bluuebunny/crossref_metadata_2025 huggingface dataset:
The management of hypoglycaemia in type 1 and type 2 diabetes
Authors: Diebel Georgia
Published: May 2014

The effective management of type 1 and type 2 diabetes now requires diabetes care teams to strive for ‘tight’ blood glucose levels. Evidence has shown that maintaining blood glucose levels of 4–9mmol/l is associated with a reduction in the long-term risk of diabetic complications such as retinopathy and nephropathy. Tight control of blood glucose levels requires the titration of either insulin (type 1) or tablets and/or insulin (type 2) doses in relation to the individual’s lifestyle. As the demand to achieve near-normal blood glucose levels increases so does the risk of hypoglycaemia. The management of hypoglycaemia in type 1 and type 2 diabetes mellitus and factors that precipitate its occurrence are discussed. The aim is to prevent blood glucose levels of less than 4mmol/l and to ensure that the person with diabetes can recognize and appropriately treat the signs and symptoms of hypoglycaemia.
Establishing a research team in general practice
Authors: Plastow L , Marshall M , Luthra M , Russell D , Stokes K
Published: May 2014

The integration of multiprofessional teaching, training and audit within general practice has demonstrated that service and academic practice are not necessarily mutually exclusive. This recognition is now leading to the development of research teams within traditional service-orientated general practices. The many unresearched and under-researched areas in primary care provide an opportunity for nursing and other professionals to combine clinical and academic practice. This article describes the process of establishing a multiprofessional research team in a non-academic practice in the South West of England. It focuses on the issues required to achieve the team’s aims, which include the development of research expertise; publication of projects; successful application of project-based grants; and the development of a research culture within primary health care. The challenges addressed and the lessons learned in the first year since its inception are outlined.
Clinical governance: improving quality
Authors: While Alison
Published: May 2014

There has been increasing concern about the deteriorating quality of care available in the NHS. Successive governments have attempted to address this concern with different initiatives ranging from managerial and structural reorganizations to educational changes including the introduction of new curricula for both nurse and medical preregistration programmes. However, despite these initiatives the quality of healthcare services continues to cause concern both for consumers and politicians alike — a concern which is also readily acknowledged in the professional press in the light of the available evidence regarding resource constraints.
Reality bites on Big Brother
Authors: Pollard Tom
Published: May 2014

Unlikely as it may have seemed at the beginning, Big Brother ended by highlighting the uncomfortable reality that is healthcare rationing in the UK. Dismissed by the more cynical among us as a game-winning ploy, Craig’s donation of his prize money to provide a heart-and-lung transplant in the US for his best friend’s cousin with Down’s syndrome turned out to be genuine.
Communicable disease and infection control: the surveillance contribution
Authors: Howard Janet
Published: May 2014

In its much publicized report (2000) the National Audit Office (NAO) has emphasized the important part surveillance plays in determining infection rates and infection control in general. Community nurses may be forgiven for pointing out that this report concentrates on hospitals, however it strongly recommends that surveillance be extended out into the community. This is a sensible move as studies quoted in the NAO report indicate that 50–70% of surgical wound infections occur during the post-discharge period. The boundaries between acute and primary care are becoming ever more blurred: increasing numbers of susceptible patients are being managed in the community and the number of invasive procedures carried out is rising in line with government policy. Action to control infection extends beyond the narrow boundaries of health care to involve the whole population, and although the idea of extending the surveillance of healthcare related infection from hospital to community settings appears to be relatively new, the surveillance of infectious diseases that occur in the community is not. It is, in effect, a key proactive infection control activity which facilitates targeted and effective infection control measures. This article aims to define and explain surveillance as it relates to infection control and communicable disease control in the community by using examples from history, the current Meningitis C vaccination programme and the surveillance of hospital-acquired infection in the USA.
Crisis within the NHS: concern over standards
Authors: Clarke Gwen
Published: May 2014

Recent media reports concerning the NHS can have done little to inspire public confidence in the health care system. This winter’s influenza outbreak in the UK uncovered the harsh reality that the health service is currently underfunded and under-resourced, with an acute sector struggling to provide care for all those in need. The shortage of acute hospital beds may have serious implications for community services in terms of the quality and continuity of care provision. Patients who are forced to wait even longer for routine and non-urgent procedures may become ill or require ongoing care in the community while others may be discharged home too early and opportunities for better recovery and rehabilitation may be lost.
An audit of drug incidents in learning disability group homes
Authors: Thurtle Val
Published: May 2014

The implementation of clinical governance (Department of Health, 1997) requires the review of practice by consideration of complaints and clinical incidents. A systematic review of the clinical incident forms in group homes for those with learning disabilities, within an NHS community trust, highlighted issues for concern. This led to an audit being conducted of drug administration procedures involving examination of records and observation of practice. It demonstrated that there was general adherence to the trust’s policies. The audit stimulated debate, and a number of potential areas for action were identified. The review of drug administration with clients who have learning disabilities raised wider questions about the scarcity of evidence in this area to support practice, the culture of client-centred homes and whether monitoring systems are sufficiently robust.
A podiatrists view of community diabetic foot management
Authors: Turns Martin
Published: May 2014

The diabetic foot is an enormous burden to the patient, society and to the NHS. This article offers a podiatrist’s view of the diabetic foot: the principles behind the disease process, the management of diabetic foot complications and how problems can be avoided. The major contributing factors of diabetic foot ulcers are discussed, the role of the podiatrist described, and the principles of screening and community-based management of ulcers outlined. Education and communication are highlighted as key elements in successful diabetic foot management.
Some new and important clues to the causes of colic
Authors: Buckley Mary
Published: May 2014

Colic, or persistent unexplained crying in infants, is commonly encountered by health professionals. While not harmful to the child, it can place a great deal of stress on the parents and family. The cause of colic has not been definitively identified. Transient lactose intolerance, as a result of inadequate production of the enzyme lactase, is one possibility. Studies have shown a reduced crying time when formula or breast milk is incubated with lactase. Colief Infant Drops consist of lactase in a glycerol and water solution which, when added to formula or breast milk, converts lactose to simple sugars and makes the feed more easily digestible.
Preparing the next generation for citizenship
Authors: While Alison
Published: May 2014

The new academic year heralds a fresh intake into schools and colleges throughout the country. It provides school nurses and others involved with children and young people with another opportunity to be an influence for good in their lives. It is now recognized that the foundations for good health and longevity are laid in childhood and, further, that there is an inextricable link between health and the realization of full educational potential.
Eroding the barriers between public and private health care
Authors: Don Jan , Sinclair Grace
Published: May 2014

A Concordat with the Private and Voluntary Health-care Provider Sector (Department of Health (DoH), 2000a) proposed a strategy to remove barriers between public and private health-care providers. The document set out a broad framework to enable the NHS to use a wider range of services more imaginatively to meet local health needs. It was recommended that decision-making be devolved to the local level to enable more tailored services to be available to the community. Primary care groups (PCGs) were therefore encouraged to commission services from the private sector. This was especially relevant to relieve pressure on hospital beds during the winter months (DoH, 2000b).
Welcome back, tax and spend?
Authors: Pollard Tom
Published: May 2014

The Chancellor, Gordon Brown’s promise to give the NHS an extra £1billion next year and his hint that higher taxation is the only way to improve funding of the NHS will have sent a shiver of excitement through sections of the health-care community. For many, it will seem a long-awaited vindication of their decision to vote Labour in 1997. The Government seems to have grasped the nettle of taxation for health which many people have supported for years. It seems that there may soon be a dependable source of funding for the grand ideals outlined in the NHS Plan.
Total continuity of care may not be achievable
Authors: While Alison
Published: May 2014

The perspective of the patient is being given increasing weight in health delivery. Concern about the service user’s experience has emerged as a key quality dimension. Continuity of care is one dimension where current health provision is acknowledged often to be lacking in this regard.
There's no alternative to taxation
Authors: Pollard Tom
Published: May 2014

Election stunt or not, the new National Service Framework (NSF) for Older People is to be welcomed. Official recognition of the second-class status that older people have had for many years – in the National Health Service (NHS) and wider society – is long overdue, and policies to tackle the neglect are timely. Yet there still remain doubts over the government’s ability (or will) to make the substantive changes that will allow all sectors of society access to the care they need.
Intermediate care doesn’t provide all the answers
Authors: While Alison
Published: May 2014

The National Service Framework for Older People (Department of Health (DoH), 2001) identifies intermediate care services as providing a necessary bridge between existing services in hospital and primary care. These new services will comprise information/advice to enable care in the home; intensive support in the home (hospital-at-home schemes); and short-term institutional care in a supportive environment such as a community hospital, nursing/residential home or sheltered housing. These services will be provided in conjunction with others such as diagnostic and ambulatory care, aids and equipment, home improvement support and carer support. An improved 24-hour provision of primary care together with better working relationships with accident and emergency departments is also planned to effect appropriate response at the time of need.
No place for prejudice or discrimination
Authors: While Alison
Published: May 2014

In Valuing People: A New Strategy for Learning Disability for the 21st Century (Department of Health (DoH), 2001), the Government set out its intention to promote the wellbeing of people with learning disabilities as equal citizens in our society. In addition to 210000 people with severe learning disabilities, there are over 1 million people with less severe learning disabilities in the UK, all of whom require substantial support. The report noted the weaknesses of current services: poor planning and coordination of provision, limited choice and many unmet needs, and few examples of partnership between different service providers and people with learning disabilities or their carers. The report’s proposals are based on the recognition that all citizens – including people with learning disabilities – should have rights of independence, choice and inclusion in their local communities.
Nurse prescribing gathers momentum
Authors: While Alison
Published: May 2014

The new year will usher in the next phase of the extension of prescribing rights. The legislation will be in place to enable a further development of nurse prescribing and prescribing by other designated health care professionals. While the extension is to be broadly welcomed, it raises a number of issues that must be addressed.
Profore (TM) bandaging system: a patient-led product development
Authors: Moffatt Christine
Published: May 2014

Four-layer bandaging has been in existence for over 15 years, during which time it has been used in numerous studies, and in many populations throughout the world, setting a gold standard of practice against which other compression systems are compared.
Bed blocking: fining councils not the answer
Authors: Pollard Tom
Published: May 2014

A relative of mine has recently joined the much-maligned ranks of the so-called ‘bed blockers’. Three weeks after falling in her residential home and banging her head, she is still in hospital because the residential home cannot take her back (she has rapidly accelerating Alzheimer’s), and no nursing home place can be found. She cannot be cared for at home, because her home has been sold to pay for her care fees. There is allegedly a 6-month waiting list for the best nursing homes in the area, raising the prospect of a lengthy stay in hospital.
3M Tegapore (TM): the case for a modern wound contact material
Authors: Fear Mair
Published: May 2014

Wound contact materials have long been viewed with suspicion: the tendency of granulation tissue to grow into gauze materials, and outdated practices such as wet-to-dry dressings for debridement mean that they are associated with pain and trauma at dressing change. Modern wound contact materials, however, have been designed to avoid these difficulties, and there are a growing number of case reports that support their use in planned wound care interventions. This article examines the case for the use of Tegapore™ wound contact material as part of the treatment of long-lived and complex wounds.
‘No change’ is not an option
Authors: While Alison
Published: May 2014

Primary care is the cornerstone of our health services with more than three-quarters of NHS contacts being through general practices (Audit Commission, 2002). However, the work of general practices has changed considerably over the last 50 years, reflecting many organizational changes as well as numerous developments in clinical care, which have both extended life and enabled effective complex disease management outside hospitals. Unfortunately the hoped-for reduction in workload from the establishment of NHS Direct and Walk-in Centres has not been realised. Further, one-third of the workforce is approaching retirement age and despite intensive recruitment and retention initiatives many GP, practice nurse and community nurse vacancies remain unfilled. Compounded with this is the recognition that services need to be modernized so that they meet population needs, with the convenience of users taking precedence over established service delivery patterns. This has resulted in numerous tensions between the traditional model of service delivery focused around the GP and modern expectations which demand rapid access, uniform care standards and extended provision to minimize hospital contact (Audit Commission, 2002).
Complementary therapies and health promotion
Authors: Mantle Fiona
Published: May 2014

Nurses have an important role to play in health promotion and it is important that they have a comprehensive knowledge and understanding of the theories of health promotion and conventional interventions. However, they are increasingly likely to be asked about the efficacy of non conventional interventions and the likelihood of these interventions being of value to the client. This paper offers a review of the evidence to support the role of complementary therapies as adjunctive treatments to enable nurses to discuss their use with their clients as part of their health choice options.
The nation is getting fatter
Authors: While Alison
Published: May 2014

Excessive weight is an increasing health issue throughout the world (WHO, 1998) with obesity in UK rising more than in other countries. It is predicted that if trends continue a quarter of all adults in UK will be clinically obese by 2010 (National Audit Office, 2001), representing a major public health problem.
Choosing the right voice for district nursing
Authors: Pollard Tom
Published: May 2014

It will come as no surprise to you that a common complaint of district nurses I speak to is the level of their caseloads. Constantly overstretched, many nurses are consequently not able to deliver the quality or quantity of care that they would like. While I am not suggesting that substandard care is necessarily the result, I think many readers would agree that the stresses of overly large caseloads can mean that care delivered may often be simply adequate rather than excellent. Patients may never know this, of course, and public support for community nurses remains extremely strong, but many nurses feel that they could do more for their patients if they only had more time.
WoundCare: meeting your information needs
Authors: Gibson Louise
Published: May 2014

Welcome to the first issue of WoundCare, published by British Journal of Community Nursing in association with the Wound Care Society (WCS). WoundCare represents an exciting new direction for the WCS. Since its inception in 1989, the philosophy of the WCS has been to assist nurses to provide informed wound management, based on sound research, while at the same time emphasizing the importance of providing total care for the patient.
Correspondence
Authors: Jones R , Perneger Thomas
Published: May 2014

was interested to see in the last issue of WoundCare [Pressure ulcer tool. Br J Community Nurs 7(9 suppl): S6] that another pressure ulcer risk assessment scale has been devised — the Fragmment scale. At first sight it would seem to be along the lines of Braden and, like Braden, professes to be a predictor, unlike Norton and Waterlow which make no such claims. The research claims that it performs better than conventional scoring systems at ‘predicting pressure ulcer development within 5 days’.
Wound microbiology: past, present and future
Authors: Cooper Rose A
Published: May 2014

Investigations into the causes of wound infection began in the late 19th century. In modern diagnostic laboratories the isolation, cultivation and identification of wound pathogens is still important, but routine sampling and recovery methods have limitations. Molecular techniques for characterizing species in clinical specimens may revolutionize our knowledge and understanding of microbial communities in wounds.
Closing service gaps will make a difference
Authors: While Alison
Published: May 2014

The Christmas-New Year break may have brought joy to many but for others it will have been a sharp reminder that they are isolated and easily forgotten. Despite various government initiatives to create a more sustainable caring infrastructure for the growing older population, services for older people are all too frequently not well coordinated and fail in their intention to support living at home independently.
The RCGP Quality Practice Award for primary care teams
Authors: Ring Nicola
Published: May 2014

Accreditation is a means of improving quality through the process of externally reviewing performance against written standards. Following the introduction of clinical governance, participation in quality accreditation schemes has been encouraged. The Royal College of General Practitioners’ Quality Practice Award (QPA) is an example of a quality accreditation scheme for primary care practice teams. QPA applies to the wider primary care team and is directly relevant to nursing and midwifery staff employed by or attached to practice teams. QPA supports evidence-based and reflective practice, continuing professional development and team working, all of which are integral to current nursing and midwifery practice. Nurses and midwives working in primary care teams must be aware of QPA and, where necessary, actively and collaboratively participate in this process.
All epidemics deserve health care attention
Authors: While Alison
Published: May 2014

The frightening progress of sudden acute respiratory syndrome (SARS) towards a potential global epidemic has caused a media frenzy. In contrast, the global epidemic in obesity has received relatively little attention despite its clear association with significant morbidity and mortality. In part the contrasting media attention reflects the emergence of a new threat which seems to be no respecter of age or health status, with fit adults experiencing similar mortality rates to the usual vulnerable groups such as older people.
Falls in older people: the role of assessment in prevention and care
Authors: Unsworth John
Published: May 2014

Falls among older people constitute a serious public health problem, which has a substantial impact on both the person and on health-care services. Falls assessment can be divided into a number of types. Community nurses are well placed to use falls risk checklists to identify older people who may be at risk of falling and then offer these individuals a more in-depth assessment. In addition, community nurses have a role to play in assessing older people who have recently fallen to prevent future falls and potential injury. Falls prevention programmes centre on the identification of risk factors and the planning and delivery of interventions designed to eliminate or ameliorate these risks. A falls assessment should include a review of intrinsic factors such as mobility, lower extremity functioning, vision, medications, footwear and past medical history. It is also important to consider extrinsic factors such as tripping, slipping and other environmental hazards.
Prevention of fractures in older people who fall
Authors: Unsworth John
Published: May 2014

Despite assessment and appropriate interventions, some older people will continue to be at risk of falling. Fractures of the hip and wrist are especially common among this group. The risk of fracture means that a comprehensive falls prevention programme must include an assessment of the individual fracture risk and the instigation of appropriate treatment to reduce this risk. This may include the use of external protective devices such as hip protectors or the treatment of bone fragility. Osteoporosis is the main case of bone fragility in this client group and it is commonly associated with postmenopausal women, although other forms exist. Osteoporosis is also a problem for men as they get older and for individuals taking steroid medications. Community nurses need to be aware of how osteoporosis manifests itself as well as how this condition can be prevented and treated.
The avoidable toll of accidents
Authors: Alison While
Published: May 2014

Despite enormous advances in many areas of life, recent years have have not seen a corresponding reduction in the number of accidents, which continue to take their toll across the lifespan. Accidents appear resistant to reduction despite being identified as a priority for action both by this Government (Department of Health (DH), 1999) and previous administrations. As the single largest cause of mortality (Towner et al, 2001) and a substantial burden on health services (British Medical Association, 2001), accidents deserve considerable public health effort.
The holistic assessment of a patient with leg ulceration
Authors: Fox Carolyn
Published: May 2014

Assessment is part of the core work of nursing; it is the necessary prelude to any nursing intervention, and forms the basis of all care and management plans. The importance of effective holistic assessment cannot be overstated. Essential to effective assessment is a clear understanding of the factors that are being assessed, and the shortcomings of the techniques used for assessment. This case study illustrates the process of a health assessment of a patient with leg ulceration, drawing on the available literature to provide guidance on the interpretation of signs and symptoms. The assessment process is based on that which Epstein et al (1992) proposed to assess peripheral vascular disease, and has been adapted for use with leg ulceration.
Court appearance 2: Presenting oral evidence in court
Authors: Griffith Richard , Channon Ceri
Published: May 2014

Armed with her knowledge of the court structure and personnel involved in the hearing, Mary has done much to demystify the working of the court yet she will still be slightly nervous giving evidence for the first time. This article will look at the process of evidence giving in court in more detail.
Changing times and a fresh start for BJCN
Authors: Pollard Tom
Published: May 2014

We all know that these are times of great change. The last decade (and probably the decade before that) has seen an unending succession of Acts, White Papers, guidelines and directives. GP fundholding has come and gone. Primary care groups have been replaced by primary care trusts. Nurse prescribing has become part of the nursing landscape. The emphasis in primary care is increasingly on prevention rather than cure, on maintaining people at home rather than rushing them off to the hospital.
Giving the influenza jab: a review of the law
Authors: Griffith Richard
Published: May 2014

As an experienced district nurse, Sister Harris is acutely aware that influenza (‘flu) is a highly infectious viral disease that mainly occurs during the winter months. An unpleasant but self-limiting illness for most people, ‘flu is a significant cause of more serious illness to at-risk groups such as frail older people. Even where the general incidence of ‘flu is low, approximately 3000–4000 deaths annually are attributed to the disease (Joint Committee on Vaccination and Immunization (JCVI), 2004).
Converting people with type 2 diabetes to insulin
Authors: Rodgers Jill
Published: May 2014

Type 2 diabetes has commonly been viewed as more benign than type 1, partly because it was once rare to use insulin in its management. With the recognition of the importance of tight control of blood glucose, it is now the case that most people with type 2 diabetes will require insulin at some point. This article discusses the reasons why insulin treatment should be used in type 2 diabetes, and some of the practicalities of insulin initiation and management.
Looking over the new primary care landscape
Authors: Boran Sue
Published: May 2014

The aims of the district nursing team are already many and varied: to prevent ill-health and to keep people healthy; to provide support for people living with long-term conditions; to treat curable problems and to provide nursing care to those with acute and complex needs; to offer palliative and terminal care to those who require it so that they may die in accordance with their wishes. Recent Government policy goes further, clearly placing district nurses in new flexible roles that are critical in enabling individuals to be supported at home, and in spearheading community-based health provision to improve the public health.
Promoting nursing, or hiding the truth?
Authors: Pollard Tom
Published: May 2014

I recently had an interesting conversation with a former nurse who accused the nursing press of effectively standing by while the health service died a slow death. I was taken aback. Surely, by promoting the sharing of knowledge and new ideas, we are making a contribution to the invigoration of the health service? Apparently not. By doing little to highlight the reality of working in the health service, the nursing press was contributing to its downfall.
Childhood H. pylori: disappearing disease or chronic infection?
Authors: Shepherd Ashley , Malcolm Cari , Mackay William G , Weaver Lawrence T
Published: May 2014

Helicobacter pylori is one of the commonest chronic bacterial infections worldwide. It is acquired during childhood and its persistence has implications for health in later life. In adults, it is the principle cause of duodenal ulcer disease and there is evidence of an association between H. pylori and gastric cancer. However, most colonized people are asymptomatic. The prevalence of H. pylori increases with age but there is a striking difference between the rates in developed and developing countries. As no significant non-human or environmental source for this infection has been identified, person to person spread is almost certainly the main mode of transmission. Community nurses should be aware of this microorganism as a potential cause of illness in children, and that they can play a role in promoting hygiene practices and educating families so that the risk of acquisition may be reduced. This review discusses the clinical features, prevalence, risk factors for transmission, diagnosis and treatment of H. pylori.
Who takes responsibility for care failures?
Authors: While Alison
Published: May 2014

The unacceptable behaviour of Sir Philip Watts, former chairman of Shell, and his Dutch colleague, Mr Van de Vijver, has been aired copiously in the press in recent weeks. The corporate image of Shell belied internal strife and misrepresentation of ‘proved’ oil and gas reserves over many years. Essentially they lied and they have rightly forfeited their jobs and their reputations. However, at the end of the day loss of investor confidence was the main consequence and no lives have been lost. Shell will now be dissected and voyeurs of all descriptions will offer armchair advice regarding the firm’s structure and culture. Compare this to avoidable loss of life or compromised levels of health and social care, which attract little comment and where the organizations responsible are rarely held accountable in the same way.
Learning disabilities: lots of room for improvement
Authors: While Alison
Published: May 2014

Whatever happened to the implementation of Valuing People (Department of Health, 2000) and the wholesale change in attitudes and behaviour of public services towards people with a learning disability? The launch of Treat Me Right by Mencap (2004) provides a stark reminder that there is still considerable room for improvement. Treat Me Right sets the scene by summarizing the tragic story of Max, who died aged 30 following a fall in which he fractured his hip. It is contended that his treatment was sub-standard and certainly below that which his non-disabled peers would have received.
Assessing cognitive impairment in older people: the Watson clock drawing test
Authors: Armstrong Esther Christopher , Hagen Brad , Sandilands Mark , Smith Christine
Published: May 2014

A non-random sample of 331 community-based clients aged 75 years and over, who were being cared for at home, were involved in a longitudinal study to assess cognitive impairment (CI). The clock drawing test (CDT) using the Watson et al (1993) scoring protocol was used to determine its utility as a tool for community nurses to assess CI. In the first phase of the study 294 CDTs were used in analysis and 58.8% (n=172) of participants were cognitively impaired. Subsequent assessments at 9months and 18 months using both the CDT and the Mini-Mental State Examination (MMSE) confirmed the high initial level of cognitive impairment among the sample. Over the course of the study 37 participants who had high CDT scores were admitted to institutional care and their cognitive status continued to decline. Among those who remained in the community, the percentage with some degree of cognitive impairment remained high, and over the course of the study there was a significant linear decline in the mean MMSE score. The CDT takes less time to administer than the MMSE and appears to be a more sensitive tool for detecting early changes in cognition. The CDT could therefore be useful as an initial assessment tool by community mental health nurses to help facilitate early intervention for older clients who are beginning to experience cognitive changes.
The heat is on: strike while the iron is hot
Authors: While Alison
Published: May 2014

Despite the fact that many PCTs recently failed to achieve the coveted 3-star rating, and regardless of concerns about the financial viability of many PCTs caused by the move to ‘payment by results’, improved chronic disease management initiatives are rolling out across the country. These initiatives make both clinical and financial sense, and provide nurses and pharmacists – through the medium of supplementary prescribing – the perfect opportunity to demonstrate their skills in this expanding arena.
Leg Club®: innovative, inspirational practice
Authors: Pollard Tom
Published: May 2014

Taking a couple of days away from the office last month, I was privileged to be able to visit three Leg Clubs in the east of England. Apart from being found to have high blood pressure, it was a fantastic experience, and I would urge any nurse interested in delivering best care to their community to visit one or find out more.
Wound care education and new opportunities
Authors: Stephen-Haynes Jackie
Published: May 2014

For those of us fortunate enough to attend the 2nd World Union of Wound Healing Societies conference in Paris in July, it was a wonderful experience. Obviously the attractions of Paris had a great deal to do with that, but the conference was full of stimulating presentations on a wide variety of topics. Of particular interest were debates about assessment, complex wounds, compression and educational strategies.
Suprapubic catheterization: challenges in changing catheters
Authors: Robinson John
Published: May 2014

Suprapubic catheterization of the bladder is used as a short- or long-term alternative to urethral catheterization. As with any indwelling urinary catheter, correct insertion, care and removal are vitally important to minimize problems. A particular problem that affects suprapubic catheters is ‘cuffing’, which on its own or combined with encrustation can potentially cause a great deal of difficulty on removal or discomfort for the patient. This article discusses the causes of cuffing, and suggests using catheters with integral balloons to reduce the incidence of the problem.
Primary care nursing research and the Scottish School of Primary Care
Authors: Campbell Susan E , McCloughan Lucy , Watson Margaret
Published: May 2014

Research capability and research capacity are two fundamental requirements in the development of a research-active, evidence-based nursing profession. The Scottish School of Primary Care is developing programmes to address these issues across Scotland.
A bumper gift for community nursing
Authors: Pollard Tom
Published: May 2014

I spent the last weekend in November struggling through a blizzard to reach the far tip of Cornwall for a long-planned holiday. It took 24 hours longer than intended, but we got there in the end.
The progress of family health nursing in remote and rural Scotland
Authors: Macduff Colin
Published: May 2014

Since 2001 the World Health Organization Europe’s family health nurse (FHN) role has been developing in remote and rural areas of Scotland. In 2003, an independent evaluation identified a need for facilitation of the FHN role and family-health orientated approaches with local primary health care teams. The Scottish Executive Health Department appointed three part-time, regionally-based family health practice development facilitators (FHPDFs) in December 2003 to work over an 18-month period. This article presents findings from a small study which sought these FHPDFs’ judgements on individual FHN autonomy and supportive colleague action at 24 sites where FHNs were practising. These judgements reveal a picture of mixed progress that is consistent with findings from other related research. This collective overview is presented in the form of a new typology and the resultant implications for future development of family health nursing are discussed.
Community matron proposals fleshed out
Authors: Pollard Tom
Published: May 2014

The New Year opened with the publication of a new document by the Department of Health (DH) in London, which adds further flesh to the bones of the department’s strategy for the future management of people with long-term conditions. Figuring large in the document is the role of the new community matron. Although apparently caught on the hop by Health Secretary, John Reid’s initial announcement of this new role, the policy-makers at the Department of Health have now had some time to figure out how to build it into their strategy for long-term care, and have come up with a document that offers exciting opportunities for district nurses (DH, 2005).
New financial year, new pension headaches
Authors: Pollard Tom
Published: May 2014

Nothing is yet set in stone, and there’s still time to make your voice heard, but there are only a few days left until the consultation on a new pension structure for the NHS closes. Many people are very concerned about the proposals, but what are they and what do they mean for the district nursing workforce?
Ellen Seymour: an award winner on a steep learning curve
Authors: Pollard Tom
Published: May 2014

Ellen Seymour, District Nurse Locality Coordinator at Riverside PCT in Chichester, recently won the Compression Therapy Award at the British Journal of Nursing Clinical Practice Awards 2005. Tom Pollard spoke to her about how she came to be there.
Making a difference to community nursing
Authors: While Alison
Published: May 2014

The re-election of a Labour Government confirms that ‘modernization’ of the NHS will continue. Time will tell how the new Secretary of State, Patricia Hewitt, will influence health policy, but of one thing we can be certain: primary care nursing of yesterday will be banished forever.
Nurse auxiliaries never went away
Authors: Bowers Kathleen
Published: May 2014

I read with interest Alison While’s article in the June issue (Making a difference to community nurses, Br J Community Nurs 10(6): 296) but am rather puzzled by her last line, ‘Welcome back the nurse auxiliary into community nursing teams’
Principles of risk management in community nursing
Authors: Leyshon Stephen
Published: May 2014

Risk is present in all aspects of practice. The changing nature of primary care means that community nurses will increasingly be expected to adopt roles that have traditionally been undertaken by other professionals and which may be associated with higher levels of risk. Although these developments offer opportunities to enhance patient care, nurses must also be aware of the implications for their own accountability. One way to embrace this accountability, and to meet the demands of clinical governance, is to engage in risk management. By adopting the principles of risk management nurses can act proactively to ensure they provide a high quality service that meets patient needs.
Rehabilitation: it makes a difference
Authors: While Alison
Published: May 2014

A significant proportion of the population has a disability and people with more severe disabilities are likely to have contact with district nursing and other support services. Well-organized multidisciplinary rehabilitation services yield substantial benefits to the individual patient and their family (Wade and de Jong, 2000), and the specialty of rehabilitation is growing in the wake of practical innovations and increasing evidence of the merits of specific interventions. However, the most significant development has been recognition of the psychological and sociocultural dimensions of disability, seeing disability less as an illness than as a personal and social experience of impaired function, which impacts on participation. This approach allows the emergence of quality of life as an important care outcome. More work will need to be done to give equal weight to subjective experiences as compared to quality of life quantified using standardized instruments, but this conceptual shift has helped rehabilitation services to argue convincingly for a more equitable distribution of health care resources.
Which way for nurse prescribing?
Authors: While Alison
Published: May 2014

The RCN has long championed extending nurses’ prescribing rights to the full formulary, dismissing potential concerns about professional competence by highlighting the requirement of the Code of Professional Conduct (NMC, 2004) for nurses to work within their area of competence. In the recent consultation on non-medical prescribing, it also did not support the proposal for advanced practice status being associated with higher levels of competence and full prescribing rights.
In an election year, focus on the positive
Authors: Gibson Louise
Published: May 2014

As is always the case, the National Health Service (NHS) is going to be one of the major issues fought over during the forthcoming general election. In particular, there is going to be a focus on hospital cleanliness, and more specifically the battle against healthcare-associated infections (HAIs) and MRSA, the hospital ‘superbug’. The Conservative party, for example, believes that increasing the hospital matron’s powers to close clinical areas which are found to be dirty and unfit for patients, could assist in reducing the number of HAIs and HAI deaths each year. However, there is a hysteria that surrounds HAIs and MRSA – compounded by political and media attention – which perpetuate a myth that all hospitals (and more specifically nurses) are bad, dirty and uncaring.
Developing the community matron role in care homes
Authors: Clegg Angie , Clingo Dee , Hinchcliffe Shelia
Published: May 2014

Care homes in England deliver complex packages of care to people with long-term conditions. The current policy focus on improving care pathways, choice and self-determination for people with long-term conditions offers tremendous opportunities for partnership working between the private and the public sector. This article describes an initiative to introduce the role of the community matron into the care home setting.
Is infection in the community a real threat? The example of CAUTI
Authors: Jenkinson Helen
Published: May 2014

Targeting health-care associated infections (HCAIs) is a key priority of current health policy. This applies as much to the community as to hospitals, although the latter receive far more media attention. One of the commonest HCAIs in the community is catheter-associated urinary tract infection (CAUTI). Cutting infection rates is a challenge. Many CAUTIs are the result of inappropriate catheterization, often combined with reduced sensitivity of bacteria to antibiotics given prophylactically. The government's rapid reaction task force has recommended use of a silver-alloy coated catheter, but closer surveillance is needed to persuade budget-holders of the cost and clinical benefits of this intervention.
A new direction for community services?
Authors: While Alison
Published: May 2014

Since Labour came to power, health policies have flowed regularly from the Department of Health (DH), setting out targets, reconfigurations and ambitions for the future. The latest white paper (DH, 2006) comes hard on the heels of the consultations conducted last summer and the RCN's successful threat of a judicial review relating to the future employment of nurses in community and primary care settings.
Making decisions for incapable adults 4: participation in research
Authors: Griffith Richard
Published: May 2014

In the final article on the Mental Capacity Act 2005, Richard Griffith discusses the safeguards in place to protect incapable persons who may be the subject of a research study or clinical trial. District nurses and other health professionals who wish to conduct research involving people with incapacity will have a duty to apply the 2005 Act's safeguards to ensure that the research is lawful
Independence for the NHS
Authors: Pollard Tom
Published: May 2014

Will 2007 be the year the NHS becomes independent? Are we going to see the Department of Health relinquish responsibility for running the UK’s biggest employer? Of course not, but the debate about NHS independence is going to intensify this year, and no-one knows yet where it will end.
Legal requirements for the prescribing and administration of medicines
Authors: Griffith Richard
Published: May 2014

On the fifteenth anniversary of the introduction of the Medicinal Products: Prescription by Nurses etc. Act 1992, Richard Griffith reflects on the development of nurse prescribing since the Acts implementation and outlines the current procedures by which district nurses may prescribe, supply or administer medicines to patients and the requirements that must be met in order to so lawfully.
Who ate all the pies?
Authors: Dawes Jonathan
Published: May 2014

It may not come as a shock to you that we are becoming fatter as a nation. I have just returned from a vacation in the USA and let me tell you it’s not just Burger King who are serving up ‘Whoppers.’ On occasion I found myself gawking at heavily laden people in sheer wonderment—thinking how on earth do people get that big. I realise that’s not exactly a politically correct stance, but lets face it this obesity epidemic is fast approaching ‘critical mass’.
Managing diarrhoea in the home to prevent admission
Authors: Nazarko Linda
Published: May 2014

Many people with long term conditions wish to receive care at home or in the nursing home where they live. Sometimes if a person develops diarrhoea the clinician’s first instinct is to transfer the person to hospital. The person who has severe diarrhoea may need hospitalization however many people especially those who have indicated that their preferred place of care is home rather than hospital can be managed effectively at home. Enabling the person to remain at home whenever possible empowers the person and enables carers, community nursing staff and nursing home staff to provide the best possible level of care.
Policy regulation has a make-over
Authors: Cook Rosemary
Published: May 2014

Professional regulation is an area of policy that even the most conscientious observer tends to skim over. Yet changes to the regulation of the professions have a profound impact on the two fundamentals that really matter: the safety of patients, and the daily practice of the professionals. So the Government White Paper on the regulation of health professionals, Trust, Assurance and Safety – The Regulation of Health Professionals in the 21st Century (Department of Health (DH), 2007), published earlier this year, is worth a closer look.
Protecting children: the role of the law 1. Principles and key concepts
Authors: Griffith Richard , Tengnah Cassam
Published: May 2014

The twentieth anniversary of the Cleveland Child Abuse scandal provides a timely reminder that children continue to be abused and this generally occurs in the community perpetrated by family members or close acquaintances. District nurses have a significant role in the prevention and identification of child abuse as they visit families in their homes. Fundamental to this crucial role is a working knowledge of the provisions and concepts of the Children Act 1989 that sets out the legal framework for protecting children.