bluuebunny/crossref_metadata_2025 huggingface dataset:
Advanced nurse practitioner registration in Ireland: An RANP cardiology's experience
Authors: Ingram Shirley
Published: May 2014

Advanced nursing practice in Ireland is tightly regulated by the Nursing and Midwifery Board of Ireland (NMBI) with a structured framework for registered advanced nurse practitioner/advanced midwife practitioner (RANP/AMP) post accreditation and individual registration. The process leading to successful RANP/AMP registration is multifactorial incorporating: education to master's degree; site preparation; job description creation; competency attainment; evidence of 500 hours of supervised clinical practice; and portfolio submission. As a recently registered RANP (cardiology), the author of this article aims to highlight the key aspects of the process, including the scope of practice, evidence of the benefits of advanced nursing practice, the framework of nursing practice and patient safety.
The Carers Act: realising the potential
Authors: Nolan Mike , Grant Gordon , Keady John
Published: May 2014

The 1995 Carers (Recognition and Services) Act became law in April 1996, for the first time affording family (informal) carers a statutory right to an assessment of their needs. However, if carers are to benefit from the Act then a fundamental reappraisal of the way in which service providers perceive their relationship with carers is necessary. This paper considers the role that community health nurses can play in developing practice in this important, but neglected, area. Whilst acknowledging that the new legislation represents an important step forward the authors also highlight some of its inherent limitations. Subsequently, attention is turned to an emerging conceptual framework – ‘carers as experts’ – which, it is argued, provides the foundation for a more relevant, comprehensive and sensitive assessment process. The essential elements of this framework are outlined and its incorporation within a temporal model of the caregiving process is described.
Empowerment: a critique
Authors: Jacob Frank
Published: May 2014

Historical analysis reveals that empowerment has its roots in the social action ideology and, it is argued, empowerment cannot be divorced from socio-economic and political factors. Various approaches to empowerment have been considered. It is argued that by adopting a cognitive/individual approach the individual may be able to feel empowered, but actual empowerment, in terms of economic and political power, does not occur. The concept of empowerment in terms of mastery and control has been questioned.

This paper suggests that the assumption has a male bias which negates the need for interdependence and communion.
Strategies to promote continence in the community
Authors: Dolman Mary
Published: May 2014

Incontinence is a distressing and embarrassing health problem for many people living in the community and affects all age groups. This article outlines the prevalence, types and possible causes of incontinence with particular emphasis on the management of incontinence in women. Assessment, investigative and treatment strategies including pelvic floor exercises, the use of weighted cones, neuromuscular stimulation and oestrogen replacement therapy are examined. The author identifies that further training and education for healthcare professionals is essential to promote and develop continence strategies in the community.
Celebrating primary care nursing work
Authors: Goodman Claire
Published: May 2014

Research has shown that the caring work that characterizes so much of nursing work is complex, drawing on intuitive, experiential understanding as well as theoretical sources of knowledge (e.g. Benner and Wrubel, 1989). However, attempts at challenging the prevailing perception that caring is a natural and spontaneous activity continue to be fraught with the difficulties of establishing in what way nursing as caring is distinguishable from similar work undertaken by others, both trained and untrained. Swanson (1993) suggests that nursing can be described as ‘informed caring’. To the outsider however, it is difficult to know how the nursing contribution can be differentiated from that of medicine, social work and particularly the caring that is undertaken within the home as part of domestic work.
Working with older people: opportunities for community nursing
Authors: Nolan Janet
Published: May 2014

This article briefly considers the role of community nurses working with older people and their carers, outlining the changing demographic trends and patterns of illness. It suggests the need for a more proactive approach which builds upon opportunities for health promotion in addition to support for family carers. The development of interventions which are of relevance to very frail older people are also discussed. The forthcoming year will see a number of major policy developments and therefore community nurses should seize the initiative and explore new possibilities while developing existing roles.
Brown bag medication review and its potential value in primary care
Authors: Nathan Alan , Goodyer Larry , Lovejoy Anne
Published: May 2014

Polypharmacy and poor patient compliance with prescribed medication regimens can result in patients failing to get the maximum benefit from their medicines and suffering adverse effects from them. The elderly are at particular risk in this regard, and problems arising from medication account for a significant proportion of the admissions to hospital for this group. ‘Brown bag’ medication review is a technique developed in the US, through which community pharmacists help to resolve patients’ medication-related problems. This article describes a pilot brown bag scheme run in south-east London. The results demonstrated that schemes based on the US model could be run successfully in the UK, with the potential for providing improved patient care and reducing NHS costs. The project also identified an important role for primary care nurses in the successful operation of brown bag schemes.
Nurse shortages are not the fault of education
Authors: While Alison
Published: May 2014

Since the New Year there has been unending press comment on the shortage of nurses and critical reviews of current nurse education systems. Unfortunately, Frank Dobson, Secretary for Health, has decided to link these two issues. However, as Christine Hancock points out there is no evidence that nurse education is to blame for the current staff shortages.
The older public’s perceptions and experiences of the district nurse role
Authors: Stone Coral
Published: May 2014

This small qualitative study explores the older public’s perceptions and experiences of the role of the district nurse (DN) and service provision. It highlights some of the disparities and consistencies between these two areas. A review of the literature revealed that recent NHS reforms have resulted in major changes in the organization of district nursing services. However, there has been little empirical research on this area of community nursing. Existing literature identifies many differences in the priorities of nurses and patients, and calls for additional research to be undertaken. Ten respondents (n=10) were interviewed to elicit their views on the district nurse’s role. The findings were compared to the Trust’s criteria using ‘packages of care’. Data analysis revealed that the demand for this service was dependent on the public’s knowledge of it; the public valued specific qualities in DNs; and participants were unaware of some areas of the district nursing service.
Primary-led palliative care
Authors: Daniels Lilian
Published: May 2014

The growing emphasis on a primary care-led NHS (DoH, 1996) is now being reflected in the field of cancer and palliative care services. The National Council for Hospice and Specialist Palliative Care Services (NCHSPCS) has provided guidelines for the care of people who are terminally ill in the community and promoted strategies for the purchase and delivery of primary palliative care (NCHSPCS, 1998). Current recommendations for the organization of cancer services (DoH, 1995) recognize the pivotal role that primary care services play in the delivery and continuity of cancer services.
With Respect to Old Age
Authors: Mangan Paul
Published: May 2014

After what has seemed a very long time we finally have the report of the Royal Commission into long-term care for older people (Royal Commission, 1999). After 14 months of exhaustive investigation into the organization and funding of long-term care by a distinguished expert committee, it was hoped that in the year the Health Secretary, Frank Dobson, called for a consensus that would stand the test of time and launch a dependable contract between the generations, we would finally see much needed improvements in the way older people in continuing care settings are treated.
The potential for lecturer practitioners in primary care
Authors: Malone Mary
Published: May 2014

The lecturer practitioner role was developed in order to integrate theory and practice in nurse education and to bridge the perceived 'theory-practice gap' between what students learnt in the classroom and what they actually experienced in clinical practice. Primary care is experiencing a gap between the theory or rhetoric of Government policy and the practice of health care delivery. A reorientation of primary care is needed but community nursing, in its present form, appears unable to effect this. The lecturer practitioner role has been experimented with in a variety of clinical settings — primary care is one of these. Recent evaluations at local and national level suggest that lecturer practitioners combine their teaching and clinical skills and intra- and interprofessional communication skills with clinical academic credibility. This unique combination of skills and credibility is particularly needed within community nursing and primary care. Joint role planning, shared definitions of the role, agreement as to its scope and preset outcome criteria are prerequisites for lecturer practitioner success. Lecturer practitioner roles are uniquely suited to primary care and it is now time to develop them further within this context.
District nurses need to define district nursing of the future
Authors: While Alison
Published: May 2014

The Audit Commission (1999) offers a timely review of district nursing as primary care redefines itself and primary care groups develop their capacities to reconfigure service provision to meet local health needs. The increasing demand for nursing in the home is clearly evident not only in terms of the patients cared for but also through the continuing high number of referrals. A noteworthy trend has been the increased district nurse workload in residential homes. The impact of demographic trends with a growing ageing population combined with the extending life span of the long-term disabled inevitability requires reconsideration of how these growing health needs may be met within primary health care — yesterday’s approach will not suffice especially as the number of qualified district nurses is on the decline.
Quality of life issues in chronic wound management
Authors: Franks Peter J , Moffatt Christine J
Published: May 2014

As a result of improvements in health care, patients are living for many years with chronic disabling diseases. For these people quality of life may be as or even more important than quantity of life. Health-related quality of life (HRQoL) measures attempt to evaluate the patients' perceived mental and social health, not merely their physical problems. Wound care is an ideal area in which to evaluate HRQoL, since the problems are rarely life threatening, but may have a major impact on the way patients live their lives. While there have been preliminary studies to develop disease-specific tools for leg ulceration and chronic venous insufficiency, other types of wound have not received similar attention. Generic tools have been used extensively, not only as indicators of the impact of ulceration on patients but also as outcome measures in both observational studies and clinical trials. The evidence suggests that chronic wounds have an important impact on patients' perceived health particularly in relation to bodily pain, mobility and psychiatric morbidity which are relieved on healing.
Food consumption in low income families with pre-school children
Authors: Mackereth Catherine J , Milner Susan J , Watson Don
Published: May 2014

Healthy eating advice aimed at families has been traditionally targeted at women in the belief that it is they who make the decisions about food consumption within the family unit. This article reports the findings of a study which explored the influence of other family members on food consumption in low income families with pre-school children. Ten couples were interviewed at home. The findings reveal that women’s decisions about food consumption within these families are influenced primarily by their partners, but also by their children. The findings suggest the existence of a ‘nutrition career’, whereby food choices and preferences are renegotiated as personal circumstances change, e.g. when cohabitation begins or on becoming a parent. During these key transition points patterns of food consumption may be voluntarily reshaped thus providing an opportunity for community practitioners to target healthy eating advice more appropriately.
Legal issues arising in community nursing 1: health and safety
Authors: Dimond Bridgit
Published: May 2014

Community nurses working for Roger Park NHS Community Trust are concerned about growing violence on an estate where there is a high level of unemployment, drug taking and vandalism. Several nurses have had their cars damaged and one was accosted by a youth who thought she was carrying drugs. The Trust have refused to take any positive action to assist the nurses. What action can they now take and what laws apply to this situation?
A comparison of two hydrocolloid sheet dressings
Authors: Baxter Helena
Published: May 2014

This article examines the clinical application of hydrocolloid dressings as a whole. Two thin hydrocolloid sheets — Tegasorb thin and Duoderm extra thin — were essayed in the clinical area, and compared for their ease of application and removal, conformability, wear time and patient comfort. Both dressings were found to be highly acceptable in clinical practice, with advantages and disadvantages to each type of dressing. There was a high level of patient acceptability and no adverse reactions were noted during this evaluation. Pain reduction was noted by patients with superficial pressure sores and trauma wounds that were treated with thin hydrocolloid sheets.
A protocol for treating acute constipation in the community setting
Authors: Withell Bridget
Published: May 2014

Constipation is a distressing symptom, common in many patient groups and traditionally treated by nurses. Ambiguity concerning limits of the nurse’s role in treating constipation exists and guidelines are scarce. Theoretically constipation is largely preventable, but acute episodes arise for a number of reasons and often need prompt treatment. This article describes the development of a local protocol which empowers appropriately trained community nurses to treat adult patients with acute constipation. A flow chart was used to define the guidelines. Implementation of the protocol is briefly discussed in relation to other current local initiatives.
The prevalence of breast-feeding in south Leicestershire
Authors: Amin M , Matthews L , Johnson T , Kilty L , Riley R
Published: May 2014

The consultative document, Our Healthier Nation (Department of Health, 1998a), outlined areas for health improvement, and offers health professionals an opportunity to use the Government’s programme to raise breast-feeding rates. This article reports the results of an audit to establish local breast-feeding prevalence rates in south Leicestershire, and when and why women stop breast-feeding. A simple questionnaire was used by health visitors to collect data on all babies born over a 3-month period (October 1997–December 1997). The audit found that 57% of mothers were breast-feeding at birth compared with national breast-feeding figures of 64%. The rate at which women stopped breast-feeding substantially increased between 10days and 6–8weeks postpartum. Women stopped breast-feeding for a variety of reasons. The information provided by the audit will be used to inform health visiting practice and in the long term will hopefully help to increase breast-feeding rates in this area.
How the district nurse cares for the terminally ill patient with cachexia
Authors: Latham Dinah
Published: May 2014

The aims of this study were to establish how district nurses cared for terminally ill patients with cachexia at home; to establish the priorities in the care given; and to establish the nurses’ understanding of the core activities undertaken. The study allowed the views of district nurses to be examined in the context of their understanding of the care they gave. A literature review revealed that the metabolic disorders associated with cachexia mean that the condition is not simply the result of insufficient food intake. However, data from the study suggest that some district nurses have little understanding of the metabolic disorders associated with cachexia and revealed that care centres around advising and encouraging the cachectic patient to increase his/her food intake; such advice and encouragement were seen as the core activities in caring for the cachectic patient at home. This small study of 10 district nurses suggests that cachectic patients are put under unnecessary pressure to eat by both the formal and informal carer, and that as a result the patient may feel unsupported by the carers’ lack of knowledge about his/her condition.
Uncommon disorders: meeting patients needs
Authors: While Alison
Published: May 2014

It seems clear that Diane Pretty, in asking the courts to permit her husband to help her die, does not feel she will die in comfort and with dignity. This poses a significant challenge to health-care providers. Her situation highlights the need for considerable disorder-specific expertise among those delivering health care at the local level. But should primary care professionals be expected to have expertise of high-prevalence disorders such as type 2 diabetes mellitus and coronary heart disease as well as disorder-specific symptom management expertise of low-prevalence disorders such as multiple sclerosis (MS) and motor neurone disease?
Culturally sensitive care: managing diabetes during Ramadan
Authors: Burden Mary
Published: May 2014

Diabetes and its treatments can cause problems for Muslims who wish to take part in the fast during the holy month of Ramadan. This article offers information about the impact of various diabetes treatments, including insulin, when fasting and some of the precautions that need to be in place. Some of the reasons people with diabetes might find it difficult to comply with advice are explored with some suggestions on how to work towards acceptable compromises. Through dialogue between health professionals and patients, it is usually possible to facilitate at least some safe fasting for those who wish to observe this annual ritual.
District nurse-led beds: an alternative to care at home
Authors: Shepperdson B , Phelps K , Turner D , Barrett A , Wileman C
Published: May 2014

Intermediate care is a key feature of the Government’s plans for the development of the health service. The intermediate care scheme described here offers a district nurse-led bed (DNLB) stay in a community hospital to patients in the community who require short-term nursing help. District nurses are given the opportunity to admit patients from their community caseloads into a DNLB in a community hospital and are responsible for their admission, care and discharge. This article describes the pilot study that monitored the first 30 patients who used the DNLBs. Patients included younger people with multiple sclerosis who were admitted for respite care, but the principal beneficiaries were those aged over 65 years with chronic conditions.
Honey as a dressing for chronic wounds in adults
Authors: Fox Carolyn
Published: May 2014

The aim of this review was to identify whether in adults with chronic wounds the use of honey as a wound dressing improves wound management outcomes. As no randomized controlled trials or comparative studies comparing the use of honey as a chronic wound dressing with usual treatment could be found, the review is based on case studies and serial case studies. These were reviewed using a framework broadly based on wound care case study guidelines (Nelson, 2000) and cohort study guidelines (Greenhalgh and Donald, 2000). Based on the case studies reviewed, honey appears to be a useful dressing in adults with chronic wounds, but the available evidence is weak and therefore must be interpreted with caution.
Overactive bladder: a challenge for primary care
Authors: Branter Julie
Published: May 2014

The important role that members of the primary health care team play in the treatment of urinary incontinence is widely recognized (Department of Health (DH), 2000). Incontinence within the general population is increasing and is known to be an embarrassing and distressing condition. It remains a taboo subject that is difficult to talk about even with a trusted health professional. As a result patients suffer from social isolation and a reduction in self-esteem. Members of the primary health care team are well placed to raise awareness about the treatment options. Nurse’s involvement in the treatment and management of incontinence is set to increase (DH, 2001). This article aims to review the types of incontinence and the treatment options available to members of the primary health care team. The National Service Framework for Older People (DH, 2001) has set us the task of establishing integrated continence services by 2004. This provides nurses with the opportunity to work in partnership to target this distressing and embarrassing condition.
Community leg ulcer clinics vs home visits: which is more effective?
Authors: Thurlby Kirsty , Grifiths Peter
Published: May 2014

District nurses manage the care of the majority of patients with leg ulcers, but there have been reports of variations in the practice and effectiveness of treatment provided by district nurses (Audit Commission, 1999). Evidence-based health care aims to promote clinical and cost-effective care/treatment through the explicit, conscientious, and judicious use of the currently available best evidence from research to guide decisions (Sackett et al, 1996). Following the method of Griffiths (2002), a mini-systematic review was undertaken, to find out whether leg ulcer clinics provide more effective treatment to patients with leg ulcers than care provided in patients’ homes by district nurses. Five databases were searched to find valid randomised controlled trials (RCTs) or systematic reviews to answer the question. The search was supplemented by hand searching of relevant publications. Only one trial met the inclusion criteria of the review. Although it concluded that leg ulcer clinics delivered improved outcomes the evidence provided was limited due to the comparison treatment being outdated, inadequate information regarding costs, and that as a relatively small, isolated RCT it provided insufficient evidence to answer the question.
Assessment for long-term care: a snapshot of nursing practice
Authors: Wright Kerri
Published: May 2014

A study was carried out to examine nurses’ assessments of clients to provide a basis for long-term placement decision-making, in both the community and hospital settings. The recommendations made by nurses, based on their assessments, have huge implications for clients. The study was carried out in south-east London. A semi-structured questionnaire was used to gather information on aspects of the assessment process, and a vignette was used to ascertain how nurses assess their clients for longterm care. The questionnaires were sent to 45 district nurses and elderly care nurses involved in assessing clients for long-term care. There was wide variation in nurses’ assessments and opinions on the appropriate timing of the assessments. Nurses did not identify the importance of allowing individuals the opportunity to rehabilitate and recuperate before the nursing assessment and so made potentially inappropriate recommendations. The nurses highlighted that they were given little formal training on how to complete assessments and had limited knowledge about the different care options available for their clients. Nurses had differing opinions on who should carry out particular care tasks – registered nurse or carer. This has implications for the determination of whether a client is entitled to, and the level of, free nursing care. The variations in nurses’ assessments indicates the importance of having more formal structures in place to train and support nurses undertaking this potentially life-changing work.
So you want to do research? 4: An introduction to quantitative methods
Authors: A Meadows Keith
Published: May 2014

This fourth article of a series of six focuses on some of the key aspects of quantitative research methods. Starting with an overview of what quantitative research is, the distinguishing characteristics of experimental and non-experimental research strategies, the different approaches for collecting data including, self-completion questionnaires, interviews and scales, together with their respective strengths and weaknesses are discussed. The differences between probability and non-probability sampling and the different methods for selecting a sample are described. Aspects of quantitative data analysis are briefly reviewed and the concepts of reliability and validity are described in the context of ensuring rigour in the research design. Finally, some guidance on the reporting the findings from quantitative research is provided.
Barriers to smoking cessation in pregnancy: a qualitative study
Authors: Tod Angela Mary
Published: May 2014

The magnitude of smoking as a public health concern in Britain is reflected in the recent government investment to develop smoking cessation services. Smoking in pregnancy is a priority. This article presents the findings of a small qualitative research study exploring barriers to pregnant women stopping smoking. The research was conducted in deprived areas of South Yorkshire, with levels of smoking-related ill health higher than the national average. The study participants revealed a belief system resulting in a self-fulfilling prophecy of relapse or failure to quit. The role and meaning of smoking for women with a high caring burden and socioeconomic problems resonate strongly with earlier studies. Other barriers were the influence of family and friends, how women interpreted facts relating to smoking risks and the nature of smoking cessation service delivery. Community nursing staff a have potential contribution in the delivery of smoking cessation interventions. Effective training should be a priority.
Older people as health service consumers 4: disempowered or disinterested?
Authors: Bentley Jenny
Published: May 2014

Giving patients a greater say in the NHS is prominent in all national service frameworks (NSF’s), and is evident in the expert patient initiative (Department of Health (DH), 2001a). One group of users who may have difficulty in making their voice heard are the elderly. The national service framework for older people (DH, 2001b) promotes user involvement in an attempt to achieve fair and equitable access to services for this group of patients who, statistically, make the highest use of the NHS and could be classified as consumers. This article, the last in a series on this topic, discusses whether a sample of older people in a village community have a consumerist ethos in regard to health care, and whether they are prepared to act in this way. Suggestions are made for better facilitating older people’s involvement in and use of services.
Community health equipment loans: developing a clinical prioritization system
Authors: Oldman Crystal , Brodie David , Nmatsakanova Naira
Published: May 2014

This project aimed to develop an objective method for making equipment loans to home-based patients using a prioritization system based on clinical need. An action research approach was selected as the most appropriate method because of the collaborative nature of the project. It involved working mainly with community nurses using questionnaires, focus groups, telephone and direct interviews. An important part of the process was a workshop with all stakeholders to involve them in decision-making. The resulting unique clinical referral form was implemented successfully. The research also highlighted existing attitudes and perceptions of the equipment loans service among health professionals. The new clinical referral form has improved service provision, is more equitable and now allows decisions to be made using agreed clinical criteria. The results of the research have been disseminated locally in the process of integration of NHS and social services equipment loans. This is a unique example of collaboration between community nursing practitioners, primary care trust managers and researchers producing a measurable difference to patient care.
Holism in community leg ulcer management: a comparison of nurses in Sweden and the UK
Authors: Hjelm Katarina , Rolfe Malcolm , Bryar Rosamund , Andersson Britt-Louise , Fletcher Margaret
Published: May 2014

Collaboration between Kronoberg County Council and Växjö University, Sweden, and Hull and East Riding Community NHS Trust and the University of Hull, UK, enabled an international comparison of care of patients with chronic leg ulcers in the two countries. An aim of the survey study was to compare what ‘holistic care’ meant to nurses working in primary health care (PHC) and nursing home settings in Kronoberg County (KC) and the East Riding of Yorkshire and Hull (ER). A questionnaire, which obtained quantitative and qualitative data, was returned by 311 (222 completed) nurses in KC and 124 in ER (response rates of 54 and 50% respectively). Assessment and planning of wound management focused on the wound. Swedish nurses paid more attention to patients’ experience of the wound, lifestyle factors and environment than UK nurses, but in both countries holistic care appeared to be lacking. Issues for nurse education concerning holistic care were identified. Revision of guidelines and consensus documents to facilitate holistic care is also suggested.
TIELLE* hydropolymer dressings: wound responsive technology
Authors: Mellor James , Boothman Stuart
Published: May 2014

Wound healing may be compromised by many different factors. Certain underlying illnesses, for example diabetes and malignancy, and wound-specific factors such as critical colonization, infection and protease imbalance can all delay or impair healing. Moist wound healing is now generally accepted in clinical practice to facilitate optimum healing under the correct conditions of wound moisture. Johnson & Johnson Wound Management have provided a solution for the clinician by developing TIELLE* hydropolymer dressings, which provide wound-responsive technology for patient care. This unique mode of action achieves positive outcomes for the patient and clinician in terms of cost-effectiveness, patient compliance, healing rates and reduced rates of undesirable adverse effects such as allergic skin reactions, wound pain and maceration.
Clinical evaluation of TIELLE* Plus dressing in the management of exuding chronic wounds
Authors: Schulze H-J
Published: May 2014

This clinical evaluation, which was carried out between May 2000 and January 2001, measured the efficacy and safety of TIELLE* Plus dressing, a novel hydropolymer dressing with super-absorbent properties. In total 2121 patients with leg ulcers (59.1%), pressure ulcers (20.7%), diabetic foot ulcers (10.9%) or other chronic wounds (9.4%) were included in the study. These were recruited by 624 physicians in a German post-marketing study. All wounds had been present for at least 4weeks prior to treatment with TIELLE* Plus dressings and many had been treated with other dressings previously. Within the observation period of 12 weeks, 43% of the wounds healed and 50.4% were considered as ‘improved’. With this combined total of about 95% the subjects clearly benefited from a change in therapy from conventional regimes (in Germany) such as ointments and gauze, but also from modern, moist wound healing dressings such as hydrocolloids. The frequency of side-effects was low at 4.8%. Over 90% of the patients rated the TIELLE* Plus dressing therapy as ‘much better’ or ‘better’ tolerated than the previous treatment regime. For the large majority of the patients the quality of life also improved. On the basis of the positive experiences with respect to effectiveness, safety and handling, 96.8% (604) of the participating doctors wanted to adopt TIELLE* Plus dressings in their therapy plan. TIELLE* Plus dressings can be considered as an effective, safe and simple-to-handle wound dressing for therapy of chronic wounds in daily practice. The shortening of healing time and the less frequent change of dressing also make this therapy regime attractive on cost grounds.
Sharing the burden: the complex practice of wound care in the community
Authors: Hollinworth Helen
Published: May 2014

Wound care in the community setting is often far from simple. Chronic wounds are the product of a complex interplay of processes that must all be addressed if healing, or an improvement in quality of life, is to be achieved. This case study highlights some of the complex issues faced in the community, and reinforces the need for all health professionals to continuously update their knowledge and skills.
Cytotoxic chemotherapy in the home: a study of community nurses’ attitudes and concerns
Authors: Gavin Noel , How Chris , Condliffe Barbara , Depledge Jane
Published: May 2014

Cytotoxic chemotherapy initiated in a hospital setting and continued in the home is an expanding service. The evolution of such a service received a boost with the publication of the NHS Cancer Plan (Department of Health (DH), 2000a) and the NHS Manual of Cancer Service Standards (DH, 2000b). The literature claims a range of benefits of such a service including enhanced standards of care and cost savings. Effective care depends on a number of key factors including assessment, management of risk and support, i.e. appropriate policies and the availability of adequate resources. This study among community nurses reveals a number of key findings including the incremental nature of the development of policy and practice, the general acceptance that changes in community practice are inevitable and welcome where the changes enhance the care of patients, and a level of concern about the availability of appropriate resources and structures necessary for safe and effective practice.
Tap water or normal saline for cleansing traumatic wounds?
Authors: Whaley Susan
Published: May 2014

The aim of this review was to identify whether cleansing with tap water results in higher rates of wound infection or delayed healing compared with other cleansing solutions in adults or children with acute uncomplicated traumatic soft tissue wounds. The review utilized a systematic search of key databases (Cochrane Library, Medline, Embase, Cinahl, British Nursing Index and PubMed), bibliographies, and internet resources. Three controlled trials were found which studied 1281 people. One further study reported outcomes but could not be fully examined as only an abstract was available. Based on the studies reviewed, results suggest no clinically significant increase in the risk of wound infection in wounds irrigated with tap water when compared to sterile normal saline in uncomplicated soft tissue injury. However, the available evidence lacks strength because of the relatively low power and poor quality of studies.
Diabetic retinopathy: protecting the vision of people with diabetes
Authors: Walker Rosie
Published: May 2014

The aim of this article is to provide an update on the effects, causes and treatment of diabetic retinopathy and to discuss practical ways in which community nurses can help protect people with diabetes from losing their vision and support them if they do.
Family health nursing: the education programme for the WHO Europe Scottish Pilot
Authors: Murray Ian
Published: May 2014

This article outlines the development of the family health nurse (FHN) programme, which was delivered by the University of Stirling in the highlands and islands of Scotland as part of a World Health Organization European pilot project. An outline of the structure of the programme and its key features is described. The concept of the FHN emerged from the WHO’s initiative to develop a practitioner who has the family as the organizing focus of their practice (WHO, 2000). An insight is provided into the experience of the first students to undergo this programme, along with a brief summary of the main findings of the external evaluation of both the education programme and the implementation of the role in the remote and rural communities of the highlands and islands of Scotland. Suggestions are made that will hopefully influence the second phase of this project, that the Scottish Executive are supporting in an urban setting, which is due to begin in September 2004.
Multi-compartment medication devices and patient compliance
Authors: McGraw Caroline
Published: May 2014

Multi-compartment medication compliance devices are widely used in primary care. The aim of this review was to reveal whether they are effective in promoting adherence among non-adherent adults living at home. Searches were undertaken using two electronic databases (Medline (1966–2003) and International Pharmaceutical Abstracts (1970–2002)). Only randomized controlled trials (including crossover studies) were included in the review. Participants had to be non-institutionalized adults receiving one or more prescription medicines each day and displaying problems with adherence. Studies had to compare multi-compartment medication compliance devices to standard packaging and outcome measures had to include either pill counts, biological assays and/or clinical response. Articles were selected if they described a follow up period of at least three months and demonstrated that over 80% of participants had completed the trial. Two studies were identified that met the criteria, reporting data on a total of 148 patients. The findings from the first study found diabetic patients receiving medication in a compliance device demonstrated better glucose control than patients receiving medication in standard packaging. The second study found compliance devices had no impact on blood pressure control in hypertensive patients. Further research needs to be conducted to assess the effectiveness of multi-compartment medication compliance devices in promoting adherence among non-adherent adults living at home.
An audit of clinical supervision in primary care
Authors: Barriball Louise , While Alison , Münch Ulrike
Published: May 2014

This article reports on an audit of clinical supervision in one primary care trust (PCT). Data were collected by telephone interviews with 44 respondents from a range of professions occupying different clinical and managerial grades in the organization. Clinical supervision varied both in terms of its availability and management between different professional groups and teams reflecting, in part, differing levels of motivation towards supporting clinical supervision by individual practitioners and managers as well as a perceived lack of trust leadership. Respondents also reported several potential and actual benefits of clinical supervision, including the improvement and standardization of practice and the facilitation of learning and professional development, although there was no consensus regarding the most appropriate format (e.g. individual, group or team) or structure (e.g. uni-professional or multi-professional) for clinical supervision. It was widely agreed that the introduction of mechanisms for monitoring both the process and outcomes of supervision, greater protection of time allocated for supervision and more training opportunities to increase the skill and number of available supervisors were needed.
The Lindsay Leg Club® Model: a model for evidence-based leg ulcer management
Authors: Lindsay Ellie
Published: May 2014

Leg Club® is a unique model of community-based leg ulcer care. By providing nursing care in a non-medical, social environment, the model has several benefits: it removes the stigma associated with leg ulcers and helps isolated older people reintegrate into their communities, which in turn improves concordance and has a positive impact on healing and recurrence rates. In an atmosphere of de-stigmatisation, empathy and peer support, positive health beliefs are promoted and patients take ownership of their treatment. The Leg Club model creates a framework in which nurses, patients and local community can collaborate as partners in the provision of holistic care. The model also provides an environment for appropriate supportive education, advice and information.
Caring for patients with leg ulcers and an underlying vasculitic condition
Authors: Armitage Margaret , Roberts Joan
Published: May 2014

It is not uncommon for nurses in the community to encounter patients with leg ulceration combined with rheumatic disease, particularly rheumatoid arthritis (RA). The aetiology of the leg ulcers in these cases is rarely straightforward, and the managent of the ulcers is correspondingly complex. Management may be further complicated in the presence of vasculitis, an uncommon disorder in which inflammatory changes cause degradation of blood vessels. Rapid deterioration and pain are the main challenges with these cases. This article discusses the aetiology of vasculitic ulcers, and presents two case studies that were successfuly managed using a new hydrogel dressing.
District nursing support for patients with cancer requiring palliative care
Authors: Kennedy Catriona
Published: May 2014

Patients with cancer spend the majority of the last year of life at home, with district nurses (DNs) as the main care coordinators and providers. However, there is a relative lack of empirical work on the DN role in this area. This study used qualitative, case-study methods to explore the role of district nurses caring for patients with cancer who require palliative care. The study focused on three patient cases and the researcher visited each patient with the DN on several occasions. The sample was three DNs and the principal data collection methods were episodes of participant observation (n=11) and in-depth interviews (n=12). The findings suggest that DN role was as linchpin or coordinator of palliative care at home. They were the main providers of physical and emotional support for the patients and families in this study. The supportive role of the DN involved referral to other agencies. Patient and carer preferences impacted on decision-making and care planning and reaching a compromise was often necessary.
Evidence-based strategies for the use of oral nutritional supplements
Authors: Todorovic Vera
Published: May 2014

Prescribable oral nutritional supplements are commonly used as a method of nutritional support in the prevention and treatment of malnutrition in adults. There is growing evidence to suggest that when used appropriately in treatment plans, individuals receiving them will benefit from functional and clinical improvements. The use of supplements in the community has increased over the last decade and questions about the increasing costs and efficacy of the products are often raised within health-care communities. The development of guidelines and protocols for the use of supplements in the community that are based on evidence of need and indicate a clear pathway of care, together with intended benefit, should help to address the issues of costly, inappropriate prescribing.
Psychological problems and stomas: a rough guide for community nurses
Authors: Burch Jennie
Published: May 2014

There are a reported 100 000 people in the UK with a stoma (McCahon, 1999), and it is thought that about 20% of them will have experienced clinically significant psychological problems following their stoma-forming surgery. This article examines some of the most common problems encountered, and offers suggestions for nurses in the community in their management.
A longitudinal study of home care clients and their informal carers
Authors: Armstrong-Esther Christopher , Hagen Brad , Sandilands Mark , Williams Robert , Smith Christine
Published: May 2014

The objective of the longitudinal study was to monitor physical and cognitive changes in a population of 330 older people being supported at home by health services. The participants were 75 years and older and classified as having moderate-to-high needs. A total of 210 primary informal carers were recruited to determine their specific needs and how they coped as dependency levels of their care-recipients changed. Data were collected using six different tools. Two questionnaires were mailed out to participating carers. Assessments of care recipients were carried out at three sampling points over the study period. The clients showed a significant increase in physical dependency and an overall increase in cognitive impairment over time. Only 32% of carers lived with care recipients, and changes in dependency, cognitive changes, lack of respite and performing activities of daily living were all major stressors for informal carers. The needs of informal carers are reported and discussed in the context of recommendations of the Commission on the Future of Health Care in Canada.
Understanding patient and family: holistic assessment in palliative care
Authors: Maher David , Hemming Laureen
Published: May 2014

Symptom relief in palliative care is dependent on the nurse undertaking a holistic general and symptom assessment and integrating these findings into a logical plan of care that can be evaluated against a set of negotiated goals. This article outlines the nature of the holistic assessment and how the establishment and maintenance of the therapeutic relationship can help the nurse to relieve distress, restore hope and enable the patient and family to achieve a good quality of life. Careful attention to the fundamentals of nursing practice, coupled with effective communication, will be shown to enhance the prospect of the patient, their family and the nurse feeling valued and enriched by encounters associated with symptom relief.
Clinical competence in sharp debridement: an innovative course
Authors: Bentley Jenny , Bishai Peter , Foster Ali , Preece Jane
Published: May 2014

A quick and effective way of promoting wound healing is to carry out sharp debridement where indicated, but this procedure carries a high level of clinical risk. Minimizing risk is an essential feature of clinical governance. A new course in wound debridement was developed at King’s College, London in response to local NHS trust demand which required assessment of competence for this high-risk procedure. This innovative development crossed traditional boundaries, and required high collaboration between education and practice.