bluuebunny/crossref_metadata_2025 huggingface dataset:
Case finding: a new approach to chronic disease prevention
Authors: Kane Kay
Published: May 2014

A working group of Specialist Nurses, Mental Health Nurses, DN Nurse Practitioners, and Community Development staff mapped the journey of a person identified with risk factors for chronic disease at a community health promotion event. The mapping exercise demonstrated that the GP was the main and only gate-keeper to a range of nursing and other services, and any health outcome depended upon the person seeking an appointment with the GP. Once a person was identified at an event, there was no follow up or mechanism of tracking the outcome.
Protecting children: the role of the law 2. Legal powers to safeguard children
Authors: Griffith Richard , Tengnah Cassam
Published: May 2014

Last month’s article on child protection considered the principles and key concepts that underpinned the approach to safeguarding children under the provisions of the Children Act 1989. This month Richard Griffith and Cassam Tengnah discuss the legal powers available under the Act that enable the proper authorities to intervene to protect children from significant harm.
Provoking a debate
Authors: While Alison
Published: May 2014

A provocative essay by Shields and Watson (2007) suggesting the impending demise of nursing has sent feathers flying. They intended to be provocative but the excitement which they caused raised some unpalatable issues. They contended that neglect of nurse education and the blurring of role boundaries with doctors and others are bound to result in the ‘assassination’ of nursing.
New guidance on PECs
Authors: Cook Rosemary
Published: May 2014

The change and upheaval resulting from the recent reorganization of primary care trusts (PCTs) has understandably preoccupied community staff for many months. Coupled with financial recovery measures that have seen vacancy freezes and even redundancies, it would not be surprising if community nurses had little interest to spare for the governance arrangements of their PCT. But the new guidance on the professional executive committees (PECs) of PCTs is relevant to all community nurses, whether or not they are PEC nurses. It will determine how the front-line nursing voice is heard in the organization, and how nurses can influence the service redesigns that will be taking place in every PCT as provider services are separated from commissioning.
Do not attempt resuscitation orders:a review of the issues
Authors: Griffith Richard
Published: May 2014

Controversy surrounding the use of do not resuscitate orders on patients often without their knowledge and without apparent good reason (Age Concern England, 2000) have led some to question the lawfulness of such orders. This article considers the legal basis for do not resuscitate orders and outlines best practice guidance that will assist district nurses and other health professionals in deciding whether making such an order is lawful and for the benefit of the patient concerned.
Doesn’t everyone matter?
Authors: While Alison
Published: May 2014

The policy theme of Every Child Matters was coined in 2003 and has been the rallying point for various policy documents (e.g. DfES, 2004) and new legislation in the form of the Children Act 2004. Underpinning this policy theme has been a government ‘commitment to put children first’ and therefore presumably others second. This commitment has seen considerable investment in social infrastructure such as Sure Start Children’s Centres. The policy pledges that every child should have the opportunity to fulfil their potential.
From nurse to editor
Authors: Dawes Jonathan
Published: May 2014

After publishing my first issue of BJCN last month I received a number of congratulatory letters, for which I am very grateful. If the truth be known I have the editorial director Tom Pollard to thank for guiding me in the right direction. It seems that people wanted to know more about my credentials to edit this journal. Unlike many journal editors I have a secret weapon in that: I am a nurse with a community background. So how is it that I have managed to ‘jump-ship’ from the clinical world to the tumultous seas of publishing? Let me explain my background.
The unpaid part of the health service
Authors: While Alison
Published: May 2014

The growing population of older people and the rising prevalence of chronic illness has consequences not only for health services but also for partners and families. There has been much focus upon how health services can be reconfigured to minimise taxpayer costs but if health services are to reduce their contribution to care then others including families will have to increase their care contribution.
Policy update: Practice based commissioning in community nursing
Authors: Cook Rosemary
Published: May 2014

This article looks at the importance of practice based commissioning (PBC) as an activity to determine what care and services are provided to patients and communities. It gives examples of where community nurses are, and could be, involved in the process of PBC, and calls for the provision of information and support to enable nurses to join other practice based commissioners in the developing PBC groups. It acts as a policy update for community nurses.
Weight management in people with type 2 diabetes
Authors: Wu Lihua , While Alison
Published: May 2014

This article sets out a comprehensive outline of the mechanism for the development of Type 2 diabetes and the importance of weight reduction in Type 2 diabetes management. Current weight reduction strategies are reviewed. Lifestyle modifications form the frontline strategy for targeted weight loss in diabetes care. However, there is a lack of knowledge regarding effective and safe interventions to promote weight management for those who have already developed Type 2 diabetes.
Using the benchmarking process to enhance pressure ulcer prevention
Authors: Parnham Alison
Published: May 2014

Pressure ulcers are a recognized source of increased debilitation that continually impact on patients’ quality of life and the NHS economy. While it remains arguable that all pressure ulcers can be prevented, it could be suggested that with closer monitoring of care provision by the healthcare professionals delivering that care, not only will quality of care be enhanced but a reduction in pressure ulcer incidence is a further potential outcome. The Department of Health prioritised pressure ulcer prevention within Essence of Care and the introduction of clinical benchmarking across a number of care settings demonstrates that care provision relating to pressure ulcer prevention can be enhanced through this process. Clinical benchmarking is an on-going process and should remain an integral component to every day nursing practice in order to sustain this positive phenomenon of change.
Nurses and society: an important debate
Authors: While Alison
Published: May 2014

The professionalism and compassion of nurses has come under question as the shortcomings of some nursing care have been reported in various enquiries including those into Maidstone and Tunbridge Wells Hospital (Health Commission, 2007). The quest for ‘bad’ news in the media gives prominence to poor practice and dissatisfied patients and neglects much excellence and many appreciative patients.
A rallying call for the New Year
Authors: While Alison
Published: May 2014

King’s College London had the honour of hosting Gordon Brown’s speech on the NHS which provided an outline of his policy vision on the dawn of the 60th anniversary of the NHS which will be celebrated in July. Not surprisingly he emphasized the enormous success of the NHS over the last six decades in terms of the care delivered and lives saved on the basis of healthcare free for all at the point of need.
Taking the sting out of pain assessment
Authors: Dawes Jonathan
Published: May 2014

We all know that pain is in fact a good thing, that in evolutionary terms it is an essential protective mechanism when facing adverse stimulation. Indeed, without normal pain pathways many patients inflict untold damage on themselves. People with diabetes and peripheral neuropathy can worsen their foot lesions because they have limited pain signals alerting them that damage is occurring.
Measuring productivity within community nursing
Authors: While Alison
Published: May 2014

Financially speaking, times are difficult within the NHS and across the whole of society with economic challenges looming large. During these times it is common for management to review how best they can maximize the effectiveness and efficiency of limited resources. The current spotlight on nurses’ productivity is an outgrowth of early studies on organizational productivity.
Share your views in the national stroke survey
Authors: Dawes Jonathan
Published: May 2014

In March, the Lancet reported on an interesting phase 2 study from Switzerland, which found that a novel vaccine can be used to lower blood pressure instead of using standard oral antihypertensive medication. The vaccine works by blocking angiotensin II in the same way as normal drugs do. However, such a vaccine would overcome the problem of poor compliance, and level off the diurnal surges of blood pressure commonly seen in practice. This study has been hailed as both promising and intriguing. While only in its infancy, the vaccine could realistically come to market within 4 years.
Lessons from Bhutan
Authors: While Alison
Published: May 2014

Bhutan is a small Buddhist nation located in the middle of the Himalayas and was probably unheard of until the first democratic elections were held at the end of March this year. It is largely undeveloped with very limited infrastructure and transport links. The few roads are so poor that a 65 year old lady was reported as walking some 600 kilometres over 14 days to her home village to vote in the general election, preferring the exercise over a difficult car journey.
Maximizing the telephone to deliver nursing care
Authors: While Alison
Published: May 2014

There are very few practitioners who do not complain about the perceived administrative burden of delivering care with time spent on the telephone ranking high among non-clinical activities. However, interdisciplinary working is predicated upon good information sharing if good collaborative working is to be assured.
Chemical straightjackets in a care home near you
Authors: Dawes Jonathan
Published: May 2014

This month has seen a public outcry against the use of atypical antipsychotic medication in the ‘treatment’ of dementia patients in care homes. BBC Radio 4 conducted a survey of 355 GPs and found that more than half would prescribe the drugs respiridone and olanzapine for dementia patients, contrary to clinical guidance clearly advising against this practice.
Holding a spotlight to an ageing society
Authors: Cann Paul
Published: May 2014

In May 2008 Help the Aged published its 3rd annual Spotlight Report. The report highlights the stark realities facing older people in the UK today and gives detailed statistical data on how the lives of some have improved but many are still being left behind.
Sixty years of nursing and the NHS
Authors: While Alison
Published: May 2014

Much has happened over the last 60 years since the foundation of the NHS on 5th July 1948. There has been unforeseen progress in healthcare interventions such as organ transplantation, joint replacements, keyhole surgery, MRI scans and in-vitro fertilization which have transformed clinical outcomes.
How should we be funding costly drugs?
Authors: Dawes Jonathan
Published: May 2014

Tennessee Williams famously said ‘You can be young without money, but you can’t be old without it.’ How true that seems to be when considering the future of the older population. We are all familiar with headlines highlighting the disparity among PCTs’ ability to prescribe certain drugs. The phrase ‘postcode lottery’ is everywhere in the press at the moment. It seems not a month can pass without the National Institute for Health and Clinical Excellence (NICE) being portrayed as an evil overlord intent on withholding the latest wonder drug from those that desperately need it.
The QNI/BJCN survey will feed into a report on district nursing next year
Authors: Cook Rosemary
Published: May 2014

The Queen's Nursing Institute and British Journal of Community Nursing survey hopes to give weight and shape to the role of district nursing, which was omitted from the Darzi Review.
A personal history of living with primary lymphoedema
Authors: Bailey Jed
Published: May 2014

Imagine standing under a cold shower on a freezing and miserable afternoon in November, having been defeated yet again on the football pitch. Standing there watching the mud slowly clogging up the drain, I got my first hint of what’s to come and what turned out to be lymphoedema—my constant companion ever since.
Where is the DoH’s strategy for tissue viability?
Authors: Toner Louise
Published: May 2014

Pressure ulcers are estimated to cost the NHS in the region of £2 Billion pounds per year - 4% of the NHS total budget and more than the whole budget allocated for Mental Health Services. A significant cost for what is claimed by many to be preventable in 95% of cases. Given this situation, the significant question is why tissue viability does not feature more strategically on the NHS agenda. It has to be acknowledged that pressure ulcers have been under the spotlight with Grade 2 and above ulcers subject to clinical incident reporting but what of leg ulcers, ulcers associated with intravenous drug use and diabetic foot ulcers to name a few? The burden of caring for these patients falls mainly within primary care with community and practice nurses bearing the greatest load.
The impact of registered nurses
Authors: While Alison
Published: May 2014

With the move to all-graduate registered nursing, the benefit of the registered nurse to patients’ lives will be closely scrutinized in the coming months. The jibe ‘too posh to wash’ challenges the ethos of academic nurse education that highlights the need to base care on both the patient’s psychosocial needs and on evidence-based clinical interventions. Indeed, the invisibility of technical nursing care from media portrayals is a cause for concern.
Providing an integrated admissions avoidance service
Authors: Cotton Julie
Published: May 2014

The long term conditions agenda is a national agenda which was introduced in 2004 as part of the NHS Improvement Plan. The plan highlighted long term conditions as one of the top three priorities for PCTs to deliver on. Initially the key element in providing the long term condition agenda was the community matron role providing care to patients who were considered to be very high intensity users of healthcare services. This article describes the integrated model of provision that Bassetlaw PCT adopted and goes on to explain the planned initiatives to enhance the model. The article explores the debate for an integrated approach and the issues associated with implementing that model. In particular the paper details the vision to provide a consistent service across the 24 hour period in order to reduce avoidable admissions to acute care. Finally, the article highlights the perceived outcomes of the model and the PCT’s future plans for expanding it.
The Law and grievance resolution in the workplace: a guide for DNs
Authors: Griffith Richard , Tengnah Cassam
Published: May 2014

Disputes at work are never pleasant and can lead to long term strain on the relationship between district nurses and managers. It is in the best interest of both to deal with any problems openly and fairly. The legislation relating to workplace grievances and claims arising from these to an employment tribunal changed on 6th April 2009. The new framework requires grievances to be resolved by both the employer and employee working together and abiding by a revised statutory Code of Practice from the Advisory, Conciliation and Arbitration Service (ACAS, 2009a). It is, therefore, important that district nurses are aware of the new law, the Code and their rights in the event of a grievance at work.
Partnership working with independent providers
Authors: Poole Ruth , Wallis Chris
Published: May 2014

The Department of Health in England want to see NHS commissioners and providers capitalize upon the expertise of the independent sector for the benefit of NHS patients. In preparing for the future what does the sector have to offer NHS nurses and how will this benefit patient care? This paper examines the role of independent providers and the way they are helping NHS commissioners and providers to break new ground in delivering more accessible and convenient care for NHS patients at home.
Are HIECs the answer?
Authors: While Alison
Published: May 2014

Health Innovation and Education Clusters (HIECs) are being proposed to: ‘establish partnerships between NHS organizations, the higher education sector, industry and other public and private sector organizations to support the spread and adoption of innovation within NHS delivery’ (Department of Health (DH), 2009). HEICs are the final component of bringing about local change as part of delivering the NHS Next Stage Review’s (DH, 2008a) ambitions of high quality healthcare, so that healthcare professionals have all the necessary skills and experience founded upon excellent education and training (DH, 2008b).
An interview with Richard White
Authors: White Richard
Published: May 2014

I first encountered acute wounds, leg ulcers and factitious wounds (dermatitis artefacta) while working in dermatology as a research fellow and lecturer in Liverpool. The usual practice for the department was to treat leg ulcer patients twice a week as outpatients. This was in the early 1980s, just when the ‘modern era’ of moist wound healing was getting underway, and we were still using paste bandages, dry dressings, and silver nitrate solution to ‘treat’ overgranulation.
Introducing high dose steroid therapy for MS relapses into the community
Authors: Cassia Barbara , Ranford-Mills Melanie
Published: May 2014

South Staffordshire primary care trust (PCT) has seen a rise in the number of specialist nurses working in the community and the development of a wide range of intermediate care services. The Community Intervention Team (CIT) has offered the patients of East Staffordshire the choice to receive intravenous antibiotics, blood transfusions (Pott, 2009), and other intravenous therapies in their own homes rather than as hospital in-patients, for over five years. The local multiple sclerosis clinical nurse specialist (MS CNS) has worked closely with CIT when any MS patients have needed extra support at home to manage a crisis and this led the authors to consider how they could work together to prevent some of these crises occurring. In this article they authors outline how they used an award from the Queen’s Nursing Institute (QNI) to help establish a community-based service to offer patients the option of receiving high-dose steroid therapy at home for treatment of a relapse, within the resources already available in the PCT.
Importance of workplace
Authors: While Alison
Published: May 2014

Despite the growing body of research evidence, the implementation of evidence-based practice and rational transformational change within service provision continues to be the ‘Holy Grail’. Indeed, increasing emphasis is placed upon the ‘development’ element of research and development within health-care organizations and research proposal applications are subject to careful scrutiny of their dissemination plans in the hope that knowledge of findings will enable their early implementation.
Implementing KSF competency testing in primary care. Part 2: evaluation of the pilot of an appraisal tool
Authors: Bentley Jenny , Dandy-Hughes Harlene
Published: May 2014

Assessment of competence is a way of measuring if staff are fit for purpose. Clinical competences, against which performance is measured, have been developed in a wide range of clinical settings in recent years (Department of Health (DH), 2008). Several trusts also operate an assessment centre in the recruitment and selection of staff, and these frequently involve competency testing in order to be certain that their new recruits are fit for their post. Agenda for Change (DH, 2004a) firmly links pay to the competences expressed in the Knowledge and Skills Framework (DH, 2004b; c) yet the KSF has not been implemented in all trusts.

In part 1 of this article (Bentley and Dandy-Hughes, 2010), the process of Southwark PCT’s competency project was described. This involved the process of writing measurable, manageable competences from the KSF, in order to develop staff to be fit for purpose. Part 2 evaluates the use of the appraisal tool that was developed from the KSF, and examines the role of the nurse consultant in education who led the competency project.
Working with carers in the next decade: the challenges
Authors: Jarvis Alison
Published: May 2014

This paper outlines two challenges to community nurses as they work with unpaid carers. These reflect a changing culture in the way that health care will be delivered in the coming decade. The first of these challenges is a shift towards focusing on outcomes for both service users and adult carers. Outcomes evidence the impact a service has on a person’s life. The second is the increasing focus on the concept of carers as partners in care.
Health literacy: just another way to blame patients for their poor health?
Authors: Phillips Jim
Published: May 2014

The Department of Health (2007) demonstrated the link between improved lifestyle choices in terms of healthier eating and reduced smoking among those with higher health literacy. But is it simply a factor that those who continue to make poor lifestyle choices do so because they have low health literacy, or is it that health professionals often contribute to ongoing health literacy problems because of the nature of their interaction with the individual?
Generic prescribing and substitution: the big issues
Authors: Duncan Debbie
Published: May 2014

In August 2009 the Department of Health recommended that by the beginning of this year medications prescribed should be substituted by dispensing pharmacies in a bid to save the NHS wasted money on issuing branded medication. Prescribing generic medication has been deemed good practice for a long time but ultimately the prescriber has the final say about what their patient is dispensed. This article looks at why some prescribers want an opt-out clause on prescriptions for groups of patients who will not benefit from this action.
Diabetes: excellence for all
Authors: While Alison
Published: May 2014

The National Service Framework (NSF) for Diabetes (Department of Health (DH), 2001) set out 12 standards to raise the standards of diabetes care in England to tackle the heavy toll it was taking on individuals and health services. There are an estimated 2.35 million people with diabetes of whom approximately 2.2 million are recorded on GP practice registers. Therefore, a substantial number of people with diabetes remain undiagnosed and there are growing numbers of those at risk of developing it because of their obesity. Indeed, it is predicted that there will be more than 2.5 million people with diabetes by the end of 2010.
A new look for a new era
Authors: While Alison
Published: May 2014

Since the May 2010 issue of the British Journal of Community Nursing (BJCN) we have had a General Election which has resulted a new Government which is quite unlike any previous Government; a coalition between the Conservatives and Liberal Democrats. We know little about how this will change the health policies of the last Government except, while there is a commitment to sustain real funding, it has been widely announced that we are entering a period of austerity as Government finances are brought back into balance.
Transforming community services
Authors: Young Lynn
Published: May 2014

The Department of Health-led programme, Transforming Community Services (TCS), has, since its introduction in Autumn 2008 created a huge volume of work for myself, other Royal College of Nursing colleagues and NHS managers who are connected to community health services.
End-of-life care: supporting independent and healthy lives
Authors: Hobson Sandra
Published: May 2014

According to Department of Health figures published in 2008, between 56% and 74% of people would prefer to be cared for and to die at home although at present only 18% of deaths occur in the home, and 17% take place in care homes. According to The Hospital Guide, published by Dr Foster Intelligence in 2009, one in seven hospitals do not provide any facilities to support relatives and carers who wish to stay in hospital with a patient during their final days.
Faecal incontinence in older people: delivering effective, dignified care
Authors: Smith Belinda
Published: May 2014

Incontinence of faeces may effect up to 10% of adults in the community but people are reluctant to seek help owing to the stigma of this debilitating and distressing condition. There are multiple risk factors associated with the development of faecal incontinence that community nurses are well placed to identify. These risk factors range from reduced dietary and fluid intake to the complex symptoms found in patients with long-term conditions. Community continence services are historically nurse led and are delivered at the patient interface by community nurses, in collaboration with other disciplines and agencies. The ongoing drive to increase productivity sets a challenge for nursing to demonstrate the value of investing in a proactive approach to preventing faecal incontinence in older people or to improve the quality of life for those with intractable symptoms. A range of proven and emerging interventions are able to achieve more positive outcomes for patients.
Medicine management: pharmacokinetic update for community nurses
Authors: Khan Ehsan
Published: May 2014

Medication management is a major part of nursing practice. Ensuring safety in medication management is all the more important in the community, where patients are not under constant observation of a health-care professional. One of the prime factors in maintaining safety with medication is establishing and maintaining adequate and safe drug levels in the body. Before drugs can have an effect, they are acted upon by the body; these processes change the drug, mainly to enhance its removal from the body. Study of these processes is called pharmacokinetics and includes the processes of absorption, distribution, metabolism and excretion. Pharmacokinetic processes determine the time of onset and duration of drug action. In turn drug pharmacokinetics is affected by concordance with medication regimes and systemic illness; factors which may render the medication useless or toxic. This article introduces the reader to the principles of pharmacokinetics and shows the link between pharmacokinetics and disease and administration of multiple drugs (polypharmacy). With an aim to equip the community nurse with a better understanding of how to recognize and foresee problems associated with medication management.
Coeliac disease: prevalence, presentation and problems
Authors: Evans Kate , Sanders David
Published: May 2014

Coeliac disease or gluten-sensitive enteropathy is an autoimmune disease that occurs in genetically predisposed individuals as the result of an immune response to gluten. The last two decades have seen a great leap in our understanding of coeliac disease. The advent of sensitive and specific serological markers, increased availability of endoscopy, and recognition of the highly variable clinical presentation have all contributed to an improved awareness and understanding. No longer considered a rare diarrhoeal disease of childhood, the modern coeliac patient is middle aged with subtle gastrointestinal symptoms. Treatment includes a gluten-free diet to reduce symptoms and complications. Coeliac disease remains under-diagnosed and this has been addressed by recent National Institute for Clinical Excellence guidelines developed to improve recognition and assessment. This review aims to give a broad overview of contemporary coeliac disease which will enable community-based health professionals to identify those at risk and support those diagnosed with this common condition.
Community nursing in systems reform: the London polyclinic experience
Authors: Peckham Stephen , Wilson Patricia , Gosling Jeni , Osipovic Dorota , Wallace Andrew
Published: May 2014

Internationally, the polyclinic has been a feature of many health systems. The recent UK policy shift towards enhanced coordination of care closer to home resulted in the development of polyclinics, most notably in London. This article explores the background to the development of polyclinics and draws on the early experience of developments in London to explore what their impact has been, and is likely to be, on community nursing. Emerging findings from an evaluation of four pilot polyclinics suggests that rather than one model, polyclinics evolved in distinctively different ways more appropriately labelled as polysystems. Although policy makers clearly identified community nursing as being one of the key components of integrated, community-based care, the evaluation suggests a focus on high-level organizational restructuring and system change can shift attention from what many would consider core activities such as community health services.
Developing an equipment library for clinical skills and simulation training
Authors: Barrott Joanne , Hope Angela
Published: May 2014

This article describes the the development of a regional equipment library for clinical skills and simulation training. This was a project undertaken to address a reduction in the available funding for the purchasing of clinical skills equipment throughout the Yorkshire and Humber region. It was envisaged that utilizing regionally accessible equipment through the development of an equipment library could support clinical areas with no other means of acquiring the necessary equipment for training. A consultation exercise met with initial concerns around the cost of some of this equipment and who would be responsible for the repair, transportation costs and maintenance. A SWOT analysis identified how these concerns may be addressed and processes of developing a database, tracking usage and auditing of the service emerged.
Made to measure? Assessing feasibility of quality indicators for district nursing
Authors: Horrocks Sue , Cook Jane , Ashton Nikki , Wye Lesley
Published: May 2014

Scant empirical information exists regarding the quality of district nursing (DN) services. This article reports the testing of 31 quality indicators (QI) in practice.

Method:

Twelve DN teams provided patient notes for audit. External auditors completed audit forms by cross-referencing between DN office records, patient notes from home, electronic GP records and discussions with DN team leaders. A patient experience questionnaire was piloted.

Findings:

277 (77%) patients’ records were audited. Access to records was problematic. QIs required further refinement of their wording, modification of inclusion criteria, deletion of some QIs and inclusion of others. Telephone administration of the patient experience questionnaire was not feasible for the DN patient population.

Conclusions:

QIs can not be used ‘off the shelf’ and need testing and modification before routine use. Trained, external auditors with clinical backgrounds ensure an informed, uniform, objective approach to data collection, which is desirable as QIs might inform commissioners in a competitive field in future.
Managing heel ulcers in the community
Authors: Beldon Pauline
Published: May 2014

As the size of the older population increases, the incidence of falls and injuries, in addition to chronic wounds, is likely to increase concurrently. This article highlights the risk of both pressure ulceration and diabetic foot ulceration and gives an overview of appropriate treatment and management.
Guarding against discriminatory treatment decisions
Authors: Griffith Richard
Published: May 2014

This article studies a case in which a 52-year-old male patient has early onset dementia, Down's syndrome and an associated heart condition, for which he is prescribed warfarin and digoxin. A district nurse, who is an independent prescriber, monitors and adjusts his medication and takes the required blood sample. The staff at the care home where the patient lives report that the patient is spitting out his medication and they have not been able to persuade him to swallow his tablets for a week. Despite the patient being assessed as lacking capacity to decide treatment decisions, the care home staff argue that his refusal to take medication should be respected and the medication discontinued. Although withdrawing the medication would make caring for the patient less challenging, the district nurse assesses the legal obligations that must be considered before this decision can be considered lawful.
Common forms of dementia and their management
Authors: Ouldred Emma , Bryant Catherine
Published: May 2014

Dementia is a common disease, especially in those over 65 and healthcare assistants and assistant practitioners are likely to come across it on a regular basis. In order to understand the appropriate type of care that dementia patients require, health providers first need an understanding of the condition. This article explains the facts about dementia and its various forms.
An overview of urinary incontinence
Authors: Foxley Susan
Published: May 2014

Incontinence is not life threatening, but certainly can be life changing. Not medically classified as a disease, it is a symptom of lower urinary tract dysfunction which gives rise to problems which can be distressing and unpleasant. This article will consider the implications of such a common and yet unrecognized condition and provide healthcare assistants and assistant practitioners with an overview of this complex topic. It will explore the care they can and should provide.
Infection control: tackling Clostridium difficile
Authors: Nazarko Linda
Published: May 2014

Clostridium difficile (C. Dificile) bacteria are hard to destroy and can live for months in an environment. If a patient has C. dificile, there is the risk that other patients on the ward will contract it if infection control procedures are not strictly followed. A patient with the infection will require careful nursing to ensure that he or she does not become seriously ill. This article aims to help you to understand who is at risk of developing C. difficile, how it is transmitted and how you can care for the person with it and prevent cross infection (Banning, 2006).
A training assistant
Authors: Roberts Julie
Published: May 2014

Having been employed with the National Health Service (NHS) for 25years, 23 as a nursing auxiliary and furthermore as the modern term ‘healthcare assistant’ (HCA), assisting in the delivery of holistic care to patients within a theatre and medical setting, I strongly felt the need to enlighten all HCAs to the opportunities available for personal development.
Is problem-based learning an effective vocational tool?
Authors: Evans Adrian Thomas
Published: May 2014

Problem-based learning (PBL) has been around in undergraduate nurse education for some time, and could be extensively integrated into other pathways. It could be argued that filtration into the healthcare assistant's vocational training could prove effective especially for HCAs of today that follow the nurse education programme upon completion of their NVQ. However, this may be harder than it sounds. This article will consider the pros and cons of PBL.
Every opinion counts
Authors: Vaughan Paul
Published: May 2014

Welcome to this month's opinion column: my first. My friends might say that I am opinionated and being Irish I can talk the hind legs off a donkey. But one way to quieten someone who always has something to say is to ask them to write an opinion column! Which got me to thinking – how many times have you heard someone ramble on about something they are not happy about behind the scenes yet they are not prepared to stand up in public and express their opinion openly. This makes it very difficult to address the issues that are at the heart of the matter and enable change to take place.
The developing role of the maternity care assistant
Authors: Gregory Irene
Published: May 2014

Maternity care assistants (MCAs) are becoming a necessary part of the healthcare workforce as the workload of the midwife increases and the number of qualified midwives falls. These MCAs have been under fire by the press recently for taking on duties not suited to their experience or qualifications. This article will consider what they are are actually allowed to do in the field of midwifery and and how their developing role will benefit themselves, their colleagues and most of all, their patients.
Finding information
Authors: Dunbar Amanda , Stewart Heather
Published: May 2014

An important aspect of reference lists at the end of each article in this Journal is that they direct you to sources of further reading which you may wish to explore. As commented on in last month's ‘Making sense of….. References’, when writing an article for a journal, authors will analyse published information to determine its quality and accuracy and only high-quality sources will be used. You can therefore be confident that the sources used in a reference list will be of a high standard and may warrant further exploration.
Caring for a relative with Alzheimer's disease
Authors: Talbot Marianne , Humphrey Deborah
Published: May 2014

My mum is 87, she has advanced Alzheimer's and Coeliac disease, and she is a complete star! I brought her to live with me four years ago when it became clear that she could not live alone any more (it was her setting fire to the microwave by baking a potato on ‘high’ for an hour that did it!). I enjoy her living with me despite the various inconveniences, she is always cheerful, eats anything and is a great enhancer of life.
Mental health part 3: assessment and treatment of depression
Authors: Simpson Clive
Published: May 2014

Depression is the most common mental health problem. Wherever assistant practitioners (APs) and healthcare assistants (HCAs) work, they can expect to come into contact with people with depression. A previous article provided some background information on depression. This article provides information on some of the interventions which HCAs and APs can get involved in which can help in caring for people with depression
Dementia: caring for patients and supporting carers
Authors: Ouldred Emma , Bryant Catherine
Published: May 2014

Dementia care is an area healthcare assistants (HCAs) and assistant practitioners (APs) are likely to be involved in. It is important that with dementia patients, there is a focus on person-centred care as this will ensure that each individual is treated and cared for as sensitively and effectively as possible. Although this area of care can and will present challenges to the carer, it can also be very rewarding if performed properly. This article will explain what can trigger behaviour associated with dementia. It will also provide advice on coping with such behaviour in order for HCAs and APs to deliver the best care possible.
Tissue viability: the physiology of wound healing
Authors: Lloyd-Jones Menna
Published: May 2014

The role of the healthcare assistant (HCA) and assistant practitioner (AP) in wound care is controversial. In some trusts HCAs and APs only care for wounds under the direct supervision of a registered nurse and in other areas they alternate dressing changes with the registered nurse. However, no matter how much or how little involvement the HCA or AP has in wound care, it is important to understand the normal process of wound healing and in particular the importance of inflammation. Without this understanding, the HCA or AP could not identify and report back any suspected abnormality.
Developing your role in the assessment of pain
Authors: Gregory Julie , Roberts Jane
Published: May 2014

Pain is a common and distressing symptom experienced by many hospital patients. It can lead to increased anxiety, lack of sleep and rest, poor appetite, increased risk of complications such as chest infections, deep veined thrombosis and pressure sores. Pain can lead to delayed recovery, increasing the hospital stay and costs, requiring extra resources. Early recognition and treatment of pain is vital for patient comfort, wellbeing and recovery from illness, injury and surgery (Innis et al, 2004; Bird, 2005). Healthcare assistants (HCAs) and carers play an important role in the assessment of pain by identifying patients’ experience of pain; they may be the most appropriate person to perform the assessment in various settings. It is important that communication and pain assessment education or training includes these groups (Bird, 2005). This paper describes the use and development of an educational programme to increase the identification of pain and improve pain management.
Assistant practitioners
Authors: Chambers Alison , Dunbar Mandy
Published: May 2014

As many qualified health professionals are all too aware, the continued success of the NHS depends largely on collaborative interprofessional working across all grades and professions of staff. This is especially important for those working on the front line delivering direct patient centred care; the healthcare assistant (HCA). HCAs working across all disciplines; nursing, midwifery and the allied health professions, to name but a few, have unerringly implemented treatment programmes and provided high quality patient care for a number of years and are valuable members of the healthcare team.
Gaining underpinning knowledge of NVQs
Authors: Bartle Caroline , Emberton Rachelle
Published: May 2014

In order to achieve your NVQ you need to demonstrate that you meet both performance criteria and knowledge evidence. There is often a gap between the two elements; of theory and practice. The key to a successful NVQ is in incorporating knowledge seamlessly into practice, in order to gather naturally occurring evidence. Many people find that when starting an NVQ they lack essential knowledge to enable them to perform competently. At New Generation College we have developed a structured approach to the delivery of NVQs that tackles these issues.
NICE clinical guidelines
Authors: Dunbar Amanda , Stewart Heather
Published: May 2014

The National Institute for Health and Clinical Excellence (NICE) is an independent body, responsible for providing guidance on how good health can be promoted, and ill health prevented or treated. To do this, NICE produce guidance in various different types (Table 1). Clinical guidelines are very relevant to healthcare assistants (HCAs) and assistant practitioners (APs) and consequently we will focus on these.
Changing times bring opportunities
Authors: Grainger Angela
Published: May 2014

Just as the seasons change, bringing with them a different climate and associated altered views of the landscape, so the NHS, social services and also the independent healthcare sector, change in accordance with government policy designed to address social needs. Autumn will very soon give way to winter and in the UK's NHS it seems that Christmas might have come early with the government announcing an annual 4% increase in the NHS budget for the next 3 years, taking the total NHS budget from £35 billion in 1997-8 to £110 billion in 2010-11.
Tissue viability: sitting and seating
Authors: Davies Patricia
Published: May 2014

Sitting patients out of bed has become an accepted, integral part of the rehabilitation process. Yet the act of sitting is paid little attention to. Sitting out for periods in excess of 6–8 hours is all too common for patients (Gebhardt and Bliss, 1994). This article will pose two questions, firstly is what we sit our patients on really fit for purpose, and secondly are there any benefits to our patients in sitting out for long periods?
Opening access and improving care with HCAs
Authors: Vaughan Paul , Carlisle Daloni
Published: May 2014

A radical model for the role of the HCA in general practice has improved patient care and helped the practice meet access targets. This article reports on Sheffield University's evaluation of this innovative scheme.
Considerations for phlebotomy training
Authors: Henry Vanda
Published: May 2014

If I had a penny for every time I have heard the phrase ‘anyone can take blood’ I would be writing this from a private villa in the Bahamas sipping a pina colada! Meanwhile, back in the real world I am sat at my desk in Fordingbridge Doctors Surgery in Hampshire. Here the management and partners thankfully believe in the fundamental education of all levels of staff. For instance, our practice manager and business partner is also a trained business consultant, we have two nurse practitioners, one of which is an NVQ Assessor, and three healthcare assistants (HCAs) all taking their NVQ Level 3.
Meeting the needs of the workforce
Authors: Moss Diana
Published: May 2014

Healthcare assistants wishing to expand their role are able to access primary-care based education centres in order to develop knowledge and skills complementary to the wider workforce modernization of nurses, doctors and other healthcare professions.

Primary-care based education centres provide a range of training opportunities; short courses, one-to-one mentorship and supervision, bespoke learning events, PCT-protected learning time activities and resource development.

Such centres serve the development needs of the primary care workforce through locally accessible training opportunities. Demand for practice learning experience in primary care from nursing, medical and other healthcare professions is stretching service placement provision. A network of multi-professional learning organizations has potential to capitalize on educator expertise providing development opportunities spanning the primary care workforce
What is research and why should we use it?
Authors: Bellman Loretta
Published: May 2014

Do you know if the care that you are providing for your patients is based upon up-to-date research evidence? This article provides a starting point for understanding research evidence - what is it and where does it come from? Also, how can research evidence be applied in practice? Finally it considers ways in which healthcare practitioners can remain up-to-date and ensure their practice is evidence-based.
Politics: why is it important to you?
Authors: Barber Christopher
Published: May 2014

Since its inception in 1948, the NHS has been a political football, being kicked from one political ideology and set of policies to another without a great deal of thought being given to healthcare workers who have to implement these political policies in the workplace. The same applies to the ‘independent sector’. This short article sets out to explain briefly what the word ‘politics’ means, the UK political system, mainstream political ideologies, how these ideologies translate into healthcare policies and the implications of these ideological stances for healthcare assistants and assistant practitioners.
Protocol
Authors: Dunbar Amanda
Published: May 2014

Many assistant practitioners and healthcare assistants are now finding that they are working within extended roles, completing clinical assessment and treatment skills which previously remained the domain of a registered member of staff. Many of these roles will rely on protocols underpinning the clinical role which provide a framework that should be followed when completing a task. This article aims to outline what a protocol is and how they are developed. Consideration will also be given to the use of protocols in the development of new skills within clinical practice.
Mentorship for healthcare assistants: a literature review
Authors: Rennie Iain
Published: May 2014

This paper discusses a literature review of mentorship of healthcare assistants (HCAs). The review identifies that HCAs need skilled mentorship but this is seldom acknowledged. Despite guidelines, mentorships vary and are influenced heavily by experience and personality rather than by any preparation programme.