control of exudate, bleeding and odour and the removal of slough and necrotic tissue.
Holistic district nursing: caring for the terminally ill
Authors: Griffiths Jane
Published: May 2014

Holistic care is the aspiration of the nursing profession yet in district nursing, it is becoming increasingly difficult to attain. Developments such as skill or grade mix and the employment of the social services carer, have carved up traditional district nursing into tasks that are allocated to a variety of nursing and related personnel, in a manner that is as cost-effective as possible. The traditional district nurse who was allowed the scope to attend to any patient need is an increasingly rare entity; some would argue rightly so. There is an exception to this, however, in the acute ‘holistic’ care of patients who are terminally ill. This paper discusses the changes to district nursing practice that have taken place in recent years and using supportive data from an ethnographic research study of district nursing work, explores why terminal care is so highly valued by the district nursing service.
An exciting year ahead
Authors: Carnell Jackie
Published: May 2014

The government's white paper on the future of the NHS, published last month, may have met with a sceptical reception from some doctors and healthcare academics. But for nurses, especially those working in the community, it offered the chance to develop their practice in ways not possible in the internal market.
Strategies for community oral health promotion
Authors: Munday Polly
Published: May 2014

This article presents a provider’s perspective of realistic strategies for community oral health promotion in an inner-city area of South-East London, reflecting on ethical issues which are often overlooked. Strategies discussed include the provision of training for those health professionals who are in a position to give oral health advice and information in their contact with people. Maintaining such alliances will also facilitate a common risk factor approach to the promotion of oral health taking regard of the ‘whole person’ rather than a ‘healthy mouth’. A strategy of prioritising oral health education to those children having high levels of disease is not straightforward and it is important to understand its limitations to address the social problems inherent in these environments. Finally, the public health measure of fluoridating water supplies, perhaps most effective strategy for oral health to reduce inequalities in oral health, is discussed. Community nurses are encouraged to include oral health within their general health promoting work in order to affect the social inequalities evident in the experience of dental disease.
Promoting oral health: nurses and pharmacists working together
Authors: Anderson Claire
Published: May 2014

Nurses and pharmacists can work together effectively in the community to promote oral health. It is important that uniform health promotion messages are given to the public. Joint training and working, along with local dentists and health promotion units, can encourage this process. Pharmacists are recognised for their accessibility and availability for health promotion and pharmacies are ideal sites for health promotion events. Areas for health promotion include diet, sugar in medicines, toothbrushing, fluoride and oral cancer. A plan for a joint health promotion event is proposed along with other models for joint working.
Was it joy all around?
Authors: While Alison
Published: May 2014

While the majority of our clients may have looked forward to and enjoyed the Christmas and New Year Bank Holidays, it is worth reflecting the extent to which the period is one of joy and pleasure for all citizens. The Christian festival, which began centuries ago to replace a pagan one, is barely recognisable with its commercial sponsors transforming shops shortly after the commencement of the new school year. Indeed, the confusion between commercialism and an established religious tradition should cause all community nurses to ponder. Firstly, there are other religious traditions within a multiethnic society which deserve equal acknowledgement – what about these important festivals? Do we remember them in our daily work? Secondly, the enforced break from normal everyday life presents a variety of challenges to individuals. Families often feel obliged to get together, not because they want to share but because it is expected of them – perhaps exposing the reality of family discord and the wisdom of minimal contact at other times of the year. And for those who have no family, through family breakdown, geographical or biological determinants, it may be a period of loneliness emphasising their deprivation of close family ties – the elderly, the mentally ill and other vulnerable groups including the runaway young person.
The harmful green paper
Authors: Halpern Stephen
Published: May 2014

One of the most important planks of this Government’s health policy was the commitment to invest in public health and particularly to redress inequalities in health. The message to get tough on illness and tough on the causes of illness was quite clear. Consequently, the publication of the consultation document, ‘Our Healthier Nation’ was eagerly awaited, In the event it has proved to be at the very least a disappointment and perhaps worse still, it might even do more harm than good.
Product focus: Axsain
Authors: Beckwith Sue
Published: May 2014

Capsaicin is a topically applied treatment for neuropathic pain. This article looks at its use in the treatment of painful diabetic neuropathy and postherpetic neuralgia. Capsaicin, brand name Axsain, is a naturally occurring alkaloid found in the fruits of species of the nightshade family (Solanancae) and is responsible for giving the chilli pepper its characteristic ‘heat’.
Community children's nursing
Authors: Whiting Mark
Published: May 2014

The House of Commons Health Committee (1997) recently expressed its concerns at the absence of a universally available community children’s nursing (CCN) service. The Committee stated that: ‘For many years there has been a community nursing service available to all adults in their own homes. We consider that, as a matter of principle, sick children need and deserve no less.’
Primary care groups
Authors: Botes Sue
Published: May 2014

Although we are told that the agenda for the White Paper The New NHS: Modern, Dependable (DoH, 1997) is to be over a 10-year period, the time given for the configuration of the primary care groups (PCGs) seems frighteningly short. Proposals are to be drawn up by August 1998 and will become operational from 1st April 1999. Guidance on the purpose and configuration of PCGs as well as the criteria for the assessment and approval process, and the migration from GP fundholding are outlined in the recent health service circulars (DoH, 1998a,b).
Nutritional assessment and screening: instrument selection
Authors: Green SM , McLaren SG
Published: May 2014

This article reviews a variety of nutrition assessment screening tools and protocols that have been developed for use in the community setting. The use of protocols and tools can help to identify patients/clients who may be malnourished or at risk of developing malnutrition. Such patients/clients can then be referred, as appropriate, to the dietitian or other members of the multidisciplinary team for a more detailed and comprehensive assessment. Before using screening tools in the practice setting acceptable standards for validity, reliability and other measures of accuracy should be met. Early identification of at-risk individuals combined with effective nutritional support may reduce hospital admissions and duration of stay, improve recovery from illness and attenuate morbidity and mortality associated with malnutrition.
Dietary problems in older people suffering from dementia
Authors: Forte Denise
Published: May 2014

Dietary intake involves a complex set of skills which build up over a lifetime and are influenced by the social and cultural milieu of each individual. In dementia, many of these life skills become lost as the illness progresses and what was once a natural activity for the sufferer now becomes an impossible task requiring the skilled assistance of another person. In recent years much of the research on nutrition has focused on the problems of malnourishment in older people; however, much less has been written on the special eating and nutrition problems which many older people with dementia face. The aim of this article is to review the eating and dietary problems associated with dementia. It identifies areas of good practice which optimize the older person’s ability to maintain an adequate dietary intake and participate in mealtimes with dignity and enjoyment.
Promoting public health
Authors: Sines David
Published: May 2014

Recent government reports have considered how best to elevate the profile and status of public health activities in the UK (Department of Health (DoH), 1997a, b, 1998; NHS Management Executive, 1998). A key aim of these documents was to consider the range of public health activities at local, regional and national levels with a view to ensuring that there is a robust public health function in support of the government's community care policy.
Clinical supervision: meeting the needs of practice nurses
Authors: Proctor Susan , Macey Sheeylar , Campbell John
Published: May 2014

Improving clinical quality and supporting professional development are key elements in current health policy and clinical governance. Clinical supervision has been proposed as a means to support such activity among nurses. Few studies have examined the views and expectations of nurses regarding clinical supervision. This article presents a qualitative study of the views and expectations of a sample of practice nurses in southeast London. Five key themes were identified: peer review; mentorship; informing and improving standards of care; professional development; and support and empowerment. The data from this study, in conjunction with Fowler’s (1996a) framework for clinical supervision, were used to inform the development of a supervisory system for practice nurses. Key considerations for implementing such a process are discussed.
The feasibility of nursing patients with sickle cell crisis at home
Authors: Smith-Wynter Lilieth , van den Akker Olga
Published: May 2014

The most common symptom of sickle cell disease is the vaso-occlusive crisis, which studies have shown is generally poorly managed. This study aimed to assess whether nursing intervention in crisis management could facilitate movement of the pain care environment from hospital to the home. Studies have highlighted that patients want this type of service provision, and 90% of cases currently try to remain within the home when in crisis (Elander and Midence, 1997), despite the poor support of primary care services. Thirty-six subjects were part of the experimental arm of this study. The results demonstrated that it was feasible to manage the majority of non-complicated crises within the home, but suggest that to do this would necessitate an increase in current primary care input into this patient group, especially of community and specialist haemoglobinopathy nurses.
Nurse practitioners: the need for recognition
Authors: Smithson Jane
Published: May 2014

The role of the nurse practitioner is a recent development within the UK and although it has been shown to be both safe and effective, it has yet to be recognized by the UKCC by being included as a recordable specialist nurse qualification. This could be important, if the specialist qualification is seen as a prerequisite to nurse prescribing, because the role of the nurse practitioner includes clinical diagnosis and treatment, with the inherent possibility of a need to prescribe medication. Nurse practitioners are developing an important role within primary care in providing patients with the choice of seeing a nurse or a doctor as the first point of contact. There are many challenges facing nurse practitioners today, such as developing new skills and coping with increased responsibilities but a major hurdle they face is that of recognition — not only by their peers and medical staff but also by the nursing establishment. Recognition of the role of nurse practitioners could result in clear and widely agreed national standards for nurse practitioner training, leading to a recordable specialist practice qualification including prescribing rights.
Management of childhood asthma: an overview
Authors: Weller Trisha
Published: May 2014

This article provides an overview of asthma in children. Wheezing illness is common in infants, however, not all will have asthma. Cough is a common symptom but evidence of airway lability should be present to confirm diagnosis. Diagnostic tests are not possible in children under 5 or 6 years of age and treatment relies on a clear clinical history and a trial of medication. Early treatment in children over the age of 3 years with inhaled steroids is advocated when symptoms are not controlled by bronchodilator treatment alone. The British Guidelines on Asthma Management (1997) provide a framework for a consistent approach to asthma management in both primary and secondary care. Caution should be exercised with high doses of inhaled steroids and all children should be monitored closely until growth is complete. It is also important to recognize the differing needs of teenagers as asthma management in this age group may raise specific issues for health professionals. Community nurses including school nurses and health visitors may with appropriate training increase and develop their involvement in the management of childhood asthma.
Local health care cooperatives
Authors: Cook Lis
Published: May 2014

In Scotland, 1999 may be remembered as the year of devolution. For those working in primary health care, it will be remembered as the year of evolution. Heralded by the White Paper, Designed to Care (Scottish Office Department of Health (SODoH), 1997), April marked the start of the move into locally-led health care. The rationalizing of trusts has been an exercise in expediency, whereas the launch of the local health care cooperative (LHCC) will see the evolution of locally-led health services.
Florence Nightingale’s legacy
Authors: While Alison
Published: May 2014

A distinction needs to be drawn between myth and reality if Florence Nightingale's contribution to nursing is to be understood. The reality of Nightingale's life is far from the image of the woman who glided through a hospital giving succour to dying soldiers. She was a radical who challenged the poor quality of women's lives as compared to those of male contemporaries. She stepped outside the boundaries of the accepted female gender role and the social expectations of her social class. She provides an example of someone who challenged the establishment pursuing a cause in which she fervently believed without seeking personal gain.
Gender issues in district nursing: a review of the literature
Authors: Canham Judith
Published: May 2014

A review of the contemporary literature that influences current district nurse practice reveals that district nursing is singled out as a (female) gender role. Within this gender role, district nurses are described as acquiescent, maintaining professional role relationships that resemble the traditional, patriarchal family unit. While this gender role is maintained, district nursing is of considerable use to health care by fulfiling women’s caring role. There is a surprising lack of discussion related to gender and gender issues, suggesting that a serious debate on gender and district nursing is long overdue.
Difficult decisions at the end of life
Authors: While Alison
Published: May 2014

People embark upon careers motivated by different experiences, philosophies and ambitions. Entry into the health professions results from a variety of motivations, among which is a desire to care for people when they are at their most vulnerable. Therefore, it is not surprising that clinical decision making relating to end-of-life care is fraught with angst and conflict which is in part due to a desire to achieve the best for patients.
Trusts ignore growing mental health needs
Authors: Ward Martin
Published: May 2014

In 1998, the Royal College of Psychiatrists launched a campaign, Changing Minds, to address the stigma associated with mental illness in different sectors of society. The paradox is that mental illnesses, and mental health problems in general, are rapidly increasing, outstripping the anti-stigmatists in the race to desensitize society to its darker side. For most health professionals, and primary care staff in particular, mental health issues constitute between 10 and 50% of their workload, being either subordinate to their own specialty or forming part of the patient’s primary condition.
Obesity: a challenge for community nurses
Authors: While Alison
Published: May 2014

The millennium is greeted with conflicts in different parts of the globe and evidence that while some populations are afflicted by diseases of affluence, others are threatened by malnutrition and preventable epidemics (Murray and Lopez, 1997). The shocking evidence from refugee camps and the developing countries is a constant reminder of just how much has been achieved in attaining current standards of health and wealth since the turn of the last century. However, comparison of UK mortality figures with those of other developed nations indicates that there is room for improvement (Acheson, 1998).
The NHS Plan: stifling the patient’s voice?
Authors: Burke Angeline
Published: May 2014

Chapter 10 of the NHS Plan outlines a ‘package of radical reform’ that it is claimed will ‘redesign the health service from the patient’s point of view’. While the government’s commitment to develop a ‘patient-centred’ NHS is to be welcomed, the proposed abolition of Community Health Councils (CHCs) — the patients’ statutory watchdog — has caused serious concern throughout the sector. Fears about the future of the NHS’s only patient-led watchdog have brought together an unlikely coalition of groups, including patient organizations, the General Medical Council, and the Law Society — each of whom has expressed serious concern about what the proposed abolition will mean for patients.
Managing people on sip feeds in the community
Authors: Barton Arlene , Kay Sarah , White Gillian
Published: May 2014

Community nurses often have the difficult task of identifying and coordinating the care of under-nourished patients in the community. Studies have shown that patients who are underweight are likely to visit to their general practitioner more often, need more medication and be admitted to hospital. Nutritional sip feeds have been shown to clinically benefit underweight patients suffering from chronic conditions as well as the older people. Adapting ordinary food to meet the patient’s nutritional requirements should be considered first, but sip feeds provide an additional source of nutrients when this proves insufficient. All patients on sip feeds should have a clear aim for this nutritional intervention (e.g. the healing of a pressure area) and be monitored regularly.
Managing chronic obstructive pulmonary disease in primary care
Authors: Mooney Danny
Published: May 2014

Chronic obstructive pulmonary disease (COPD) causes significant morbidity in primary care. The main symptoms of COPD are cough and shortness of breath, while the main cause of the disease is smoking. It is a treatable condition, and to ensure best treatment it needs to be differentiated from asthma. Following the publication of guidelines by the British Thoracic Society in 1997, primary care has been given a framework for managing this condition. In primary care, COPD is best managed in a specific COPD clinic. This allows for staff training (both management decisions and techniques of lung infection monitoring), as well as presenting the patient with a therapeutic environment conducive to positive lifestyle education. This article discusses the setting up and running of a COPD clinic in primary care.
Clinical teaching by community nurses in the Australian context
Authors: Jarvis Lynda Ann
Published: May 2014

A study was conducted to explore factors that impact on the clinical teaching role of community nurses involved in the education of pre-registration nursing students. Respondents were community nurses working in the Western Sydney Area Health Service in New South Wales, Australia. A self-report questionnaire was developed to collect data. Results indicate that community nurses are interested in clinical teaching, that it is an important part of their role and that they perceive themselves to be effective clinical teachers, with the majority indicating motivation to continue developing their clinical teaching skills. Aspects of clinical teaching important to community nurses included facilitating the transition of education from theory to practice, sharing expertise, knowledge and skills and maintaining high standards of nursing practice. There was little support for the view that community nurses experienced difficulty in managing the dual teaching and practice role. Approximately a third of participants reported that being with a student on a one-to-one basis could be stressful. Strategies to assist community nurses in their clinical teaching role were identified.
Age is not a barrier to individuality
Authors: Holt Ian
Published: May 2014

Just as each health professional is unique and different, with his/her own identity and individuality, so too is each individual for whom care is provided. This editorial challenges readers to debate the nature of difference especially in relation to older people and the process of ageing. The UKCC recently announced that it was placing increased value on the diversity of individuals as employees, professionals and members of society (UKCC, 1999). Nursing is often reported to embrace individualized care through adopting a holistic and patient-centered approach, yet one frequently encounters examples both in direct patient care and in underlying attitudes which regard all persons over 65 years of age as being the same or having similar needs to adults under 65 years.
Discharge planning for older people: a review of current research
Authors: Bull Margaret J
Published: May 2014

The NHS and Community Care Act 1990 emphasized the importance of discharge planning for elders and recognized the role of community health nurses in promoting continuity of care. Given the emphasis on discharge planning for vulnerable populations at policy level, it is timely for nurses to examine the research literature for evidence that may guide practice. This article reviews the key findings of research related specifically to discharge planning for older people and suggests areas in which additional research is needed.
Pharmacists perceptions of nurse prescribing of emergency contraception
Authors: Cooper Neil , Blackwell David , Taylor Gemma , Holden Keith
Published: May 2014

Proposed strategies to reduce the rate of unplanned pregnancy in the UK include widening access to hormonal emergency contraception (HEC) through nurse prescribing and over-the-counter sales by pharmacists. This article reports on the perceptions of pharmacists regarding the appropriateness of nurse prescribing of HEC drawn from a survey of pharmacists’ attitudes towards HEC deregulation. A 10% sample (n=3999) of all members of the Royal Pharmaceutical Society of Great Britain was surveyed and a response rate of 38.6% (1543 respondents) achieved. Pharmacists were asked whether or not nurses should prescribe HEC and in what capacity. In respect of the statement that: ‘Nurses should not be allowed to prescribe postcoital contraception’, 42% of respondents agreed while 31.6% disagreed. This indicates that pharmacists do not have a consensus view regarding nurse prescribing of HEC. Arrangements for pharmacists prescribing under protocol received the support of 60.2% of respondents, whereas 41% expressed support for nurse prescribing under protocol. There was also relatively little support for ‘specifically trained’ nurses prescribing HEC. The findings are considered in relation to the development of a coherent and accessible provision of HEC and the wider implications for interprofessional relationships concerning prescribing.
New guidelines for good practice in continence
Authors: Kirk Gill
Published: May 2014

It is estimated that in excess of 3 million people in the UK have continence problems at any one time (Thomas et al, 1980). This equates to up to 10000 individuals in some primary care group (PCG) areas. To look at the problem from another perspective, as many as 1 in 7 women aged between 45 and 67 years living at home may have problems with continence (Department of Health (DoH), 2000a). It is not surprising, then, that a recent estimate has put the NHS continence care bill at over £400 million (DoH, 2000b).
Validity of the Walsall Community Pressure Sore Risk Calculator
Authors: Chaloner Donna M , Franks Peter J
Published: May 2014

The Walsall Community Risk Score Calculator has been in use for the past 8 years. Outcomes from a trust-wide prevalence audit identified that this assessment tool may benefit from re-evaluation. This study examined the tool’s validity and reliability and has resulted in some changes being made to the original score. To assess validity, a cross-sectional study of 720 patients was undertaken looking at the incidence of pressure damage, despite intervention, over a 12-week period. Using logistic regression analysis new weightings for each category were developed. This also led to the removal of one factor (bodily pain) which did not appear to contribute to increased risk of pressure damage. The updated score shows an improved prediction of pressure sore development compared with the existing method.
Maintaining trust in therapeutic relationships
Authors: Clarke Gwen
Published: May 2014

Recently there has been much media coverage of cases such as those of James Elwood, a pathologist, and the gynaecologist Rodney Ledward, which have caused terrible suffering. It is right that such cases are adequately and accurately reported and that the public is informed. People have a right to be protected from malpractice and incompetent professionals. The fact that such cases are now being exposed may not be indicative of worsening standards of care but may signify that clinical governance is beginning to take effect.
The use of medication compliance devices by district nursing services
Authors: McGraw Caroline , Drennan Vari
Published: May 2014

This article presents a critical review of the literature relating to medication compliance devices and the findings of a survey which examined the use of such devices by district nursing services. The UKCC (1992) does not regard the loading of compliance devices by nurses as safe practice; however, compliance devices continue to be used by district nurses. The evidence base concerning the value and use of medication compliance devices is examined and significant gaps in the literature relating to the use of such devices are identified. There is an absence of studies that focus on the effect of compliance devices on adherence among older patients and the nature and frequency of drug administration errors involving these devices. The survey findings show that nurse-loaded compliance devices are used in over one-third of the sample. Further research is necessary to assess the clinical effectiveness of, and clinical risk attached to, compliance devices for older patients in the community. It is suggested that this is an issue of serious concern for primary care groups considering the principles of clinical governance.
The challenge of The NHS Plan: impossible mission?
Authors: While Alison
Published: May 2014

The ambitions of the Government to transform the National Health Service (NHS) are laudable, but are they realistic? The new NHS is to be founded on increased access to primary care and consultant-delivered specialist services which will comprise 7000 extra beds, staffed by 20000 extra nurses and 6500 extra therapists (Department of Health (DoH), 2000a).
Community nurses’ contribution to oral health
Authors: Gallagher Jenny , Rowe Jean
Published: May 2014

Oral health is an important component of general health and wellbeing. Although oral health has improved dramatically in children and young adults, oral diseases remain common, particularly among disadvantaged and vulnerable groups. Many patients seen by community nurses will fall into these categories and are less likely to have sought treatment. This article presents the epidemiology of oral diseases and conditions for specific groups in society that community nurses will be caring for. It looks at prescribing principles and describes treatment and advice for common oral conditions, including those where prescription may be appropriate. Community nurses play an important role in the oral health care of society, particularly among those least likely to access dental services.
An evaluation of a clinical supervision programme
Authors: Willson Leanna , Fawcett Tonks N , Whyte Dorothy A
Published: May 2014

In response to needs identified by community nurses in remote and isolated areas in North Argyll, Scotland, a programme of clinical supervision was implemented. The term ‘practice support’ was chosen by the community nurses for this project. The purpose was to provide peer support to counteract geographical isolation and to facilitate professional development through the use of reflective practice. Practice support was carried out over a period of 9 months. Pre-implementation and post-implementation questionnaires were used to evaluate the project.
Diagnosis and management of fungal infections of the skin
Authors: Lansdell-Smith Judy
Published: May 2014

Fungal infections of the skin are very common in the general population, and will be among the conditions most frequently encountered by nurses in primary care. In this article the types of fungal infections that the nurse will meet are described and the signs and symptoms outlined. The diagnosis of each fungal infection will be discussed as well as the treatment that is available to the nurse in these instances. The importance of preventing re-infection and transmission of the fungi is highlighted, and ways of prevention are also discussed.
Is a blueprint for care of older poeple be enough?
Authors: While Alison
Published: May 2014

It is proper that at last the care of older people who represent about a fifth of the population has received the recognition which it deserves through the release of a National Service Framework (Dept of Health, 2001). Older people, like others, want to enjoy good health and have access to high quality services to support them in times of need. It is perhaps remarkable that the issue of equity has for so long been overlooked with discriminatory practices being tolerated within publicly funded provision.
Health visiting under fire. Or is it?
Authors: Pollard Tom
Published: May 2014

Primary care nursing is – like the health service as a whole – in a state of flux. As the focus of health care shifts more and more towards the primary sector, changes are being enacted that will eventually lead to the dissolution of traditional professional boundaries. This is intended to encourage the development of fully integrated primary care teams, and more responsive care for all.
Restoring pleasure: nutritional management of dysphagia
Authors: Kemp Sarah
Published: May 2014

Dysphagia is associated with many different conditions and although widespread it is frequently not recognised. People with dysphagia are at risk of developing serious complications such as malnutrition, dehydration and aspiration. Texture modification, food fortification and dietary supplements are important elements in effective nutritional management of dysphagia and can also help bring back some of the pleasure to mealtimes. The ideal approach to the management of dysphagia involves a multidisciplinary team.
The patient’s view: the benefits and limitations of nurse prescribing
Authors: Brooks N , Otway C , Rashid C , Kilty E , Maggs C
Published: May 2014

This study was undertaken in a primary care group to explore nurse prescribing from the patient/client’s viewpoint. All prescribing health visitors, district nurses and practice nurses were asked to recruit five patients for whom they had prescribed; 50 patients/clients participated in the study. Identified benefits of nurse prescribing included a more effective use of the nurse’s and doctor’s time; a quality relationship between the nurse and patient; nurses’ awareness of their own professional limitations; their expertise in certain types of care; and their providing timely, convenient, practical and successful treatment. Limitations and the proposed options for change included the training and competency of nurse prescribers and the limitations of the Nurse Prescribers’ Formulary. On a local level the study informs nurse prescribers that they are currently meeting the needs of the majority of recipients, and provides evidence of some of the benefits and limitations of nurse prescribing.