bluuebunny/crossref_metadata_2025 huggingface dataset:
Current perspectives in adult congenital heart disease
Authors: Faganello G , Stuart AG
Published: May 2014

The last four decades have witnessed a revolution in the management of patients with congenital heart disease. Life expectancy and quality of life have improved and in the UK there are now more adults than children with congenital heart disease. The demands placed on the medical care system by this new patient group have led to the development of a new sub-specialty within cardiology (the ‘adult congenital heart disease team’). However, it is still common to come across patients with congenital heart disease in non-cardiac care units. In this we outline the healthcare requirements of these patients, who represent a new clinical and managerial challenge for the NHS.
Reading and critiquing randomized controlled trials
Authors: Goodman Margaret , Gilchrist Mollie
Published: May 2014

Margaret Goodman and Mollie Gilchrist outline key features of randomized controlled trials and points to bear in mind when reading published studies adopting this methodology
The impact of a nurse-led rapid-access atrial fibrillation clinic
Authors: Holding Shona , Tyndall Keith , Russell Craig , Cowan Campbell
Published: May 2014

Atrial fibrillation (AF) is a common cardiac arrhythmia and is growing in prevalence. It is associated with significant mortality, morbidity and reduced quality of life. Furthermore it is an important risk factor for stroke. However access to treatment can often involve long waits and stroke prevention strategies can remain suboptimal. This article describes how a focused, nurse-led AF clinic can improve access to appropriate investigation, therapy and information for patients, and draws on the findings of the first 17 months.
Drugs used in conscious sedation
Authors: Denman Tim
Published: May 2014

Conscious sedation is risky business but by closely adhering to national and international standards the risk to patients can be minimized. Many people may be unaware these guidelines exist and implementing them can be challenging. In the first part of this article some common questions about conscious sedation are answered. A key theme in all guidelines is the education and training of all staff involved in sedation. Using readily accessible resources the author endeavours to show that gaining in-depth and up-to-date information about high-risk medicines is within everyone’s grasp. You may find you have questions of your own after reading this article and a tasklist is provided to help direct further learning
The first 13 months of nurseled ward rounds for patients post PCI in a tertiary centre
Authors: Pottle Alison
Published: May 2014

In the past couple of decades nursing has undergone significant change. This has partly been driven by changes in medical practice such as the European Working Time Directive and also the desire of nurses to extend and expand their skills and scope of practice. Nurses are now frequently carrying out roles which were previously felt to be in the domain of medical staff. The cardiac field has seen a rapid expansion in specialist nursing posts and therefore the development of a variety of exciting changes in the way nurses contribute to patient care.

This article describes the establishment of a nurse-led ward round for patients following percutaneous coronary intervention and discuss the use of non-medical prescribing in this setting. It also shows how collaborative working with other members of the multidisciplinary team can be used to benefit both patients and the organization.
ECG of the month
Authors: Regan Claire
Published: May 2014

Clare Regan presents an ECG for you to analyse. The answer is given on page 563
Reducing length of stay through the use of ambulatory chest drains and nurse-led follow-up
Authors: Myatt Rebecca
Published: May 2014

This paper explores the use of ambulatory chest drains to promote earlier discharge. The insertion of an underwater seal chest drain is routine following thoracic surgical intervention to facilitate post operative lung expansion. This generally takes between 3-5 days. Once the lung has expanded, the drain is removed and the patient discharged. In a minority of patients, namely those with a persistent air leak, recurrent malignant pleural effusion or empyema, lung expansion is slow and consequently discharge is delayed. Many of these patients are able to tolerate an ambulatory device such as the Portex bag or PleurX catheter. A clinic was developed to enable followup on a regular basis by a specialist nurse. Outpatient visits, regular telephone support and input from community nursing teams allowed management of this patient group. Audit of the clinic revealed a reduction in length of hospital stay (to 7.3 days) for patients with prolonged air leaks following surgery
The future of ventricular assist device therapy in the UK
Authors: Hards Rachel , Bowles Christopher
Published: May 2014

Rachel Hards and Christopher Bowles consider recent developments and the potential future role for this form of mechanical support
Hounds Help Hearts
Authors: Evans Lynda
Published: May 2014

Lynda Evans discusses the rationale behind the new joint initiative from Harefield Hospital's cardiac rehabilitation service and the charity, Dogs Trust
Clinical assessment of a patient with stable heart failure
Authors: Thackwray Jane , Walton Anita
Published: May 2014

Heart failure is a complex condition with numerous symptoms and signs, both specific and nonspecific. Consequently, obtaining a comprehensive patient history is of great importance. Thorough assessment of past medical and cardiac history, comorbid conditions, signs and symptoms are essential forthe planning and implementation of effective care. This article describes a practical approach to conducting such an assessment and uses a case study as an example of this. Social and psychological factors may not impact greatly at the beginning of the disease trajectory, but are relevant for patients who wish to consider future coping strategies. Health education enhances patient understanding and concordance with the management plan and is paramount to patient empowerment and effective care. A management plan for the patient discussed in the case study is suggested.
Promoting health behaviour change in the cardiac patient
Authors: Tierney Paul , Hughes Colin , Hamilton Stephen
Published: May 2014

The importance of giving patients advice in relation to positive health behaviour change geared towards maximizing physical health must not be overlooked and is an important role of the cardiac nurse in contemporary health care. However, over-reliance on offering advice can often be counter-productive and less likely to achieve effective change. Patients are more likely to make positive health behaviour changes when they self-generate their own solutions to the health issues and problems that they face. In this article, the authors encourage cardiac nurses to embrace a less directive and more facilitative approach to patient health behaviour change in light of the mounting evidence that exists to the effectiveness of motivational interviewing techniques.
Spotting and treating a stroke
Authors: Kukanesen Jeeva , Patel Mehool
Published: May 2014

Stroke management in the UK has only moved to the forefront of medicine in the recent past. Stroke is the third most common cause of death after heart disease and cancer and has an estimated total cost to the economy of approximately £9 billion per year. Almost 20% of ischaemic strokes are cardioembolic in origin and potentially treatable. With the publication of the National Stroke Strategy in 2007 and the establishment of hyper acute stroke units, the NHS hopes to deliver a world class service for the treatment of strokes.
Schizophrenia: A major risk factor for cardiovascular disease
Authors: Ohlsen Ruth , Gaughran Fiona
Published: May 2014

People with schizophrenia, bipolar disorder and other severe mental illnesses (SMIs) die earlier than mentally healthy people, largely because of the range of physical health problems they experience. This article reviews the factors behind the increased risk of cardiovascular disease in people with SMIs. These include lifestyle factors compounding a pre-existing vulnerability to metabolic disorders and also side-effects of antipsychotic drugs used in treatment of their condition.

Examples from the literature of physical and behavioural strategies that have been trialled to prevent or manage this problem are discussed.
Wolff-Parkinson-White syndrome, pre-excited AF and Ebstein’s anomaly: A case study
Authors: Eftekhari Helen , Osman Faizel
Published: May 2014

This article reviews the definition and treatment of Wolf-Parkinson White Syndrome (WPWS), the risk of pre-excited atrial fibrillation (AF) in WPWS, the importance of recognizing pre-excited AF in WPWS and emergency treatment. It discusses the importance of cardiac imagining in WPWS to assess cardiac structure, as mild Ebstein’s anomaly, a rare congenital abnormality, can first present with arrhythmias and is a major risk for sudden cardiac death.

This article addresses these issues in the context of a case study.
Developing a heart failure unit and ambulatory care pathway
Authors: Crouchley Jane
Published: May 2014

Heart failure affects as many as 875 000 in the UK and is responsible for 1 million inpatient bed-days per year. These admissions are expected to rise due to the aging population and to survival rates following myocardial infarction.

There is well-documented evidence that there is a lack of resources and coordinated health care services in chronic heart failure and available therapeutic strategies are underutilized. Barriers to optimal treatments are numerous, stemming from patients, physicians and health-care systems, and result in considerable human and financial consequences. One remedy for this is to streamline the patient pathway and to consider allocation of hospital space, so that more facilities are dedicated to the proper care of chronic heart failure patients where adequate therapies and interventions can be administered along with adequate discharge planning to reduce length of stay and reduce hospital readmission.

This article discusses the process of developing a new pathway for heart failure patients in a tertiary care centre.
Circulatory shock part 1: Overview, causes, and types
Authors: Jones Ian , Rushton Melanie
Published: May 2014

This article, the first in a series of two, provides an introduction to the subject of circulatory shock. It discusses the definition of shock, its pathophysiology and incidence, and discusses its different causes. The second part of the series will provides the reader with an overview of the acute nursing management of patients presenting with the different forms of circulatory shock.
Nurse prescribing for the management of hypertension
Authors: Beverley Bostock-Cox
Published: May 2014

This article focuses on the importance of making a correct diagnosis of hypertension in line with National Institute for Health and Care Excellence guidance. The evidence-based approach to managing hypertension is discussed with reference to pharmacological treatments and lifestyle interventions.

It is important that nurses know how to correctly measure blood pressure, particularly as ambulatory and home blood pressure monitoring should provide the basis for the diagnosis and decisions relating to patient management of hypertension. The different types of hypertension (stage 1, stage 2, severe and white coat hypertension) are described. The evidence-based approach to managing hypertension is then discussed with reference to pharmacological treatments and lifestyle interventions. This discussion is accompanied by the ACD algorithm highlighting the first four steps in hypertension treatment.
The management of valvular heart disease
Authors: Linden Belinda
Published: May 2014

elinda Linden discusses how nurses can help patients adapt to living with this condition, and offers an overview of its clinical management.
Thrombolysis and pulmonary embolism
Authors: Rowbury Gemma
Published: May 2014

Acute pulmonary embolism is a condition that is associated with serious morbidity and mortality. Thrombolysis is a therapeutic option advocated by national guidelines for patients with haemodynamic compromise. However, this treatment is the subject of debate and there are a number of well-recognised complications associated with its use. This review aims to discuss the evidence surrounding this topic and the implications of thrombolytic therapy in nursing care.
The role of the cardiovascular public health nurse in Ireland
Authors: Hartigan Irene , O’Connor Imelda , Keane Triona
Published: May 2014

Cardiac rehabilitation services are vital to patients and their carers, particularly in easing the transition from the hospital to the home. Cardiac nurses have specialised knowledge and fulfil a range of functions in cardiac rehabilitation. The role of cardiac nurses in the community in Ireland is known as the cardiovascular public health nurse and has a multi-faceted role which requires a broad range of knowledge, expertise and skills. This article introduces the role of the cardiovascular public health nurse in Ireland, and gives an account of patients’ experiences. This small study showed that cardiovascular public health nurses are well regarded by patients and are a valuable contribution to cardiac rehabilitation services.
Cardiac rehabilitation: an individualised programme
Authors: Elliott Mark
Published: May 2014

Patients who are invited to attend cardiac rehabilitation following an acute cardiac event or intervention can be anywhere on the awareness spectrum, from complete denial that they have a potentially life-threatening condition to being disabled by fear of the consequences of their heart disease. The role of cardiac rehabilitation is to unpack misconceptions and fears, thus facilitating the patients’ recovery through empowerment, education and support with changing health behaviours. Cardiac disease is a long-term condition and in order to bring about sustained health improvements, cardiac rehabilitation programmes need to engage, inform and empower cardiac patients so they are more likely to achieve their goals.
NICE Public Health Guidance: Individual approaches to behaviour change
Authors: Linden Belinda
Published: May 2014

Belinda Linden discusses the National Institute for Health and Care Excellence Public Health Guidance (PH49) on Behaviour Changes, issued in January 2014
Cultural influences on healthy lifestyle behaviours
Authors: Milligan Fiona
Published: May 2014

Fiona Milligan discusses how barriers to healthy eating and exercise are being tackled in Qatar with consideration for cultural and belief system influences
Supporting the development of research skills by community nurses and midwives
Authors: Bryar Rosamund
Published: May 2014

Between 1990-1993 Teamcare Valleys (TCV), a multi-disciplinary primary health care development unit, undertook a wide range of activities aimed at facilitating the application of research to practice. One of the purposes was to meet the need to develop a critical mass of nurses and midwives in the community who have research skills. In particular the project utilised the post of clinical fellow as a means of developing such skills. A multi-disciplinary group of clinical fellows was appointed, but this paper concentrates on the nurses who were appointed as long or short term clinical fellows. These practitioners developed skills in all stages of the research process, through undertaking projects and participating in other TCV activities. TCV provided the research advice, supervision and support vital for the development of these skills.

Such posts, in particular short term appointments for practitioners, have the potential to develop a group of research-aware nurses and to influence practice in the wider primary health care team.
Primary care led NHS
Authors: Dickson Niall
Published: May 2014

Am I alone in wondering whether the primary care led NHS is all it is cracked up to be? There are times when, like the mother at Sandhurst who saw the rest of the platoon marching out of step with her son, it is reasonable to assume that others might be right.
Intuition and health visiting practice
Authors: Goding Lois
Published: May 2014

Intuition is an important dimension of integrated theory and practice, but may not necessarily be addressed in the community nurse curriculum. Rich sources of information may be ignored by educators, leaving this critical dimension of practice unexplored. The intuitive aspect of community nursing, including speed of thought, perceptual ability and responsiveness, leads to improved quality of care and cost effectiveness by influencing the process of needs assessment and, consequently, the client's feeling of well-being and satisfaction. A humanistic, constructivist approach to community nurse education emphasising the intuitive and aesthetic qualities of performance, would overcome the behaviouristic, mechanistic approach apparent since the 1950s. Intuition may be defined in many ways, but there is some agreement that it is rooted in the subconscious, and is associated with perceptual ability and responsiveness (Langer 1953, Polanyi 1967, Benner 1987). This paper will discuss the meaning of intuition in relation to integrated theory and practice in the art of health visiting practice. Consideration of the relevance to intuitive practice of aesthetics will be followed by implications for community nurse education and assessment. This will then be discussed in the light of social and political pressures.
Men and sexuality in stoma care
Authors: Bond Carolyn F
Published: May 2014

Sexuality is a key component of life, and surgery that leads to an altered body image can have a major effect on the individuals sexuality. It is often assumed that heterosexual men can cope with this issue unless they openly ask for help, but there is evidence that in society today many of them are unable to raise the subject. This paper reviews some of these factors that affect communication, and discusses the role of the nurse in this key area.
Sexual health information in primary care
Authors: Lempp Heidi , Rink Elizabeth , Harris Tess
Published: May 2014

A postal survey was conducted in 1996 in the London Borough of Wandsworth. It included: all GPs in the Borough (154); all practice nurses (95); and a random sample of 300 young people (aged between 18-20 years). The aim of the study was to explore the views of GPs, practice nurses and young people on sexual health information in primary care. Responses were received from 89(58%) GPs, 69(73%) practice nurses and 96(32%) young people. These three groups agreed that a sexual health service should be provided for young people and also that this service could be appropriately provided in a general practice setting with GPs and practice nurses acting as the source of information. Young people have concerns regarding confidentiality; they also find it difficult to broach these issues and would like to receive more specific sexual health and physiological information from primary health care staff. Fifty-one per cent of practice nurses and 30% of GPs felt that they did not have enough training to deal with sexual health matters. The findings of this study indicate that current provision of information and sexual health services in primary care does not meet the needs of young people.
An overview of compression bandages and hosiery
Authors: Moody Marion
Published: May 2014

It is widely accepted that correctly fitting compression bandages and hosiery are an essential component of the effective management of lower limb disorders of the venous and lymphatic systems. This article examines pathophysiological factors affecting the vascular status of the lower limb and the role of graduate compression therapy. The current cost of treating lower limb disorders is in the region of £300–400 million per annum (Laing, 1992). Evidence presented in this article will clearly demonstrate the need for a complete range of bandages, hosiery and accessories to be made available on the Drug Tariff to aid patient compliance. The importance of adequate patient and practitioner education, training and support in the provision of clinically cost-effective management is also emphasized.
Communication between school nurses and primary care teams
Authors: Baptiste Lucretia , Drennan Vari
Published: May 2014

Recent policy changes have reinforced closer working relationships between health visitors and district nurses and general practice. However, school nurses have in the main been excluded from this movement. This article describes a small study undertaken to investigate perceptions of the relationship between school nurses and other healthcare professionals in primary care. A questionnaire was used to gather data from health visitors, district nurses, practice nurses and GPs (n=57). The study also included a focus group of school nurses (n=6). Inductive content analysis revealed a number of key themes. While an understanding of the role of the school nurse existed across all groups, health visitors were the only group to describe communication processes which involved collaboration in health care. GPs described communication with school nurses as being almost non-existent, indicating that the work of school nurses remains hidden from them. GPs made positive suggestions regarding how to improve working relationships but felt that it was the responsibility of school nurses to make the necessary changes.
The menopause and hormone replacement therapy: an overview
Authors: Abernethy Kathy , Jones Helen
Published: May 2014

The menopause is a time of change for many women. This article examines the effects of the menopause as well as the benefits and risks of hormone replacement therapy (HRT). The benefits of HRT are many and varied, but there are also associated risks and side-effects. It may be difficult for women to make a decision to use HRT and therefore they should be given the opportunity to discuss the risks and benefits with an appropriate health professional. Nurses, by becoming better informed, may empower women to ask relevant questions and make informed choices about the various strategies available for promoting health following the menopause.
Euthanasia: the debate continues
Authors: Mangan Paul
Published: May 2014

Many people have been eagerly awaiting publication of the British Medical Association’s (BMA’s) guidelines for doctors on the withdrawl of treatment. The debate seemed to have reached a pivotal point over the past few months with the sentencing in the US of Dr Jack Kevorkian to between 10 and 25 years in jail and the removal of a Preston GP from the medical register in this country.
Setting up a nurse-led clinic for intractable childhood constipation
Authors: Muir Julia , Burnett Clare
Published: May 2014

Childhood constipation is a common problem yet clinical management is often inappropriate and ineffective. The development of a nurse-led clinic, which is able to provide consistent advice, support and education, is ideally placed to overcome some of the challenges. This article outlines some of the essential issues that need to be considered when setting up such a service. It also identifies potential benefits to the nursing profession and the consumer.
Making a difference: the new strategy
Authors: Bagnall Pippa
Published: May 2014

The Government’s new strategy for nursing in England Making a Difference: Strengthening the Nursing, Midwifery and Health Visiting Contribution to Health and Healthcare (Department of Health (DoH), 1999) was launched recently and forms part of this Government’s proposals to modernize the health service. Not only does this clearly written document explain how policies affecting health and social care fit together but it also reinforces the crucial and critical role that nurses, midwives and health visitors will have in this visionary plan. It signifies the dawning of a new culture where practice developments will be positively reinforced as the pathway to better health and a better health service.
Termination of pregnancy: a difficult decision-making process
Authors: Dyson Liz , While Alison
Published: May 2014

This article considers the issue of termination of pregnancy from the perspective of the woman and the professionals involved. Current information regarding termination of pregnancy and some of the reasons for unwanted pregnancy on a nationwide scale are reviewed. The literature (mainly two British studies) on nurses’ attitudes to abortion is examined and some of the psychological and spiritual issues involved in termination of pregnancy are explored. Suggestions are made regarding how professionals can help women to make informed choices concerning their unplanned pregnancy. Ideas on how health professionals can help a woman to explore the issues imaginatively and non-judgmentally, whatever their beliefs, are outlined.
The management of schizophrenia: cognitive behavioural therapy
Authors: Siddle Ronald , Kingdon David
Published: May 2014

Over the past decade advances in the management of schizophrenia in the community have involved increasing emphasis on the psychosocial dynamics of care, coordinated through a care programme approach, and the introduction of new medication. In particular, the use of cognitive behavioural therapy (CBT) has been shown to be an effective means of tackling symptoms associated with schizophrenia (Jones et al, 1998). While some of the techniques used in CBT may be too advanced for untrained therapists to use, the approach described in this article may be used by registered mental health nurses and community professionals. This approach includes medication adherence, coping strategies, questioning style, the prevention of patient relapse and dealing with relatives.
The child patient and consent to treatment: legal overview
Authors: Rodgers Margaret E
Published: May 2014

The giving of consent by the patient before medical treatment is a central tenet of medical law. Although it may be fairly clear when an adult patient has given consent, the situation can be less clear, and more complex, when a child patient is involved. This article seeks to explore the legal issues and concepts that arise when treating a minor, and to show how the courts and legal process may become involved.
Informed choice in cancer pain: empowering the patient
Authors: Cartmell Reena , Coles Anne
Published: May 2014

Cancer and palliative care service users can often feel isolated and disempowered (Tower, 1999). Physical changes, medical interventions and pain can mean that they no longer feel in control of their bodies or their futures. In recognition of this, many health professionals within cancer and palliative care have adopted the mantra of ‘patient empowerment’, but it is not always clear what it means for either the patients or the professionals. Empowerment is an interactive process that develops and increases power through cooperation, sharing and working together (Marquis and Huston, 2000), and it plays a central role in health professionals’ personal and working lives. A person’s ability to make decisions and choices demonstrates control of his or her own destiny. This article aims to direct health professionals’ participation and involvement in restoring this ability to patients who have pain related to cancer.
Evaluation of an electric bed frame and pressure-reducing mattresses
Authors: Gray D , Whelan S , Russell G , Balura N
Published: May 2014

Pressure ulcers remain a challenge to all healthcare professionals. With the trend towards caring for ill patients in the community there is a need to ensure that equipment used to prevent pressure ulcers in these patients is effective. It is not always appropriate to simply use equipment designed for hospital. This article describes the evaluation of an electric bed frame and three mattresses specifically designed for patients in the community, in either their own homes or nursing home/residential care. The location of this research can reduce the number of participants recruited. In order to compensate for this, three different methods of evaluation were employed — clinical, laboratory and anecdotal — which have produced results relevant to both purchasers and users of the system tested.
A community nurse-led project to tackle health inequalities
Authors: Forbes Angus
Published: May 2014

The Government has emphasized the importance of reducing inequalities in health and health care by giving those working with deprived communities the opportunity to develop new initiatives to address inequalities. Community nurses, although laying claim to the wider public and community health agenda, have yet to clarify the nature of their contribution in reducing inequalities and demonstrate it in practice. This article reports on an evaluation of a community-based nursing initiative in a deprived inner-city community. The findings suggest that community nurses can play an important role in supporting people to access health care more effectively. In addition, by contextualizing health messages and initiatives to reflect the local culture, community nurses can make it easier for people to participate in health-enhancing activities. It is also suggested that some of the theoretical models developed to guide practice in addressing community health issues like inequalities need to be more rigorously tested and evaluated in practice.
Male catheterization and the extended role of the female nurse
Authors: Shallcross Pauline
Published: May 2014

Although the incidence of long-term catheterization has declined in recent years, catheterized patients still require care to be provided by competent practitioners, regardless of their gender. Custom and tradition decreed that male catheterization was carried out by male nurses and doctors. Myth, misunderstanding and misbelief can perpetuate the notion that it is inappropriate for a female nurse to catheterize a male patient. However, the advent of the autonomous practitioner and a move from extended to an expanded role provides an opportunity for improved care of the catheterized male patient, particularly in the community where female practitioners greatly outnumber their male counterparts.
Discussing emotional health in pregnancy: the Edinburgh Postnatal Depression Scale
Authors: Clark Geraldine
Published: May 2014

Antenatal depression is an important and neglected aspect of pregnancy and despite its prevalence there is little mention of it in the literature. However, early detection and management may prevent the development of postnatal depression (Henshaw, 1994). This article reports on the administration of the Edinburgh Postnatal Depression Scale (EPDS) in women during the antenatal period in one community practice. This tool was designed to detect postnatal depression and was used by health visitors (n=4) in the third trimester of pregnancy to identify clients (n=15) in need of emotional/social support. Clients and health visitors were then interviewed and their comments recorded and transcribed verbatim. The findings suggest that the EPDS aided the recognition of low mood/antenatal depression. By using the EPDS antenatally and focusing on the needs of the mother, low emotional wellbeing was identified. Use of the EPDS provided both clients and health visitors with an opportunity to discuss emotional health regardless of their antenatal EPDS score.
Evidence-based nursing and community practice
Authors: Tyler Patricia
Published: May 2014

The initial problem encountered on considering evidence-based practice (EBP) is the proliferation of terms in use (Griffiths, 1999). Consequently, there is a danger that some practitioners may despair when faced with such a multiplicity of ‘buzz-words’ and on finding that there is little consensus among experts on the way forward (DiCenso and Cullum, 1998).
Management of bladder problems in patients with multiple sclerosis
Authors: Unsworth John , Freeman Lynn
Published: May 2014

Bladder problems are a common feature in patients with multiple sclerosis (MS). Many patients experience distressing symptoms such as frequency, urgency and incontinence, unaware of the range of treatments which are available to either overcome or manage their bladder problems. While patients with MS may experience many types of bladder dysfunction, certain types of problem are more common in this patient group. These problems can be grouped under the headings of storage, emptying or combined dysfunction. Community nurses are well-placed to offer methods of containment by providing first-line treatment as well as identifying which patients need to be referred to other members of the multidisciplinary team.
The changing perspective of caring
Authors: Pateman Brian
Published: May 2014

In this time of rapid change in health care there is one constant that we can be sure of and that is change itself. How do community nurses deal with these rapid policy shifts? There is a temptation for nurses to keep their heads down, and do the work; policy perspectives shift, but patient needs are more constant. Adopting a ‘wait and see if I have to do something’ approach is perhaps not only logical, but may be the only option open to some nurses. As Antrobus and Kitson (1999) point out, the majority of nurses are involved in delivering care, which in management theory is analogous to the situation of the shop floor worker in that ‘the factory does not need input from the shop floor worker at the level of strategy. Rather the shop floor worker is informed of strategic decisions related to factory business and is managed accordingly.’ The authors make the important point that only if nursing’s unique contribution to the public’s health is recognized will nursing have an input into policy.
Free nursing care for all - a half-hearted gesture
Authors: Pollard Tom
Published: May 2014

Since 1st October, changes have been implemented in who pays for nursing care for residents in long-term care in England. The move has been cautiously welcomed by charities working with older residents as a step in the right direction, but many still have reservations about the new system. Chief among them is that the new funding arrangements fall well short of the recommendations of Royal Commission on Long Term Care (RCLTC).
Bereavement visiting: older people’s and nurses’ experiences
Authors: Lyttle C Paul
Published: May 2014

A review of the relevant literature failed to find material specifically related to the older person’s experience of bereavement visiting by community nurses. Since the community nurse’s role includes actively visiting older people who have been bereaved it was considered worthwhile to explore the service from the perspectives of both older bereaved people and community nurses. The study has addressed a number of issues in the wider literature and highlighted certain models of care which this literature advocates. This ongoing study uses qualitative and survey approaches; a sample of 20 community nurses and 10 older people were interviewed and the interviews were then analysed in order to identify core concepts. The core concepts from older people were found to be relationships and their perceptions of self. The core concepts from the viewpoint of community nurses were relationships, practice and organizational aspects of care.
The management and prevention of incontinence dermatitis
Authors: Le Lievre Sarah
Published: May 2014

Incontinence dermatitis (ID) is rising in incidence along with the increasing elderly population. Its management must therefore take on a greater level of importance. The focus of care must be on finding the causes of incontinence; in many cases it can be cured or the symptoms greatly improved and the development of ID prevented. Where it does occur, effective intervention is necessary. However, a survey into the knowledge base of nurses in caring for skin, carried out by the Royal Colege of Nursing Continence Care Forum in 1995, sowed that care was based on customs and practice rather than evidence. This often causes incorrect treatment to be given, resulting in extra cost for the National Health Service (NHS). This article examines the aetiology and presentation of ID, and supports the need for greater dissemination of guidlines for incontinence professionals and the need for evidence-based literature.
MMR vaccination: the case for evidence-based practice
Authors: Moreton Judith
Published: May 2014

The outgoing general secretary of the Royal College of Nursing (RCN), Christine Hancock, has criticized general practitioners (GPs) and nursing’s critics for not recognizing the recent progress made by nurses (Munro, 2001). The move from hospital-based ‘apprenticeship’ training to higher education ensures that nursing has advanced and is based on clinical evidence.
Enuresis services: carers knowledge
Authors: Cox Elizabeth , Croghan Emma
Published: May 2014

The research described in this article examines parents’ and carers of children with bedwetting (enuresis) problems’ attitudes to, and knowledge of, enuresis and enuresis services in southern Derbyshire. A specialist enuresis service was already running in this area and the continence nurse advisor (children’s services) had noted a high number of referrals complaining about lack of knowledge prior to attending clinic and a lack of clarity and continuity of advice given by other health professionals. The specialist continence service needed to be needs-led and validated as an appropriate and adequate service. Following a literature search and pilot study, a questionnaire was sent to parents of children who had been referred to the clinic in the previous year. Analysis was performed using the SPSS statistical package. Results showed a high value being given to the specialist nurse-led service by parents and children and a high amount of conflicting, non-evidence based advice being given to parents and carers from various health professionals prior to referral to the specialist nurse. The results of the study lead to the formulation of recommendations to improve services available to children with enuresis, their parents and carers.
Compression hosiery in venous insufficiency: a natural nurse-led field
Authors: Bowskill Dianne
Published: May 2014

The use of compression hosiery for the treatment and prevention of venous ulceration caused by venous insufficiency is commonplace in community practice. In recent years the role of the nurse in the management of these patients has grown supported by increasing levels of knowledge, nurse specialists and the implementation of nurse prescribing. The full list of compression hosiery items available on NHS prescription are included in the list of nurse prescribing items in the Nurse Prescribers’ Formulary and the Drug Tariff. Central to a successful treatment outcome is the patient assessment. This forms the base for a partnership approach to care upon which product choices and advice can be tailored to meet the individual needs of that patient. An understanding of venous physiology, limb measurement skills and hosiery care place the nurse in an ideal position to lead in this area of nursing practice.
The role, responsibilities and educational needs of the non-nurse carer
Authors: Fletcher Dave , Rush Denise
Published: May 2014

Non-nurse carers have been a feature of the British health-care system for many years. Changes in the health service, including the loss of nurses from the workforce, have led to the increased use of non-nurse carers being advocated. However, if they are to be employed effectively, issues relating to their role, responsibilities and educational needs must be carefully addressed. This article examines literature on the contribution of non-nurse carers to the nursing profession in acute and primary care settings and the attitudes of qualified nursing staff, and highlights attempts to define the role and its requirements.
Use of pressure reducing seats and cushions in a community setting
Authors: Collins Fiona
Published: May 2014

It is generally accepted that sitting for long periods of time without frequent repositioning or provision of appropriate cushions or chairs can lead to pressure ulcer development in people who are elderly, frail, immobile or neurologically impaired. When sitting, in comparison to lying, only a small surface area of the body is providing support, predominantly the buttocks and thighs, and the feet. Therefore, interface pressures are much greater in sitting than lying. Sitting for long periods of time can result in the person adopting poor posture, which in turn can lead to the development of pressure ulcers, particularly on the buttocks, sacrum, greater trochanter and heels. Assessment and provision of appropriate seating equipment for people at risk is often difficult for clinicians working in the community. This article aims to describe the problems experienced by people who sit for long periods of time, to discuss where people should go in order to obtain help with seating needs, and outline some of the potential solutions to poor seating which are available to community staff.
The expert patient: issues and implications for community nurses
Authors: Wilson Patricia M
Published: May 2014

First highlighted in Saving Lives: Our Healthier Nation (Department of Health, 1999), the Expert Patient programme is now being piloted throughout England and Wales. The programme is focused on helping individuals to self-manage their long-term condition more effectively. While acknowledging the expertise an individual brings to the management of their condition, the programme seeks to further develop these skills with the aim of reducing incapacitation and increasing symptom control and self-esteem. As this is a lay-led programme it is unlikely that community nurses will have an explicit role within the initiative. However, all community nurses have significant input with individuals with long-term conditions and will know clients whom they would term as expert. Following an outline of the initiative, this article presents a number of case scenarios and seeks to explore some of the issues that patients, families and practitioners face when dealing with the concept of ‘expert patient’.
Marie Curie nurses: enabling patients with cancer to die at home
Authors: Higginson Irene J , Wilkinson Susie
Published: May 2014

Marie Curie Cancer Care established its nursing service in 1958, however, the service has had little formal evaluation. This study aimed to describe and evaluate the care provided by Marie Curie nurses, and in particular to determine whether patients in their care remained and died at home. Two existing data sets were used: data on all patients referred to the Marie Curie Nursing Services in 147 areas of England, Wales, Scotland and Northern Ireland for 26 months, and data on cancer death registrations in England. A request for a Marie Curie nurse was made for 26632 patients, 97% of whom had cancer and 11% of whom lived alone. The amount of care provided varied enormously (<1 hour–2862 hours), although the vast majority of patients less than 300 hours of nursing care. Place of death was recorded for only half these patients: 94% died at home, 2.5% in a hospice, 2.3% in a hospital, 0.2% in a nursing home and 0.6% other. Home death was most often associated with patients receiving medication via a syringe driver, patients living with other people, patients with cancer other than prostate cancer, shorter time between referral and death and younger age. The results lend support to the theory that the care given to patients in their homes by Marie Curie nurses facilitates home death for many patients. Services need to ensure that mechanisms are in place to achieve data collection. Rigorous prospective evaluation is needed in the future.
Life after shingles: the management of postherpetic neuralgia
Authors: Williams Heather
Published: May 2014

Chronic pain may have devastating effects on the physical and psychological well being of many patients (Harden, 1999). Most community nurses are in contact with a number of patients with chronic pain and will be asked for advice and recommendations with regards to its management. Chronic neuropathic pain is a complex and sometimes intractable condition that patients will seek help for, from either their GP or from the community nursing team. This article will examine one neuropathic pain syndrome – postherpetic neuralgia – and review the evidence base in relation to treatment strategies, in an attempt to support community staff in the management of this difficult to treat pain syndrome.
Chronic non-cancer pain in older people: current evidence for prescribing
Authors: Cowan David T
Published: May 2014

Chronic pain is a serious problem for many older people, yet its management in this population is often less than satisfactory. The high incidence of toxicity and side-effects with some medications, and irrational fears of opioid dependence are significant barriers to effective pain management. In this article, the research evidence relating to these issues is examined, and their impact on nurse prescribing considered. More studies are needed to assess the veracity of opposing arguments, and to support effective assessment and prescribing by nurses.
The wound infection continuum
Authors: White Richard J
Published: May 2014

For many people, a wound is either ‘infected’ or ‘not infected’. However, this binary distinction is too simplistic: between these descriptions is a spectrum of microbial involvement. This spectrum has been termed the ‘infection continuum’, and is a framework for classification, assessment and management of the wound and its microbial load (or bioburden). By recognition of pre-infected stages and appropriate intervention, the progression of a wound to infection could be avoided. Such avoidance would benefit the patient and, by lowering costs, the health-care system.
Preventing blockage of long-term indwelling catheters in adults: are citric acid solutions effective?
Authors: Mayes Jane , Bliss Julie , Griffiths Peter
Published: May 2014

Community health practitioners are frequently faced with the problem of indwelling catheters failing to drain. This mini-review examines the evidence regarding the effectiveness of citric acid-based bladder washout solutions (solution G, solution R), compared with saline for preventing blockage of long-term catheters in older adults. Although there is some evidence on the effect of citric acid solutions in laboratory conditions, the search yielded no evidence measuring catheter patency in humans. Only one randomized controlled trial addressing the use of citric acid solutions with human subjects was found. This provided some confirmation that solution G had immediate effect but gave no evidence of long-term benefit. No difference was apparent on examination of catheter tips. As the evidence is weak, practitioners should consider the use of citric acid maintenance solution as non-routine and only following formal evaluation in a one-off trial on appropriate patients.
Suprapubic catheter removal: the cuffing effect of deflated catheter balloons
Authors: Robinson John
Published: May 2014

Supra-pubic catheterisation plays an important role in patient care and management when this method of indwelling catheterization is required. However, one area of concern often experienced by nurses is the problem removing supra-pubic catheters or not being able to remove it. Catheter balloons when deflated, incur crease or ridge formation. Removing supra-pubic catheters, a ‘cuffing’ effect occurs as the catheter is being removed. This seems to affect 100% silicone catheters more than non-silicone catheters. This article looks at the changes 100% silicone catheter balloons undergo following deflation and removal.