bluuebunny/crossref_metadata_2025 huggingface dataset:
Mens health: present practice and future hope
Authors: Robertson Steve
Published: May 2014

There is an increasing interest in matters relating to masculinity and men’s health. This paper discusses a role theory approach to masculinity (as this underpins much present preventative health work with men) and why this fails to fully address their health needs. Thus, a fuller theory of masculinity is provided, that recognises the present power relationships in society and how these effect both men’s relationships and organisational structure. This theory of masculinity is then applied to present health services in order to explain how the NHS itself creates a barrier for men wishing to access preventative services and stifles health professionals opportunities for innovative work with men. Finally an outline of how this analysis provides hope for future work with men is discussed.
Letters
Authors: Deahl Dr Martin P , Caldwell Robert
Published: May 2014

1. Hackney mood and blues defeating depression in the inner city; 2. 'Nurse consultants' the latest sop
Pressure area care in the community setting
Authors: Cave Jayne
Published: May 2014

Pressure sore prevention is high on the agenda for most healthcare professionals. The shift of care from hospital to the community has brought about many changes over the past few years. Providing 24-hour care to reduce pressure sore development in the community can be difficult. This article discusses some of the key issues related to pressure sore prevention and examines the importance of education, risk assessment and equipment loan services in the provision of 24-hour care. A mulitdisciplinary approach to pressure sore prevention is essential in the community but so too is the adequate availability of resources.
Is Sure Start good for health visiting
Authors: While Alison
Published: May 2014

The future direction of the health visiting profession would appear to hang in the balance with news of cutbacks in health visiting provision in different parts of the country and suggestions that Sure Start needs outreach workers similar to health visitors -- thus providing the long sought after home for health visiting and raising the spectre of a role in social control.
Hand hygiene in the prevention of community-acquired infection
Authors: Gould Dinah
Published: May 2014

The association between lack of hand hygiene and the transfer of infection in hospital has been long established. In contrast the role of hands in the transfer of community-acquired viral and bacterial infection is less well appreciated both by health professionals and members of the public. This article presents evidence to show that many, perhaps most community-acquired infections are disseminated by contact. It is suggested that a more careful approach to hand hygiene by health professionals could reduce the risk of infection in primary care settings. Greater awareness of the role of hand hygiene on the part of the general public could reduce time away from work, school and social activities caused by respiratory and enteric infections.
Diabetes Mellitus - update on treatment
Authors: MCDowell Joan RS
Published: May 2014

This paper addresses current philosophies and new treatments for people with diabetes mellitus. It identifies possible alternative routes for insulin injections and new injection devices. The new lispro insulin is discussed as are its implications for patient care. There are several new oral hypoglycaemic agents available and several more currently being researched. Combination therapy is discussed and novel approaches utilising insulin and oral hypoglycaemic agents presented. Other forms of oral agents are described although several of these are not yet available for clinical use. Current trends in the ultimate form of treatment, a pancreatic transplant, are presented and discussed.
Female patients views on discussing sexual health
Authors: Dilloway Mark , Hildyard Sarah
Published: May 2014

This article is the second in a series on the Sex and Health Project in East London. The main objective of the project, which was completed in 1996, was to define the needs of service users. It was intended that this information could then be used to design training initiatives to promote sexual health in general practice. This qualitative study examines female patients’ concerns and experiences in relation to a number of sexual health promotion issues. Study findings show that while a number of patients recounted having negative experiences with both nurses and GPs, the attitude and approach of the health professional was perceived as being the most important factor in encouraging women to discuss their sexual health.
Public health approaches to family support: how good is the evidence?
Authors: Perkins Elizabeth R
Published: May 2014

This article reviews the literature on family support from a public health nursing perspective. It discusses the difficulties posed for a practitioner who wishes both to take a public health perspective and be evidence based, given that much of the literature and even more of the well-funded research studies using randomized controlled trials focus on individual, professional family support rather than lay, group or community-based methods. The absence of comparable evidence on the latter does not indicate that these methods are unsuitable, even though they are under-researched. Practitioners wishing to pursue public health approaches can therefore proceed, taking account of the smaller-scale studies that are available and looking for ways of improving the evidence base available for public health practice in family support.
Failing to take the medicine
Authors: While Alison
Published: May 2014

Prescribing, purchasing and taking medication is a major component of healthcare provision in UK. The effectiveness of medication depends on both the appropriateness of the medication and the regimen used. Thus failure to take medication appropriately is likely to result in therapeutic failure such as a continued infective state and unrelieved symptoms. However, inappropriate use of medication also has major economic consequences at national and individual levels, e.g. misuse of expensive drugs, the social and economic costs of ill health and increased health needs which may result in the need for secondary care. Nonetheless, the evidence suggests that many clients do not follow the terms of their prescriptions and this is particularly true in chronic illness.
Role of zinc in the healing of venous leg ulcers: a literature review
Authors: Boon Helen , Unsworth John
Published: May 2014

The role of nutrition remains one of the most poorly understood areas in wound healing, and nurses often miss an ideal opportunity to hasten healing because they do not consider ways of improving or maintaining the patient’s nutritional status. One particular nutrient, zinc, has been the subject of extensive debate. The role of zinc in cellular development and the later stages of tissue repair is fairly well understood. This review of the literature examines the effectiveness of both oral zinc supplementation and the topical application of zinc in patients with venous leg ulceration. Although the evidence is inconclusive, there are reports of improved healing rates following oral zinc supplementation in patients with zinc deficiency. Furthermore, one study advocates the use of topical zinc in patients with leg ulceration, because of the likelihood that circulatory insufficiency will reduce the uptake of zinc by the tissues.
New clinical guidelines for patients with stroke
Authors: Bliss Julie
Published: May 2014

An estimated 100000 people and their families are affected by a cerebral vascular accident (CVA) every year (Office of Population Census and Surveys, 1993). The recently published national clinical guidelines for stroke patients (Royal College of Physicians (RCP), 2000) provide a framework for providing high quality care from the initial diagnosis through to rehabilitation and long-term care. The message evident throughout the guidelines is clear, namely, that effective care depends on good multidisciplinary teamwork. It is suggested in the core principles that ‘all members of the healthcare team should work with the patient and family using an agreed therapeutic approach’. The guidelines also highlight that, after the acute phase, specialist services provided in the hospital or community, yield the same results if care is well coordinated.
Estimating resources for setting up an HV service for postnatal depression
Authors: Fuggle P , Haydon K
Published: May 2014

Postnatal depression (PND) presents a significant health burden for mothers and their offspring. Research has indicated that screening for PND increases detection (Holden et al, 1989) and also that counselling by health visitors (HVs) is an effective intervention. This article describes a pilot PND screening and treatment project which aimed to assess the resource and organizational implications of introducing new health visiting services modelled on research findings compared with existing practice. The pilot project included approximately 400 new mothers in an inner-city, multicultural area and confirmed previous findings regarding prevalence of PND (19%) and the effectiveness of brief counselling interventions. It resulted in significantly reduced estimates of the HV resources that would be required to introduce screening as part of the core health visiting programme. The project also revised expected training requirements and challenged existing concerns about its appropriateness for minority cultural groups.
Informal peer support: a key to success for nurse prescribers
Authors: Otway Christine
Published: May 2014

A study was conducted in Leicestershire and Rutland (NHS) Healthcare Trust to determine the continuing professional development needs of nurse prescribers. Qualitative and quantitative approaches were applied to the sample frame of 350 nurse prescribers to elicit the most significant factors which have influenced the development of nurse prescribing. The majority of nurse prescribers considered prescribing to be a skill, which is now an essential part of core practice. The study indicated that informal peer support seems to have compensated for the absence of formal clinical supervision. Any development such as nurse prescribing has the added benefit of examining practice from new perspectives. Reflection on how this was achieved highlights important issues as to how the next stage can be even more successful.
Nurse referrals of children to social services
Authors: de St Paer Anne , Appleton Jane V , Williams Julia
Published: May 2014

This literature review examines current referral systems and processes used by community nurses when making referrals of children in need and children in need of protection to social services departments. The problems surrounding definitions of need, children in need and children in need of protection are considered. The ambiguity of the language used and the difficulties encountered by community nursing staff in trying to identify criteria and thresholds for referral are highlighted. The review focuses on research exploring the assessment and referral processes used by community nurses, in particular by health visitors, and draws attention to the lack of research concerning these areas. Government recognition of the problems encountered by agencies working in this field is acknowledged in recent Department of Health publications.
Evidence informing practice: introducing the mini-review
Authors: Griffiths Peter
Published: May 2014

The use of evidence to inform health-care practice has long been advocated. However, in practice it is often difficult and widely misunderstood (Griffiths, 1999). For example, community nurses often rely on potentially biased information from drug company sales people (Luker and Kenrick, 1992). Instead we are now urged to make use of current research-based knowledge to inform our decision-making and to critically appraise what we find (Sackett et al, 1996). For many this might be interpreted as the use of authoritative text books and review articles. Unfortunately (or fortunately) Antman and colleagues (1992) showed clearly how the recommendations of text books and even ‘scholarly’ reviews could completely misrepresent or ignore the available evidence. The practitioner then faces the often-daunting task of finding and appraising the primary research himself or herself.
Fall prevention among older adults: is London ready for the NSF?
Authors: Hughes Michael
Published: May 2014

Fall prevention is a key standard of the National Service Framework for Older People (Department of Health, 2001). This article describes a study exploring the extent and nature of fall prevention initiatives among London primary care NHS services. It outlines fall prevention approaches used, considers the shortfalls of current practice and recommends ways to meet the demands of the national service framework.
The use of topical antimicrobials in wound bioburden control
Authors: White Richard J
Published: May 2014

The control of wound bioburden is believed to be valuable in avoiding possible deterioration into infection; in reducing critical colonization; and in treating frank infection. While the immune response is the governing factor in the development of infection, the reduction of bioburden – if achieved to a sufficient degree and for sufficient duration – can enable host defences to regain control. Topical antimicrobial agents, carefully selected and correctly dosed, can help achieve these goals. This review examines the value of topical antiseptics and antibiotics in various formulations in controlling the bioburden of acute and, predominantly, chronic wounds. The currently held perception of antibiotic misuse is reinforced and reiterated. Topical antibiotics must be used with caution and only for specific, limited indications. Topical antiseptics have a much broader range of applications and are generally safer when used appropriately. Conditions and circumstances of use are provided for these agents.
Stoma siting: what the community nurse needs to know
Authors: Readding Linda A
Published: May 2014

Stoma siting is often regarded as the most important part of preoperative preparation. Marking the abdominal skin at the proposed stoma site takes place after a period of assessment, discussion, observation, consideration and evaluation, that will have begun on the first meeting between the patient and the nurse. The siting procedure is a joint decision made between the patient and the nurse about the most suitable place for their stoma. The position of the stoma should allow the patient to manage it independently and to resume their normal activities after recovery. The success of the stoma can depend on the site and its condition. The purpose of this article is to describe and discuss the siting process and how it benefits the patient. Community nurses should gain a greater understanding of the issues involved, as well as the considerations for both the nurse and the patient. This article is intended to help the community nurse feel more aware of the issues involved in siting, and feel more prepared to assist the patient to prepare for and begin their life with the stoma. The outcome and effects of a ‘poorly’ or ‘less than ideally’ sited stoma (e.g. formed during emergency surgery), and its care and management will also be discussed. Illustrations have been included to assist the reader through the process of siting.
Health-related beliefs and behaviours of health visitors in Scotland
Authors: Barberia Ana Maria , Canga Navidad
Published: May 2014

There is some evidence that health professionals’ performance of health promotion activities is strongly influenced by their own health beliefs and health related behaviours. In the light of the current trend in health policies in Scotland and elsewhere towards a health promotion focus, this study sought to gain a description of, and to identify an association between, health beliefs and health-related behaviours among a sample of Scottish health visitors. A questionnaire was sent to randomly selected health visitors in a large Scottish city. Respondents reported behaviours they believed to be important to health, e.g. not driving under the influence of alcohol, dental care and smoking. While the health visitors’ own performance of some health-related behaviours, such as smoking, was associated with their health beliefs, others such as drinking coffee, were not. Health visitors could be advised to reconsider some or their health beliefs, in particular those related to areas where the government has focused its attention.
An analysis of clinical risks in vaccine transportation
Authors: Fernando Martina
Published: May 2014

‘Cold chain’ transport is an integral part of a system of vaccine transportation that assures the potency of vaccines. If the temperature of vaccines is not kept between the ranges of 2°C–8°C, this can lead to adverse effects especially for the recipients of first time immunization, as no protection is offered. This investigation has shown that there is considerable risk of vaccines being rendered impotent due to ad hoc collection of vaccines by health-care professionals from pharmacy services, outside of the cold chain transport agreement with the vaccine supplier. This is because at present there are no guidelines for ad hoc collection of neither vaccines nor the approved cold chain equipment provided to transport the vaccine. The root cause analysis has shown that the general practice can manage this risk by making changes to its system for vaccine ordering, stock control and maintenance. A number of changes are proposed, including the appointment of a vaccine coordinator and the development of a protocol for ad hoc collection of vaccines from pharmacy. By focusing on improving the quality of the process, the practice can improve the care and safety of its immunization programme.
Evaluation of the impact of an educational initiative in diabetic foot management
Authors: Jones June , Gorman Anna
Published: May 2014

The diabetic foot project was an initiative designed to help develop a training package for community nurses and podiatrists. It also aimed to evaluate the impact of two days’ training on the knowledge and reported practice of nurses and podiatrists in the management of the diabetic foot. The study used a two-group pre- and post-test design, which replicated the work of Luker and Kenrick (1993) and Nelson and Jones (1997). The Wilcoxon signed-rank test was used to determine if there was a difference between the experimental and control group scores. The results reported demonstrate the positive effect of the study days on practitioners’ knowledge and reported practice, and the study has highlighted the potential to improve practitioners’ knowledge and reported practice.
Identification of skin cancers 1: benign and premalignant lesions
Authors: Freak Jane
Published: May 2014

Skin cancers are the most commonly diagnosed cancer in the UK, and their incidence is growing. They can present in all age groups, and are particularly common in older people, but the incidence among younger people is increasing. However, the majority of skin lesions are not malignant. In this, the first of two articles, the author discusses the range of common benign growths that can be mistaken for cancers, as well as the precancerous lesions that can become a cause for concern if untreated. The second article will examine the common malignant lesions.
Urinary catheter-related infection: an education programme for users
Authors: Jenkinson Helen
Published: May 2014

While infection control has increased in profile both clinically and politically, it has also become embedded in clinical governance frameworks of NHS trusts. Over the last few years the Department of Health has produced a number of documents in an attempt to highlight the increasing risk of health-care associated infections. Today, the need for education as a key component in health care has been recognized as well as the need for patients and carers to receive information and be trained in, for example, techniques of hand decontamination and catheter management following discharge from hospital. The objective of the education programme outlined in this article was to work alongside government guidelines in an attempt to improve education and understanding about infection control and management of infection in the catheterized patient.
Communication skills and district nurses: examples in palliative care
Authors: Lawton Sally , Carroll David
Published: May 2014

This article discusses some communication skills that may be challenging for district nurses who are working with palliative care patients. The article suggests that assessing what the patient knows about their illness is a key factor to effective communication. It pays particular attention to the first visit made by the district nurse. The article also discusses some specific situations that the district nurse may encounter, such as answering direct patient questions, denial, collusion and anger. A framework of communication styles developed by Wilkinson is used to understand the responses that may be given in such challenging situations.
Urinary urge incontinence: causes and management strategies
Authors: Rigby Deborah
Published: May 2014

Bladder control is a skill most people learn in childhood, so if control is lost in adult life the impact can be very significant, particularly on the quality of life of the person affected. There are many causes of loss of bladder control, ranging from neurological conditions to menopause, as well as certain medications. This article discusses urinary urgency and urge incontinence, examines its causes and diagnosis, and provides an overview of the nursing interventions available to treat the problem.
Catrix: an easy-to-use collagen treatment for wound healing
Authors: King Stephen
Published: May 2014

Collagen plays a major role in wound healing. Its presence is important in all stages of the healing process. Catrix® is a new collagen wound-healing powder that has been shown to be effective in the treatment of wounds healing by secondary intent such as pressure ulcers, venous stasis ulcers and diabetic ulcers as well as second-degree burns and post-radiation dermatitis. Catrix has also been shown to be effective in the treatment of wounds unresponsive to conventional treatments. It promotes the growth of fibroblasts and keratinocytes in the wound, prevents loss of fluid from the wound and protects the wound from bacterial infections and other agents. Catrix is biodegradable and therefore does not require removal from the wound bed before re-application.
What does social enterprise mean for community nursing?
Authors: Cook Rosemary
Published: May 2014

The concept of social enterprise has gained currency since the publication of the health white paper Our Health, Our Care, Our Say (Department of Health, 2001). Social enterprise is a way of introducing competition into health-care provision without focusing on extracting maximum profit, since in most cases any profits are reinvested into the enterprise.

Rosemary Cook takes a look at the thinking behind social enterprise, its potential role in the NHS and what is could mean for community nursing.
Supporting older people: Cold, poor and baffled
Authors: Kohler Mervyn
Published: May 2014

In this article, brought to you in association with Help the Aged, Mervyn Kohler discusses the twin issues of fuel poverty and benefits take-up by older people. Community nurses can have a direct impact on these problems.
Full prescribing rights are now a reality
Authors: While Alison
Published: May 2014

Following a long legislative journey, suitably qualified nurses can now legally prescribe any licensed medicine for any medical condition within their field of competence (Department of Health, 2006). They are also permitted to prescribe some controlled drugs for specified conditions, and prescribe the full range of controlled drugs and unlicensed medicines if they are listed on an agreed clinical management plan relating to a specific patient.
Risks of long-term catheterization in the community--and managing them
Authors: Potter Jennie
Published: May 2014

Catheter-associated urinary tract infections continue to be a major source of morbidity in hospital and the community. In part, this may be the result of ritualistic practices, compounded by poor communication on discharge from hospital. This article highlights many of the issues that lead to continued high rates of CAUTI, and challenges health professionals and health-care providers to use all available guidance and tools to reduce the incidence of CAUTI across the NHS.
Compensation for psychiatric injury: evolution of a law of nervous shock
Authors: Griffith Richard
Published: May 2014

District nurses will be well aware that if a person receives an injury because of someone else's negligence they are entitled to compensation for the harm that has been caused.

However, where the injury is in the form of psychiatric harm the law has traditionally imposed rules that set out the conditions to be met before a successful claim for damages can be made. Even in today's enlightened society the law still does not always treat a psychiatric injury in the same way as a physical injury.

In this article Richard Griffith outlines the development of the law in relation to psychiatric injury—historically called ‘nervous shock’—and considers the current approach to claims for damages where a person suffers psychiatric harm because of another's negligent act.
Alternative ways of managing access to wound products
Authors: Stevens Helen , Henderson Val
Published: May 2014

Wound management in primary care is recognized as the remit of nurses. Until quite recently, however, wound products had to be prescribed by GPs, a prescription collected by the nurse or patient, and the products dispensed by a pharmacist. This has changed, and wound products made up the majority of the items that were first listed as items district nurse prescribers could prescribe. However, several years later, there still remains an issue with accessing the products in a timely fashion, because of the delay in having products dispensed by the pharmacist.
Looking forward, moving forward
Authors: Moffatt Christine
Published: May 2014

I would like to give you a very warm welcome to the second British Journal of Community Nursing supplement on lymphoedema. Since we published the first supplement we have been very encouraged by the positive feedback we have received. It is very clear that the management of lymphoedema and other forms of chronic oedema are an important problem for community nurses and we are delighted to be able to publish this supplement dedicated to you.
Making mental health important
Authors: Pollard Tom
Published: May 2014

Ever since I started working on this journal I have been aware that mental health, though widely recognized as ‘important’, is something of a Cinderella issue for many community nurses: not fully understood, not embraced, even a bit untouchable. Yet aspects of mental health touch every aspect of community nursing practice, from care of the patient with a chronic wound or indwelling catheter, to care of the patient dying at home and their family, to helping someone with diabetes manage their insulin. The social, emotional and psychological consequences of chronic illness and old age are numerous and readily identified by nurses: poor self-image, social isolation, depression to name a few. Dealing with these issues forms part of the practice of caring.
Home enteral feeding: Part 2 current issues in community practice
Authors: Fogg Louisa
Published: May 2014

Part 1 provided an overview of enteral tube feeding and management in the community. Due to the limited evidence base there are many aspects of the practical management of patients on home enteral tube feeding (HETF) that has as yet not been standardized, particularly around issues such as the type of syringes and water that should be used in HETF. There are also some areas where the guidelines are clear but difficult to apply in the community (such as with maximum feed ‘hanging times’) or where further guidance is required (such as for confirming the position of nasogastric tubes in patients on acid-reducing therapy). Finally, as NHS trusts look at further ways to save money, enteral feeding is being increasingly scrutinised and needs to be carefully managed, with the involvement of healthcare professionals who understand patient needs and the commercial HETF market. This article is based on personal views and local discussions about the issues in question and, until further research and national standards are available, are subject to local interpretation.
European Pressure Ulcer Advisory Panel
Authors: Toner Louise
Published: May 2014

This month sees the 10th Anniversary Meeting and Conference of the European Pressure Ulcer Advisory Panel with both European and International speakers providing a wealth of education and research in respect of pressure ulcer prevention and management. This promises to be a significant event in terms of adding to the evidence base in this field but also in respect of the ongoing debate regarding Grade-2 Pressure Ulcers. It is anticipated that both Commissioners and Providers of Services are represented at this conference to ensure optimum care for patients across the primary and secondary care interface.
Dry eye syndrome (DES) and watering eyes
Authors: Redmond Neill , While Alison
Published: May 2014

Dry eye symptoms and watering eyes increase with age and are relatively common among older people. The conditions cause distress which can be ameliorated if patients are advised appropriately. Accurate diagnosis of the underlying cause provides the basis for management. This paper outlines key features of the conditions and the range of therapies available.
Deprivation of liberty safeguards
Authors: Griffith Richard , Tengnah Cassam
Published: May 2014

The Mental Health Act 2007 introduced an amendment to the Mental Capacity Act 2005 that authorizes the deprivation of liberty of a person who lacks decision-making capacity in a care home or hospital where this is necessary to protect them from harm. District nurses will have such patients on their case loads and will need to be aware of the requirements that are due to come into force in April 2009.
The role of the district nurse when involved in the coronial process
Authors: Griffith Richard , Tengnah Cassam
Published: May 2014

The inquisition into the death of Diana, Princess of Wales has highlighted the role of the coroner in the investigation of the cause of death in England and Wales. The coroner provides an important safeguard to an administrative system for the registration of deaths in the United Kingdom that relies heavily on a doctor to confirm the cause of death. Coroners are required to hold an inquest where the person has died a violent or unnatural death, has died suddenly from an unknown cause or has died in custody or at the hands of the police or where an inquest is required by statute.

District nurses will encounter death in such circumstances during the course of their duties and the coroner’s court is the most likely court where a district nurse will be called to give evidence. It is essential you know the duties of the coroner and what is expected when giving evidence at an inquest. Following the inquiry into the case of Dr Harold Shipman the government is proposing changes to the coroner’s role that will have an impact on district nurse practice (The Shipman inquiry, 2004).

In a series of articles Richard Griffith and Cassam Tengnah review the role of the coroner and consider the impact of reform on district nurse practice.
How telemedicine is aiding prompt ECG diagnosis in primary care
Authors: Lieberman Jonathon
Published: May 2014

This article examines the approach taken by St Gabriel’s Medical Centre in Prestwich, Manchester in monitoring and managing cardiac conditions within a primary care setting. It outlines how diagnosing and assessing cardiac problems in-surgery can improve patient care and working practice for GPs and clinicians while alleviating some of the financial and operational burden on secondary and emergency care providers. The cardiac telemedicine service imports cardiac expertise into a GP’s surgery providing clinicians with fast, expert ECG interpretations, enabling them to deliver timely and preventative care to their patients.
A guide to continence assessment for community nurses
Authors: Nazarko Linda
Published: May 2014

Problems with continence are common in older people, therefore quality continence assessment advice and follow up are essential in providing a high standard of care. Many older people can be helped to regain some measure of control over their continence. Continence assessment can often focus on containment rather than cure. This is a sad state of affairs which adversely affects patients’ well being. This article explains how continence assessment enables the nurse to assess and treat continence issues and improve quality of life.
Management of dry skin conditions in older people
Authors: Davies Ann
Published: May 2014

This article examines the physiological changes that occur in the skin with advancing age that make it more prone to skin problems. Examples of common skin disorders that may affect older people are provided. Intrinsic factors such as a genetic tendency to eczema, and extrinsic factors such as the effects of sun damage and general poor health can both affect the skin of older people. The management of dry skin conditions in this age group is investigated and the value of emollient therapy, involving the use of bath emollients, soap substitutes and leave-on emollient lotions, creams or ointments, is discussed.
Caring for a patient with a urostomy in a community setting
Authors: Nazarko Linda
Published: May 2014

Around 7500 people in the UK have a urostomy. A urostomy is normally performed if a person has bladder cancer, congenital bladder abnormalities. Many people who have a urostomy have long term conditions and may require the help and support of community nurses. This article examines common complications of urostomy including stomal complications, urinary tract infections and dermal complications. Although stoma complications are common and can affect quality of life, many people with a stoma tend not to seek help. Community nurses can provide care and support to optimize stoma management and enable the person with a urostomy to enjoy the best possible quality of life.
Improving pressure ulcer prevention in nursing care homes
Authors: McKeeney Louise
Published: May 2014

This article describes a tissue viability program in nursing care homes in Coventry, using a variety of methods to improve standards in pressure ulcer prevention including clinical practice, benchmarking, supervision, training, education and clinical assessments.
Understanding the role of diet in type 2 diabetes prevention
Authors: Wyness Laura
Published: May 2014

The number of people with type 2 diabetes is increasing at an alarming rate. Almost 4% of the UK population currently have diagnosed diabetes. Non-modifiable risk factors for diabetes include genetic predisposition, some black and ethnic minority groups and increasing age. Type 2 diabetes, (formally known as maturity onset diabetes), used to be a condition affecting adults only, although due to the increasing levels of obesity, it is now being diagnosed in young people and children. A healthy diet and lifestyle can help to prevent or delay the development of type 2 diabetes. In particular, strategies to reduce obesity will have a beneficial effect on the prevalence of type 2 diabetes, as excess adiposity (particularly central adiposity) is a strong risk factor for the condition. Dietary measures to reduce the risk of coronary heart disease will also help prevent diabetes. Diets low in fat (particularly saturated fat), and high in fibre and complex carbohydrates are effective in reducing the risk of developing diabetes. Good quality evidence from trials is required to determine the role of specific micronutrients in diabetes prevention.
Wound care teams: redesigning community nursing services
Authors: Haworth Marcia
Published: May 2014

A pioneering community-based multi-disciplinary wound care team, working alongside a tissue viability service, developed within East Lancashire teaching PCT. The drive to push the nurse-led wound care agenda forward requires powerful champions to acknowledge the value of multi-professional care, therefore this article embraces a care delivery model based on a ‘spend to save’ framework. This live platform, using a multi-disciplinary specialism, uses an electronic database to demonstrate measurable outcomes, reporting weekly and monthly patient and non-patient activities. The impetus for developing this service was to enable community nurses to refocus their time on patients with long-term conditions.
Working together to achieve more
Authors: Toner Louise
Published: May 2014

The recent annual Harrogate wound care conference raised some interesting points in respect of the policies of some NHS trusts regarding organizations visiting staff in practice to discuss existing products and those already included within trust formularies. It is apparent that access to staff is quite diverse across the country with some trusts allowing no access and others allowing access but through a central person or an in-between arrangement. Not all trusts have a tissue viability infrastructure and in some instances more junior staff are leading services and therefore may not be the appropriate individuals to engage in discussions with industry. However, where there is an infrastructure with consultant nurse/tissue viability specialist leads, they should have the knowledge and expertise to engage in such activity, controlling the exposure of staff to new and existing products and to work within the codes of the appropriate regulatory bodies.
The use of a new two-in-one treatment (K Two Start) in a venous leg ulcer
Authors: Gardner Sarah
Published: May 2014

Delayed or palliative wounds affect a high number of patients, resulting in increased costs and decreased nursing time elsewhere. In this case study, an 87-year-old female patient was treated with a new wound healing product, after one year of unsuccessful treatment. K Two Start was used in the new treatment regime. After one week, the patient no longer felt constantly in pain, and after 16 weeks, the wound had healed. The cost for the unsuccessful year of treatment (£9077) is compared to the successful trial (£1329). A total saving of £7748 was estimated by the use of the new treatment regime.
Lipoedema: presentation and management
Authors: Todd Marie
Published: May 2014

Lipoedema is a distinct clinical condition characterized by bilateral, symmetrical enlargement of the buttocks and lower limbs owing to excess deposition of subcutaneous fat. It is found almost exclusively in women. The common features associated with this condition are ‘column- shaped’ legs with sparing of the feet, bruising, sensitivity to pressure, and orthostatic oedema. The progression to lipo-lymphoedema or morbid obesity is possible. Conservative measures used in the management of lymphoedema can prevent progression/limit the orthostatic oedema. Surgical procedures may also play a part in the management of lipoedema.
An interview with Sylvie Hampton
Authors: Hampton Sylvie
Published: May 2014

I have been working within tissue viability for nearly 20 years and you cannot work in that field without caring for patients with venous leg ulceration that is associated with chronic oedema. Twenty years ago, we did not have the understanding of chronic oedema and its dangers that we have today. We now realize that chronic oedema in the lower limb can have a tipping point that takes it from simple oedema to a much more serious problem of lymphoedema. Although chronic oedema is not strictly lymphoedema in physiological terms, it is a mixed form of the condition and will lead to deterioration of lymphatic function and will become lymphoedema in time.
Nutrition in the palliative care of chronic and life-threatening illness
Authors: Holmes Susan
Published: May 2014

Palliative care should be available to all those with chronic, incurable or life-threatening illness and is intended to alleviate symptoms and improve quality of life. Although good nutrition is needed - not only to meet the body’s physical requirements but also many social and psychological needs - such patients often experience reduced oral intake during the course of their illness. This raises many challenges for practitioners but may include the use of nutritional supplements or artificial nutrition using enteral or parenteral feeding.
Fall prevention in the community: what older people say they need
Authors: Dickinson Angela , Machen Ina , Horton Khim , Jain Deepak , Maddex Ted , Cove Jenny
Published: May 2014

Uptake of and adherence to fall prevention interventions is often poor and we know little about how older people's perceptions of and beliefs about fall prevention interventions affect uptake. This study aimed to explore older people's perceptions of the facilitators and barriers to participation in fall prevention interventions. We undertook a qualitative study with older people who had taken part in, declined to participate or adhere to fall prevention interventions using semi-structured interviews (n=65), and 17 focus groups (n=122) with older people (including 32 South Asian and 30 Chinese older people) in primary and community care settings in the South of England. A number of factors acted as either barriers or facilitators to uptake of interventions. Older people also made recommendations for improving access to interventions. Community nurses are ideally placed to screen older people, identify those at risk of falling and refer them to appropriate interventions as well as providing health promotion and education.
Management of malodour in palliative wound care
Authors: Gethin Georgina
Published: May 2014

Palliative wounds arise from a myriad of underlying chronic conditions. Care of such wounds requires the skills and expertise of the multidisciplinary team in order to optimize the quality of life of the individual, manage symptoms and stabilize the wound. Malodour is cited as one of the most distressing symptoms of these wounds, is a complex phenomenon with multiple potential causes, and may signify infection or necrosis. Malodour can cause depression, social isolation, nausea, anorexia and, in some individuals, a gagging or vomiting reflex. This paper will explore the causes of malodour and current management strategies, with particular reference to palliative care wounds.
Psoriasis: symptoms, treatments and its impact on quality of life
Authors: Parrish Liz
Published: May 2014

Psoriasis affects between 1% and 3% of the population and there is no cure for this chronic skin disease. This article gives an overview of the condition and available treatments. It focuses on managing symptoms, the range of medications available and the impact this chronic condition can have on a sufferer's quality of life. The article looks at medication non adherence remaining the biggest obstacle to management of the condition and the debilitating effect psoriasis can have on an individual's self-esteem and general well-being. It concludes by considering the role of patient support services such as the touch programme.
Resting Doppler ankle brachial pressure index measurement: a literature review
Authors: Sihlangu Dorcus , Bliss Julie
Published: May 2014

Peripheral vascular disease (PVD) is under-diagnosed in primary and acute settings. The use of Doppler ankle brachial pressure index (ABPI) is effective in diagnosing PVD , aid in determining aetiology of leg ulcers and is cost efficient in reducing the effects of atherosclerosis and cardiovascular events. The aim of this literature review was to review practitioners’ experience in using Doppler ABPI, different skills used to measure ABPI and to examine practitioners’ confidence in ABPI. The findings identified variation in method for Doppler measurement: including position of the artery, arm measurement, resting period and type of equipment for measuring blood pressure, variations in practitioners’ training and experience have demonstrated variability in ABPI results. Although limited in number, the studies have demonstrated knowledge gap, and the need for training among health professionals.
The total contact cast: controversy in offloading the diabetic foot
Authors: Whitelaw Sophie
Published: May 2014

otal contact casting has long been considered the gold standard for offloading the diabetic foot. However, it remains underutilised with less than 2% of clinicians reportedly using it for the treatment of the majority of diabetic foot ulcers. Proper TCC application with avoidance of iatrogenic lesions requires skilled cast technicians, trained in casting the insensate foot, and is an expensive and time-consuming process. Additionally the TCC is contraindicated in patients with infection or critical ischaemia and must be used with caution in elderly patients, those with visual or equilibrium problems, those with a contralateral foot ulcer or with varicose veins. There is minimal robust evidence for the use of the TCC over other offloading modalities such as the removable cast walker and the instant total contact cast. However there is also minimal evidence for iatrogenic lesions caused by TCC. Additionally, the superior offloading properties and expedited healing rates of the TCC are demonstrated in a number of smaller studies. In conclusion there is a lack of consensus on the best device to offload DFU. However offloading is undoubtedly paramount to successful and timely healing. More research with larger samples sizes is required to support the TCC as the gold standard off loading device.
Skin tears: achieving positive clinical and financial outcomes
Authors: Stephen-Haynes Jackie
Published: May 2014

Skin tears are one of the most common wounds found among frail, older individuals, and are considered to be largely preventable. Skin tears occur frequently in those with fragile skin, in neonates and the elderly; particularly those with comorbidities affecting their balance, e.g. postural hypotension, motor neurone disease, diabetes and cerebral vascular accident (CVA). Those taking oral medications including steroids and anticoagulants are also at risk of developing skin tears. The increase in the population of older people is likely to produce a concurrent rise in the number of skin tears. Health professionals and health care assistants have a significant role to play in skin tear prevention, assessment and management.
Public health and obesity: the role of the district nurse
Authors: Sellwood Lynn
Published: May 2014

The World Health Organization (WHO) (2012) estimates that half a billion adults in the world are classified as obese. This article outlines initiatives that could be undertaken by district nurses to reduce the prevalence of obesity and improve the statistics relating to morbidity and mortality from obesity-related conditions. As district nurses already have a complex caseload, the initiatives discussed by the author are simple enough to be incorporated into the assessments and health screening already being undertaken.
An alternative model of prescribing stoma appliances
Authors: Mangnall Joanne , Lakin Stuart , Burke Diane , Midgley Kate
Published: May 2014

The NHS is challenged with making efficiency savings of £20 billion by 2015. In order to achieve a target of this magnitude, commissioners, clinicians and patients are required to work together to evaluate current service delivery and explore all options which have the potential to increase efficiency. This article describes the significant service redesign work undertaken in Rotherham by commissioners, clinicians and patients which has improved the way in which prescriptions are issued to patients requiring stoma products. The project has achieved impressive financial savings and, importantly, has improved patient experience. The project illustrates how new ways of working can significantly contribute to the £20 billion savings target, avoiding cuts in service provision while simultaneously improving the quality of service provided to patients.