bluuebunny/crossref_metadata_2025 huggingface dataset:
The African Health Profession Regulatory Collaborative (ARC) at two years
Authors: McCarthy Carey F , Zuber Alexandra , Kelley Maureen A , Verani Andre R , Riley Patricia L
Published: May 2014

Background

The African Health Profession Regulatory Collaborative (ARC) for nurses and midwives was created in response to the increasing reliance on shifting HIV tasks to nurses and midwives without the necessary regulation supporting this enhanced professional role.

ARC Approach

The ARC initiative comprises regional meetings, technical assistance, and regulatory improvement grants which enhance HIV service delivery by nurses and midwives, and systematic evaluation of project impact.

Results

Eight of 11 countries funded by ARC advanced a full stage in regulatory capacity during their 1-year project period. Countries in ARC also demonstrated increased capacity in project management and proposal writing.

Discussion

The progress of country teams thus far suggests ARC is a successful model for regulation strengthening and capacity building, as well as presenting a novel approach for sustainability and country ownership. The ARC platform has been a successful vehicle for regional harmonisation of updated regulations and promises to help facilitate the enhancement of HIV service delivery by nurses and midwives.
Continuous positive airway pressure ventilation part one: Physiology and patient care
Authors: Nehyba Katrine
Published: May 2014

Continuous positive airway pressure (CPAP) offers a method of non-invasively supporting a patient’s respiratory and cardiac function. It is a commonly used treatment in level two and level three care. The decision making process for the care of patients requiring CPAP is multidisciplinary and should involve doctors, nurses and physiotherapists. CPAP can offer significant benefit to a patient in respiratory distress, yet also has significant complications and unique care needs that nursing staff must be aware of. Part one of this article outlines the physiological rationale for CPAP and a practical guide to its use in the care of cardiac patients. Part two will discuss the indications and contraindications of CPAP for the three main groups of cardiac patients who use this therapy.
Intra-aortic balloon pump counterpulsation therapy
Authors: Catton Jacqueline
Published: May 2014

Intra-aortic balloon pump counterpulsation therapy was first introduced to treat patients in cardiogenic shock but it is now one of the most commonly used cardiac assist devices. This therapy mechanically assists and supports patients who have experienced a myocardial infarction, have poor left ventricular function, are in cardiogenic shock and who require additional support before undergoing cardiac surgery or high risk angiogram or angioplasty. The aim of this article is to examine the nursing care and the wide range of interventions required for a patient needing intra-aortic balloon counterpulsation therapy. It will consider indications, contraindications and how to minimize the complications of therapy.
Cardiac assessment part 2: Auscultation
Authors: Massey Debbie
Published: May 2014

Over the last 15 years numerous political drivers have paved the way for the development of new and innovative models of practice in cardiac care. these were discussed in the first article of this two-part series. Part one introduced and described the elements of inspection, palpation and percussion in relation to per forming cardiac assessment. this paper offers practitioners an opportunity to develop and augment their knowledge of cardiac auscultation. It suggests and introduces a systematic model that may be used in clinical practice.
The radiofrequency ablation of atrial flutter
Authors: Tabbernor Lynne
Published: May 2014

This care study presents the management of a 66-year-old man with typical atrial flutter. Complications of atrial flutter are hear t failure and stroke. The management of this man involved rate control, anticoagulation, cardiovascular risk reduction and referral for radiofrequency ablation. Radiofrequency ablation is a safe and effective first-line treatment for typical atrial flutter and has a number of advantages over long-term pharmacological management. Issues such as quality of life and patient choice also need to be addressed by health professionals when formulating management plans.
Alternative therapies in critical care areas: The limitations and benefits
Authors: Duke Zoe
Published: May 2014

Over the past decade there has been increasing interest in the use of complementary therapies in health care settings (Hill, 1995). Although holistic techniques designed to reduce stress and anxiety, such as massage and aromatherapy, are viewed within the realm of nursing, such techniques are infrequently used and inadequately evaluated in critical care settings (Hobbs and Davies, 1998). This article aims to review the available literature on the effects of massage in critical care areas
Sildenafil: A recent advance in the treatment of pulmonary arterial hypertension
Authors: Grady Duncan , Suntharalingam Jay
Published: May 2014

Pulmonary arterial hypertension (PAH) is a rare but devastating disease that affects the pulmonary vasculature. It causes progressive right ventricular dysfunction and leads to worsening breathlessness, impaired quality of life and premature death. This article explores the role of the erectile dysfunction drug sildenafil in the treatment of PAH. The article discusses how, through its action on the phosphodiesterase-5 enzyme, sildenafil may help reverse vascular remodelling and cause selective vasodilatation of the pulmonary arteries, with little effect on the systemic circulation. Important adverse effects and potential serious drug interactions are also highlighted to help ensure the safe use of sildenafil in clinical practice.
Developments in heart failure care
Authors: Riley Jillian
Published: May 2014

In this issue of the journal a special focus has been placed on the area of heart failure care. Jillian Riley discusses some of the changes that have taken place and how practice can be improved.
Recording a standard 12-lead ECG: Filling in gaps in knowledge
Authors: Crawford Jacqui , Doherty Linda
Published: May 2014

Jacqui Crawford and Linda Doherty discuss some of the reasons for inaccuracy in electrocardiography and ways to ensure correct placement of electrodes
A practical approach to transthoracic echocardiography
Authors: Oxborough David
Published: May 2014

David Oxborough describes the process of a transthoracic echocardiographic examination and presents examples of normal echocardiograms
Meet @ TeenHeart: Working with teenagers with heart disease
Authors: Lillie Stefanie , Card Diane
Published: May 2014

Stefanie Lillie and Diane Card introduce the British Heart Foundation’s initiative to develop a support network aimed at teenagers, and the online resources it prompted
Reducing the risk of thromboembolic events
Authors: Huntington Sarah , Acomb Chris
Published: May 2014

Warfarin is the most commonly prescribed anticoagulant in the UK and is used for both the treatment of thromboembolism (deep vein thrombosis, pulmonary embolism) and for thromboprophylaxis (atrial fibrillation, mechanical prosthetic valves or thrombophilia). It acts as a vitamin K antagonist, resulting in the formation of inactive forms of factors II, VII, IX and X; important steps in the clotting cascade. The evidence base supporting the clinical use of warfarin is extensive but it is far from an ideal treatment. There is a critical balance between thromboembolism prevention and haemorrhagic events. In addition, warfarin is susceptible to a wide range of drug interactions, due to its metabolism by cytochrome-P450, and has large interpatient dose variation. It is essential that regular monitoring and blood tests are performed and the patient receives sufficient education on warfarin treatment.
Diuretics in heart failure part 1: Pharmacology and mechanisms
Authors: Khatib Rani
Published: May 2014

Diuretics have a major role in the management of heart failure (HF) as they relieve oedema, congestions and dyspnoea. However, there are no large or long-term placebo-controlled trials of the use of diuretics in HF. Thiazides can be used for patients with very mild fl uid retention. Otherwise, loop diuretics are usually the agents of choice in HF. Potassium-sparing diuretics can be used to reduce the risk of hypokalaemia. In HF diuretics should be administered in addition to an ACE-inhibitor (or ARB) and a beta-blocker if tolerated to reduce decompensation and maintain clinical stability. In this article (the first of two parts) the pharmacology and mechanism of action of the three main classes of diuretics used in HF will be outlined.
Chronic kidney disease stages 1–3: Its relationship with CVD
Authors: Murphy Fiona , Byrneis Gobnait
Published: May 2014

Chronic kidney disease (CKD) is classified into five stages with stages 1 to 3 identified as early CKD. This disease advances further in stage 4, while in stage 5 patients require renal replacement therapy to survive. It is estimated that 10% of the UK population have early CKD. Diabetes and hypertension are two of the leading causes of CKD and the risk factors for cardiovascular disease (CVD) are also the risk factors for CKD. However, CKD is itself also a major risk factor for CVD and many patients with CKD die from CVD. The management of a patient with stages 1 to 3 CKD include the treatment of hypertension, dyslipidaemia, anaemia and the overall prevention of CVD.
Cardiac assessment teams: A focused ethnography of nurses’ roles
Authors: Smallwood Andrew
Published: May 2014

Objective: Development of a tertiary cardiology ser vice in an acute hospital trust prompted evolution of a cardiac assessment team to assist in the management of all acute coronary syndrome patients. This study aimed to explore the roles of nurses working in the team, delivering care in two main settings; a medical assessment unit and the emergency department (two of the main portals of patient entry to hospital and on-site cardiac ser vices).

Method: A focused ethnographic approach was used to explore, describe and interpret the roles of nurses in the culture established in the cardiac assessment team. Data were collected by inter view, participant observation and the use of a field journal.

Results: Four main roles, encapsulating the clinical practice of the cardiac assessment team, emerged from the data; gatekeeper, specialist consultancy practice, catalyst and diplomat. These roles appeared to flex dependent on the prevailing organizational culture of the clinical areas in which they practiced.

Conclusions: Dimensions of this interface role were revealed as team members facilitated managed care in an, at times, uncertain organizational culture.
Qualitative research: An overview
Authors: Astin Felicity , Long Andrew F
Published: May 2014

Felicity Astin and Andrew F Long present an introduction to the philosophy and concepts of qualitative research, including some of the methodologies and methods that may be used
Family history of premature coronary heart disease: Exploring the experience
Authors: Wrigley Martha , Lathlean Judith
Published: May 2014

Evidence confirms that a family history of coronary heart disease is an independent risk factor for coronary heart disease. Having a close family relative diagnosed with heart disease has lasting implications and repercussions for the family. This qualitative study aimed to explore the issues and challenges that people face when a close relative is diagnosed with heart disease and their own future risk for developing heart disease subsequently increases. Using narrative enquiry, participants told their stories associated with this event. They spoke about the period leading up to the diagnosis and what happened during this acute phase; they described the process of coming to terms with this diagnosis and how it has affected them and their family. This study shows how awareness of key issues associated with this group of people may have the potential to enhance preventive strategies.
Home-based cardiac rehabilitation: A review
Authors: Blair Julie , Leslie Stephen , Thompson David R , Angus Neil
Published: May 2014

Cardiac rehabilitation has positive effects on mortality, morbidity, quality of life and many cardiac risk factors. Cardiac rehabilitation is usually delivered within a hospital or ‘centre’ setting, however, home-based programmes may offer greater accessibility and choice to patients. While there have been fewer studies of home-based cardiac rehabilitation, the available data suggest that it is acceptable, safe and effective and has comparable results to hospital-based programmes. Furthermore, home-based cardiac rehabilitation results in longer-lasting maintenance of physical activity levels in patients compared with hospital programmes. It has the potential to be more cost-effective for patients who cannot easily access their local hospital or centre. Home-based cardiac rehabilitation may be particularly useful in patients in a remote or rural setting. Despite the options available and the evidence based benefits, the uptake of cardiac rehabilitation remains low. It is the responsibility of all cardiac health-care workers to ensure that the uptake of cardiac rehabilitation improves.
Assessing quality of life in cardiac rehabilitation: Choosing an appropriate tool
Authors: Dempster Martin
Published: May 2014

Quality of life is an important outcome for people undergoing cardiac rehabilitation. This paper discusses the difficulties with defining the concept of quality of life and how it might be distinct from the concept of health-related quality of life. Based on a review of the literature, a description is provided of health-related quality of life questionnaires that have been used in cardiac rehabilitation populations. Some criteria for choosing between these questionnaires are then discussed and, finally, a brief discussion is presented of the concept of response shift and how this might influence the assessment of health-related quality of life in a cardiac rehabilitation setting.
Appraisal and illness delay with symptoms of ACS: A questionnaire study of illness representations
Authors: Farquharson Barbara , Johnston Marie , Bugge Carol
Published: May 2014

Background: Reducing patient delay is key to reducing mortality in acute coronary syndrome (ACS). Interventions to date have had little success.

Aim: To explore whether illness representations (Leventhal's Commonsense Model of Self-Regulation (CS-SRM)) are associated with patient delay (appraisal or illness delay) in those with symptoms of ACS.

Design: A CS-SRM questionnaire study

Methods: A random sample of 182 patients who contacted NHS 24 with symptoms of ACS completed the Revised Illness Perception Questionnaire and gave access to data from their NHS 24 records.

Results: Median appraisal delay was 2 hours. Median illness delay was 75 minutes. Women were more likely than men to have long appraisal delays (>2 hours) (57% vs 43%, c2(df=1)=3.93, P=0.047) but did not differ regarding illness delay. Gender and illness representations (identity, emotion and consequences) predicted appraisal delay category (c2=19.907, df=4, P=0.001).

Conclusions: Appraisal and illness delays may be associated with different factors. Interventions addressing illness representations might reduce appraisal delay, especially in women.
Distress thermometer validation: heart failure
Authors: Holly Deirdre , Sharp John
Published: May 2014

Psychological distress in heart failure populations is associated with non-adherence to treatment regimens, increased hospital readmissions and mortality. Routine screening for psychological distress may be possible. However, commonly used standardised measures can be costly and require training. This study assessed whether the distress thermometer (DT) is capable of identifying psychological distress within heart failure. Participants recruited from outpatient heart failure clinics completed the DT and its standardised 32-item problem list. The hospital anxiety and depression scale (HADS), and the brief symptom inventory-18 (BSI-18) were also completed as comparison measures. Receiver operating characteristic curve analysis suggests that the DT has strong overall accuracy and that a cut-ofh score of 6 had optimal sensitivity and specificity compared to established cut-off scores on the comparison measures. These findings suggest that the DT compares favourably with established measures of anxiety and depression and is a valid screening measure within this population.
Women's experience of coronary heart disease: why is it different?
Authors: Almond Susanna C , Salisbury Helen , Ziebland Sue
Published: May 2014

Coronary heart disease remains the leading cause of death and disability in women in the UK. Delays in diagnosis and treatment contribute to increased mortality and morbidity. This article reviews the recent literature to identify reasons for delayed diagnosis and treatment of coronary heart disease in women, using a modified version of Anderson's model of Total Patient Delay. Quotations from qualitative patient experience research are used to illustrate the causes of delays. Key differences identified between women and men include that women are less aware of risk, less likely to experience chest pain, have more atypical symptoms and a higher incidence of prodromal symptoms. Furthermore, there is evidence to suggest that women may experience delays in triage and be treated differently from men. Awareness of these differences should inform clinical practice with the aim of improving clinical care and reducing missed diagnosis.
Constipation: A common postoperative complication of cardiac surgery
Authors: Myatt Rebecca
Published: May 2014

Constipation is a common problem for the cardiac patient in the postoperative period. It can have a profound negative impact on quality of life, which is frequently underestimated by health-care professionals. Active prevention of constipation remains in its infancy with few assessment tools developed. The nurse working in a cardiac environment needs a good understanding of the issues that can exacerbate the situation in the post-operative period. This article discusses common causes and management options available to optimise patient care and prevent serious problems developing.
The intra-aortic balloon pump: a nursing care study
Authors: Piper Rosy , Bowden Tracey
Published: May 2014

Cardiogenic shock is an uncommon but potentially fatal complication of acute myocardial infarction and must be managed carefully to maximise recovery and patient prognosis. Current guidelines aim to manage this by earliest possible revascularisation along with potential mechanical interventions such as intra-aortic balloon pump (IABP) therapy (and continuous positive airway pressure) and pharmacological management such as intravenous diuresis, opiates, vasodilators, inotropes and vasopressors.

Nursing care of the patient with an IABP focuses on assessing the patient's cardiac output, assessing the efficacy of pressure augmentation, observing for and managing any potential complications of this invasive therapy and psychological and spiritual care of the patient.
Prevalence of erectile dysfunction in men diagnosed with heart failure: implications for practice
Authors: Steggall Martin , Butler Jane
Published: May 2014

The management of heart failure is often a complex process and therefore best managed via a multidisciplinary approach. Patients with heart failure express anxiety in relation to sexual activity and need guidance and support from their clinical team. One anxiety reported is erectile dysfunction (ED). ED has a prevalence of 8% in 40-year-old men which increases to 40% in 60-year-old men. In a survey of 52 men attending a heart failure clinic, the prevalence was 90%. Quality of life was adversely affected and men erroneously believed that treatment was unavailable or contra-indicated by virtue of their diagnosis of heart failure. Quality of erection was established using the self-reported Sexual Health Inventory for Men (SHIM) which is a 5-item questionnaire examining various aspects of sexual function. The mean SHIM score was 11.1, indicating moderate ED.

The aim of this paper is to identify the prevalence of ED in a convenience sample of men attending a heart failure clinic in East London, and to discuss how nurses can raise the profile of ED and outline treatment options.
The effect of smoking on the cardiovascular system
Authors: Graham Cope
Published: May 2014

Smoking is a significant risk factor for all aspects of cardiovascular disease. It affects the myocardium and occludes the blood supply, increases atherosclerosis and contributes to myocardial infarction, cardiomyopathy and peripheral vascular disease. Nicotine, carbon monoxide and other tobacco constituents have direct effects on the endothelium, causing inflammation, atheroma and thrombosis. Free radicals are abundant in cigarette smoke and these initiate and intensify the inflammatory cascade, increasing leukocyte infiltration and cytokine production. It is important to obtain accurate information about smoking habit, but data gathering should not rely on self-report which is misleading, but should use some form of biochemical biomarker, preferably cotinine. Smokers should then be intensively counselled, both by in-house trained staff and via the specialist smoking cessation services. It should be explained to patients in basic terms about the deleterious effects of smoking on heart disease and atherosclerosis. Patients should be encouraged to use all sources of counselling and to visit their pharmacist to obtain advice about the best way to use nicotine replacement therapies or other pharmaceutical aids to quit.
C-reactive protein and its role in coronary artery disease
Authors: Potts Katherine
Published: May 2014

C-reactive protein (CRP) is a marker of inflammation traditionally used to detect inflammation and infection. This is measured by taking a venous blood sample. There are two assays of CRP available with the most commonly-used assay used to detect a wide range of CRP levels in acute infection and inflammatory processes. A second assay is that of high-sensitivity CRP (hs-CRP) that has been studied in many diseases such as cardiovascular disease, peripheral vascular disease, hypertension and diabetes to name a few. There has been extensive research into the role of CRP in the atherosclerotic process of cardiovascular disease. It is recognized that inflammation plays a role in the development of coronary artery disease and plays a part in cardiovascular risk estimation. High sensitivity measurement of CRP adds to current tools for risk estimation and also as a prognostic tool to predict future events such as myocardial infarction, revascularization and death in patients with proven acute coronary syndromes (ACS).
The effect of sleep quality on patients in a coronary care unit
Authors: Mashayekhi Fateme , Rafiei Hossein , Arab Mansour , Abazari Farokh , Ranjbar Hadi
Published: May 2014

Background:

Patients in coronary care units (CCUs) are at risk of sleep deprivation. This study investigated the effects of ear plugs, eye masks and both together on the sleep quality of patients in a CCU.

Materials and methods:

This randomised-controlled trial was conducted on 90 patients in Imam Khomeini Hospital in Jiroft. Patients were randomly assigned to three groups: eye mask (group 1), ear plugs (group 2), and both together (group 3). Using the Verran and Snyder-Halpern Sleep Scale, perception of patients' sleep with and without intervention were evaluated. This tool consists of 16 items grouped into three main subscales: disturbance, effectiveness, and supplementation.

Results:

The mean length of time patients slept for was 6.34±1.2 hours. In group 1, the quality of sleep improved significantly in relation to disturbance and effectiveness. In group 2, all three subscales showed significant improvements. In group 3, which used the eye mask and ear plugs together, only the disturbance subscale showed significant improvement.

Conclusion:

The use of ear plugs and eye masks is an easy and cheap method of improving the quality of sleep in CCU patients. Nurses should consider these devices for reducing environmental factors that disturb the sleep of CCU patients.
Employing a grounded theory approach: core characteristics
Authors: Maz Julia
Published: May 2014

Nurses have embraced grounded theory (GT) as a useful research methodology. This paper presents an overview of the main characteristics when using GT to explore clinical practice. There is no consensual definition or single procedure to follow when using GT. This is largely attributable to the re-contextualisation of it over time through diversification in and across many disciplines. Thus, it is imperative to consider some of GT's core characteristics. To identify core characteristics, I have collated my own experience of using the methodology and a scoping review of pertinent GT textbooks, journal articles, attendance at GT workshops and discussion with principle GT theorists.

Essentially, GT is a method for gathering, synthesising, analysing and conceptualizing qualitative data to construct theory. While GT is aligned to the interpretive tradition, there is divergence between researchers on its objectivist or constructivist position, but there is consensus that it investigates social process(es) and that data analysis drives the data collection phase and also the theory construction. This paper will consider constant comparative method, theoretical sampling, theoretical saturation or sufficiency, and core category construction as fundamental features considered in comprising a GT approach.
Telephone follow-up for patients eligible for cardiac rehab: A systematic review
Authors: Phillips Patrick
Published: May 2014

Phase two cardiac rehabilitation (CR) is discussed but not clearly described in the literature; there is insufficient evidence from existing systematic reviews to support decisions regarding the most effective method of delivery. Aim: To evaluate the available evidence of the effectiveness of telephone follow-up (TFU) as an intervention in the early post-discharge period. Methods: Systematic review and meta-analyses Results: There is evidence, from narrative synthesis and meta-analyses, of statistically significant intervention effects on psychological wellbeing at 6 months (anxiety, depression and emotional components of healthrelated quality of life (HRQoL)) and on smoking rates. Conclusions: The available evidence supports the use of TFU in the provision of phase two CR; however, further research is necessary to confirm its effectiveness and to identify mechanisms of action and contextual factors to maximise the benefits of TFU.
Traditional and modern Asian weaning patterns in Britain
Authors: Rote Sandra
Published: May 2014

This paper enquires into the traditional beliefs of Asian women when weaning children, and how these are translated into practice. Asian children tend to be weaned later than is considered advisable in Britain, and when weaning does begin there is said to be an over-reliance on commercially produced food. It is noted that both parents and health professionals do not have the knowledge to prepare suitable home cooked foods for Asian babies. Consequently these children are more likely to have problems such as anaemia, rickets and a failure to thrive.

Asian grandmothers who raised at least one child in India or Pakistan were interviewed by interpreters to explore the issues and concepts surrounding the weaning of children onto solid food. A topic guide was used to structure the focused interviews. The results of this research confirm that it is traditional practice to wean children later than is considered normal in Britain. Recommendations are made to health professionals in relation to advising Asian parents about weaning.
Learning disabilities: a practical approach to helping people grieve
Authors: Elliot David
Published: May 2014

Reasons why people with learning disabilities do not receive the support they require following a bereavement are explored in the context of a social model of disability. Grief and bereavement issues are also seen as a health promotion issue.

A variety of interventions are identified which could meet the needs of people with learning disabilities at this sensitive time in their lives. The outcomes of health promotion interventions are highlighted, and a facilitation model of grief is outlined (based on Heron 1989). This model is designed to help people who have experienced uncomplicated grief reactions and consists of six dimensions of facilitation which are detailed. Finally, ways of moving forward in this sensitive area are suggested.
Study of care management arrangements for dying children
Authors: While Alison , Cornish Jocelyn , Citrone Christina
Published: May 2014

An interview study of ‘key’ providers of care for children over one year of age with life-limiting, incurable disorders is described. The study was conducted in 12 District Health Authorities (DHAs) across four selected Regional Health Authorities.The data were drawn from 92 semi-structured transcribed interviews with care professionals, such as social workers, community nurses and paediatricians.

Not all DHAs had written local strategies to guide care management. A wide diversity of provision, together with care management arrangements, was described for a number of diseases. Several care professionals were found to contribute to the care of these children and their families in a variety of ways.

The need for more respite care facilities and bereavement services was highlighted, although most DHAs had plans for the future development of services. Equity of access to treatment and support services to a common standard is a major issue which needs addressing, as is the relative merit of specialist versus generalist service provision.
Looking forward to the new asthma guidelines
Authors: Crockett Anthony
Published: May 2014

Asthma is a chronic common disease which is mostly managed from within primary care. Modern asthma care aims to abolish and prevent symptoms and to aim for perfection. Care may be delivered by the most appropriate member of the extended primary health care team, but for care to be consistent and of the highest standard there must be good teamwork and communication.

Although there is no cure for asthma there are a variety of excellent treatments. Asthma severity varies between individuals and in an individual over time. The treatment of asthma must similarly vary, to meet or anticipate the needs of each patient. Guidelines on how and when to alter treatment have been widely used for many years, and should be shared by all members of the extended primary health care team. There have been recent changes in our knowledge and care of asthma – the guidelines therefore need to be revised and updated to reflect these changes.
Integrated nursing: a review of the literature
Authors: Bull Jackie
Published: May 2014

Limited research suggests that successful implementation of integrated nursing increases perceptions of overall primary health care team functioning. This paper reviews those studies and also reports on the findings of relevant studies of teamwork in the wider primary care context. Effective teamwork is essential if the concept of a primary care-led NHS is to become a reality. Achieving effective teamwork however is fraught with difficulties and requires skilled facilitation to overcome obstacles such as fear of change, professional jealousies and diverse lines of accountability. The facets of good teamwork include a high level of participation by all members, support for innovation, clarity of team objectives, task orientation and mutual role understanding. The diversity of problems encountered in primary care makes auditing the collective work of teams very difficult. As a result, most research in nursing and primary health care teams has concentrated on team process rather than outcome. Efforts should now be channelled into refining existing methods of evaluation and developing new outcome measures.
District nurses’ and social workers’ understanding of each other's role
Authors: Bliss Julie
Published: May 2014

Partnership between the NHS and local authorities continues to be central to government policy concerning the provision of quality community care. Much has been written regarding the facilitators and inhibitors of collaborative working including the need for practitioners to have a clear understanding of the term role. This article outlines an ethnographic study undertaken to identify district nurses’ and social workers’ perceptions of each other's role. Semi-structured interviews which included the use of vignettes were used for data collection. The study identified that at times there was little agreement regarding role within each professional group and also that there was even less agreement between these groups on each other's role spefication. Factors influencing the understanding of the concept of role were found to include the use of technical language and different philosophies and values regarding care provision. Social workers and district nurses involved in this study demonstrated a strong commitment to working together. They identified that formal meetings in which to share knowledge and discuss common areas of practice may be a one way to promote partnership in care provision.
A holiday play scheme for children with learning disabilities
Authors: Toocaram Jill Marie
Published: May 2014

This article outlines the provision of an alternative client-led service for children with learning disabilities. It describes one example of how developing a holiday play scheme for children with a learning disability can make a real difference to the quality of life for those people utilizing the service. The author developed this initiative by using a wide range of skills gained through an in-depth knowledge of, and experience in, the area of learning disabilities, hard work and commitment which was underpinned by research-based evidence. The benefits of this play scheme for children, parents and healthcare professionals are highlighted. The article stresses the importance of community learning disability nursing in reducing family stress and promoting the family's ability to cope with a child who has a learning disability.
The long shadow of perinatal bereavement
Authors: Dyson Liz , While Alison
Published: May 2014

Perinatal death constitutes a major bereavement, the impact of which is felt by women and their families for many years following the experience. It is widely acknowledged that support is needed both at the time of death and for some time afterwards. Women may experience periods of grief or loss throughout their lives especially during times of crisis and/or stress and therefore these women may again be in need for support from healthcare professionals who come into contact with them at times of crisis not related to perinatal loss. This article examines the data from a small qualitative study on mothers’ experiences of stillbirth and illustrates some personal aspects of perinatal bereavement. Possible reasons for reflecting on perinatal loss years after it has happened are outlined and the potential involvement of healthcare professionals is addressed.
Promoting continence in the community
Authors: Moore Katherine , Fader Mandy
Published: May 2014

This article explores the significant role of the community nurse in the primary assessment and treatment of people with urinary incontinence. Community nurses are particularly skilled at environmental assessments and helping people to cope with or adjust to urinary incontinence. These skills may be taken further with a primary history and physical assessment. This article presents an overview of the types and causes of incontinence and treatment strategies that community nurses may undertake with confidence. Community nurses are in an excellent position to implement care that will significantly improve quality of life for people with incontinence.
The challenge of implementing evidence-based healthcare
Authors: Griffiths Peter
Published: May 2014

Evidence-based healthcare (EBH) is widely discussed, however, it is often dismissed as simply stating the obvious. This article examines some of the basic techniques and resources available for the practice of EBH. Two examples of relevance to community practitioners are used to demonstrate this — the use of tea tree oil to treat head lice and the use of pressure bandaging for the treatment of venous leg ulcers. It is argued that EBH is not the norm in nursing practice and, indeed, its application is often far from straightforward. However, despite its limitations it is important that community practitioners and their managers ensure that patient care is based on the best available evidence as ultimately, if a practitioner, knowingly or unknowingly, is not using the available evidence he/she risks harming their patients.
Caring for technology-dependent children at home
Authors: Kirk Susan
Published: May 2014

A new group of chronically ill children who are dependent on technology for their survival has emerged as a result of medical advances. Many of these children are being cared for at home by their parents. However, in the UK little is known about the prevalence or the experiences of families caring for technology-dependent children or of the professionals supporting them in the community. This article explores the potential implications for the practice and education of community-based nurses caring for technology-dependent children.
Multisensory environments and evidence-based practice
Authors: Thurtle Val , Wyatt Linda
Published: May 2014

Multisensor y environments are well established and increasing in number. They are used with a variety of client groups and nurses working in community settings will encounter clients who use them. There have been attempts to research the benefits of multisensory environments but ethical and methodological difficulties exist. The current state of the evidence indicates that multisensor y environments are useful but the evidence remains inconclusive. Practitioners working with such environments need clear standards and guidelines but these are dependent on a strong evidence base that does not currently exist. It is important that nurses, carers, and therapists contribute to the generation of research-based evidence and the development of guidelines.
The costs of long-term catheterization in the community
Authors: Evans Ann , Pheby Derek , Painter Daniel , Feneley Roger
Published: May 2014

The prevalence of long-term catheterization in the adult population is of the order of 0.03–0.07%, rising to 0.5% in those over 75 years and 2% in those over 85 years old. Studies have shown that the prevalence of urinary incontinence increases with age and is higher in females. Little is known about the costs of long-term catheterization, which have consequences for care decisions. A pilot study was conducted to test (a) the applicability in the UK of a methodology developed in the USA for measuring the cost of long-term catheterization in community based patients, and (b) the feasibility of using it in larger-scale community-based studies. The study made use of the method developed in the USA by Wagner and Hu (1998) to assess the true costs in the population. Patients were selected in order to represent as broad as possible a range of underlying disease processes and social circumstances. Eight patients were selected, drawn from 3 distinct groups of patients. The pilot study demonstrated wide variation in direct costs for 7 patients living in the community over a 3-month period, ranging from £118.80 to £2585.26. Since staffing is — for the most part — the most significant cost element, this indicates significant variation in levels of need. Resources deployed for one nursing procedure clearly impact on opportunities to undertake other procedures. An understanding of the costs of any procedure is necessary in order to make best use of the limited resources available.
A health visitor for older people in an accident and emergency department
Authors: Bridges J , Meyer J , McMahon K , Bentley J , Winter J
Published: May 2014

Published studies indicate that older people have special needs on discharge from accident and emergency (A&E) departments that are not always fully met. The literature reflects that although a significant proportion of older people have a decrease in functional independence and an increased need for services following discharge from A&E, social and functional assessment by A&E staff can be inadequate, as can the arrangement of follow-up community services. As part of a wider study into the organization of care for older people in A&E, a health visitor for older people was funded to work part-time in the A&E department of a large NHS Trust. The health visitor identified potential clients through reviewing the A&E documentation of patients aged 75years or over discharged directly from A&E. Telephone calls or home visits were used to follow up those individuals deemed to be vulnerable by the health visitor. Interventions included health education, referral to other agencies and patient or family counselling. None of the clients followed up by the health visitor (n=212) had been referred by A&E to a specialist in gerontology, which suggests that these clients would otherwise not have received the potential benefit of specialist intervention. The pilot study described here highlights a number of practical issues in relation to the health visitor post for older people in A&E, including the importance of dedicated office space and access to a telephone. Data collected during the study, plus the positive evaluation of the role by a small group of A&E staff confirm the claims made in other studies (e.g. Runciman et al, 1996) that health visitors for older people may be of value in meeting the post-discharge needs of these people.
District nursing assessment practice: case study findings
Authors: Bryans Alison
Published: May 2014

Patient assessment is widely acknowledged as a core element of community nursing expertise (Griffiths and Luker, 1994). With the current drive towards evidence-based practice, it is becoming increasingly important to provide sound evidence about this key aspect of community nursing practice. This article describes how district nurses’ assessments of a carefully constructed simulated patient have provided new insight into community nursing expertise. The innovative approach used in this study of district nursing assessment practice is outlined. One of the simulated patients developed for the study is then described. A case study of one nurse participant who assessed this simulated patient forms the main focus of the article. The case study (one of four) is based on a synthesis of simulation and interview findings relating to a particular study participant. It reveals some interesting associations between various elements of nursing knowledge and provides important insight into how the quality and effectiveness of patient assessment may be affected by a practitioner’s approach and knowledge base. The usefulness of this approach and the relevance of the findings for nursing practice and education are also addressed.
A qualitative evaluation of the effectiveness of health visiting practice
Authors: Worth Allison , Hogg Rhona
Published: May 2014

The evaluation of health visiting interventions is a contentious issue and there is a need to develop methods of evaluation which move beyond organizationally-led targets. This article presents the findings of a study which explored the effectiveness of health visiting interventions from the perspectives of parents and health visitors. A qualitative approach was used which allowed the views of parents and health visitors to be examined within the context of their understanding of the parenting role. It is argued that this approach contributes to the evidence base of health visiting. Findings support the value of the health visitor–client relationship, formed mainly through home visiting, as the cornerstone of successful interventions. Parents in this study welcomed the health visitor’s support in helping them to develop their parenting skills against a background of social change. At a time when the roles of health visitors are being renegotiated, the findings demonstrate the relevance of health visiting in contemporary society.
A study of current nursing management of long-term suprapubic catheters
Authors: Evans Ann , Feneley Roger
Published: May 2014

Problems associated with long-term catheters can place increased demands on nurses’ time and resources. This article reports a study which investigated the nursing management of 113 patients with long-term suprapubic catheters. The study identified that 52% of catheters were changed routinely, 30% of catheters were changed only when they became blocked and 30% of nurses experienced problems when changing catheters. A total of 42% of patients received either a bladder ‘washout’ or instillation and 60% required a dressing around their suprapubic site. This study also examined the reasons for applying dressings, the type of dressing used and the frequency of dressing changes, which has long been a neglected area of research. Recommendations for future practice are discussed.
Crown II: the implications of nurse prescribing for practice nursing
Authors: Baird Anne
Published: May 2014

Certain limited presribing rights have now been granted to district nurses and health visitors. Proposals to extend prescribing rights to other healh professionals have recently been put forward in the Review of Prescribing, Supply and Administration of Medicines (DoH, 1999). Practice nurses are one group who are likely to apply for such rights. This article reports on selected findings from a small-scale qualitative study designed to investigate the current and poyential future of practice nurses in prescribing. It was found that practice nurses exercise considerable influence over prescribing in diverse therapeutic areas within general practice. However, it may be difficult to accommodate the prescribing requirements inherent in such a broad scope of practice within the framework of the present proposals. Important issues of accountability and patient safety are raised, and recommendations made for policy, research and education.
Promoting patient partnership in wound care
Authors: Bentley Jenny
Published: May 2014

Involving patients in their care is a key component of the NHS plan and clinical governance (Department of Health, 1999a). Involvement is enhanced through nurse–patient relationships which are based on partnership in which the patient’s viewpoint is given equal weight to that of the practitioner. In the management of wounds, this may be complex due to conflict between clinically effective treatment and a patient’s wish. High quality care relies on a holistic assessment of the patient and a negotiated care plan which is implemented and evaluated in order to judge the effectiveness of care.
Barriers to research implementation by community nurses
Authors: Griffiths JM , Bryar RM , Closs SJ , Cooke J , Hostick T , Kelly S , Marshall K
Published: May 2014

This article presents the community findings from a study of nurses in community and acute settings using Funk et al’s Barriers to Research Utilization Scale (Barriers) (Funk et al, 1991a), which aimed to identify the main barriers to implementing research in practice. The Barriers questionnaire was sent to all nurses working in three community trusts in Yorkshire (n=2327), and practice nurses in one Yorkshire health authority (n=190). A 51.5% response rate gave a sample of 1297 nurses. The top two barriers were reported to be lack of time and resources. There were significant differences between sub-samples, e.g. older nurses perceived more barriers than younger colleagues, and practice nurses had particular problems with the cooperation of GPs. Factor analysis generated four new factors different from those found by Funk et al (1991a) (shown in brackets): benefits (nurse characteristics); quality (research characteristics); accessibility (presentation of the research characteristics), and resources (setting characteristics). Recommendations include developing nurses’ critical appraisal skills so that, given more time and adequate resources, research findings might be judiciously implemented in practice.