bluuebunny/crossref_metadata_2025 huggingface dataset:
Acute management of right ventricular infarction
Authors: O’Donovan Kate
Published: May 2014

Right ventricular infarction is commonly seen in the presence of inferior ST-segment elevation myocardial infarction (STEMI) but its recognition and diagnosis is a clinical challenge. Right ventricular infarction has been described in up to 50% of patients with acute inferior STEMI with the majority of patients remaining asymptomatic and clinically stable. The classic triad used to describe the clinical manifestations is hypotension, raised jugular venous pressure and clear lung fields on auscultation. A right-sided ECG demonstrating 1 mm ST elevation in V4R, which is transient, confirms suspicion of RVI.

Treatment goals include prompt reperfusion, avoidance of medications that reduce preload, volume loading with the option of adding inotropic support or insertion of an intra aortic balloon pump. Prognosis is positive with the majority of patients recovering baseline right ventricular function in the months following the event. Clinical consequences of RVI include hypotension, bradycardia, conduction disturbances and depressed right ventricular function if not recognized promptly. Emergency and cardiovascular nurses have a pivotal role in the identification, assessment and treatment of these patients as they are commonly the first point of medical contact.
A nurse-led rapid access chest pain clinic post NICE guidance: Analysis of audit results
Authors: Robson Gemma
Published: May 2014

Background: Rapid access chest pain clinics (RACPCs) became an immediate priority following the introduction of the National Service Framework for Coronary Heart Disease (CHD) in 2000, aiming for prompt assessment to determine the likelihood of CHD. The benefits of nurse-led RACPC are well documented throughout the literature. In March 2010, the National Institute for Health and Clinical Excellence (NICE) set out structured evidence-based guidance to support the assessment of chest pain in these clinics, marking a significant movement away from treadmill testing towards clinical assessment and non-invasive functional imaging. Setting: Nurse-led RACPC in a large London teaching hospital. Method: Patients seen in clinic referred via GP fax, from April 2010 to April 2011. Results: 646 patients seen. The largest initial patient referral (42%) was for CT coronary angiography. Final patient diagnosis identified that 350 patients (53%) had non-anginal/non-cardiac chest pain, 153 patients (24%) had non-obstructive disease and 103 patients (16%) had angina. Conclusions: Nurse-led RACPC leads to effective triage and a fast rout to diagnosis of the symptoms of ‘chest pain’. NICE provides clear guidance for these clinics, with a move away from exercise tolerance testing towards clinical assessment and functional imaging. A national annual audit may be required to monitor the clinical effectiveness and cost-effectiveness of this new guidance.
Indications for postoperative (transthoracic) epicardial pacing
Authors: McNaughton Amanda
Published: May 2014

Coronary heart disease remains one of the biggest killers in the UK today. In 2012 over 20 000 patients benefitted from cardiac bypass operations, some inevitably experiencing epicardial pacing wires as routine care. It is imperative that nurses caring for these patients have knowledge of caring for patients with epicardial pacing wires. This article provides a general introduction to epicardial pacing, including nursing care and some of the controversies surrounding this area.
Depression and the pathogenesis of heart failure
Authors: McGowan Doireann
Published: May 2014

Chronic heart failure is a widespread condition and its prevalence in the UK continues to grow. Living with chronic heart failure can severely impair longevity and quality of life. Despite the known severe impact this chronic disease has on patients’ lives, little research has explored the prevalence of depression among the UK heart failure population. Recent evidence suggests that depression may not only further worsen the already diminished quality of life for heart failure patients, but it may also significantly increase the mortality risk of the patient living with heart failure. This article reviews current evidence and guidelines to consider the prevalence of depression among UK heart failure patients and illustrates how the pathophysiology of depression negatively impacts on the pathogenesis of heart failure.
Overview of pathophysiology and management of AF
Authors: Banner Davina , Lauck Sandra
Published: May 2014

Atrial fibrillation (AF) is a common supraventricular arrhythmia associated with uncoordinated and irregular atrial activity. It significantly affects morbidity and mortality by escalating the risk of thromboembolic phenomena and haemodynamic compromise. AF is associated with high health-care costs and symptom burden for patients. This article provides an overview of the causes, clinical manifestations, pathophysiology and management of this condition. As AF is encountered throughout a range of care environments, including primary health care, emergency care and acute care, it is critical for nurses to have a good understanding of the mechanisms and management of AF in order to effectively contribute to the diagnosis, treatment and support of patients. In this article, the important contributions of nurses in optimising the care of patients who have AF are discussed and key topics for patient education and support are identified.
Review of femoral artery vascular closure devices
Authors: Chen Alexander WY
Published: May 2014

Coronary angiography is often performed via the femoral artery. Following removal of the arterial sheath, there are various methods of closing the arteriotomy. The traditional method is to use manual compression. Vascular closure devices emerged in the 1990s to promote more rapid haemostasis. This article reviews the various vascular closure devices on the market today, examining their mechanisms of action, as well as their individual advantages and disadvantages.
Smoking cessation: the heart of the matter
Authors: McEwen Andy , Grothier Lucy
Published: May 2014

Smoking is the single biggest cause of preventable mortality and morbidity, doubling the risk of developing heart disease and other cardiovascular diseases. Smoking cessation significantly improves current and future health, but it is not easy to achieve due to the addictive nature of nicotine.

Offering patients who smoke very brief advice on smoking can motive them to make a quit attempt; ensuring that a quit attempt takes place with the help of medication and behavioural support from a trained stop smoking practitioner will maximise the chances of these quit attempts being successful. Nurses are ideally placed to deliver these life-saving interventions. Training for health professionals in how to deliver very brief advice is available through the National Centre for Smoking Cessation and Training.
Home blood pressure monitoring in hypertension
Authors: Lambie James
Published: May 2014

National Institute for Health and Care Excellence (NICE) guidance promotes the role of home blood pressure monitoring (HBPM) in the diagnosis and ongoing monitoring of patients with primary and secondary cardiovascular disease risk. Literature on this mostly originates from outside the UK though, with room for the development of UK nurse-led models of care, including self-management. The use of appropriately validated devices is fundamentally crucial, as is thorough patient education and establishing support for individuals. This article traces the development of HBPM and presents the concept of blood pressure variability, illustrating the context of the NICE guidance. Factors to consider when integrating HBPM into everyday practice are highlighted. Nurses caring for cardiac patients, especially in primary care, should assess the particular needs of their patient groups in approaching the use of HBPM.
ECG of the month
Authors: Regan Clare , Regan Martin
Published: May 2014

Clare Regan and Martin Regan present an ECG for you to analyse. The answers are given on page 50
Compliance with lipid-lowering medication after diagnosis of coronary heart disease
Authors: McKellar Sandra , Fulbrook Paul
Published: May 2014

Background

Previous studies indicate that medication compliance within chronic disease populations, including coronary heart disease (CHD), is poor.

Aim

To determine lipid-lowering medication (LLM) self-reported compliance of CHD patients 12 months following hospital discharge.

Methods

Two 1-year follow-up studies were conducted in tertiary, private and public hospitals. A random sample of patients (n=211) diagnosed with CHD by angiography was recruited. Data were collected via telephone interview, using a standardised questionnaire.

Results

At 12 months, all private hospital participants were still taking LLM and only four public hospital participants had ceased LLM independently of medical advice. Conclusions: The high self-reported compliance found in this study is significantly better than previous research reports of 12-month compliance rates of around 50% in chronic disease populations. Several factors may be relevant, of which the most important may have been the positive influence of the National Heart Foundation of Australia guidelines, which specify early implementation of LLM.
Targeting services for single teenage mothers
Authors: Hawksley Barbara A
Published: May 2014

Single teenage mothers may be at increased risk of not maximising their own or their children’s health potential. In the current climate of change in the National Health Service (NHS), and the move to a primary care led service, targeting services for single teenage mothers may prove to be a more effective use of community based resources. This paper attempts to examine ways in which community nurses may enhance personal and family life, and which of these options may be possible within existing resources.
Therapeutic touch
Authors: Benor Rita
Published: May 2014

Therapeutic touch is a modern form of healing derived from the ancient art of ‘laying on of hands’. It was originated in America in the 1970’s by Dolores Keriger, and is grounded in research. The theoretic framework is within Martha Rogers’ nursing model, Science of Unitary Human Beings.

The roots of therapeutic touch are in the laying on of hands. However, it is not performed within a religious context because in order for therapeutic touch to be effective, the practitioner is not required to have religious beliefs, and the recipient does not have to have faith or necessarily believe in the technique.

An overview of these issues relating to therapeutic touch is presented in this paper.
Skillmix and community profiling in a general practice
Authors: Roberts Geoff , Anstead Elizabeth
Published: May 2014

The progress of a fundholding practice is charted from its decision to implement skillmix through a new nursing management structure to the development of a multi-agency health and social needs profile. The nursing team developed a more participative, flexible and progressive approach to the use of nursing skills and role development in primary care. The multi-agency work produced greater collaboration between individuals at the grassroots.

The practice described in this paper serves 10000 patients in a town in west Surrey with a mixed population. ‘Old Camberley’ has retired generals and others in large old houses, but there are also large estates of young families, a London overspill council estate built in the 1960s, newer small estates of large executive homes and a mobile population of army families.
Pressure sore risk: validating an assessment tool
Authors: Edwards Margaret
Published: May 2014

A study was conducted within a South London community trust to establish whether the Waterlow Pressure Sore Risk Score could usefully assist district nurses in their allocation of pressure relieving equipment to elderly patients.

In part one of the study 40 elderly patients with and without pressure sores were assessed by two community nurses, to measure the level of agreement. In part two, 31 randomly selected patients were followed up for eight weeks, at fortnightly intervals, to measure the ability of the Waterlow Score to predict pressure sore formation. High levels of agreement were not found.

The findings indicate that the Waterlow Score should not be used as the sole basis for the allocation of preventive devices to this group of patients. However, the study did suggest that high to very high Waterlow scores may be a predictor of ill-health in the population. This hypothesis requires further investigation.
Community psychiatric nursing – challenges and opportunities
Authors: Beese Jacquie , Turnbull Jacquie
Published: May 2014

The complexity of dealing with serious mental illness in a community setting presents a significant challenge to mental health services. To meet the needs of this client group the contribution and function of the community psychiatric nurse needs clearer definition. Post registration qualification is essential for this. The focus of training and practice should be on health care needs, to avoid the perceived similarities with social work practice. The dominance of the medical model is weakening, providing the opportunity for community psychiatric nurses to become more autonomous, as is currently evident in their role in court diversion schemes. This automony can be demonstrated in the key pivotal role the community psychiatric nurse can play at the interface between health services and the criminal justice system, primary care and specialist mental health care. Political awareness of their situation will be needed if community psychiatric nurses are to rise to this challenge and promote significant health gain for the seriously mentally ill.
The use of IT in community health care
Authors: Harvey Trevor
Published: May 2014

In the NHS the information follows the patient. As community nursing is information intensive, IT is likely to play an important role in the care of the patient, and community nurses may be required to transfer their IT skills to the new portable technologies. The power of sharing information, however, has yet to be realised, but promises among other things more rational care purchasing.

Data integrity, security and confidentiality are top priorities and improved NHS data standards will eliminate any drawbacks.
Expanding community children's nursing services
Authors: Whiting Mark
Published: May 2014

Although children make up around a quarter of the UK population the provision of community children’s nursing services is inconsistent. In England, which has more provision, pro rata, than Scotland, Wales or Northern Ireland, almost 50% of children who may potentially benefit from such a service have no means of accessing one. Ever since the Platt Report (1959) on the ‘Welfare of Children in Hospital’, support for the development and expansion of such services has been widely advocated in order to meet the wide spectrum need for nursing children in the community. The House of Commons Health Committee (1997) has recently endorsed the expansion of such services. This article examines the background to the Committee’s deliberations and provides insight into how service development may be achieved in the future.
Education for patients with Parkinsons disease
Authors: Harris K , Osbourne L , Richards K , Stewart J
Published: May 2014

A 3-year study, referred to as the Community Parkinson’s Disease Nurse Specialist Project (CPDNSP) 1997 is currently evaluating the effectiveness of Parkinson’s Disease Nurse Specialists (PDNSs) in the community. This study is aimed at improving the quality of life for people with Parkinson’s disease. The findings discussed in this article are based on a survey carried out on 847 patients participating in this project (CPDNSP). The aim of the survey was to assess the level of patient knowledge about Parkinson’s disease and related drug therapy before PDNS intervention began. The results showed that the majority of patients had little understanding of the disease or its treatment. This article explores the relationship between the patients’ understanding of their disease and the improvements in long-term management. The importance of patients recognizing their own symptoms is also discussed. The authors suggest that there is a specific need for further education in this area. PDNS would appear to be in the best position to implement this and can do so by focusing on measures to increase the knowledge of other healthcare professionals, patients and carers.
The therapeutic relationship in cognitive-behaviour therapy
Authors: Sloan Graham
Published: May 2014

District nurses, health visitors, practice nurses and community mental health nurses provide ongoing care and support for clients with varying levels of psychological distress in primary care. As a result they are increasingly using cognitive-behavioural therapy (CBT) interventions in their clinical practice. This article highlights the relevance and importance of the therapeutic relationship when using CBT. Empathy is an integral aspect of the cognitive-behavioural framework and transcripts from therapy sessions are used to illustrate the use of empathy to convey understanding. The role of clinical supervision in developing CBT skills is explored.
Managing fatigue in patients with advanced cancer
Authors: Ream Emma
Published: May 2014

Fatigue is a significant problem for patients with cancer and generally increases as the patient‘s disease advances. It may be caused or exacerbated by numerous factors which become increasingly common with advancing disease including inadequate nutrition, cachexia and weight loss, dyspnoea, depression and treatment. This symptom can be particularly difficult for patients and healthcare professionals to understand and manage effectively as patients move along the disease trajectory. This article reviews the prevalence of fatigue in advanced cancer and discusses the problems associated with recognizing and managing fatigue in this patient group. Potential strategies that can be employed to manage cancer-related fatigue are examined. The theoretical frameworks underpinning nursing knowledge of cancer-related fatigue are critiqued and their potential for guiding the assessment and management of fatigue evaluated. Efficacy of strategies used by patients to manage this symptom and their value for people with advanced cancer are discussed. Finally, the author outlines recommendations for future practice and research.
The link between practice nurse training and asthma outcomes
Authors: Hoskins G , Neville RG , Smith B , Clark RA
Published: May 2014

This article details the results of a study undertaken to establish whether or not there is a link between the level of practice nurse training and clinical outcomes in asthma management. General practices within one health district voluntarily ‘opted in’ to an asthma management initiative which involved clinical audit of 30 asthma patients. Thirty two (41%) practices submitted details on 954 asthma patients. Positive patient outcomes were associated with practices that had clinics organized by a specially trained asthma nurse (n=11). Fewer patients in this group suffered from asthma symptoms, they had fewer acute attacks, were given more aggressive short course systemic steroids and fewer patients lost days as a result of asthma, when compared with practices where the clinics were run by nurses who did not have the diploma qualification (n=14). The authors conclude that there is a strong case for recommending that all general practices should employ a nurse who has undertaken specialized training in asthma in order to improve patient management.
Discharge planning
Authors: Crosbie Bob
Published: May 2014

The impetus prompted by the NHS and Community Care Act 1990 means that acute trusts now regard the discharge planning process as a collective activity with each professional discipline making its own contribution. Multidisciplinary involvement is the key to successful discharge planning. Early referrals to community nursing services, social services, physiotherapy or occupational therapy will promote consideration of patients' medical, personal, functional and social circumstances.
Bowlbyߣs attachment theory: implications for health visiting
Authors: Partis Mary
Published: May 2014

This article reviews the current state of research in attachment theory. It also examines the relations between attachment, child care and development, and the significance of attachment to adult functioning and well-being. It seems likely that humans need close emotional relationships or bonds with others. This need applies particularly to infants, who look to parents or other care givers for love and security. The best-known psychological explanation of this need is attachment theory, which has been influential in increasing our understanding of the early mother-infant relationship, and in the formulation of guidelines for child care (Melhuish, 1998). Good-quality parental care may be difficult to define, and questions remain regarding the nature of child care and the consequences that it can have for later development. This article concludes with a discussion of the possible implications for health-visitor intervention within families, which are intended to improve the quality of the relationship between parents or care givers and the infant.
Management of patients with atopic eczema in the primary care setting
Authors: Peters Jill
Published: May 2014

Nurses in primary care are ideally placed to successfully manage patients with common skin conditions such as eczema. The ability to manage the condition involves combining knowledge of the disease process, aggravating triggers, allergens and the role of the topical therapies that in combination are used to control the condition. Nurses must be able to offer the patient practical information about the application of therapies and changes to lifestyle and environment to enable the patient/carer to anticipate and control potential exacerbations of the disorder. This article cannot discuss all age groups and types of eczema in definitive detail, but introduces the principles of care for this group of patients.
A study of health services for the Chinese minority in Manchester
Authors: Chan Christine
Published: May 2014

This article describes a small-scale study which examined the views of both users and providers of primary healthcare services for the Chinese minority in Manchester. Thirty Chinese mothers of pre-school children were selected from immunization records and interviewed face-to-face at their homes using structured questionnaires and unstructured discussions. Thirty-eight GPs who had the largest number of Chinese patients (n=10) registered with them, and 26 health visitors who worked with these GPs were also interviewed, using semi-structured questionnaires. The findings indicate that a discrepancy exists between the views of GPs, health visitors and Chinese mothers on the use of primary healthcare services. The health professionals’ awareness of the effects of socioeconomic characteristics, demographic profile and indigenous health beliefs and attitudes on the quality of primary healthcare services for Chinese families in Manchester is discussed.
The Expert Patient: a proactive role for DNs?
Authors: Wilson Tricia
Published: May 2014

In contrast to health visiting, school nursing and occupational health nursing, district nursing is not identified as having a major role in the implementation of Our Healthier Nation: Saving Lives (Department of Health (DoH), 1999). There is very little research into the public health role of the district nurse, and it is often regarded by practitioners as simply being one of individualistic health promotion (Cantrell, 1998). This reactive role, with a client population that is typically elderly and chronically sick, does not fit easily with a public health agenda that focuses on health and preventive care. However, at last the Expert Patient initiative presented within the document Saving Lives (DoH, 1999) puts the needs of individuals with a chronic illness explicitly within the public health arena.
Electromuscular stimulation for urinary incontinence: Levator 100
Authors: Dolman Mary
Published: May 2014

Electromuscular stimulation (EMS) can be an effective conservative treatment option for pelvic floor muscle dysfunction for many women. This treatment can be administered by nurses in primary care and by practice nurses and specialist nurses in continence care, provided that they have received comprehensive training. Correct patient selection is essential for the treatment to succeed. This is done by assessing the patient fully and involves obtaining a clinical history and a physical examination of the pelvic floor muscle. Informed patient consent must be sought before commencing treatment. There are some contraindications to the use of EMS; however, when used with the right client for the right conditions, EMS is a safe treatment and can improve symptoms of urinary and faecal incontinence, dyspareunia, vaginismus or lax vaginal muscles. The outcome of an audit of the use of the Levator 100 EMS device, the forerunner to the newer Levator Turbo CS200, is examined.
Exploring the role of the district nurse in rehabilitation
Authors: Goodman Claire
Published: May 2014

This article reviews the available literature to examine the district nurse’s contribution to rehabilitation of the older patient in the community. It is argued that policy and demographic changes indicate that there is a demand for nursing care in the home that enables individuals and their carers to live with chronic health problems and develop strategies that maintain and improve their health. The ways in which district nurses incorporate an understanding of patient rehabilitation within their work is discussed. It is suggested that although there is an expectation that district nurses can and should be involved in planning and supporting rehabilitation for their patients, the process is often poorly defined, hampered by contextual problems and dependent on the cooperation and support of others. Furthermore, in specific areas of care such as cardiac rehabilitation and services for those recovering from stroke, there would appear to be an increase in specialist nurses who either undertake or coordinate the rehabilitation process for patients. This raises questions regarding how district nurses should develop their skills in rehabilitation and what strategies could be adopted to develop patterns of work that ensure collaboration and development rather than overlap and duplication.
An overview of risk in community mental health care
Authors: Leiba Tony
Published: May 2014

Management of risk in mental health nursing is a complex practice and policy issue, and has an impact on mental health policy, the law and service response. The knowledge base and awareness of all those working in situations of potential risk need to be improved, and training has a crucial role to play in developing practitioners’ knowledge and skills base. How the concept of risk relates to mental health is the subject of research and evaluation, which will help develop tools to facilitate prediction and assessment. This article provides an overview of the different views of risk in community mental health services, and comments on the relevance of the legal, social, cultural and psychological aspects of risk to practitioners and users.
Public health and the role of the nurse: the need for greater clarity
Authors: Molloy Jane , Caraher Martin
Published: May 2014

There is evidence that public health is currently taking centre stage in the challenge to improve the population’s health. This represents a change from the 1980s and 1990s where health promotion was the dominant concept among community nurses. Public health means different things to different people and while nurses have a role to play, there is a need to be more precise about their specific contribution. The creation of public health nursing posts across the UK is contributing to this confusion, as there is little emerging consensus as to what professionals in these posts should do. At present, there does not appear to be a dominant strategy or model of working. A preliminary analysis of job advertisements for public health nursing posts indicates a requirement for a ‘supercharged’ health visitor to work in a specific area to provide a link between the professional and lay communities. The emphasis is on community development with little on population health. Government policy on public health clearly highlights the important role of nurses in contributing to the public health agenda. The current role and function of public health nursing posts may not allow them to be classed as specialist public health posts or nurses in such posts to qualify for registration as public health specialists. There is a need for clarity on the role of public health nurses/nursing and to provide educational opportunities for nurses to develop the knowledge and skills which will enable them to work alongside medical and other healthcare colleagues in the pursuit of specialist public health practitioner status.
An audit into homeless families in temporary accommodation
Authors: Riley Rebecca , Johnson Tracy , Pearson Loretta
Published: May 2014

This article describes a clinical audit project undertaken in a number of hostels providing temporary housing for homeless families and individuals in Hinckley, Leicestershire. The audit, carried out over a 6-week period, aimed to collect information about the health and social needs of the residents in the hostels to determine whether an on-site dedicated health visiting service would be of any benefit to them. Family members housed in three council-run hostels were interviewed and a detailed questionnaire was completed. This was used to gather information about the facilities in the hostels, the nutritional and mental status and health and social needs of the residents, the uptake of childhood immunizations and child health surveillance. It also provided information about the resident families’ contact with their family health visitor. Families were living in cramped conditions with shared facilities and no safe play areas for their children. The audit clearly demonstrated that the residents living in the hostels had a range of health problems similar to those described in the literature about the homeless. As a result of the audit, a number of recommendations were made which are discussed in this article.
An audit of problems associated with urinary catheter withdrawal
Authors: Evans Ann , Godfrey Helen , Fraczyk Linda
Published: May 2014

Long-term catheterisation is associated with many complications, including urinary tract infections which may lead to encrustation and catheter blockage. Current management of catheters susceptible to frequent blocking is to attempt to prolong catheter life by using bladder maintenance solutions or to change catheters proactively by identifying a characteristic blocking pattern for the patient. However, catheter removal is associated with a number of problems. This article describes an audit conducted in one trust to identify the types of catheter material associated with removal difficulties. All-silicone catheters appeared to have a higher incidence of reported problems. The formation of a ‘cuff’ in all-silicone catheters when the catheter balloon fails to deflate to its original shape has been investigated as an important factor in difficult removal. The audit also examined what action was taken when nurses were unable to remove a catheter.
Developments in education and training for nursing home staff
Authors: Hicks Allan
Published: May 2014

The independent sector has always provided a proportion of the care needed for a variety of client groups in the UK. Although the vast majority of the recipients of care are older people, groups such as those with mental health problems and those suffering from various disabilities are also cared for. The sector is currently facing the need for major changes in the way it provides care. Legislation and a number of reports and strategy documents mean that these changes are necessary for the sector to survive. To drive and to respond to the new situation, education and training has a part to play. This article will examine how the new situation following the sector will impact on the education needs for nurses.
Record keeping and nurse prescribing: an issue of concern?
Authors: Dion Xena
Published: May 2014

As options are explored by the NHS Executive to extend nurse prescribing in terms of expanding the Nurse Prescribers’ Formulary and widening the groups of nurses eligible to train to prescribe, issues surrounding record keeping in the community need to be revisited in order to safeguard professional integrity. Prescribing nurses in the community face barriers to accurate and adequate record keeping when access to all patients’ records is not permitted and/or time constraints and extra travelling impede the process, potentially threatening the safety of the patient. Until information technology provides the answer to safe and effective use of shared patient records, nurses who prescribe any treatments need to ensure they share full access to all patients’ notes.
Transfix: a new range of all-silicone male incontinence sheaths
Authors: Pascoe Gill
Published: May 2014

Urinary incontinence can have a significant detrimental effect on a person’s body image and self-esteem because it undermines society’s norms relating to control of the body. This can be further complicated by the use of devices to control urinary incontinence. Sheath drainage systems are the most common method of managing urinary incontinence in men. A discreet, reliable sheath drainage system can have both physical and psychological benefits. A full continence assessment is paramount for a successful outcome as there are several potential problems associated with this method of management. There are many products available, so the health professional needs a comprehensive knowledge of both products and application techniques. The Sims Portex Transfix range of all-silicone self-adhesive sheaths have many benefits and offer a reliable form of sheath management for male urinary incontinence.
Managing gravitational eczema and allergic contact dermatitis
Authors: Patel GK , Llewellyn M , Harding KG
Published: May 2014

Venous leg ulceration is a common chronic problem in the community, and gravitational eczema is a common complication of it. The presence of gravitational eczema can lead to further ulceration and may also impair wound healing. Treatment often requires more than one topical preparation, to gain control and prevent relapse. Knowledge of the benefits and risks of these therapeutic modalities is essential. In this article we aim to provide a practical approach to the treatment of gravitational eczema. We also discuss allergic contact dermatitis, a common complication of gravitational eczema.
Wound care assessment with the Polaroid Macro 3 SLR
Authors: Williams Clare
Published: May 2014

A holistic wound assessment is a vital first step in the wound management process. If it is not undertaken it is impossible to implement a treatment plan. The health care professional who undertakes the assessment must have an underpinning knowledge of the anatomy and physiology of the skin, associated tissues and organs, and of the wound healing process. Young (1997) stated that:
Investigations in the management of lower limb ulceration
Authors: Vowden Peter , Vowden Kathryn
Published: May 2014

This article explores the concept of compression-bandaging for venous leg ulcer management within the framework of clinical governance. It considers areas, such as clinical evidence, clinical audit, clinical risk-management, quality assurance and professional development, and relates this to everyday practice in the management of venous leg ulcers using compression-bandaging. It acknowledges that the elements of clinical governance are not new to nurses, but provide the relevant information that brings together clinical issues with nursing policy and government directives.
Meeting demand for clinical placements in one community trust
Authors: MacLellan Maureen , Leyshon Stephen
Published: May 2014

The effective management of learning in clinical practice is assuming growing significance for all health-care organizations. This is due to various professional and political imperatives that underscore the need to produce increasing numbers of practitioners who are sufficiently skilled to be deemed ‘fit for practice’, and must also be prepared to use their skills in different ways in a ‘modernized’ NHS. This article explores some of the ways in which one community trust has responded to this challenge, a challenge compounded by the need for extended final year medical student primary and community care placements. It also attempts to illustrate the extent to which we have recognized the importance of adopting an interprofessional approach to learning in and about practice.
The politics of nurse prescribing
Authors: While Alison
Published: May 2014

The Cumberlege report (Department for Health and Social Security, 1986) first recommended that community nurses should prescribe from ‘a limited list of items and simple agents’ as part of their care delivery. This suggestion was supported by the first Crown report (Department of Health (DoH), 1989) which additionally recommended the capacity to adjust the timing and dosage of medicines within set protocols. However, it was not until 1992 that legislation was enacted to permit independent prescribing by nurses from a limited list of medicines, after a management consultant report indicated the potential benefit of speedier access to medicines together with professional time savings.
Do poor nutrition and display screens affect visual acuity in children?
Authors: Kerr Catriona M , Tappin David M
Published: May 2014

Two studies conducted in Scotland have shown an increase in visual acuity (VA) screening failure among primary school-aged children in recent years. Two other trends were observed during the same period – an increase in children bringing packed lunches to school, and increased access to display screen equipment (DSE) including television, computers and hand-held computer games. This study set out to assess if either DSE use or poor diet could be linked with visual acuity screening failure in Scottish primary school children. Information was collected on diet and DSE use from 1384 children who had received VA screening in eight primary schools in Glasgow. After controlling for deprivation, DSE use other than watching television was associated with an increased risk of VA screening failure, as was a ‘poor’ diet. If these findings are confirmed by other studies and a causal link can be made, then health education at school could be designed to prevent VA screening failure.
Fungal nail infections: far more than an aesthetic problem
Authors: Bending Angela
Published: May 2014

Onychomycosis (fungal nail infection) is common and causes considerable discomfort and pain for many otherwise healthy patients. However, onychomycosis is especially prevalent in some patient groups seen regularly by community nurses (e.g. the elderly and people with diabetes, human immunodeficiency virus (HIV) infection or psoriasis). This article discusses the causes and types of onchomycosis, and examines in detail the various treatments available. Both the infection and its treatment can cause several clinical problems including drug interactions, difficulties with differential diagnosis and compromise of clinical outcomes. In particular, onychomycosis can undermine foot care in people with diabetes. The role of community nurses in treating and preventing onychomycosis is discussed.
Practical skills: prescribing consultation in practice
Authors: While Alison
Published: May 2014

Whether trained to use the Nurse Prescribers’ Formulary for District Nurses and Health Visitors or the Nurse Prescribers’ Extended Formulary, nurses who prescribe will have to develop a range of new or enhanced skills to practice effectively. In the first of an occasional series on practical skills for prescribing, Alison While examines the prelude to any prescription: the consultation.
Randomised, comparative study of three primary dressings for the treatment of venous ulcers
Authors: Charles Hildegard , Callicot Charlotte , Mathurin Desma , Ballard Kate , Hart Jeff
Published: May 2014

In this article, we describe a randomised trial in which two established primary dressings – Comfeel® (Coloplast, UK) and Granuflex® improved formulation (Convatec, UK) – were compared to Cutinova® foam (Beiersdorf Medical, UK) in the management of venous leg ulcers. Patients that met the study trial criteria were randomised to receive one of the three primary dressings. All ulcers were secondarily bandaged with Comprilan® (Beiersdorf Medical, UK) short-stretch compression. The three dressings were compared in terms of their ability to promote ulcer healing (closure rate and healing rate) and reduce the prevalence and severity of ulcer-associated pain, over a 12-week period. The ease with which dressings could be used in a busy outpatient clinic setting was also considered. On enrolment, groups were well matched in terms of all of the patient and ulcer parameters studied. Six patients were withdrawn for reasons unrelated to study dressings or trial procedures. Following non-parametric analysis of the study data, the three dressings were found to be equally effective at promoting ulcer healing and alleviating ulcer-associated pain. Study personnel rated Cutinova® Foam as easy, if not easier, to use than Comfeel® or Granuflex®. This study suggests that Cutinova® Foam is as safe and effective as both Comfeel® and Granuflex®, in the treatment of venous leg ulcers.
To use or not to use? The debate on the use of antiseptics in wound care
Authors: Scanlon Elizabeth , Stubbs Nikki
Published: May 2014

The use of antiseptics for wound care has long been controversial. Antiseptics have a broad spectrum of activity that, in addition to making them effective against a broad range of microorganisms, makes them toxic to living human tissue. Consequently antiseptics gradually fell out of favour following the introduction of systemic antibiotics. In recent years, however, there has been renewed interest in antiseptics as a result of the evolution of antibiotic resistant bacteria, and considerable funds are being invested in the development of modern antiseptic dressings. This article aims to discuss some of these issues and set them in a practical context so that readers recognize the complexities of decision-making where antiseptics are concerned. This in turn should enable them to make a better-informed choice for their patients or, where appropriate, seek expert advice.
BagBath: the value of simplistic care in the community
Authors: Collins Fiona , Hampton Sylvie
Published: May 2014

Community nurses need to manage and embrace both the clinical and public health needs of their clients, which requires both ingenuity and improvisation. Although the community care environment is very different to hospital care, like all professionals, community nurses must live with the inevitability of change. The modern nurse must offer high-quality patient care and should be constantly striving for cost-effective methods of providing that care. In this product focus, the cost-effectiveness and infection control potential of the prevalent practice of ‘bed bathing’ is compared with the new concept of BagBath (Westholme Ltd). BagBath is a quick-drying one-step bed bath product offered as an alternative to the bowl of water, soap, flannel and towel.
Multidisciplinary communication in the Irish public health nursing service: a study
Authors: Hanafin Sinad , Cowley Sarah
Published: May 2014

Public health nurses (PHNs) in the Republic of Ireland work as part of a multidisciplinary team in the delivery of community-care services. Good interdisciplinary communication is therefore vital to enable them to offer the best possible care to their clients. This article reports on one section of a national survey of PHNs who work with families with infants. The findings suggest that although in general, PHNs reported good working relationships with other professionals – particularly with speech therapists, area medical officers and community welfare officers – the same could not be said for hearing and eye specialists. Feedback also varied according to professional group, with less than one third of PHNs reporting they always received feedback from GPs, eye specialists or social workers. A significant statistical correlation was found between reported working relationships and the frequency that feedback was received. These findings have implications for communication and teamworking in primary care in the Republic of Ireland and elsewhere.
How effective is training in compression bandaging technique?
Authors: Feben Katherine
Published: May 2014

The aim of this review was to investigate whether formalized compression bandage training is required for nurses to achieve compression bandaging of high quality, that is bandaging which produces sustained graduation from toe to knee. Medline, CINAHL and Embase databases were used in the search. Randomized controlled trials and quasi-experimental trials were included where (at a minimum) nurses experienced in compression bandaging had their skills reviewed before and after training, and then reviewed once more at a later follow-up session. Three studies matched these criteria. In all three, nurses in general did not achieve sustained graduated compression before training, despite being defined as experienced bandagers. There was a substantial improvement in bandaging skills immediately following training. Two trials found that this improvement was sustained for between 2 and 4 weeks. The results of the third study suggested that improvements might not be sustained in the longer term. This review raises issues for further research including the current standard of compression bandaging, by those individuals who consider themselves competent in this skill. In addition, there needs to be argument on how nurses’ bandaging skills can be improved and maintained, including the depth of role of feedback. In the meantime, nurses need to be as diligent as possible in maintenance of their compression bandaging skills, and the training they give junior staff. The effectiveness of current training cannot be assessed by short-term improvements and must not be assumed.
What are older people prepared to do to avoid falling? A qualitative study in London
Authors: Simpson Janet M , Darwin Cressida , Marsh Nicola
Published: May 2014

Falls prevention strategies form a significant part of recent government policy relating to older people. In this article we report a qualitative study to examine the extent to which older people are willing to adopt any of the following strategies in order to avoid falling: balance and lower limb strengthening exercises, home safety advice, and ‘taking care’. A sample of community-dwelling inpatients who were more or less afraid of falling were interviewed. Some older people blamed their own unsafe behaviour rather than hazards in their home for falls, so taking care (moving slowly, holding on, being vigilant to and avoiding danger) was a widespread strategy. The benefits of exercise in falls prevention were poorly understood and there was little enthusiasm for exercising especially if it was perceived to be inappropriate in old age or painful. Awareness of home hazards and taking measures against them was common but home visits tended to be regarded as intrusive. Inadequate negotiation about adaptations was widespread and led to resentment and unwillingness to cooperate. Building on the widespread ‘taking care’ strategy may help educate older people in safe behaviour. Health professionals should encourage older people to exercise and when making home safety visits should confer with their clients, taking their preferences about adaptations into account.