bluuebunny/crossref_metadata_2025 huggingface dataset:
A multidisciplinary approach to leg ulcer management in primary care
Authors: Taylor Adrienne , Smyth J V
Published: May 2014

The majority of management of venous leg ulcers takes place in the community, where it plays a major role in the workload of the district nursing service. District nurses are generally able to manage uncomplicated venous leg ulcers effectively, but may face difficulties when faced with ulcers with more complex aetiology. This article describes the formation, structure and operation of a multidisciplinary team in Salford which has had a significant impact on the management of this difficult problem. In doing so, it raises some important points for other trusts to consider when establishing a dedicated leg-ulcer service.
Valuable information for wound care practitioners
Authors: Gray David
Published: May 2014

In this, the second Silver Supplement, we hope you find information of benefit and relevance to your clinical practice. In a fast changing field such as wound healing it can be difficult to keep track of new developments. Supplements such as this offer the opportunity to consider our wound care practice in light of the information provided. In this supplement the three authors have examined issues of particular relevance to the prevention and management of wound infection using an activated charcoal dressing containing silver.
Failing to make contact: young men’s health
Authors: While Alison
Published: May 2014

There is consistent evidence that men have a higher health risk than women, with heart disease, accidents, and alcohol and drug abuse being particularly significant (Lloyd and Forrest, 2001). Most of these differences are attributable to behaviour rather than genetics. Harrison and Dignan (1999) have suggested that men ignore their health because cultural emphasis on combat, competition and independence results in them taking ‘risks’ for ‘fun’. Further, Helman (1994) has suggested that maleness requires the drinking of alcohol and the smoking of cigarettes as part of the validation of the gender role. In this way male culture negatively impacts on health through its promotion of unhealthy life choices and occupations.
Does accident prevention education reduce the incidence of childhood accidents in the home?
Authors: Close Jessica
Published: May 2014

This mini-review examines whether accident prevention education reduces the incidence of home accidents among children under the age of 5 years. The Cochrane Library, Medline, CINAHL and Embase databases were searched for randomized controlled studies (RCTs) and systematic reviews of RCTs that compared parents who received accident prevention education with those that did not. Only two RCTs met the inclusion criteria for analysis in this review. The results of these studies showed that there was no statistically significant difference in accidents between the two groups but the quality of the trials was low. An RCT in process (Watson et al, 2002) looks likely to provide evidence of a high standard, so that practice decisions regarding accident prevention education can be made.
Politics is undermining health care
Authors: Pollard Tom
Published: May 2014

The political storm over the treatment of Rose Addis at the Whittington hospital is the surest sign yet that politics is returning to normal after the truce following September 11th. No more pulling punches, no more cooperation – it’s each party for itself, and once again the NHS is caught in the middle. Labour is fervently defending its record on health, while the Tories are intent on bringing Labour to its knees in time for the next general election.
Choice and confusion: nurses need to lead
Authors: While Alison
Published: May 2014

The relentless media frenzy about the dangers associated with living is causing untold anxiety and confusion. It is taking place in the pursuit of apparently providing information to guide informed choice. In fact, the burden of making the right ‘choice’ is increased to the point that normally rational citizens become unable to make any decisions with confidence. They will frequently persuade themselves that it would be better not to take a risk by undertaking an activity, while not recognizing that such a strategy in itself carries a potential risk.
Our lives, our bodies: thorny issues of consent
Authors: Pollard Tom
Published: May 2014

I confess it was a certain ghoulish fascination that prompted me to accept an invitation to the press conference in advance of the opening of the Body Worlds exhibition last week. I was frankly keen to see this collection of expertly dissected human bodies.
Don’t hide your light under a bushel
Authors: Pollard Tom
Published: May 2014

There’s just under a month left for people to comment on the consultation document on supplementary prescribing (Medicines Control Agency (MCA), 2002), and I would strongly encourage people to do so. This is one of the key developments that will underpin the success or failure of the NHS Plan, extending prescribing rights as it does to a wider range of nurses and pharmacists.
Time to make headway on Agenda for Change
Authors: Pollard Tom
Published: May 2014

Despite the bounty of the Chancellor’s 2002/2003 budget and the billions of pounds heading for the health service, there is still a long way to go before a final settlement is reached on a new structure for nurses’ pay and conditions. We can only hope that when it arrives it lives up to expectations.
Diet and coronary heart disease: advice on a cardioprotective diet
Authors: Daniels Luci
Published: May 2014

Coronary heart disease is a major disease leading to early morbidity and mortality in the UK. The causes are multifactorial, a combination of modifiable and non-modifiable risk factors. Although recent statistics show a reduction in the coronary heart disease mortality rate, the disease continues to be a major focus in health care, with strategies being developed to improve prevention and treatment. Dietary modification has a role to play in both primary and secondary prevention.
Management of a paraplegic patient with a full thickness ischial pressure ulcer
Authors: Cobb Ann
Published: May 2014

Betty was a 72-year-old paraplegic patient with a full thickness ischial pressure ulcer. After an overview of the care delivered in hospital, this case study will focus not on the management of the wound but on the attempts made towards safe discharge home of the patient after an initial failed discharge. The diversity of problems encountered over a period of 18 months proved extremely challenging for all disciplines involved and required the development of close working relationships to achieve an eventual successful outcome. On reflection there are many aspects of this case that would undoubtedly be now managed differently. I had been in post for only a short time when my involvement with the patient began and my links with other members of the multidisciplinary team were tenuous. However the relationships fostered over this period of time have ensured that future cases have been dealt with efficiently and effectively. The case study concludes with a happy ending for the patient when successful surgery to repair the ulcer was initiated, not by medical or nursing personnel but by the patient herself.
Care management revisited: a follow-up study
Authors: Bergen Ann
Published: May 2014

This article describes a follow-up to a study of community nurse care managers, undertaken in 1993–1994, in the light of the community care policy of the time. The original research found care management to be a viable practice model for community nurses to adopt, given the contemporary context; however, its long-term future was debatable. The present study comprised a questionnaire sent to two groups of community nurse care managers and their managers, who had participated in the original research. Responses indicated that a large proportion remained in a care management role some 4–5 years later, with the mental health and learning disability specialties being better represented than district nursing. Once again, survival was found to be dependent on a number of related contextual variables, which are discussed. The study concluded that the philosophy and principles of care management are still relevant to today’s community nursing practice, even though the actual title appears to be less in evidence and current policy changes may render it less viable for the future.
Are health service targets doing their job?
Authors: While Alison
Published: May 2014

Improving health care, like other public services, is never going to be easy when financial constraints are coupled with shortages of skilled manpower. Many general elections have been fought over the battleground of different strategies to best satisfy the health needs of the population and no doubt the next general election will be no different, as political parties scrap over the health service.
Getting the message across: Valuing People
Authors: While Alison
Published: May 2014

Valuing People (Department of Health, 2001) was published two years ago but it seems that the enormity of the changes which it heralded have yet to be fully appreciated. Importantly, people with learning disabilities are to be cared for by mainstream health services with access to extra help or facilitation as needed. So people with learning disabilities can no longer be forgotten by being side-lined into services run exclusively for this client group, rather they are to have access and rights to the same health services as the rest of the population. However, the reality of access to health services will depend as ever on the staff who run them and in particular the primary care services which act as gatekeepers to secondary services.
Pharmacy proposals show muddled thinking
Authors: Pollard Tom
Published: May 2014

Just as the Government is giving with one hand, it may be on the verge of taking away with the other. In the middle of January, the Office of Fair Trading (OFT) published a report recommending the abolition of the control of entry regulations for community pharmacy – the local ‘needs test’ that a pharmacy must satisfy in order to open. These regulations are intended to deliver a sufficient ‘spread’ of pharmacies to permit universal access. The OFT’s recommendation would effectively deregulate the community pharmacy market and open the way for any retailer wishing to employ a pharmacist to do so. The result, many fear, would be a loss of local pharmacies and contraction of community pharmacy services into the large supermarkets.
Accountability and drug administration in community care
Authors: Griffith Richard , Davies Ruth
Published: May 2014

Medicines are a key therapeutic intervention in community care but their adverse effects can give rise to concern for patient safety. This article considers the legal regulation of medicines with emphasis on the right to administer medicines and the standard of administration. It further considers the consequences for primary care staff of the inappropriate use of widespread practices such as tablet crushing and covert administration of medicine.
Older people as health service consumers 2: health and illness in a village context
Authors: Bentley Jenny
Published: May 2014

Involving users in the future shaping and development of health care services is part of the drive to restore public confidence in the NHS (NHS Executive, 2002). A fundamental part of this process is working in partnership with patients, and attempting to include marginalized groups. Illness, infirmity and lack of knowledge may prevent older people from being actively involved in decisions about health care services, and the culture to which they belong may act as a further barrier. For true partnership and patient involvement, there needs to be a common understanding of the meaning of health and illness. This article discusses the prevailing cultural health beliefs within an elderly, white village community in South England.
Antibiotics should only be used as needed
Authors: While Alison
Published: May 2014

Enormous advances in health outcomes since World War 2 have in large part been due to antibiotics. Antibiotics are now so well established in the vocabulary of the general public and health care professionals that there has been neglect of the potential consequences of their overuse. The Department of Health (1998) report should have been a wake up call to all health professionals.
Star ratings: are they worth all the fuss?
Authors: Pollard Tom
Published: May 2014

Many readers in England will have spent at least a little time over the last few weeks pondering the meaning of their PCT’s performance in the recent star ratings. For those with three stars, a pat on the back all round. For those with none, a disconsolate sigh, and off to the next patient. Or perhaps complete disdain of the whole worthless procedure. After all, not one of the performance indicators examined nurses’ input into care.
The development and implementation of an acute traumatic wound guideline
Authors: Stephen-Haynes Jackie , Downing Phil
Published: May 2014

Accident and emergency (A&E) departments and minor injury units (MIUs) are faced with a wide variety of acute traumatic wounds on a daily basis. Yet despite the existence of a county-wide tissue viability policy, guideline and formulary in Worcestershire, there had been no attempt to standardize treatment for traumatic wounds in the county. This article describes the process of developing a guideline for acute traumatic wound care by a wide multidisciplinary team. It identifies key points that may be considered when developing similar guidelines, including planning, leadership, communication and the motivation to finish the project. Development of guidelines is advocated as a means not only of improving and standardizing care to patients, but as a means of fostering multiprofessional team-building and improved communication between health professionals.
Exudate management in the 21st century
Authors: White Richard
Published: May 2014

Clinicians faced with the challenges of wound management routinely face the well-known problems of wound deterioration or delayed healing, maceration and leakage of exudate, and infection. These clinical problems are rarely simple and straightforward to deal with. There is usually an element of ‘creativity’ or ‘art’ in the clinician’s approach to their management. So it is with exudate management. We are now urged to create the ‘optimum moist environment’ and to avoid maceration, and to be cost-effective. However, the means to reach these goals are not always obvious, nor easily achieved.
As the rugby showed, teamwork always wins out
Authors: Gibson Louise
Published: May 2014

The rugby world cup is finally over and at last I can reclaim the weekends as my own. One aspect of the competition that I particularly enjoyed was the joining together of the variety of teams from across the world. The elite teams stormed ahead as expected but it was the determination of the underdogs that most impressed me. I was particularly amazed with their determination and self-belief and wondered where they got their strength from, particularly when they were being annihilated.
Ann Keen MP: a district nurse at the heart of government
Authors: Pollard Tom
Published: May 2014

Ann Keen’s career has, over 25 years, spanned nursing, education and politics. She’s now MP for Brentford and Isleworth and Parliamentary Private Secretary to Gordon Brown, the Chancellor of the Exchequer. ‘I’ve got the best job in parliament,’ she says. ‘I’m right at the heart of government.’
Drug fiasco highlights need for more openess
Authors: Pollard Tom
Published: May 2014

The recent advice to doctors from the Medicines and Healthcare products Regulatory Agency (MHRA) to stop prescribing a whole class of drugs (selective COX-2 inhibitors) has come as something of a shock to most people. For patients who have been taking these drugs – well over 1million people according to press reports – it has been a source of considerable concern.It will also have further shaken the public’s already weakened trust in the MHRA’s ability to protect them from big business (i.e. pharmaceutical companies).
Taking the Queen’s Nursing Institute into the future
Authors: Pollard Tom
Published: May 2014

The Queen’s Nursing Institute is best known now for its annual awards and its work in supporting innovation and professional development across community nursing. Younger nurses, however, may be unaware of its origins – as the first institution to supply highly trained district nurses and provide supervision of their work. Primary care is now undergoing its most significant reorganization since the foundation of the NHS, and there is the possibility that the treasured title of ‘district nurse’ may be lost. So where does the institution most closely allied to that title see its future? I spoke to the new director as she was about to take up her post.
Developing career pathways for new nurses: lessons from inner London
Authors: Abbott Stephen , Bryar Rosamund , Hostettler Marcus , Hutt Jane , Jones Peter , Sealy Angela
Published: May 2014

Inner city primary care trusts (PCTs) often have difficulty in recruiting nursing staff, while newly qualified nurses are often unaware of what opportunities community settings offer. This article reports the development of a rotational scheme designed to reduce recruitment problems and to assist understanding by newly qualified nurses of the interface between hospital and primary care. The scheme was jointly run by a PCT, a hospital and an academic unit. Various difficulties were encountered, as revealed in an interim evaluation. For example, the impression was created among some participating staff nurses and their mentors and managers that they had student status, which limited their opportunities both to learn and to provide care. The scheme was re-designed in the light of the evaluation, and a further evaluation found that participating staff nurses appreciated the opportunities the scheme offered, and that their work was valued by placement mentors and managers.
Representing ‘grass roots’ nurses at the top of the management ladder
Authors: Pollard Tom
Published: May 2014

Avril Roulston had been a nurse in the north-west for over 30 years when the opportunity arose to take on a dramatically different role. It was 2001, and primary care trusts were being established across England. ‘I was really excited about PCTs. I thought they were exactly the right thing to do, and I wanted to be part of the process,’ she says. Driven by a strong belief in grass-roots representation, Avril stood for the professional executive committee (PEC), and was elected.
The law and intimate examinations and treatments
Authors: Griffith Richard
Published: May 2014

District nurse Sister Mary Green cares for a patient left bed-bound when a road traffic accident damaged her spine. Continence management is a particular nursing problem and, following discussion with her consultant at the spinal injury centre, her GP is now recommending manual evacuation of faeces as the best form of bowel management. Sister Green is concerned by this proposal as the patient has become extremely distressed on previous occasions when a simple digital rectal examination was performed. She wonders if such intimate procedures are lawful.
The importance of recognizing abuse of older people
Authors: Potter Jennie
Published: May 2014

Abuse within families happens far more often than most people would be prepared to acknowledge, and can take many forms. Action has been taken by government to address issues of child abuse and domestic violence, but abuse of older people has until recently been neglected. In this article, the CDNA’s elder abuse specialist discusses why this is so, and how to identify abuse of older people when it happens.
Staking a claim to manage chronic disease
Authors: While Alison
Published: May 2014

Everyone agrees that nurses make a significant contribution to patient care, although there is relatively little research evidence to quantify it. The challenge for all qualified nurses in this rapidly changing service delivery environment is to articulate their contribution as distinct from that of unqualified, but trained, healthcare assistants. For district nursing, the challenge is even greater as PCTs begin to reconfigure home support around community matrons, various chronic disease models and care pathways, and implement the knowledge and skills framework and the new single career structure across the health-care workforce.
Acknowledging failures is the key to success
Authors: Pollard Tom
Published: May 2014

If opinion polls at the time of writing (one week before the General Election) are correct, by the time you read this Tony Blair will have spent a couple of days reassuring the British public that Labour’s third term mandate (albeit on a much reduced majority) will lead to a fairer, healthier, more prosperous nation.
The law and accountability in district nursing practice
Authors: Griffith Richard , Tengnah Cassam
Published: May 2014

The Welsh health minister Dr Brian Gibbons commented earlier this year that, ‘Of all the professions who work in the community, nurses are the most respected and valued’ (Western Mail, 25th January 2005). The minister’s words reflect numerous opinion polls in recent years where nursing tops the list of most respected professions (Moore, 2004). Vital to this public trust and confidence is the concept of accountability. In this article, the authors encourage you to reflect on your accountability and evaluate how the law imposes standards of practice and behaviour to protect the public and the patients in your care.
Chris Beasley: looking at primary care nursing in the round
Authors: Pollard Tom
Published: May 2014

I needn’t have been nervous about meeting the CNO - she immediately put me at ease. Calm and measured, she projects authority. We got straight down to business.
Promoting influenza vaccination in older people: rationale and reality
Authors: While Alison , George Cathy , Murgatroyd Beth
Published: May 2014

Influenza is a serious, preventable disease for older people. Vaccination saves lives and reduces health-care costs. The UK should be vaccinating 85% of risk groups by 2010. The uptake of vaccination is influenced by four factors: the socioeconomic status of patients; the system of vaccination; vaccine mistrust and fear of side-effects; and health beliefs. An effective vaccination programme needs to target and be sensitive to the particular needs of older people. It should include a combination of strategies to promote vaccination (flyers, personal invitations; doctor’s recommendation); acknowledgement of lay beliefs; special clinics organized around older people; and special arrangements for housebound older people and those living in care homes.
Intermittent self-catheterization appliances for disabled patients
Authors: Robinson John
Published: May 2014

Occasionally, district nurses may be asked to teach a patient intermittent self catheterization (ISC). However, if the patient has some form of physical disability that reduces their manual dexterity or limits their movement, should this stop the patient undertaking the procedure? This article outlines some of the appliances available to help disabled patients undertake ISC.
Exploring the use of emollient therapy in dermatological nursing
Authors: Peters Jill
Published: May 2014

This article explores how nurse prescribing has enabled patients with dry itchy skin to choose the product most suitable for the severity of their dry skin with the nurse. This is done through education, negotiation and trial of emollients. Health practitioners should ensure that patients understand how the environment challenges the skin, the processes of inflammation and ageing and how emollients used on a regular basis can support the epidermal barrier. Practical advice on technique of application is as essential to the concordance of the treatment as is the choice of product to be prescribed.
What do informal carers need from district nursing services?
Authors: Bliss Julie
Published: May 2014

More than 5 million informal carers provide support to individuals who wish to remain within their own homes. The role of informal carers in maintaining people within their own homes has been identified as crucial. This article considers the assessment of need of informal carers in the primary care setting, placing particular emphasis on the role of the district nurse as an advocate for informal carers when working with other health and social care service providers. Central to working with informal carers and acting as an advocate is communication, and unless informal carers feel that they are involved in the decision-making process, and listened to, they are unlikely to access appropriate support.
Concordance: a widely used term, but what does it mean?
Authors: Hobden Alison
Published: May 2014

The term concordance was first used by the Medicines Partnership to describe a new way of consulting with patients in order to gain the most effective use of medicines (Royal Pharmaceutical Society of Great Britain 1997). Over recent years, the term has become associated with many different health care interventions. The aim of concordance is to improve satisfaction with the process of health care consultations, having the ultimate goal to reduce wastage of health care resources. Concordance has evolved from terms such as non-compliance and non-adherence and reflects a shift in the culture of health care interventions, aiming to empower patients. Suggestions to the content of concordant consultations are outlined in this article and will be further developed in the second article.
Older people who fall: why they matter and what you can do
Authors: Oliver David
Published: May 2014

The population is ageing in all developing nations. As treatments and survival rates improve for conditions affecting younger people, age-related problems linked to frailty, functional impairment and long term conditions will pose an ever larger challenge to health and social care systems. Falls and associated injuries or loss of function are such a problem. Effective falls intervention strategies mean that primary care and community nursing must play a central role, as many patients will never present to hospital services, nor could hospital services cope – for instance one in three people over 65 will fall in a given year and one in two women will sustain a fracture during their lifetime. Fall and fracture prevention has, until the past few years, been a low priority in service delivery, training and research.

However, its importance as a public health challenge has been increasingly recognized in government policy and in clinical guidelines, though we are still a long way off delivering evidence-based interventions and assessments to those who would benefit. There is plenty that clinicians can do to reduce the chance of further falls and injuries, to optimize patients’ confidence and ability to cope and to use falls as a ‘case-finding’ trigger to address a host of other, often unrecognized problems. There is plenty community nurses can do in initial assessment, intervention and monitoring. This article sets out the key practice points and in particular the key sources of evidence for practice development.
Understanding confidentiality and disclosure of patient information
Authors: Griffith Richard
Published: May 2014

The need to share information about patients is vital to effective care and protection, especially where it relates to children or vulnerable adults. District nurses in common with other health professionals are often reluctant to share information because of a misunderstanding over the extent of their duty of confidence to patients. This has resulted in the needs of patients being unmet and in some cases tragic deaths have occurred. In this article Richard Griffith outlines the extent of the district nurses duty of confidence and considers when sharing patient information is lawful.
A district nurses’ guide to disability discrimination law: part 2
Authors: Griffith Richard , Tengnah Cassam
Published: May 2014

In last month’s article Richard Griffith and Cassam Tengnah began their series on Disability Discrimination law by considering the definition of disability. This month they look at how the law protects disabled people from discrimination in the workplace, provision of services and in education.
A focus on ActiFormCool® in the reduction of pain in wounds
Authors: Hampton Sylvie
Published: May 2014

Pain is a very common problem in wound management and is one that is often neglected. This has an impact on both healing rates and patient quality of life. Pain is an indication that something is wrong and acts as one of the body’s most important protective mechanisms and as such, should never be ignored. A comprehensive assessment of pain is vital and a plan of care formed that considers the type of pain that is being experienced and what interventions should be used. ActiFormCool is an ionic hydrogel dressing that has the ability to reduce pain in painful wounds, and this natural type of intervention should be the first consideration in reducing pain.
Exciting times for tissue viability
Authors: Toner Louise
Published: May 2014

Welcome to this edition of Wound Care, the first since the emergence of the Wound Care Alliance UK. I hope you like our new corporate image and the changes the British Journal of Community Nursing team has made to reflect our new logo and colour scheme. I feel sure you will continue to find this supplement an invaluable resource to support you in your clinical practice, academic study and research.
How do district nurses choose which products to prescribe?
Authors: Hall Jason , Noyce Peter , Cantrill Judith
Published: May 2014

The aim of this study was to explore the influences on product selection by district nurses when they start to prescribe a product for the first time. Representatives from the pharmaceutical industry had the biggest impact on the prescribing of new products followed by the nurses’ colleagues with specialists being viewed more positively than non-specialists. The primary care trust and patients appeared to have little impact on product selection. The challenge for primary and secondary care trusts is to promote safe cost-effective, evidence-based prescribing and to maximize consistency across the primary – secondary care interface. NHS organizations wishing to influence prescribing must convince prescribers that they are interested in more than just reducing costs and they could do well to take a lead from the pharmaceutical industry when they try to get their messages across to prescribers.
Evaluating practice-based learning specific to the community matron role
Authors: Banning Maggi
Published: May 2014

Since the inception of the community matron role in 2004 there has been much debate about the exact nature of the role in primary and secondary care. How to effectively skill-up and educate a diverse group of clinicians has been a hot topic. This study involved a small focus group of community matrons in training. The qualitative themes extracted from this work are reported on and suggest that practice-based learning is both valuable and efficacious.
The Female Genital Mutilation Act 2003: an overview for district nurses
Authors: Griffith Richard , Tengnah Cassam
Published: May 2014

Female genital mutilation (FGM) includes procedures that intentionally alter or injure female genital organs for non-medical reasons. An estimated 100 to 140 million girls and women worldwide are currently living with the consequences of FGM with some three million girls at risk in Africa every year. The procedure has no health benefits and can cause severe bleeding and continence problems, and later, potential childbirth complications and newborn deaths. FGM is internationally recognized as a violation of one’s human rights (World Health Organisation, 2008). In the UK it is a procedure outlawed by the Female Genital Mutilation Act 2003.
VIRTEx project aims to promote long term health and improve social care
Authors: Sadler Steve
Published: May 2014

Funded by the Technology Strategy Board’s Assisted Living Innovation Platform, the VIRTEx project aims to develop the potential of telehealthcare to provide community-based care and increased social activity, inclusion and support for the growing number of people with long-term needs.
A new debate on an old problem
Authors: Cook Rosemary
Published: May 2014

The recently announced Prime Minister’s Commission on the future of nursing and midwifery faces some formidable challenges. Following the reviews of pre-registration nursing and of post-registration nursing careers, and the Next Stage Review of the NHS, it could be argued that there is no need to look yet again at the role and contribution of nurses and midwives.
Modernizing community nursing services in Scotland
Authors: Kennedy Catriona
Published: May 2014

Scotland is in the midst of a major review of community nursing which began in 2006. The Scottish Executive, as part of the modernisation of the National Health Service, began a radical and far reaching review of nursing in the community. What transpires in Scotland over the next few years has the potential to contribute to the global debate about how community nursing may be developed to meet the needs of people and communities.
The QNI is open-minded when it comes to social enterprise
Authors: Cook Rosemary
Published: May 2014

It cannot have escaped the notice of any community nurse in England that current Government policy favours the development of social enterprises as delivery vehicles for community services. And since social enterprise is neither a new invention, nor confined to health or social care purposes, community nurses across the UK must be watching with interest to see if this form of business has any potential to deliver their own professional (or private) good ideas.
Supported self care and care planning for patients with long-term conditions
Authors: Beasley Christine
Published: May 2014

Christine Beasley explains the benefits of supported self care for patients with long-term conditions, enabling them to make decisions about their care, in partnership with their health-care professional. The article also includes a case study of the Leeds Community Healthcare team, outlining how nurses implement the self care ethos into daily clinical practice.
An interview with Keith Cutting
Authors: Cutting Keith
Published: May 2014

Having acquired experience in medical and surgical nursing and subsequently working part-time in what became the Wound Healing Research Unit (Cardiff) I came to the conclusion that wound care offered opportunities beyond other clinical specialties, particularly that of being able to make a personal difference. Another aspect that attracted me to wound care was that of continuity of care. Working in a university hospital and a busy wound clinic, before the advent of Trusts, enabled close contact with patients to be maintained and allowed participation in their care virtually from start to finish of the care process.
BLS Awareness Week: 20-26th April 2009
Authors: Pike Cheryl
Published: May 2014

‘All lymphoedemas are chronic oedemas, but not all chronic oedemas are lymphoedemas’ is often overlooked or misunderstood in practice and further education is needed to ensure that best practice is delivered and appropriate referrals are made for these patient groups.
An interview with Marie Todd
Authors: Todd Marie
Published: May 2014

I started my career as a staff nurse in a hospice in Glasgow. John Welsh was keen to provide treatment for patients suffering from lymphoedema so he set up the service in 1991. Margaret Key was the first specialist in Scotland and Margaret Rice and I covered for her at the weekends and when she was on holiday. I was fortunate enough to be asked to go to a session that Caroline Badger and Eunice Jeffs held in Edinburgh to publicise a specialist course they had developed. I was so inspired by them that I was determined to get on that course.
Overcoming the problem of overgranulation in wound care
Authors: Johnson Sue
Published: May 2014

Overgranulation tissue is also known as hypergranulation tissue, exuberant granulation tissue, proud flesh, hyperplasia of granulation tissue and hypertrophic granulation tissue (Dealey, 1999; Dunsford, 1999). Overgranulation tissue usually presents in wounds healing by secondary intention. It is clinically recognized by its friable red appearance. The presence of overgranulation tissue inhibits epithelialization. Historically treatment consists of destruction of the overgranulation tissue by cautery, curettage, silver nitrate, steroid preparations or pressure (Semchyshyn, 2005)
Managing skin grafts with TNP and Wound Assist®
Authors: Edwards Jacky
Published: May 2014

Skin grafting is one of the most common operations performed in plastic surgery. This is now spreading rapidly to other disciplines, but can pose a variety of wound care problems for nurses. Shearing or displacement of the graft prevents revascularization of the graft, therefore immobilization is important. An ideal dressing for a skin graft should prevent mechanical displacement, allow drainage of serous wound exudate and haematoma, and be easy and painless to change. Application of topical negative pressure (TNP) ensures stabilization of the skin graft as well as prevention of shear and seroma formation underneath the skin graft, thus preventing loss of skin graft and promoting `take`. Use of TNP ensures graft take and means that the patients do not need to go back to the operating theatre for further grafting and can be discharged earlier. This paper sets out to demonstrate the use of Wound Assist® (Huntleigh Healthcare), on newly applied skin grafts.
An interview with Brenda King
Authors: King Brenda
Published: May 2014

I suppose my interest grew when I started work as a district nurse and was exposed for the first time to chronic leg ulcers. I cringe when I think of some of the treatments we used to employ, from strange topical applications to ritualistic practice that was not evidence-based. Fortunately, I was able to attend a Tissue Viability Society conference in Harrogate in 1990 and was enthralled by the lectures on the management of leg ulcers and other aspects of wound care. I returned motivated to make a difference and began a long battle to improve services locally.
Take care of yourself
Authors: Pike Cheryl
Published: May 2014

Following the Lymphoedema Awareness Week in April of this year, and the ongoing efforts of professionals in raising awareness of this chronic condition to primary care staff and patients, some areas have noticed an increase in referrals to their clinics. There has also been an increase in requests for education in lymphoedema management, especially in the community setting, and this in itself means we must be aware of the tasks involved in providing the care this group of patients needs.
Manual handling in lymphoedema: the importance of getting it right
Authors: Pike Cheryl
Published: May 2014

This article aims to highlight the need for risk assessments, especially with a patient group that is seen outside of a clinical setting. As workloads and demands on our time and resources increase it becomes more important to consider the manual handling constraints that face us on a daily basis. It becomes all too easy to commence a task without prior thought and consideration to the short and long-term effects of our duties, especially when out in the community.
An interview with Vaughan Keeley
Authors: Keeley V L
Published: May 2014

I first became interested in chronic oedema when I started to work in palliative medicine in Cambridge. Inevitably, the initial problems were those associated with advanced cancer, but I also became interested in cancer treatment-related oedema. This was all in the 1980s when there were very few lymphoedema services available. Together with physiotherapy and nursing colleagues we started a fledgling service in Cambridge, having learned a lot from a visit to the Oxford lymphoedema service. There was no formal training then!
Lymphoedema is part of who I am
Authors: Summerhill Lindsey
Published: May 2014

In 1999, when I was 19 years old and in my 2nd year of university, I remember standing in the living room saying to my housemates, ‘Do my legs look swollen to you?’ They agreed they did look a little swollen but we didn’t know why so left it there. A few months later I moved to Reading to carry out my placement year for my 3rd year of university. This meant for the first time I had a ‘proper’ office job. I very much enjoyed my job and was learning lots of new exciting things, however, there was something which appeared to be bothering me during the day at work and that was my legs. I asked the women in my office for their advice as to why they thought I was getting swollen legs and they said it could be because I was sitting down all day or water retention.
Care planning: more than meets the eye
Authors: Phillips Jim
Published: May 2014

The Government pledged in its last White Paper that all people with a long-term health condition should have the opportunity to have a care plan by 2010 (Department of Health (DH), 2006).
Society owes carers a debt of thanks
Authors: While Alison
Published: May 2014

The approaching financial challenges within health and social care are well heralded and will inevitably cause strain in the care system. It is likely that in the name of efficiency there will be reductions in hospital in-patient stays and a reluctance by local authorities to extend their provision for those with significant care needs. Indeed, the context is being set for further exploitation of carers in the coming years.
Reporting of scientific studies: misleading titles
Authors: Kirshbaum Marilyn
Published: May 2014

A recent article in a respected British newspaper led with the headline ‘Atheist doctors more likely to hasten death’ which ruffled my feathers in exasperation. The phrase ‘to hasten death’ seems almost synonymous with euthanasia, which are acts that are distinct from end-of-life care. What were the background justification and the findings from the original study? They are well worth reading in full (Seale, 2010).
What does the future hold for people with long-term health conditions?
Authors: Phillips Jim
Published: May 2014

The Government have proposed significant structural reforms to the NHS. These have been billed as a bottom-up reform. NHS staff will be able to take over the running of services, clinicians will be at the heart of commissioning and all will be based upon a patient-centred NHS, where the patient, guided by the GP is able to chose the location of their treatment and the person who gives it. This will be supported by improved information on hospitals and services. The GP is to be the patient’s expert guide who will help the patient make informed choices about treatment and care and over time be responsible for the commissioning of that care. Inevitably much of that expert guide role, the making sense of choices available and interpreting information will fall to nurses working out of GP practices. Whether these changes will result in an efficient and effective NHS only time will tell.
Palliative care based on need not diagnosis; challenges for nurses
Authors: Kennedy Catriona
Published: May 2014

Across the UK and beyond, and in response to demographic changes and policy directives, palliative care services are transitioning. There is little doubt that district nurses, alongside general practitioners and other members of the multi-professional team, are essential to the provision of community palliative care and pivotal to implementation of palliative care policies and service plans.
Cuts, concerns and compromise: standards must not be jeopardized
Authors: Cook Rosemary
Published: May 2014

The QNI’s Right Nurse, Right Skills campaign launched just one month ago, but already we are getting a very clear message about how essential it is. Baroness Sally Greengross, Chief Executive of the International Longevity Centre, has leant her support, commenting that:
End of life care: work together, achieve more
Authors: Smith Julie
Published: May 2014

The King’s Fund has just published Delivering Better Care at End of Life (King’s Fund, 2010), a report from the Sir Roger Bannister Health Summit (Leeds Castle, 19–20 November 2009). Within this report is a chapter dedicated to the community (’Driving improvements within the community Delivering end of life care: The challenge for providers working together’). Its focus is on the need for health providers to join forces in order to provide the best possible level of care for those nearing the end of their lives. One of the main problems the author notes, is the lack of teamwork between different health providers.
Nurses will always be needed at home
Authors: Ryder Elaine
Published: May 2014

During the last decade, we celebrated the 60th anniversary of the NHS. At the beginning of this new decade – this year – we will mark the 100th anniversary of the death of Florence Nightingale. In celebrating her tremendous contribution to the development of the modern nursing profession, there will no doubt be great emphasis on her work to bring order, cleanliness, infection control, basic patient care and humanity to hospital wards. Much less prominent in most memorials is Florence Nightingale’s seminal contribution to the development of district nursing, about which she advised William Rathbone for many years, and which she admired enormously for its impact on the daily lives of people who received district nurses’ services.
Dementia strategy: not enough money to deliver?
Authors: While Alison
Published: May 2014

The Department of Health (DH) (2009) published a strategy for dementia care: Living Well with Dementia to promote effective dementia care on a par with care for cancer and cardio-vascular disease. It was based on evidence to enable cost-effective commissioning and care provision and was an ambitious and comprehensive strategy for dementia. Like all strategies, it required a strong implementation plan if it was to yield the intended improvements for dementia services. However, the National Audit Office (NAO) (2010) has challenged the espoused ambition of the DH that dementia is now a national priority because there is little evidence of the urgency normally expected for such a priority.
Cultural competency: Haiti and at home
Authors: Thompson Geoffrey
Published: May 2014

Nearly 2 months have passed since Haiti was struck by a devastating earthquake, causing an estimated 230000 deaths. We read and saw in the media the frustration, anguish and anger of the survivors and rescue agencies as they struggled against the sheer scale of destruction hampering the rescue of those still alive under the rubble and the supply of food, water and provision of first aid.
Equality and anti-discrimination legislation in health care
Authors: Griffith Richard , Tengnah Cassam
Published: May 2014

The NHS constitution for England (Department of Health, 2009) sets out the rights and responsibilities of patients and staff in relation to the delivery of health care. A key requirement for staff is to ensure that they not to discriminate against patients or staff, and adhere to equal opportunities, equality and human rights legislation. Successive governments have introduced a varied range of anti-discrimination laws that district nurses are required to abide by. These have often developed in isolation to one another, with distinct requirements and rules applying to different forms of equality law.

It is essential that nurses working in the community are aware of these rules and that they fulfil their duty under the NHS constitution, the law and their code of conduct.
Protecting patients
Authors: While Alison
Published: May 2014

The National Pandemic Flu Service has been closed although the antiviral collection points will continue to operate until the end of this year’s influenza season. While case numbers are decreasing and most cases are not serious, H1N1 is still causing severe illness in some people and, occasionally, death. However, swine influenza, like seasonal influenza, is a preventable disease and therefore it is important to consider what lessons can be learnt to prevent unnecessary deaths and suffering.