bluuebunny/crossref_metadata_2025 huggingface dataset:
Variations in venous leg ulcer care in the community
Authors: Collins Karen , Morrell Jane , Peters Jean , Walters Stephen , Louise Brereton
Published: May 2014

This paper highlights the range of treatments used by district nurses in four Trusts in Trent when treating venous leg ulcers in the community. It also reports on the time spent by the district nurse for each patient travelling to the patient’s home, treating the leg ulcer and overall time in the home. The grade of nursing staff used for each patient visit was also recorded. Information reported in this paper is taken from that collected as part of a randomised controlled trial of the cost-effectiveness of community based leg ulcer clinics, using four layer bandaging, compared with usual care at home provided by the district nursing service.
Patient education: facilitating life-long self-management
Authors: Coates Vivien
Published: May 2014

It is widely agreed that patient education is a vital aspect of diabetes care (Assal et al, 1983; Alberti et al, 1991; Day and Assal, 1997). The European Patients' Charter (Alberti et al, 1991) states that: 'continuing education for you and your family is a fundamental right for people with diabetes'. It is generally acknowledged that diabetes self-management is often inadequate to enable patients to achieve optimal health. Research suggests that lack of knowledge per se may not be the problem, rather that patients do not put their knowledge into practice. Therefore in this article general principles in the process of patient education which should facilitate self-management behaviour will be considered. In particular the importance of an individualised approach to care, patient assessment, the implications of the work of Strauss and Glaser (1975) on the self-management of chronic illness and Malcolm Knowles' (1990) work on facilitating adults to learn will be discussed in relation to diabetes education.
Practice nurses and venepuncture: a multipractice study
Authors: Woodman Joan , Smith Helen
Published: May 2014

The objective of this work was to investigate the frequency and nature of other issues being introduced by patients when seeing the practice nurse for venepuncture, and the ability of the practice nurse to respond without referral to another team member. A survey was designed for of all consultations for venepuncture with 18 practice nurses over a two week period. These were set in general practices in Wessex. Rural, semi–rural and urban practices were represented. The main outcome measures were: the proportion of venepuncture consultations which included an associated activity; the frequency with which patients presented a new problem; and the ability of the nurse to deal with the patient's problem. Results show that 85% of venepuncture consultations included associated activities and that 36% of patients presented a new problem which the nurse felt able to deal with in 95% of instances. It is concluded that associated activities frequently accompany the task of venepuncture when performed by a practice nurse rather than a phlebotomist. The ‘added value’ a nurse brings to this task include monitoring patients with chronic conditions, clarification of what the GP has said in a previous consultation, and dealing with newly presented health problems. Decisions about delegation of tasks within the primary health care team should consider not only the complexity of the task and the savings accrued, but also the quality of care and the ‘knock on’ effects of change on consultation rates.
Causes and assessment of faecal incontinence
Authors: Chelvanayagam Sonya , Norton Christine
Published: May 2014

Faecal incontinence remains a taboo subject and patients frequently conceal their symptoms, because of fear and embarrassment. Sensitive and appropriate assessment will encourage people to seek advice and treatment if required. This article discusses the causes and assessment of faecal incontinence. It explains the structure and function of the anal sphincters in maintaining continence. Assessment of bowel control is discussed in depth. Questions are suggested which will help to identify problems and thereby enable access to appropriate care.
A strategy to target the health needs of prostitutes
Authors: Lazenbatt Anne , Sinclair Marlene , Hunter Pauline , Orr Jean
Published: May 2014

This article presents a proposed strategy to target the health needs of prostitutes. An ethnographic approach was used to assess the prostitutes’ health and social needs and the study identifies the role of the nurse practitioner (NP) as a lead professional in the delivery of primary health care. The main emphasis of the pilot project is the introduction of a drop-in centre for this marginalized group of women. Qualitative and quantitative methods are currently being used to assess need and evaluate the success and efficacy of this outreach organization. The pilot study is located in central Belfast and will serve the target population of prostitutes in this disadvantaged area. The NPs will have dual roles. Their clinical role will involve providing a clinic service offering nursing care, information, counselling and support. NPs will also have a research role which will include service evaluation.
The need to address sexuality in older people
Authors: Peate Ian
Published: May 2014

Many factors affect the ability of older people to express their sexuality. The community nurse is encouraged to consider the impact that negative attitudes (from both the patient’s and the nurse’s perspective) can have on the individual’s wellbeing. Nurses should not approach elderly people and their sexuality from a negative perspective, as this may lead to stereotyping and the provision of poor quality care (Van Ooijen and Charnock, 1994). This article considers the older person in a holistic manner and advocates the routine inclusion of sexuality when assessing the needs of older people. Community nurses can offer both factual and practical advice. In order to provide high quality care, community nurses need to be aware of the many problems that may face older people regarding their sexual health. When the nurse is unable to deal with these problems he/she should refer the individual to the most appropriate agency.
Managing change in the community 3: conflict in PCGs
Authors: Parkin Paul
Published: May 2014

Recent Health Service Circulars (NHS Executive, 1998a,b,c), which arose from the White Paper The New NHS; Modern, Dependable (Department of Health, 1997), dealing with governing arrangements in primary care groups (PCGs) consistently stress the importance of achieving and maintaining ‘consensus’ in management. Consensus management has been promoted in previous NHS reorganizations but has been criticized for promoting the false belief that consensus equals correctness which may result in ‘lowest common denominator decisions’ (Department of Health and Social Security, 1983). Current research shows that ‘cognitive’ conflict within groups can be an important and positive force in developing and refining high quality decisions and may lead parties to integrate opposing interests. This article discusses the management of conflict within PCGs. It considers the role of consensus, types of conflict and potential areas of conflict within PCGs. It is suggested that if community nurses are to develop an effective leadership and commissioning role, they need to engage in high level arguments and evidence-based problem-solving strategies.
Urinary catheters: selection, management and prevention of infection
Authors: Pomfret Ian
Published: May 2014

Urinary catheterization is a common procedure for both hospital and community patients. Nurses make many of the decisions in regard to both catheter selection and subsequent catheter care. These decisions, for example, in the type of catheterization (intermittent, indwelling, urethral or suprapubic) should be made on an informed basis. Choosing the optimum catheter material and size can benefit catheter care. Encrustation can be a problem for some catheterized patients and nurses are often involved in trying to prevent or treat it. This and other aspects of catheter management including infection control, constipation and meatal hygiene are discussed.
Self-inflicted wounding 2: identification, assessment and management
Authors: Moffatt Christine
Published: May 2014

The spectrum of conditions associated with self-inflicted wounding and their presenting features were outlined in the first part of this article (Moffatt, 1999). In part two, the assessment and management of self-wounding patients is discussed. Manipulative behaviour can be a barrier to treatment, as well as a disruptive force within the healthcare team. Awareness of its effects are essential to the successful development of a therapeutic relationship. However, the current possibilities for effective treatment of self-wounding are limited, and there is an urgent need for more research into both its causes and the various management options available.
The role of community-based nurses in health promotion
Authors: Whitehead Dean
Published: May 2014

It is the responsibility of all nurses to incorporate health promotional and health educational activities into their professional roles. Much of the literature around this issue relates to the specific role of community-based nurses in the primary healthcare team, and identifies their unique position and responsibility for pioneering the universal acceptance and adoption of health-promoting practices. Community-based nurses are in a good position to commission health-related activities and integrate them into practice (Department of Health and Social Security, 1987; Department of Health, 1992, 1996). On the basis of this, one might expect that the results of studies in this area would identify evidence of good understanding, adoption, parity and support for such initiatives among community professionals. However, many studies have identified a state of confusion, poor understanding, a lack of parity between professional groups, a lack of professional support and training, and haphazard implementation of such strategies (Dines, 1994; Russell, 1997). Inconsistency in study findings is problematic and tends to present a skewed picture of current practice. It is suggested that community-based nurses may benefit from a change in the way they view the implementation of health promotional practices, and that policy issues related to practice could be further clarified and enforced.
Legal issues arising in community nursing 4: expanded role
Authors: Dimond Bridgit
Published: May 2014

Shorter length of stay and earlier discharge from hospitals have meant that the role of the community nurse has changed radically over recent years. Many patients are discharged still needing a high level of nursing input. The concept of the hospital at home requires that community nurses possess skills which would in the past have only been practised in a hospital setting. The traditional role of the community nurse has developed so that he/she is now expected to be able to provide many of the skills used by a nurse in an acute medical or surgical ward.
Public health: a new nursing role for community practitioners
Authors: Hoskins Robert
Published: May 2014

This article discusses the six key activities identified by the Royal College of Nursing (1994) as essential ingredients for public health nursing. Examples of public health practice and community nurse involvement are given to illustrate each activity. Public health skills such as health profiling, building healthy alliances and policy development are outlined. Current barriers to community nurses participating in these activities are identified and models of public health practice are reviewed. The potential for a radical transformation of community nursing practice is discussed in the context of an expanding the public health role of community nurses in Scotland. Options for future practice are presented and discussed.
Current challenges in wound care management: an overview
Authors: Evans CA , Hagelstein SM , Ivins NM
Published: May 2014

This article provides an overview of the latest theories and technology in compression therapy, and the use of growth factors and skin substitutes. Compression therapy is a major factor in the treatment of venous leg ulcers and is widely used and readily available on the Drug Tariff. Skin substitutes and growth factors provide a new technological approach to wound healing with hope for the future management of both acute and chronic wounds. While new technologies are an exciting prospect for the future of wound management, there can be no substitute for good wound care. In the interests of optimum wound management and patient care, health professionals have a duty to find ways to improve patients’ quality of life.
Issues surrounding record keeping in district nursing practice
Authors: Anderson Evelyn E
Published: May 2014

This article examines some aspects of nursing documentation following the publication of the document Guidelines for Records and Record Keeping (UKCC, 1998). The importance of nursing documentation in patient care, in guiding practice and in providing information for members of the interprofessional healthcare team is highlighted. Record keeping forms an important part of the clinical governance initiative in terms of quality improvement and risk management. The issues surrounding the legal requirements of record keeping in district nursing practice are discussed. Suggestions are made for assessing the quality of nursing documentation by audit and research, in order to establish the suitability of using the present systems in the community setting.
Enteral tube feeding training for nurses and care assistants
Authors: White Gillian , Whitehead Kirsten
Published: May 2014

Increasing numbers of patients are enteral tube-fed in the community, often requiring community nursing support. Appropriate training facilitates effective patient care in this rapidly changing area of practice. The project described involved the development, piloting and evaluation of a validated home enteral tube-feeding training programme for community staff. Following wide consultation, four pilot days were provided (two for registered nurses and two for care assistants) which were positively evaluated. Post-training evaluation suggested the training led to beneficial changes in practice. Additional funding obtained has enabled the basic training to continue on a monthly basis for 2 years with biannual updates. Significant risks are attached to home enteral tube feeding; opportunities to integrate theory and practice in a safe environment should enhance patient care and decrease clinical risk.
Preventing unnecessary suffering: an audit of a leg ulcer clinic
Authors: Bentley Jenny
Published: May 2014

Unnecessary patient suffering and increased costs in leg ulcer care were reported in an Effective Health Care bulletin (NHS Centre for Reviews and Dissemination (NHSCRD), 1997). Follow-up assessment of patients with a history of venous ulceration has beneficial effects for patients’ quality of life, and for effective and efficient management of resources for community nurses. This article describes the process of implementing evidence-based practice in a leg ulcer clinic in South London within existing resources, which resulted in the successful prevention of leg ulcer recurrence.
Nurse prescribing: views on autonomy
Authors: Rodden Chris
Published: May 2014

The introduction of nurse prescribing throughout Scotland in the primary care setting has proved to be an interesting development for nurses. The aim of this study was to assess the impact of nurse prescribing on district nurses and health visitors in one NHS trust in Scotland. All prescribing nurses in the trust were asked to participate in the study. This explored their perceptions of autonomy and the level of dependence on GP colleagues since being able to prescribe. In addition, prescribing patterns were examined to ascertain whether there was a relationship between the area of nursing (e.g. district nursing or health visiting) or the length of prescribing experience, and the number of prescriptions written.
Clean intermittent self-catheterisation and children
Authors: Senior Jeni
Published: May 2014

The best chance for good renal health and continence for children with a neuropathic bladder is clean intermittent self-catheterisation. In order to maximize potential for good renal health and continence the child and family need to be well supported by the multidisciplinary team, making good use of the knowledge of the children’s urology specialist nurse who is able to provide relevant information, advice and education. With support many children with a neuropathic bladder are able to achieve continence while maintaining good renal health.
Venous leg ulcers: 10 years of assessing cost-effective solutions
Authors: Bosanquet Nick
Published: May 2014

The adoption of 4-layer bandaging as a standard treatment for venous leg ulceration is a story of professional and governmental reluctance to accept a new innovation, while old procedures were followed which had no evidence base. Ten years of trials were needed before the therapy had proved itself, during which time thousands of patients were denied effective treatment. Repeated studies have shown 4-layer bandaging to be a clinically effective and cost efficient treatment for this distressing and disabling condition.
Achieving value for money? Evaluation of two wound dressings
Authors: Gray David , White Richard , Russell Fiona , Cooper Pam
Published: May 2014

During the past three decades there has been dramatic increase in spending on wound dressing products in the UK. While the rise in costs in many ways reflects a rise in the performance of the products purchased, it remains vital that nurses charged with prescribing such products achieve value for money. This article describes a small study of the use of a primary dressing and a secondary wound dressing in 12 patients, representing a range of wounds. In each case a more expensive alternative would normally have been used. In each case observed, involving both primary and secondary dressings, no deficit in clinical performance was noted but potential cost benefits were identified. The authors conclude that these initial findings are encouraging and further studies are required to address this important area of wound management.
Glucosamine therapy compared to ibuprofen for joint pain
Authors: Ruane Rachael , Griffiths Peter
Published: May 2014

To determine the effectiveness of oral glucosamine with ibuprofen for the relief of joint pain in osteoarthritis a mini-review (Griffiths, 2002) of double-blind randomised controlled trials comparing the two was undertaken. The population was adult patients diagnosed with osteoarthritis at any site. The outcome was arthritic pain reduction. Searches on Medline, Embase, AMED, the Cochrane Library and the Merck index identified four trials. Of these, two studies were obtainable and were included in the review. Both compared 1.2g ibuprofen daily with 1.5g glucosamine sulphate daily, in three divided doses. The combined number of participants in the studies was 218. The results of these studies showed glucosamine to be of similar efficacy to ibuprofen. The conclusion is that glucosamine is effective in relieving joint pain associated with osteoarthritis. Glucosamine’s pain-relieving effects may be due to its cartilage-rebuilding properties; these disease-modifying effects are not seen with simple analgesics and are of particular benefit. In practice glucosamine can be used as an alternative to anti-inflammatory drugs and analgesics or as a useful adjunct to standard analgesic therapy.
Community care policy and end-of-life care: one patient’s story
Authors: Clough Anita
Published: May 2014

This article examines the effect of community care policy on the care of a young woman with a terminal illness from a minority ethnic group. Current NHS policy advocates collaboration between health and social care agencies to provide a seamless service for patients. The article considers aspects of interagency and interprofessional collaboration, teamwork and patient empowerment and analyses how beneficial these factors were in a patient’s care. It also examines the concept of health promotion within the sphere of palliative care.
Community provision for informal live-in carers of stroke patients
Authors: Simon Chantal , Kendrick Tony
Published: May 2014

Stroke is common and disabling. Most stroke patients are cared for at home by informal carers. This study of informal carers of stroke patients measured service provision and satisfaction with different aspects of community care received by these carers. Dissatisfaction was expressed with training and information provision for carers, communication between carers and community services, speed of response and coordination of community services, and perceived support. Problems of information provision were most marked for those patients with most disability and/or older carers.
PEG site infections: a novel use for Actisorb Silver 220
Authors: Leak Kathy
Published: May 2014

Any breach in the integrity of the skin, such as occurs in wounds and incisions, and intravascular catheters, can act as a portal for the ingress of microorganisms and thereby predispose the patient to infection. The infection, if unchecked, can put the patient at risk of bacteraemia. We have reviewed the care of PEG sites in our trust hospital and in the local community and have implemented practice guidelines to reduce infection risks. These include protocols for skin care around PEG sites, and, the use of an antibacterial dressing – Actisorb Silver 220 – to manage local colonization. The preliminary results of this exercise indicate that patient comfort can be improved, hypergranulation reduced, and methicillin-resistant Staphylococcus aureus colonization and infection eradicated.
Lay workers for improving the uptake of childhood immunization
Authors: Whittaker Karen
Published: May 2014

The aim of this review was to identify whether non-professional volunteer support might be effective in improving the uptake of child immunization. The Cochrane Library, Medline, Cumulative Index to Nursing and Allied Health Literature and Embase databases were searched for randomized controlled trials comparing groups of parents supported by lay volunteers with those supported by conventional child health services. Two such trials met the review criteria. These studies suggested that using non-professional volunteers to support parents can be an effective strategy for improving the uptake of immunization in children younger than 2 years, but there is limited evidence to suggest that this effect is sustained for older children. Equally, intervention effects could, because of differing cultural and sociodemographic factors, be less marked when applied to British populations, in which the parents of pre-school-aged children have access to immunization support from a generic health visiting service.
A literature review of the public health roles of health visitors and school nurses
Authors: Hawksley Barbara , Carnwell Ros , Callwood Ingrid
Published: May 2014

This paper describes a two-stage review relating to the family-centred public health role of health visitors and the child-centred public health role of school nurses. During the first stage, literature was searched using CINAHL and Medline databases and two models were used to frame the literature analysis. The findings of this analysis were, however, disappointing. Although many policy documents advocate development of the family-centred public health role of health visitors and the child-centred public health role of school nurses, there was no overwhelming evidence of reports of these approaches in health visiting and school nursing practice. The second stage of the review comprised a content analysis of West Midlands community trusts’ strategic development plans. Seventeen plans were analysed. Of these, only two were ‘formal’ plans, the remainder being fragmented documentation related to plans for the development of health visiting and school nursing services. It may be concluded from the analysis that NHS trusts are beginning to adopt ideas from the rhetoric of national policy documents. Additionally, public health practice initiatives form an integrated part of most of the trust strategic development plans that the researchers examined.
Management of functional constipation in childhood
Authors: Rogers June
Published: May 2014

Functional constipation is a common childhood condition. In the majority of cases the constipation develops as a result of a complex weave of factors including specific triggers, e.g. reduced fluid intake following a viral infection or periods of restricted access to the toilet. The passage of large painful stools perpetuates the problem when the child begins to associate pain with defecation. The management of constipation can often be a challenge in children, who initially may be reluctant to sit on the toilet. This article will discuss the contributory factors to the cause of constipation and identify the keys to successful treatment, including ensuring an holistic child-focused approach with effective initial evacuation and appropriate maintenance therapy
Managing home enteral tube feeding for children
Authors: Khair Jamil
Published: May 2014

There is a growing awareness of the long-term consequences of undernutrition in childhood. Consequently, an ever-increasing number of children are receiving nutritional support using an enteral tube. While most of the children will commence artificial feeding in hospital, a significant proportion will continue to be artificially fed on discharge into the community. This article discusses the various routes of enteral tube feeding, their indications and contraindications and problem-solving procedures. The article also discusses the issues of cooperation and coordination between acute and community services, and offers some guidance on effective discharge planning for these children.
Indwelling catheter-associated urinary tract infections
Authors: Parkin John , Keeley Francis X
Published: May 2014

Catheter associated urinary tract infection accounts for a large proportion of all hospital-acquired infections, and there has been little change in the incidence of such infections since the introduction of closed sterile urinary drainage systems in the 1960s. The aim of this paper is to review the literature on the subject of catheter associated urinary tract infections, with reference to the use and possible improvement of closed sterile catheter drainage systems.
So you want to do research? 1: an overview of the research process
Authors: Meadows Keith A
Published: May 2014

Relative to some other health care professionals, nursing has an immature research tradition as well as a limited body of research-based knowledge to draw on. Nevertheless, research is important to the nursing profession which over the past 15 years has increasingly had pressure placed on it to be more accountable for its actions. Research is also important so as to answer specific and broader clinical questions. This article, the first in series of seven, is aimed to provide novice researchers with an overview of the research process, with a specific focus on developing the research question, undertaking a review of the literature, describing the different research methodologies, sample size, data collection methods and analysis. Different approaches for ensuring more effective dissemination of research findings to different audiences are also briefly discussed.
Nicotine, CO and HCN: the detrimental effects of smoking on wound healing
Authors: Whiteford Lesley
Published: May 2014

During the 1960s, the Royal College of Physicians published its first report on smoking and health, concentrating on the association between smoking and lung cancer, chronic obstructive pulmonary disease and heart disease (RCP, 2000). It was not until a decade later that the effects of smoking on wound healing were first reported (Mosely and Finseth, 1977). Although it is now widely accepted that smoking impairs wound healing, extensive studies have yet to be performed. Clinical practitioners have a role to deliver evidence-based care and provide smoking cessation programmes for patients with wounds. This article discusses three key toxins in cigarette smoke and research studies that have examined the effect of smoking on healing of acute wounds.
Cytotoxic chemotherapy: what do community nurses need to know?
Authors: Cooper Caroline , Depledge Jane
Published: May 2014

Among the range of increasingly complex care demands made of community nurses in the UK is the support of patients undergoing cytotoxic chemotherapy at home. The NHS Cancer Plan and associated standards (Department of Health, 2000 a, b) have identified that community nurses need an increased awareness and knowledge of the procedures and drugs involved to ensure a quality service provision. This article, based on a validated education course commissioned for community nurses in East Berkshire, explores key areas that enable community staff to care for and support patients through the course of their treatment and allows them to begin identifying an operational structure that promotes a quality service. Health and safety (as part of risk management), routes of administration, recognizing neutropenic sepsis associated with chemotherapy, and communication and collaboration are presented as key points identified from the course.
Overweight and obesity: Helping clients to take action
Authors: Mary Tod Angela , Lacey Anne
Published: May 2014

This article presents the results of a qualitative research project to explore factors that encourage or discourage overweight people from low income groups to access weight loss services. Semi-structured interviews were conducted with 16 people attending a commercial slimming organization in South Yorkshire. The study revealed weight loss decisions to be complex and fragile. The experiences reported mirror the ‘stages of change’ model described by Prochaska and DiClemente (1992). Triggers to action occurred cumulatively and decisions were reached gradually. The triggers included embarrassment and humiliation, health, fear, critical events and image. Disincentives to action were denial, previous bad experiences, previous failure and money. Decisions were linked to low self-esteem and confidence, making people vulnerable at the point they take action. The implications of this for nursing practice and services in primary care are considered.
The effectiveness of pin site care for patients with external fixators
Authors: Williams Heather , Griffiths Peter
Published: May 2014

The aim of this mini-review was to establish if cleaning, dressing and removing crusts from external fixator or skeletal pin sites affected the risk of infection. A systematic search was conducted using Cochrane, Medline, CINAHL and Embase databases. Inclusion criteria were orthopaedic patients with skeletal pins or external fixator devices applied to either upper or lower limbs. The databases were searched for controlled studies comparing at least one aspect of pin site care (cleansing, dressing or crust removal) with a control group of ‘observation only’. Only one study met the inclusion criteria. It focused on cleansing external fixator pin sites. The study included two treatment groups, one using 0.9% normal saline and one using 70% alcohol, and a control group which had no cleansing. While the control group had a more favourable outcome than the treatment groups, there is still insufficient evidence from this one study to recommend no cleansing. It is also important to note that the most frequently recommended solution for cleansing pin sites in UK protocols (0.9% normal saline) had the worst outcome, therefore its efficacy in this population may need to be challenged.
Exploring the significance of place in community nursing
Authors: McGarry Julie
Published: May 2014

There has been a dramatic shift in emphasis in health care in the UK in recent years towards the community setting. Caring for someone in their own home takes place in a different context from caring for them in hospital, and requires a different approach. This article highlights a number of issues raised by this change, and suggests that there needs to be a focused effort to understand the impact of these issues on practice.
Managing leg and foot ulcers: the role of Kerraboot®
Authors: Ashton Jacqui
Published: May 2014

Foot and leg ulcers are chronic wounds characterized by slow or non-healing breakdown of epidermal and dermal tissue on the foot or below the knee. The prevalence is high and ulcers are a significant drain on the NHS in terms of nursing time and cost of dressings, and are incredibly burdensome to the individual patient. This article reviews the evidence for a new wound management system, Kerraboot®, designed for the management of leg and foot ulcers. It is a boot-shaped dressing that completely surrounds the ulcer creating an optimum healing environment. In clinical investigations, Kerraboot® offered patients relief from pain, was comfortable, easy to use and effectively controlled embarrassing odour, while also saving nursing time. Currently, Kerraboot® is recommended for the management of diabetic foot ulcers and venous ulcers where the patient is unable to tolerate compression therapy.
Fear of the known? District nurses’ practice of compression bandaging
Authors: Field Hilary
Published: May 2014

District nurses are the acknowledged experts when it comes to the care of leg ulcers in the community setting. An audit in one trust nevertheless highlighted a degree of diagnostic caution among district nurses that led to some patients not receiving the compression therapy that national guidelines recommend. This article reports on a small-scale qualitative study that sought to explore this issue in more depth. The results highlight that there is some conflict between district nurses’ practice as expert practitioners and strict adherence to guidelines, which the nurses resolve in various ways. The implications for practice are explored.
Taking up the challenge of communication
Authors: While Alison
Published: May 2014

Poor communication within health-care teams and between practitioners and patients are the most frequent source of complaint registered at the Parliamentary and Health Service Ombudsman. The implementation of the national programme for information technology (NPfIT) has been identified as key to overcoming some of these problems by providing a seamless communication system across the NHS. But sadly the NHS does not have a good record of managing information technology change.
District nurses: the new community matrons – 8 July 2005, Gloucester
Authors: Pollard Tom
Published: May 2014

This year’s annual conference of the Association of District Nurse Educators took place on a glorious sunny day in early July, at the University of Gloucester. There was a slight other-worldliness to the proceedings: the conference took place the day after the first London bombings, but at that stage there were only hints of the scale of the destruction. The conference began with a minute’s silence out of respect for the (then anticipated) dead and injured.
Palliative care services in England: a survey of district nurses’ views
Authors: Shipman Cathy , Addington-Hall Julia , Richardson Alison , Burt Jenni , Ream Emma , Beynon Teresa
Published: May 2014

Good access to health and social services is essential to enable palliative care patients to remain and die at home. This article reports on a survey of perceptions of availability of such services by district nursing teams (651 respondents) across eight cancer networks in England. Only just over half of respondents thought GP home visits and specialist palliative care assessment were always available. Many district nurses reported, at best, only sometimes being able to access inpatient palliative care beds, respite care, Marie Curie/night sitting services or social work assessment. Wide variation in access to all services was reported between cancer networks. Equitable provision of services is essential if more patients are to be cared for and die at home, but our results indicate considerable room for improvement. Primary care trusts, cancer networks and strategic health authorities must work together to ensure minimum standards of access nationally if the recommendations of the NICE guidance on supportive and palliative care are to be achieved.
Dysphagia, medicines and older people: the need for education
Authors: Morris Heather
Published: May 2014

Dysphagia is particularly common in elderly patients and may contribute towards difficulties in swallowing solid dose medications. Two recent community surveys have revealed that the problem might be more prevalent in primary care than previously thought. The community nurse is particularly well placed to help identify patients with dysphagia and provide appropriate support and advice.
Lymphoedema: recognition, assessment and management
Authors: Linnitt Nina
Published: May 2014

This article aims to review the function of the lymphatic system, what lymphoedema is and how this condition can be treated. It identifies the differences between oedemas with the emphasis on pure lymphoedema. Topics covered include differentiating between oedemas, basic treatment plans, the importance of early detection and appropriate referral to specialist practitioners. It highlights the need for all health professionals to have some understanding and awareness of this chronic condition.
Community nurse use of Doppler ultrasound in leg ulcer assessment
Authors: French Lorraine
Published: May 2014

Doppler ultrasound is used by community nurses to measure the ankle brachial pressure index (ABPI). This is required before applying compression therapy for patients with chronic venous insufficiency and venous leg ulcers. However, emphasis on the ABPI result has resulted in inappropriate referrals to the vascular department which led the author to survey current practice within one primary care trust. Results illustrated variations in how nurses obtain training and maintain their competency in using Doppler ultrasound. This has an impact on the accuracy of interpretation of the ABPI measurement and subsequent management of the patient. Practical issues also explained the difficulties nurses encountered in using the correct procedure within the community, which may result in unreliable measurements. There is a need to standardize training for all community nurses, and to review the structure of current clinical guidelines to enable a wider analysis of arterial assessment, in order to reduce the emphasis purely on the ABPI measurement.
Static magnets prevent leg ulcer recurrence: savings for the NHS?
Authors: Eccles Nyjon
Published: May 2014

The objectives of this survey were to examine the effectiveness of a static magnet device – 4UlcerCare – in preventing recurrence of leg ulcers after healing. Two hundred and eighty-nine randomly selected purchasers of 4UlcerCare were telephoned and asked to complete a short questionnaire. Our focus was on the 211 respondents who had ulcers that had already healed. The average age of subjects was 70.6 years and sex distribution was 55% female to 45% male. Mean duration of leg ulcers before using 4UlcerCare was 4.4 years. Sixty-five per cent of those surveyed had had ulcer recurrence before using 4UlcerCare, with a mean of 2.41 episodes of ulceration. This was close to the expected recurrence rate in the population of 67%. Using 4UlcerCare daily, these respondents’ ulcers had healed within an average of 3.57 months. The survey took place an average of 19.94 months after healing. The manufacturers advise wearing 4UlcerCare daily post-healing, and of those respondents that had, none had suffered any recurrence.

Extrapolating these results across the health economy, an estimate has been made of a potential £153.7 million per year saving on leg ulcer care to the NHS.
Easing compression hosiery application: ActiGlide
Authors: Stephen-Haynes Jackie , Lindsay Ellie , Muldoon Jeannette
Published: May 2014

Providing care for patients with leg ulceration is predominantly the responsibility of nurses in primary care. The most common form of leg ulceration is that arising as a result of venous disease, for which compression—either by bandaging or hosiery—is the ‘gold standard’ treatment. However, before commencement of any form of compression, an accurate assessment must take place, the aetiology of the limb condition or active leg ulcer must be properly determined and a differential diagnosis formulated. This should be undertaken by a health care professional trained in leg ulcer management (RCN, 1998).
Malnutrition: supplements and food fortification in the older population
Authors: Dunne Annette
Published: May 2014

There is an important relationship between positive nutritional status, dietary intake and a healthy population. Lifelong adoption of healthy eating patterns is essential for life and can help reduce the risk of development of many illnesses. Malnutrition remains very prevalent in both developed and developing countries despite ongoing awareness campaigns. The consequences of malnutrition are broad-ranging and ultimately impact on quality of life, increase length of stay in hospital and overall; increase the risk of unsuccessful outcomes of treatment. The management of malnutrition requires using appropriate screening tools to identify malnutrition and access to a registered dietitian—who are the experts in nutrition—who will provide dietary advice to improve dietary intake through conventional dietary means and if unsuccessful through artificial supplementation. Failure to acknowledge the risks of malnutrition can seriously impact on morbidity and mortality rates.
Improving engagement with older people
Authors: Swann Amy
Published: May 2014

This article seeks to explore how the older person can be involved and informed in making policy at a local level. Their experience and expertise is invaluable and older people are best placed to voice where services are falling down and their needs are not being met. Government needs to engage with the older person much more effectively.
Complex skin changes in chronic oedemas
Authors: Linnitt Nina
Published: May 2014

Skin changes can occur in an untreated or inadequately treated lymphoedematous limb over a period of time. These changes occur due to the chronic inflammation that is present in the limb, which increases the proliferation of connective tissue. The time it takes to develop these changes is different depending on the individual. Good skin care can significantly reduce the risk of these skin changes occurring. It is important to educate the patient as to the importance of maintaining a healthy, intact skin. This will significantly reduce the risk of these changes occurring. This article looks at the common skin changes found in lymphoedema, how to identify and treat them.
Acting on screening results: a guide to treating malnutrition in the community
Authors: Scott Anna
Published: May 2014

Part 1 of this article described the Malnutrition Universal Screening Tool (MUST) and its implementation. Part 2 aims to provide basic practical guidance for treating malnutrition. Establishing the aim of treatment and undertaking a dietary assessment will provide the basis for your intervention. Addressing nutrition-related problems, such as drug induced gastrointestinal disturbances, will improve the efficacy of your treatment. A food-first approach should be adopted, paying attention to meal pattern, snacks, appropriate food choices, and food fortification. Over-the-counter supplements can be useful. Proprietary (prescribable) nutritional supplements or sip feeds should be used if dietary intervention does not sufficiently improve nutritional status. Consideration of patient preferences regarding flavour, style and presentation are necessary for compliance and particular care is required when selecting sip-feeds for patients with diabetes. Regular monitoring is essential and gradual discontinuation of supplements should commence if the aim of treatment is achieved. Assistance from dietetic services should be sought in developing a locally agreed policy for treating malnutrition.
Pharmacological treatment for chronic oedema
Authors: Keeley Vaughan
Published: May 2014

Chronic oedema is mainly treated by physical methods (compression, lymphatic drainage, massage and exercise), with drugs not having a major role to play. However, antibiotics are essential in the management of cellulitis, a common and important complication of chronic oedema. Diuretics and cortico-steroids may be appropriate in some types of oedema such as that associated with advanced cancer. Analgesics may be helpful in managing pain, particularly in the short term e.g. pain from cellulitis, although long term use may also be appropriate, e.g. in cancer pain. Benzopyrones are not routinely used in the management of lymphoedema in the UK.
Quality of life assessment tools in chronic oedema
Authors: Keeley Vaughan
Published: May 2014

Chronic oedema can significantly impair a person’s quality of life (QoL). QoL assessment tools can be used in routine clinical practice or in research projects e.g. clinical trials. The characteristics of the different types of tool are discussed. A number of QoL measures have been used in studies of chronic oedema both generic instruments such as SF-36 and condition-specific tools e.g. ULL-27. Currently there is no standard validated QoL tool for chronic oedema used in routine clinical practice in the UK to assess individuals, plan care and measure the outcome of treatment. Possible options for this are considered.
Case studies evaluating 3M’s two-layer compression system: Coban 2
Authors: Hayes Wendy , Day Julie
Published: May 2014

Compression therapy is the cornerstone of venous leg ulcer management. In this evaluation of a Two-layer compression bandage system, the article focuses upon the performance of the bandage together with the patients’ perspective regarding comfort and acceptability when carrying out normal daily activities. Twenty patients were recruited into the evaluation, and four case studies are presented here as an example of the evaluation.
Ileoanal pouch dysfunction and the use of a Medena catheter following hospital discharge
Authors: Perry-Woodford Zarah L , McLaughlin Simon D
Published: May 2014

With the advent of new surgical techniques to manage colorectal disease, the number of ileoanal pouch operations has amplified and therefore increased numbers of pouch patients are being discharged into the community setting. Community nurses will now encounter the ileoanal pouch patient and may be required to manage related complications. Restorative proctocolectomy with ileoanal pouch anastomosis (RPC) has become established as the gold standard operation for patients with ulcerative colitis (UC) and selected patients with familial adenomatous polyposis (FAP).

Using a reservoir constructed from small bowel as a substitute rectum is a medical triumph which in the majority of cases improves the quality of life for patients, not only by eradicating disease and preserving anal sphincter function but also by avoiding a permanent ileostomy. Recent investigation into the use of Medena catheterization for pouch dysfunction has found that it is tolerated in the long term and is associated with satisfactory quality of life in pouch patients with outflow obstruction.