bluuebunny/crossref_metadata_2025 huggingface dataset:
Articulate or dissipate: nursing’s stark choice
Authors: While Alison
Published: May 2014

There is a steady stream of evidence that the overall level of health care in the UK is variable and sometimes poor; both provider and user surveys show significant variations in accessibility, quality and range of care. Meanwhile, the preoccupation with evidence-based practice means that additional monies for qualified nurses have to be justified in terms of nurses’ contribution to clinical outcome. However, the narrow definition of what constitutes ‘good’ evidence – i.e. randomized controlled trials – disadvantages nursing and other marginalized areas of health care that do not attract research funds on the same scale as medical interventions and drug treatments. The multifaceted role of nurses presents a complex range of interactive activities from which it is hard to identify which individual or group of activities contributes to clinical outcome. Yet much nursing research provides self-report description in place of explanation and analysis which could inform both the definition and future direction of nursing.
Medicines management in care homes for older people: the nurse’s role
Authors: Cowan David , While Alison , Roberts Julia , Fitzpatrick Joanne
Published: May 2014

Increasing attention is being paid to the inappropriate use of medicines in UK care homes for older people. While polypharmacy may sometimes be necessary, older people can be particularly sensitive to the effects of medicines due to physiological changes, while the effect of a mixture of medicines is often unknown. The harmful consequences of inappropriate prescribing for older people unnecessarily add to overall healthcare expenditure and the workload of staff. Community nurses can play an important role in attenuating some of these problems while enhancing the quality of life of older people in care homes. The growing population of older people and burgeoning health-care expenditure on medicines demands that greater attention is given to medicine management among older people so that the efficacy of therapeutic regimes are maximized.
Faecal impaction: older people’s experiences and nursing practice
Authors: Annells Merilyn , Koch Tina
Published: May 2014

A number of authors have identified the paucity of evidence available to inform community nursing practice in relation to faecal impaction. Little is known of its incidence or its impact. In an attempt to address this, this article reports part of an extensive descriptive survey in Australia that sought to explore the experience of, and response to, constipation of older people living in the community. The focus here is the participants’ experience of extreme constipation in the form of faecal impaction and obstipation (obstinate constipation). Faecal impaction was found to cause great discomfort and distress, often leading to obstipation. The imperative for self-management of constipation was strong, and laxative use frequent. However, manual evacuation was often necessary, either by self or others. This article discusses the results in relation to a recent emergence of concern in the US and UK about how faecal impaction and obstipation should be treated by community nurses.
Bandages and bandaging techniques for compression therapy
Authors: Finnie Alison
Published: May 2014

Bandaging skills are essential for community nurses not only as a method of supporting joints, or retaining a dressing, but as an important treatment of leg ulceration. It is important to be able to choose the correct type, size, and composition of bandage and then apply it safely using the most appropriate technique as incorrectly applied bandages may lead to pressure necrosis and subsequent limb amputation. Bandaging applications have changed little over the last 100years and the two most commonly used techniques are still the spiral and the figure-of-eight methods. There are advantages and disadvantages of both, and successful bandaging depends on choosing the correct product, and good technique, both in stretching the bandage to the correct tension, and ensuring proper overlap between layers.
The RCP’s ‘Three Key Questions’ for asthma: review of practical use
Authors: Steven K , Neville RG , Hoskins G , Sullivan FM , Drummond N , Alder EM
Published: May 2014

Assessment tools are a vital component of chronic disease management. The Royal College of Physicians has developed a patient-focused outcome measure for the treatment of asthma, the ‘Three Key Questions’. However, in a study investigating the goals of people with asthma, several issues related to the tool emerged. Forty-seven adults of a range of ages and asthma severity but with no significant co-morbidity were interviewed. It emerged that the outcome measure may be subject to recall bias. Also, symptom reports may be conflated if daytime symptoms also occur with activity. ‘Interference with activity’ is a subjective term the interpretation of which varies considerably. Changes in the level of activity undertaken may be reported rather than changes in symptom severity. The ‘Three Key Questions’ are not fully patient-centred because they assess the presence of symptoms rather than their importance to the individual. The use of the ‘Three Key Questions’ as an outcome measure may not allow valid comparisons to be made between settings.
Preventing avoidable hospital admission of older people
Authors: Jiwa Moyez , Gerrish Kate , Gibson Andy , Scott Helen
Published: May 2014

The National Service Framework for Older People (Department of Health, 2001) stresses the importance of preventing unnecessary hospital admissions for older people. Such admissions arise when there is inadequate health and social support available in the community to meet the needs of this age group. This article reports on a study designed to evaluate the effectiveness of a programme of enhanced primary care support intended to reduce the risk of hospital admission for people aged 75 years and above. Nineteen patients out of a possible 322 in one GP practice were judged by GPs and district nurses to be ‘at risk’ of avoidable hospital admission. All at-risk patients were visited by a GP or district nurse to review their needs for enhanced support, six patients subsequently accepting a referral for additional support. No statistically significant difference in the number of hospital admissions in the intervention group was observed compared with a group of patients with similar demographic characteristics but deemed not to be at such high risk, suggesting that the intervention might have been effective in reducing the number of avoidable hospital admissions.
Minor illness in children: parents’ views and use of health services
Authors: Allen Jane , Dyas Jane , Jones Margaret
Published: May 2014

Consultation rates in young children are high, and parents and carers of young children have reported feeling disempowered and anxious when their children display common symptoms. Parents have stated that more information would help them manage these symptoms appropriately. This focus group study explored how parents and carers of young children feel when their child displays common symptoms, what information they need to assist them in appropriate management, and to determine if they would value an educational intervention on the management of common symptoms. Findings showed that many parents sought help from families and friends following negative experiences of seeking advice from health professionals and many were wary of the information presented in health information leaflets produced by pharmaceutical companies. Parents and carers who took part in this study stated that they would value an educational intervention that would help them to appropriately manage common symptoms. They wanted to receive the information through interactive group sessions, led by a health visitor, with the inclusion of simple and non-product biased ‘take home’ materials.
Not just the same old song, on the radio
Authors: Pollard Tom
Published: May 2014

The image of district nurses as angels in blue dresses will have been solidly reinforced following a recent programme on Radio 4. The District Nurse, broadcast in two parts, followed Jenny Weston, a district nurse team leader, and her colleagues from Sparkhill, Birmingham though their daily routines, from team meetings to home visits. The programmes painted a picture of the district nurse and her environment quite at odds with the often idealized portrait found in government documents, yet listeners were left in no doubt of the boundless patience, good humour and resolve of the protagonists.
Providing adequate treatment for children with nocturnal enuresis
Authors: El-Radhi A Sahib , Board Christine
Published: May 2014

Nocturnal enuresis is the most common urological problem in children. With increasing age and persistence of enuresis, children may experience psychological problems. Active treatment is therefore required not only to achieve dryness but also to prevent and treat such an experience. Although nocturnal enuresis has multiple causes, in recent years emphasis has focused on three main causes: lack of arousal, lack of antidiuretic hormone secretion and lack of bladder stability. This article stresses the importance of applying a specific treatment based on this ‘three system approach’ for every child presenting with enuresis.
A pilot study of user’s experiences of urinary catheter drainage bags
Authors: Fraczyk Linda , Godfrey Helen , Feneley Roger
Published: May 2014

Despite the wealth of literature focused on the management of people living in the community with long-term indwelling urinary catheters, little attention has been paid to their impact on daily life. In a pilot study, a purposive sample of people with long-term indwelling urinary catheters were sent a questionnaire asking about their indwelling urinary catheter, method of drainage and impact of the catheter drainage bag on their daily life. Nearly one-quarter of respondents stated that wearing a drainage bag had a major impact on their normal daily living. The study also highlighted a number of methodological issues that need to be addressed in future research.
The art of striking the right balance
Authors: Pollard Tom
Published: May 2014

The pharmaceutical industry has been on the receiving end of a great deal of criticism in recent months. Television programmes about stifled research into antidepressants or pharmaceutical companies’ treatment of those in developing countries have not only tarnish the image of some of the largest companies in the world, but also undermined public confidence in them.
Child health services for the future
Authors: While Alison
Published: May 2014

The first two parts of the long-awaited national service framework (NSF) for children have been launched. Emerging Findings (Department of Health (DH), 2003a) focuses on services outside hospital for 12million children with many needs. Standard for Hospital Services (DH, 2003b) has limited relevance to those working in the community and primary care, yet it does emphasize that services for children should be integrated and coordinated around the young person and their family, and there should be a good interface with social care and other health services in meeting ongoing needs. For the first time in a health policy, the transfer from child to adult services is acknowledged as an important issue, reflecting the growing number of young people surviving childhood who are often poorly integrated into adult services.
The exudate continuum: moisture for healing
Authors: White Richard
Published: May 2014

When asked to consider the factors that will compromise or delay wound healing, diabetes, wound infection, and protease imbalance are usually identified; however, this is often without due consideration for moisture balance. Although moist wound healing has been accepted practice for many years, the ‘ideal’ level of wound moisture has been discussed but still not accurately defined. Practitioners are urged to maintain a balance that is ‘not too wet, yet not too dry’ without a valid framework to assess wound moisture. The dangers of excess moisture, in terms of high exudate, are manifest as maceration. This state has been covered in detail in recent publications, yet all too often patients present with pre-existing maceration – usually attributable to inappropriate dressings or too long a wear-time. Although there are no data on incidence of maceration in chronic wounds, it is likely to be an underestimated cause of morbidity. The other end of the ‘exudate continuum’ is the dry wound. This will be slower to heal owing to the lack of moisture; this will impair cell migration and autolytic debridement processes among others.
The rise of the district nursing profession
Authors: Billingham Kate
Published: May 2014

In nursing there tends to be a separation between nurses who ‘talk’ and nurses who ‘do’. Those of us who do the talking get noticed, while those who are busy doing keep their heads down and get on with the day job. What we need are nurses who do both. Where talking grows from practice and where practice is informed by a wider view of the world. Nowhere is this needed more than in district nursing which often receives less attention than it deserves. Both the setting (the home) and the patient group (often frail older people) tend to make this one of nursing’s least visible disciplines.
Is that really my job? A guide to job profiling
Authors: Savage Yvonne
Published: May 2014

Agenda for Change is fundamental to the NHS modernization agenda. It will lead to all non-medical NHS personnel being paid equal salaries for equal work. Key to the success of the changes will be the accurate evaluation of each individual’s job (job profiling), so that people are properly rewarded for their work and responsibilities. This article discusses how community nurses can ensure that their job profile accurately represents their job, so that Agenda for Change will work for them.
Capillary blood glucose monitoring and its role in diabetes management
Authors: Walker Rosemary
Published: May 2014

Capillary blood glucose monitoring (CBGM) plays an important part in achieving levels of diabetes control which are associated with reduction in the risk of developing diabetes complications. It is vital that the results of CBGM are used to adjust treatment to achieve the recommended blood glucose targets. Community nurses have a key role in both performing regular and accurate CBGM and in teaching people about its use. Equipment used for CBGM, whether by health professionals or people with diabetes needs to be properly maintained so that the results are accurate and reliable.
Ileostomy products: an update on recent developments
Authors: Sica Jo , Burch Jennie
Published: May 2014

This article aims to give the reader a brief overview of recent developments in appliances for people with an ileostomy. After a brief background, the latest products that have been introduced to the market place will be discussed.
A personal and professional drive to implement joined-up services
Authors: Pollard Tom
Published: May 2014

Margaret Kennedy’s early career was not untypical. Starting out in nursing, she found little to engage her in the acute sector, and after qualifying crossed over into the community as a district nurse.
Pressure ulcer risk assessment and prevention
Authors: Stephen-Haynes Jackie
Published: May 2014

Pressure ulcers were once viewed as an inevitable consequence of being infirm and bed-ridden. As it has been recognized that this is not the case, pressure ulcers have come to be seen much more as an indicator of the quality of care provided, and are consequently high on the political and health agenda. This article provides an overview of the key aspects of pressure ulcer risk assessment and prevention drawn from a variety of national policy documents.
A fragile future for primary care nursing?
Authors: While Alison
Published: May 2014

Government plans for health services rely on a vibrant population of qualified nurses prepared to take on new roles and work differently to deliver the improvement and expansion of NHS services. Much depends on an increase in new nurses, improved nurse retention and a continuing flow of nurse returners. Indeed, there is growing evidence that low nurse staff levels are associated with poorer care outcomes such as increased mortality rates, higher cross-infection and other infection rates, and more staff errors (Buchan and Seccombe, 2004).
Does traumatic birth increase the risk of postnatal depression?
Authors: Parker Jacqueline
Published: May 2014

The aim of the study was to review if experiencing a traumatic birth, in the form of caesarean section or assisted vaginal births, increases the risk of developing postnatal depression. This issue is significant to health professionals when planning postnatal care. A focused search of databases containing medical and psychiatric research relevant to this question was performed and the selected papers critically appraised and reviewed. The numbers of mothers recording depressive symptoms for each birth method were measured using a validated outcome tool for postnatal depression. Two research papers met the inclusion criteria and were reviewed using a checklist for critically appraising cohort studies. Although the papers met many of the quality markers, both reported limited data relating to obstetric factors in the development of postnatal depression and both sets of published results were incomplete. More studies may be found by searching psychological and psychiatric medicine-oriented databases as just one was included in this evaluation. The conclusion of this review is that there is no evidence on which to base a reappraisal of current clinical practice.
Lay and professional views on health visiting in an orthodox Jewish community
Authors: Abbott Stephen
Published: May 2014

This article reports research examining the relevance of a health visiting service to an orthodox Jewish community. Data were gathered by 14semi-structured interviews with community members and health visitors. The community was seen by members of both groups as self-sufficient, with a very well-developed network of voluntary support networks. Orthodox Jewish mothers typically have large families and have a lot of child-care experience. Some health visitors seemed oblivious of the Jewish religious calendar. Cultural practice and health visitor advice relating to breast-feeding were at odds. The community’s relationship with health visitors was distant rather than close, and health visitors’ role was unclear to and unvalued by the community. The service had persistent problems of recruitment and retention. Health visiting needs to work in partnership with community organizations and representatives to develop a service that the community finds valuable.
Chronic obstructive pulmonary disease and community-based pharmacological care
Authors: E Scullion Jane
Published: May 2014

Chronic obstructive pulmonary disease carries a high morbidity and mortality and is one of the few chronic diseases where the number of people affected is rising, a trend that looks set to continue. Unfortunately patients often present at a late stage of the disease when therapeutic options are more limited and many patients are undertreated, overtreated or misdiagnosed. While patients present both in primary and secondary care it is primary care where the majority of patients are managed and where patients are likely to be seen at an earlier stage of the disease process when interventions are likely to be more effective. Therapeutic options for patients with COPD include pharmacological approaches and these should be prescribed on an individual basis and both subjective and objective criteria used in evaluating effectiveness.
Alternative approaches to managing a non-draining urinary catheter
Authors: Rawlinson Mark , Clark James
Published: May 2014

Best practice in the management of indwelling urinary catheters has been debated for many years. Proactive preventative strategies are widely considered favourable, but inevitably patients are referred with sudden, acute or unexpected non-draining catheters requiring a reactive or problem-solving response. This article considers the lack of comprehensive evidence on which nurses can base their practice when problems arise. It proposes that a clinical framework is necessary to guide nurses logically and rationally through the decision-making process. In addition, the case for diagnostic irrigation is assessed and the issue of catheter re-siting as an alternative to re-catheterization is highlighted.
Keeping secrets: confidentiality and the community nurse
Authors: Griffith Richard
Published: May 2014

The dilemma faced by Lucy Russell is one that is frequently faced by nurses in primary care, although generally the facts are far less dramatic. The common concern is what course of action is open to nurses when faced with a demand for information concerning a patient. In particular, under what circumstances can the professional duty of confidence be breached?
pH testing in catheter maintenance: the clinical debate
Authors: Rigby Deborah
Published: May 2014

The pH of urine is widely recognized as being a major contributory factor in urinary catheter encrustation. What is less widely appreciated is the range of factors that affect the pH of urine, and which therefore affect the reliability and validity of urine pH testing. This article examines the validity of various urinary pH testing methods, and discusses the theoretical and practical implications of the uncertainty surrounding their practical value.
Tackling obesity: we need a hand from Nanny
Authors: Pollard Tom
Published: May 2014

The House of Commons Health Committee has been extremely busy recently, producing two explosive reports in as many months. The report on elder abuse published in April will, it is hoped, lead to significant changes in the training of health and social care professionals, and a far greater awareness of the prevalence of abuse. Few will argue with its recommendations.
Correspondence
Authors: Knupfer Ann
Published: May 2014

I read with interest the recent article in the British Journal of Community Nursing regarding legal requirements for safe handling (Griffith R, Stevens M (2004) Legal requirements for safe handling in community care. BJCN 9(5): 211–15). I was very concerned after reading this as to where the individual nurse’s own human rights are to be considered.
Fundamental principles of indwelling urinary catheter selection
Authors: Robinson John
Published: May 2014

Catheter selection is a skilled element of continence care, particularly when the catheter is intended to remain in situ for prolonged periods. It is important to choose carefully, referring to catheter length, material, Charrière size and balloon infill volume, any of which may – if not attended to correctly – cause problems. This article gives some advice on catheter selection and outlines what may occur if certain issues are dealt with incorrectly.
The issue of consent and children: who decides?
Authors: Griffith Richard
Published: May 2014

Primary care workers have patients of all ages on their caseload and it is essential that any care or treatment delivered to them is done within the law. Consent is an essential element of the lawfulness of treatment. It provides a defence to criminal assault and the tort or civil wrong of trespass to the person (F v West Berkshire Health Authority [1990]).
Adult abuse register must apply to all
Authors: Pollard Tom
Published: May 2014

The recent launch of the Protection of Vulnerable Adults scheme (POVA) in England and Wales is a welcome development. With it, the Government has taken a significant step towards equal protection for all vulnerable individuals, from childhood to old age. However, it still falls short of the complete coverage required. The gaps must be plugged as soon as possible.
Dr Lisbeth Hockey 1918–2004 ‘A pioneer of nursing research’
Authors: Goodman Claire
Published: May 2014

Nursing has lost a remarkable woman and a pioneer of nursing research. On 15 June 2004, Lisbeth Hockey died, aged 85 years.
Protecting vulnerable adults from abuse: a case study
Authors: Griffith Richard
Published: May 2014

Sadly, Ann’s situation is not uncommon. Elder abuse is on the increase. The Health Select Committee of the House of Commons recently reported that an estimated 500 000 older people suffer abuse; equivalent to between 5–9% of the older population (HC 111-1, 2004). The committee also found that the majority of abuse, approximately 67%, occurs in the person’s home. These statistics are confirmed by the results of a Community and District Nurse Association (CDNA) study which found that 88% of community nurses had encountered elder abuse in their caseload (CDNA, 2003).
Contact dermatitis: diagnosis and management
Authors: Smith Anne
Published: May 2014

Contact dermatitis accounts for 85–90% of all occupational skin diseases and, as a frequent cause of hand dermatitis, it can lead to unemployment and permanent disability. This article examines the two main types of contact dermatitis, their diagnosis and treatment.
New ways of working in primary care nursing
Authors: Smith Christine , Williams Ann
Published: May 2014

The suggestion by Alison While in the August 2004 issue of BJCN (While, 2004), advising community nurses to ‘strike while the iron is hot’, raises issues about the differences within the United Kingdom in the development of primary care nursing. It may be useful to take stock of how nursing is responding to these opportunities in other parts of the country. There are, as Alison suggests, immense opportunities and possible threats for nurses in primary care settings.
Colostomy products: an update on recent developments
Authors: Burch Jennie , Sica Jo
Published: May 2014

This article gives the reader an overview of recent developments in appliances for people with a colostomy. After a brief background, the various products that have been brought onto the market in the recent years are discussed.
User views and the future of nursing
Authors: While Alison
Published: May 2014

In 2000, The NHS Plan (Department of Health, 2000) emphasized the centrality of the user and primary care in health-care provision. As a consequence, the last 4 years have witnessed a refocusing on chronic disease management in primary care and an increasing emphasis on user views and involvement in service development. The new General Medical Services contract provides rewards for high-quality chronic disease management and user feedback to practices as an incentive to meet these health policy objectives. However, the success of this approach will not be known for at least a year.
Don’t be too thick-skinned: everyone will benefit
Authors: Gibson Lousie
Published: May 2014

Nurses are often described as caring, compassionate and empathetic people who are able to recognise patients’ and carers’ anxieties and concerns and manage them accordingly. As a nurse I would like to think that I demonstrate these behaviours, both in my capacity as a specialist nurse and as a member of the general public.
Reflection is the way to improve practice
Authors: Gibson Louise
Published: May 2014

In my position as a tissue viability nurse specialist I am often seen as the ‘expert’ by both patients and nursing staff. One definition of an expert is ‘a person with special knowledge or ability who performs skilfully’. It could be suggested that the majority of practitioners who care for patients with wounds on a regular basis are experts, as they are widely recognized as having valuable knowledge in this particular area, and demonstrate the ability to deal with a particular task or problem much more efficiently than most people. But what does the term ‘expert’ really mean to practitioners and, more importantly, to the patients we deal with on a daily basis?
Outpatient stem cell transplant: effectiveness and implications
Authors: Ritchie Louise
Published: May 2014

The aim of this mini-review (Griffiths, 2002) was to assess whether outpatient autologous haematopoietic stem cell transplant (AHSCT) is as effective as the traditional inpatient approach in terms of bed occupancy and morbidity. The Cochrane Library, Medline, Embase and CINAHL databases were searched for relevant studies. No systematic reviews or randomized control trials were found and after applying inclusion criteria, four non-randomized control trials were identified. The studies were conducted in North America, where high costs associated with AHSCT have led to the development of outpatient programmes designed specifically to reduce use of costly inpatient facilities. From the evidence available, it appears that outpatient AHSCT is not associated with increased morbidity and studies found either in favour of the intervention group or that there was no statistically significant difference between the two groups. The studies were unanimous in their findings that outpatient AHSCT is associated with a significantly reduced bed occupancy outcome. These findings may have a significant implication for the advancing practice and workload of community nurses. It is evident that good quality trials are needed in the UK to better and more relevantly address this question before implementing such programmes but it seems that outpatient AHSCT is achievable in carefully selected patients.
Complementary therapies in palliative care: a summary of current evidence
Authors: Hemming Laureen , Maher David
Published: May 2014

Complementary therapies are often cited as a possible alternative to the management of symptoms in palliative care, as another element in the armoury for coping with unmanageable problems. But how efficacious are these therapies, and what is the evidence to support their use in symptom management? Patients who are in the terminal stages of illness or require palliative care are in a very vulnerable position, so are they being exploited or are there real benefits from using complementary therapies? This article review some of the evidence currently available.
Public health 2: Criminal liability for spreading disease
Authors: Griffith Richard , Tengnah Cassam
Published: May 2014

Last month’s article considered the role of the law in preventing the spread of infectious disease in cases such as tuberculosis and SARS where isolation, quarantine and treatment are effective in controlling the outbreak. Other forms of infectious disease that district nurses encounter – such as hepatitis B and C and the HIV virus that are spread through contact with blood or sexual intercourse – rely far more on the infected individual to act responsibly in preventing others from being infected. This month’s article considers whether those who act recklessly and put others at risk of infection should be held criminally liable and prosecuted for their actions.
Sue Burke: a community matron with passsion
Authors: Pollard Tom
Published: May 2014

The community matron role was made for Sue Burke. Having been a staff nurse in Basildon PCT for 10 years, she started her district nurse training in 2003. While training, she started to notice that many of her nursing home clients were not being assessed, ‘purely because they had no obvious nursing need.’ Her subsequent career path has grown out of this observation.
Hard choices: what can we afford?
Authors: While Alison
Published: May 2014

We have at our disposal ever more cures and symptom alleviators, but all come at a high financial cost. The recent public debate about access to Herceptin, a breast cancer treatment, highlights the problem. Patricia Hewitt’s decision to widen access to the drug to all suitable women will cost the NHS about £100 million a year. This cost will inevitably filter down to local health budgets, where there is to be no extra funding to meet it. Instead, trusts are required to make efficiency savings to free up funding for ‘front-line’ services.
An overview of constipation management for community nurses
Authors: Peate Ian
Published: May 2014

Constipation is thought to affect nearly one-fifth of the population, and can arise for a multitude of reasons, some physical, some psychological. Nurses must therefore approach constipation in the awareness of the range of contributory factors, and consequently the range of treatment options available.
Impact of a course on community nurses’ practice: an evaluation
Authors: Wright Kerri
Published: May 2014

An evaluation of a community course for nurses working in primary care was undertaken to ascertain whether it made an impact on the students’ clinical practice. The course was undertaken by 16 nurses working within community nursing teams that included intermediate care, health visiting, school nursing and district nursing. Three quarters of the nurses had worked in the community for less than one year and half of these were newly qualified nurses. The evaluation consisted of semi-structured questionnaires, which were completed after the course and by the student and their mentor after 3 months. The assessment of practice document submitted by the students for assessment was also scrutinised for examples of changes students had made to their practice. The results demonstrate that the students felt that the community course has made an impact on their practice and encouraged them to develop some of the key skills identified for community nurses (Department of Health, 2004).
Information preferences of MS carers
Authors: While Alison , Cookson Diana , Forbes Angus , Mathes Lucia
Published: May 2014

People with multiple sclerosis (MS) require support from a large range of formal carers during the course of their disease. Many of these carers have little or no training in the needs of people with MS and work in a wide range of settings supporting people with a variety of care needs reflecting the population in their caseloads. Outside hospitals these formal carers work in care homes or as part of primary care services.
Acti-Glide: a simple method of applying compression hosiery
Authors: Hampton Sylvie
Published: May 2014

Compression hosiery is often worn to help prevent aching legs and swollen ankles, to prevent ulceration, to treat venous ulceration or to treat varicose veins. However, patients and nurses may experience problems applying hosiery and this can lead to non-concordance in patients and possibly reluctance from nurses to use compression hosiery. A simple solution to applying firm hosiery is Acti-Glide from Activa Healthcare.
After the election, what now?
Authors: Pollard Tom
Published: May 2014

I suppose it’s a hangover from the daily barrage of announcements and initiatives of the general election campaign (the longer, unofficial one, that is), but it seems to me to have been an uneventful first month for the new Secretary of State for Health, Patricia Hewitt. If, as several pundits have suggested, the health service was a deciding factor in many people’s choice of Labour at the election, why has it gone so quiet?
Tacking obesity head on means making men more aware
Authors: DeVille-Almond Jane
Published: May 2014

I love National Men’s Health Week. It not only highlights real areas of concern in the health of our men, but it also gives hundreds of nurses around the country permission to do something about men’s health, for one week of the year at least.
Antimuscarinic management of overactive bladder
Authors: Winder Ann
Published: May 2014

The symptoms of an overactive bladder (OAB) has a negative effect on the health-related quality of life of a sufferer. Many do not seek help and up to 73% of those of who are assessed do not take medication to relieve their symptoms. The key to managing this condition is a multidisciplinary approach to conservative behaviour therapy in the form of bladder training. This management is more effective when combined with antimuscarinic medication.
Speaking up to have health-care assistants recognized for their skills
Authors: Pollard Tom
Published: May 2014

Kathleen Bowen was quite enraged by Alison While’s suggestion in the last issue of BJCN that district nursing teams should be preparing to welcome nursing auxiliaries back into the fold – you can read her letter to this effect on page 312. So I thought I would give Kathleen the opportunity to vent her frustration further, but also talk about the positive aspects of her job, and her hopes for the future.
Dying is hard, and not getting easier
Authors: Pollard Tom
Published: May 2014

Most district nurses will agree that palliative care is among the hardest, but most rewarding parts of their job. It is a great privilege to help someone die a ‘good death’ - free from pain, anxiety and fear. But unfortunately this is not always possible. So much of the dying process is not understood that health professionals, for all their clinical expertise and good intentions, can do little but try to manage the patient’s symptoms as best they can and hope for a rapid end.
The domino effect: obesity, type 2 diabetes and cardiovascular disease
Authors: Green Veronica
Published: May 2014

Rising levels of obesity in the UK are leading to corresponding increases in type 2 diabetes and threaten to jeopardize recent successes in combating cardiovascular disease. This article will discuss the key role district nurses have to play in breaking this continuum. Through health promotion activities, patient assessment and facilitating the early diagnosis of type 2 diabetes, community nurses can help reduce cardiovascular risk factors and ensure that holistic treatment regimens are initiated early on in the disease process. An overview of current regimens is provided. Effective monitoring of patients response to treatment will help diabetes specialists set and prioritize appropriate treatment goals.
Zinc paste bandages and the treatment of Flegel’s disease
Authors: Lindsay Ellie
Published: May 2014

Such is their prevalence in the population that community nurses are very likely to encounter unfamiliar dermatological problems during their practice, many of which will have been self-treated for some time before professional help is sought. This article reports a case of a rare congenital condition called Flegel’s disease, which leads to the presence of small horny papules on the skin, predominantly on the legs. In this case, the papules had deteriorated and were causing wider problems.
Case study detailing treatment of bilateral lower limb lymphoedema
Authors: Linnitt Nina
Published: May 2014

Primary lymphoedema is a chronic condition which will continue to worsen if treatment is not commenced. Old diagnostic techniques often caused more complications and recurrent cellulitis, which damages the superficial lymphatics and worsens the condition of the lymphoedema. This article looks at the treatment of a person who had a diagnosis for 18 years without treatment as service provision was unavailable until recently. It also looks at how quality of life and patient empowerment can be improved with simple instructions and an appropriate course of treatment.
Managing and promoting change: implementing the Leg Club model
Authors: Seymour Ellen
Published: May 2014

Patient knowledge of their disease may increase concordance to compression therapy. The Lindsay Leg Club® model (Lindsay, 2004) empowers the community nursing team to truly get to know their communities and deliver local, high-quality, evidence-based care for patients with leg ulcers and leg related problems. The author’s experience of opening a Leg Club has lead to changes in clinical practice: re-evaluation of the use of long stretch bandages in favour of short stretch; replacing conventional compression bandage systems with two piece graduated compression hosiery; increased patient concordance post healing with increased use of compression hosiery; the introduction of toe bandaging and appropriate long-term management for those patients with lymphoedema; and developing the role of the nursing auxiliary in leg ulcer care.

This article won First Prize in the Compression Therapy Award at the British Journal of Nursing Clinical Practice Awards 2005.
Politics and the future of wound care
Authors: Timmons John
Published: May 2014

For me, the Wounds UK conference in Harrogate is always a sign that the festive season will soon be upon us. I enjoyed the conference this year on many levels. There was an excellent range of clinical work being presented and many of the ‘big names’ in wound management were in attendance.
Continence: sizing and fitting a penile sheath
Authors: Robinson John
Published: May 2014

Male patients suffering from urinary incontinence can benefit from being fitted with a penile sheath and drainage bag rather than using incontinence pads or having to have an indwelling catheter to treat or manage their problem.

In selecting a penile sheath it is important to select the correct size of sheath to fit onto the shaft of penis and length of sheath. A penile sheath fitted too small may cause problems not only in drainage of urine but also by restricting blood circulation to the shaft of the penis. A penile sheath fitted too large will cause creases to form, allowing urine leakage and causing the sheath to fail and fall off.

This article explains what is required before fitting a penile sheath, examines various sheaths and alternatives, and how to fit one correctly.
Making decisions for incapable adults 1: Capacity and best interest
Authors: Griffith Richard
Published: May 2014

The Mental Capacity Act 2005 is expected to come into force in April 2007. It will change the way decisions are made for incapable adults in England and Wales. District nurses, along with other health professionals, will be required to abide by the provisions of the Act when providing care and treatment to incapable adults. In a short series of articles, case studies will be used to illustrate how the new law will affect district nurse practice, beginning with the assessment of capacity and best interests.

District nurse Mary Holt regularly visits a patient, 78-year-old Jane Harris, in her home to treat a chronic leg ulcer. Jane has been diagnosed with Alzheimer's dementia but is managing well with support from the local authority. However, Mary has noticed recently that Jane's behaviour has become a little strange. She looks unkempt and she is continually washing dishes that are not dirty.

On her last visit, Jane she refused to allow the Mary to remove the dressing on her leg and treat the ulcer, which has become infected. Mary is concerned that Jane's wound needs to be treated to prevent further complications.
Management of bowel dysfunction in people with multiple sclerosis
Authors: Bywater Anna , While Alison
Published: May 2014

Bowel dysfunction is a common problem for people with MS. It impacts upon both physical disability and psychosocial wellbeing. This article reviews the limited evidence underpinning best practice. The evidence highlights the importance of a thorough bowel assessment and adequate fluid and fibre intake together with the benefits of pelvic floor exercises. Biofeedback therapy, aerobic exercise and anal plugs are helpful for some people with MS. The use of pharmacological interventions needs to be considered with care.
Lessons from Stoke Mandeville
Authors: While Alison
Published: May 2014

It is all too easy to regard events in the acute care sector as having little relevance to primary care, but this would be a mistake. The Healthcare Commission (2006) recently investigated two outbreaks of Clostridium difficile at Stoke Mandeville Hospital in which more than 30 people died. It concluded that organizational failings at the trust resulted in avoidable deaths. The first outbreak of C. difficile arose as a consequence of a poor care environment, poor infection control practices and insufficient priority given to infection control by senior managers. In other words, patient safety and clinical risk were subordinate to other pressing priorities, such as meeting the 4-hour wait target in the accident and emergency department.
Part 2: Defining the unique role of the specialist district nurse practitioner
Authors: Barrett Anne , Latham Dinham , Levermore Joy
Published: May 2014

This is the second of a series of articles exploring the unique role of the district nurse. Case scenarios demonstrate the value of high quality care provided when delivering, home IV therapy, Catheterization, Medicine reviews, risk assessments, referrals and acting as the patients advocate.
Medicines use reviews – what they are for and how to make use of them
Authors: Rodgers Jill , Walker Rosie
Published: May 2014

Many people are not able to take their medication as it has been prescribed, for many reasons. Medicines Use Reviews (MURs), introduced as part of the 2005 Community Pharmacist Contract, provide the opportunity for pharmacists to offer NHS consultations, held privately, to discuss their customers’ medication with them. The MUR can help to identify any side-effects or reasons why the medication might be ineffective or simply not taken, and agree an action plan which will then be shared with the general practitioner and other significant people involved in their care. This article highlights what this process entails, and how MURs offer an opportunity for even greater multi-disciplinary working, enhancing communication and ensuring best use of NHS resources.
Listening to the socially excluded: the european national action plan
Authors: Sinclair David
Published: May 2014

Over the past two years, Help the Aged has worked with colleagues across Europe, through the Age network of 160 aging organizations, to help excluded older people feed their views into the European National Action Plans on Social Exclusion; to better understand the barriers faced when consulting older people.
Elder abuse: campaign seeks to raise awareness and improve action
Authors: Davison Sophie
Published: May 2014

This article, brought to you in association with Help the Aged, highlights the issue of elder abuse, and calls for nurses’ involvement in recognizing and dealing with the problem.
Addressing the weight problem
Authors: While Alison
Published: May 2014

Obesity has been identified as a major public health problem affecting all age groups. There is accumulating evidence that obesity is associated with serious health problems which include cardiovascular disease, type 2 diabetes and some cancers (WHO, 2000), in addition to reduced quality of life with obesity having a negative impact on psychological and social wellbeing (Blissmer et al, 2006).
Pandemonium over painkillers persists
Authors: Cowan David
Published: May 2014

Chronic non-cancer pain remains under-treated. Five years ago it was highlighted that more research was needed into the safety and efficacy of NSAIDs and opioid drugs in older people (Cowan, 2002). Concerns remain over NSAID-induced pathology and now there are safety concerns over the continued use of supposedly safer COX-2 agents. There also remain concerns over the problematic use of opioids, including the potential for psychological and physical dependence. While more research is still needed to inform prescribing for older people, it is also apparent that we still need long-term studies of commonly used pain medications for the whole spectrum of age groups. Data derived from such studies would inform nurse prescribing.
Specialist cardiology nurses audit post-MI community aftercare
Authors: Bowler Mandy , Blake Alison
Published: May 2014

The transition of care into the community gives rise to the auditing and examination of custom and practices. This article describes how the community cardiology specialist nursing team at Sunderland Teaching PCT. have audited the practice of home visiting for acute myocardial infarction patients following discharge from hospital. The aim of the audit was to examine current practices and to consider whether or not other nursing teams have the skills to deliver this service thus enabling the specialist nurses to develop their skills further and develop nurse led initiatives to support the national service framework for coronary heart disease.
The benefit system and older people
Authors: Pearson Anna
Published: May 2014

This article, brought to you in association with Help the Aged, looks at the maze of benefits available to the older person. There are significant benefits going unclaimed annually. The article provides up to date information and useful addresses for making claims and getting professional benefit advice.