bluuebunny/crossref_metadata_2025 huggingface dataset:
Caring for patients with COPD and their families in the community
Authors: McHugh Gretl , Chalmers Karen , Luker Karen
Published: May 2014

Community matrons have a key role to play in the management of patients with long-term conditions. With the expected increase in prevalence of Chronic Obstructive Pulmonary Disease (COPD), largely due to cigarette smoking, the management and care of patients with COPD is a priority for the NHS. This paper examines the current and future role of community matrons in the management of patients with COPD.

Community matrons have a potential role in providing evidence based care and could fill a gap in the implementation of effective interventions to help patients and family members stop smoking. A family focused approach to assessment and case management are important to achieving quality care and management of these patients. Recommendations are made with respect to the improvement of service provision for individuals and families with COPD.
Down syndrome: caring holistically in primary health care
Authors: Hayes Catherine
Published: May 2014

All primary health care should be underpinned with a firm theoretical knowledge. The holistic management of Down syndrome patients should be an integral part of this knowledge base. The application of this knowledge should ideally encompass a positive approach to empowering patients to lead healthy, active and normal lives. This article highlights a basic documentation of what ‘Down syndrome’ is. The article gives community nursing staff the opportunity to firstly refresh their knowledge of the condition and then encourages critical reflection on professional practice within primary care, with the intention of both raising skill and awareness for the holistic management of patients with Down syndrome.
An evaluation of a community matron service from the patients’ perspective
Authors: Wright Kerri , Ryder Sherrie , Gousy Mamood
Published: May 2014

Community matrons are a relatively new government initiative aimed at case managing people with long-term conditions to reduce the number of emergency bed day’s used in hospitals. Although there have been extensive evaluations of similar case management projects, to date there has been little evaluation of the community matron’s role and the perceptions patients have of this new service. One of the main Government’s agenda for care is to deliver a high quality service driven by the needs of the service users (DH, 2000). In order to drive this agenda, it is important that the views and perceptions of people on the receiving end of the services are heard, valued and appropriate actions taken. This two part evaluative report sets out to explore how people with long-term conditions perceive the impact of community matrons and the differences this new service may have had on their lives. Questionnaires were sent to 100 patients who were currently being case managed by a community matron to evaluate the community matron service from the patients perspective. Part two reports on patients perceptions of the community matron role and the influences of the role on their health.
Spreading tissue viability far and wide
Authors: Stephen-Haynes Jackie
Published: May 2014

The Government has recently announced an investment of £67 milllion in improving care homes. The money will be used in part to produce a Dignity in Care Practice Guide, which will be used to inform care staff of the need for dignified and respectful treatment.
Long term urinary catheter problems: a flow chart to aid management
Authors: Mitchell Nicola
Published: May 2014

In this article the author presents a flow chart designed to assist nurses in providing evidence-based care of long term urinary catheters. The flow chart guides the nurse in making a proper assessment of the reason for urinary bypassing, blockage and non-drainage. The flow chart is intended to help identify a cause and to aid the practitioner in following a long term management plan.
Minimizing the complications associated with migrating catheters
Authors: Billington A , Crane C , Jownally S , Kirkwood L , Roodhouse A
Published: May 2014

This article seeks to explore the clinical practice of urinary catheter fixation. Traditionally, this area of practice has been neglected and nurses are familiar with tension lesions and dermal problems associated with inappropriate or incorrect urinary catheter fixation. A novel solution to this problem is a catheter fixation device. This device secures the catheter safely, making clinical practice safer and the experience of catheterization more tolerable for the patient. An example of a urinary catheter fixation device available in the UK is Bard’s StatLock®.
Managing a colostomy or ileostomy in community nursing practice
Authors: Bradshaw Elissa , Collins Brigitte
Published: May 2014

After stoma formation the patient should be independent with their own stoma care. However, with emphasis being placed on community nurses for ongoing aftercare of ostomates: Skingley (2004) has asserted that many community nurses did not feel confident undertaking stoma care. This article is ideally placed for the community nurses to obtain a broad overview of some of the key points pertaining to stoma care. The article looks at care of ostomates and ileostomates in relation to available appliances and also discusses dietary recommendations.
District nursing workforce planning: a review of the methods
Authors: Reid Bernie , Kane Kay , Curran Carol
Published: May 2014

District nursing services in Northern Ireland face increasing demands and challenges which may be responded to by effective and efficient workforce planning and development. The aim of this paper is to critically analyse district nursing workforce planning and development methods, in an attempt to find a suitable method for Northern Ireland.

A systematic analysis of the literature reveals four methods: professional judgement; population-based health needs; caseload analysis and dependency-acuity. Each method has strengths and weaknesses. Professional judgement offers a ‘belt and braces’ approach but lacks sensitivity to fluctuating patient numbers. Population-based health needs methods develop staffing algorithms that reflect deprivation and geographical spread, but are poorly understood by district nurses. Caseload analysis promotes equitable workloads but poorly performing district nursing localities may continue if benchmarking processes only consider local data. Dependency-acuity methods provide a means of equalizing and prioritizing workload but are prone to district nurses overstating factors in patient dependency or understating carers’ capability. In summary a mixed method approach is advocated to evaluate and adjust the size and mix of district nursing teams using empirically determined patient dependency and activity-based variables based on the population’s health needs.
Understanding obesity in the older person: prevalence and risk factors
Authors: Haslam David
Published: May 2014

District nurses deal with many overweight and obese clients on their caseloads. Many of these people have various co-morbities; their weight issues are often glossed over, prioritizing more pressing clinical issues. This however is a mistake, in this article the issue of obesity in the elderly is mapped out. It starts with looking at the reasons behind the epidemic and looking at individual factors. The elderly suffer from sarcopenia as a result of ageing which leads to changes in body morphology. If not tackled early, such changes lead to considerable increases in cardiometabolic risk. Widespread increases in BMI have been shown to promote CHD, hypertension, type 2 diabetes and certain types of cancers. Clinical depression can be a manifestation of obesity. An overview of the prevalence and non-conservative clinical management is given.
A UK literature review of progressive long-term neurological conditions
Authors: Wilson Eleanor , Elkan Ruth , Seymour Jane , Almack Kathryn
Published: May 2014

Progressive long-term neurological conditions are relatively rare, and policy attention has only recently been directed at community services for people with these conditions. This literature review draws together findings from 16 UK studies relating to the provision of care in the community for people with progressive long-term neurological conditions. The purpose is to identify elements of best practice which could be promoted at a national level to improve services. The findings point to the uneven coverage of services and their lack of flexibility. Multidisciplinary care delivery was considered essential and patients and carers highly valued the use of key workers. The studies also highlighted the potential for self-managed care. This evidence can be used to inform service developments for the delivery of community care for people with progressive long-term neurological conditions.
An alternative model for case management in Flintshire
Authors: Moran Greg , Coleman Val , Heaney Sally , Willcocks Fiona
Published: May 2014

This article presents and reviews the evidence from a local service that has been developed in order to meet the predicted rise in the level of chronic disease in Wales. Three nurse case managers have been proactively working with surgeries in Flintshire (North East Wales) for the past two years to introduce a case management approach for the patients from those practices. Using data for the 12 months before and after the case managers intervention for each patient, the service appears to reduce emergency admissions, by a median of 1 emergency admission per patient and reduces length of hospital stay by a median of 2 days
Mental Capacity Act 2005: statutory principles and key concepts
Authors: Griffith Richard , Tengnah Cassam
Published: May 2014

The Mental Capacity Act 2005 represents the most significant development in the law relating to people who lack decision making capacity since the Mental Health Act 1959 removed the states parens patriae jurisdiction preventing relatives, courts 0and government bodies consenting on behalf of incapable adults (F vs West Berkshire HA [1990]).

The Mental Capacity Act 2005 impacts on the care and treatment provided by district nurses and it is essential that you have a sound working knowledge of its provisions and code of practice. In the first article of a series focusing on how the Mental Capacity Act 2005 applies to district nurse practice, Richard Griffith and Cassam Tengnah consider the principles and key concepts underpinning the Act.
Should patients be self-testing their INR?
Authors: Dawes Jonathan
Published: May 2014

The trend in people living longer and healthier lives is not about to change, current government policy reflects this. The Conservative party is looking increasingly likely to get a foothold on a delicate NHS. Never since the beginning of the NHS has there been a more urgent time to save money. The limited pot from which we all draw is providing more services to a growing population.
Community nursing: redesign in Scotland
Authors: Quickfall Julia , Pollock Linda
Published: May 2014

The report ‘Visible, accessible and integrated care’ (VAIC) proposes a new Community Health Nurse (CHN) model which involves the combination of the four current disciplines of district nursing, public health nursing (health visiting and school nursing) and family health nursing into a single generic role (Scottish Executive, 2006b). The Queen’s Nursing Institute in Scotland (QNIS) wished to identify the implications of the VAIC report; a series of national focus groups were held throughout Scotland during 2007 with key stakeholders, initially including managers and senior nurses, practitioners, staff nurses and educationalists, and later family health nurses, practice nurses, school nurses, and General Practitioners. Finally, a patient and carers’ focus group was held to establish a public perspective on the changes. This article summarizes the key findings from the QNIS focus groups and highlights the emerging themes concerning the implementation of VAIC.
Mental Capacity Act 2005: advanced decisions to refuse treatment
Authors: Griffith Richard , Tengnah Cassam
Published: May 2014

In the fourth of a series of articles on the Mental Capacity Act 2005, Richard Griffith and Cassam Tengnah consider the impact on district nurse practice of the introduction of advanced decisions refusing treatment that will allow a person to refuse even life sustaining treatment in incapacity.
Assessment of skin integrity in the elderly 1
Authors: Bianchi Janice , Cameron Janice
Published: May 2014

Intrinsic changes to the skin are a normal part of the ageing process. Careful assessment of the skin for any abnormalities should be included in any patients’ holistic assessment. It is essential that all health care professionals have a fundamental knowledge of the structure and function of the skin in order to be able to assess any changes to normal skin; identify existing skin problems and potential risk factors. Only by carrying out a detailed and systematic examination, we can implement effective strategies of management. This is the first of two papers. This paper will describe the structure and functions of the skin and explore skin assessment. The second paper will describe some of the more common skin conditions seen in ageing skin and their management.
Case study: psychosocial aspects of chronic bilateral venous leg ulcers
Authors: Mapplebeck Lynda
Published: May 2014

This case study gives an concise report on how venous leg ulceration can cause deep psychological problems for those suffering with this condition. As with all disease, you cannot separate the physical from the psychological. Suffering with clinical depression and not seeing a future, Emily’s life has been turned around by the evidence-based application of a 2-layer bandaging system. Emily’s ulcers are now almost healed showing that good clinical skills and collaboration with patients are the key to effective clinical outcomes in hard-to-heal wounds.
Malodorous fungating wounds: how dressings alleviate symptoms
Authors: Hampton Sylvie
Published: May 2014

Fungating wounds are unlikely to heal and therefore, the prime consideration should be the treatment and, where possible, the elimination of symptoms such as malodour. Malodour is the byproduct of bacteria and the fatty acids that are part of necrotic tissue. Application of dressings that block the odour, such as charcoal, or dressings that are antimicrobial, will reduce or remove the malodour that has such a negative effect on the patient’s quality of life.
Problems encountered managing pressure ulceration of the sacrum
Authors: Beldon Pauline
Published: May 2014

Pressure ulcers cause a great deal of distress, loss of dignity for the patient and can be problematic in terms of management. Pressure ulceration in the sacral area may lead to added complications if the patient has problems with urinary and faecal incontinence. Maintenance of the patient’s skin integrity is vital to avoid added discomfort and distress due to moisture lesions. Prevention of wound and dressing contamination with urine and faeces is difficult and can lead to increases in clinical risk (infection) and cost if not managed successfully.
How caseload analysis led to the modernization of the DN service
Authors: Kane Kay
Published: May 2014

As we move into a new century and care moves out of hospital and into the community, there is a drive to seek new models for providing nursing care to patients in their homes. Following a Caseload Analysis report, the District Nursing Modernization Project was launched in April 2004, aimed to redesign the structure and delivery of the district nursing services in South and East Belfast. The service was totally re-engineered within the existing budget and workforce. Nursing careers changed as new supporting services were developed and new job opportunities became available within the service. The structure of the services was designed on the basis of caseload analysis gathered over a number of years. Evaluation of the project indicated that the project aim and objectives had been achieved. Caseload Analysis was instrumental in establishing the need to modernize district nursing services and how this should be carried out.
Observational pain assessment scales for people with dementia: a review
Authors: While Christine , Jocelyn Angus
Published: May 2014

Dementia may alter the experience of pain and the ability to communicate it; this will, in turn, result in poor pain detection and inadequate treatment. The aim of this literature review is to identify the observational pain scales that have clinical utility and feasibility for use with people living with dementia in the community by district nurses in their daily practice. It was found that a consensus could not be reached on which tool to use in clinical practice. A further evaluation of the Non-communicative Patients Pain Assessment Instrument has improved its feasibility for use in the community environment, as it can be administered by family carers. This literature review concludes that observational pain scales need to be validated for use in the community and that there is a need to consider the involvement of the informal carer in the assessment of pain.
Mentoring a student immediately prior to registration: a qualitative study
Authors: Middleton Rosemary , Duffy Kathleen
Published: May 2014

A literature search revealed limited research exploring the experience of the community nurse mentoring the student nurse immediately prior to registration. This qualitative study was undertaken in order to describe the lived experience of the community nurse when mentoring a final placement student. The study was conducted in compliance with relevant ethical procedures and institutional guidelines. Three focus groups were convened and the experiences of twelve community nurses working within a large city-based community health practice in Scotland who had mentored a student nurse immediately prior to registration were explored. Analysis suggests the community nurse mentors require support and development opportunities in relation to mentoring and assessing final placement pre-registration students.
What does enhanced recovery mean for the community nurse?
Authors: Burch Jennie
Published: May 2014

The enhanced recovery programme (ERP) is being increasingly performed in hospitals in the UK. This article discusses the principles of enhanced recovery and aims to dispel myths and concerns that the ERP might increase the workload for the community nurse. Enhanced recovery can be used after colorectal and other surgery; this article will focus on colorectal issues, particularly stoma care. With enhanced recovery hospital stays can be reduced to approximately 4 days for resections of the colon. To achieve this care a number of elements are required including early feeding and early mobilization and this results in patients getting better quicker than they would with traditional hospital care.
Triggers for weight gain and loss among participants in a primary care-based intervention
Authors: Visram Shelina , Crosland Ann , Cording Helen
Published: May 2014

Numerous studies have sought to investigate the causes of obesity and the effectiveness of interventions for its treatment. However, there is little published evidence to describe patients’ experiences of becoming and being obese. This paper reports on a qualitative study to explore the views and experiences of patients who had recently completed a primary care-based weight management intervention. Weight gain was often attributed to life events that caused changes in appetite and activity levels, rather than directly attributed to over-eating or inactivity. Triggers to help-seeking included health concerns, image factors and past experiences of stigmatization. Personalized messages and ongoing support from professionals and peers were identified as facilitators to successful weight management. This paper has implications for the role of primary and community care staff in the prevention, treatment and management of obesity, in terms of supporting patients through significant life events and encouraging them to access services.
Community matrons and case managers: who are they?
Authors: Lillyman Sue , Saxon Ann , Treml Helen
Published: May 2014

In 2005 John Reid, the then Secretary of Health, announced the need for 3?000 community matrons to be appointed to coordinate the care of the growing numbers of people living with long term conditions. Although by the date agreed there were only 1?348 in post, according to Snow (2007), some PCTs have decided not to recruit further community matrons. Following the first evaluations of the role there also appears to be some confusion as to the title used by professionals who case manage this client group. The title of community matron has been used interchangeably with case manager, and therefore requires some clarification. This paper attempts to review the role of community matron and case manager, identify the professionals who take up these posts, and the professional qualifications and preparation required for the roles.
Diet and lifestyle measures to protect the ageing heart
Authors: Stanner Sara
Published: May 2014

Coronary heart disease (CHD) is a leading cause of mortality and morbidity in the UK and risk increases substantially with age. It is estimated that more than 1 in 3 men and around 1 in 4 women aged 75 and over is currently living with the condition. Evidence from epidemiologic studies indicates that the same factors that are associated with increased risk of CHD in middle-aged people are relevant in older adults. Clinical trials have shown that changing these risk factors in older adults can reduce CHD risk as effectively as it does in middle-aged adults. A diet that is low in fat (particularly saturates), rich in carbohydrate (particularly whole-grains), contains plenty of fruits and vegetables, and a portion of oily fish each week and is not too high in salt can offer significant protection against heart disease. Such diets, together with regular physical activity, avoidance of smoking, sensible drinking habits and maintenance of a healthy body weight, may prevent the majority of cardiovascular disease in Western populations. The greatest benefit will be achieved by adopting these habits throughout the life-course.
The role of skin assessment in older people
Authors: Wheeler Tracey
Published: May 2014

Understanding what to look for, what is normal and what needs to be referred to a specialist, gives community nurses confidence in assessing older skin. Skin health checks should become a normal part of health surveillance in primary care. This article reviews some of the most common changes that occur as skin ages, drawing attention to features that indicate possible malignancy as well as briefly indicating some common changes due to dry skin and disease processes. The principles of sun protection, including some helpful products, and skin treatment to aid hydration and maintain health are discussed.
Sorbion Sana: a non-adherent, highly absorbent, hypoallergenic dressing
Authors: Beldon Pauline
Published: May 2014

The management of highly exuding wounds represents a significant clinical challenge. Protection of the surrounding skin from the effects of exudate, while not stimulating a skin sensitivity, can be difficult in venous leg ulcer patients with their higher than usual predisposition for skin allergy/sensitivity. Venous leg ulcer patients can require frequent dressing changes, which are costly in terms of time taken to wash the limb, dress and apply compression bandages, in addition to the actual cost of dressings and compression bandages.

This product focus article considers Sorbion Sana®, a dressing that provides a means of absorbing and retaining exudate, so reducing the frequency of dressing changes and the likelihood of skin allergy/sensitivity.
Mindfulness: me-time counts
Authors: While Alison
Published: May 2014

Mindfulness has its origins in the practices of Buddhism and describes meditation exercises to develop mindfulness skills, that is, paying complete attention in a particular way. The practice of mindfulness involves the individual focusing upon internal experiences in each moment in a non-judgemental manner, thereby enhancing awareness of emotions, thoughts and sensations. Training in mindfulness is not only for adherents to Buddhism but has recently attracted attention both for enhancing general mental health and wellbeing but also for its therapeutic value with cognitive therapy and other psychological therapies (Baer, 2003).
Use of Hydrofilm® and Hydrofilm® Plus in the community: an assessment
Authors: Palfreyman Simon , Stevens Jane
Published: May 2014

The aim of this article was to critically examine the case for using film dressings with a particular emphasis on two dressing manufactured by Paul Hartmann Ltd: Hydrofilm® and Hydrofilm® Plus. The authors undertook a review of the current published evidence and present four case studies where Hydrofilm® and Hydrofilm® Plus were used in the community setting.
Tissue viability 2010 -2015: from good to great
Authors: Milne Jeanette , Ousey Karen
Published: May 2014

This paper explores the challenges of the changing face of the NHS with specific relation to the challenges for community-based tissue viability services following the publication of government documents that identify the need to provide a quality service for all patients in health-care settings. Patients receiving care in the community is paramount to the success of the NHS going forward; service redesign, improvements in quality, outcome tracking, seamless discharge and patient satisfaction/responsibilities has been heralded as the core prerequisites of successful services. Tissue viability is a relatively young specialism, with most services being nurse led and established less than 15 years. It is argued that in order to continue to be successful as a specialism, tissue viability has to challenge traditional patient and nursing beliefs and values.
Overview of depression: epidemiology and implications for community nursing practice
Authors: Lazarou Chrystalleni , Kouta Christiana , Kapsou Margarita , Kaite Charis
Published: May 2014

Depressive disorders are among the most common psychological conditions currently affecting individuals living in the Westernized world. Yet, available data indicate that fewer than one third of adults with depression obtain appropriate professional treatment. This is attributed, among other reasons, to the under-recognition of the problem by health professionals, including district nurses. In order to improve recognition of the problem, it is imperative for nurses and especially those working in community settings, to appreciate the importance of prompt diagnosis which presumes both an understanding and knowledge of basic aspects of the problem and, an understanding of their role in dealing with depression.

This overview presents epidemiological data and identifies the potential consequences of depression on daily functioning and other aspects of life among adults in Westernized countries, aiming to raise awareness and sensitize district nurses about the issue The article discusses how the role of district nurses can be enhanced to improve recognition rates.
Skin care in the older person: a focus on the use of emollients
Authors: Wingfield Carrie
Published: May 2014

This article gives an overview of pathophysiological changes in the older person's skin, with particular focus on dry skin and the important use of emollient therapy. This includes guidance on emollient choice, function and application. Education is emphasized as an important factor in patient/ carer concordance, with additional advice also recommended to extend education to other health care professionals in terms of correct usage and prescription amounts. Best practice of the use of emollient therapy is the main objective of this article, promoting the health professional to place skin care assessment high on the patient need agenda, and to recognize this therapy as the first-line treatment in all dry skin management.
Assessment and management of diabetic foot ulcers
Authors: Roberts Peter , Newton Veronica
Published: May 2014

Diabetic foot ulcers can cause considerable disability and morbidity. The complex pathology requires expert and in-depth assessment and management to achieve the best outcomes. Assessment is underpinned by attention to four key points: vascular sufficiency, neurological/sensory status, appropriateness of footwear, and presence of foot deformity. The ‘shopping list’ for management is derived from the assessment and requires careful planning and a multidisciplinary approach. This article outlines key first line principles and practices in assessment and management of diabetic foot ulcers, including the importance of offloading pressure and mechanical trauma to aid healing and prevent recurrence.
Meeting the policy agenda, part 1: the role of the modern district nurse
Authors: Dickson Caroline AW , Gough Helen , Bain Heather
Published: May 2014

The challenges posed by the current context of health and social care offer opportunities for different models of care delivery. District nursing has evolved, and continues to evolve to meet these challenges. The traditional reactive role of district nursing has developed as contemporary practice expects district nurses to meet both planned and unplanned care required by practice populations. Modern anticipatory care approaches to care are being adopted, while care and case management is being facilitated and delivered to patients and families with complex health and social care needs. Additionally, district nurses are recognizing the need to further develop management and leadership skills as the teams delivering care consist of a skill mix of nurses and other disciplines. They are also charged with evidencing the impact of what they do and influencing care delivery at every level of healthcare organizations. This first paper of two will explore the current UK policy context and ways in which district nursing services within each country are changing to meet the challenges posed. A second article will argue the need to ensure the district nursing workforce is underpinned by robust educational standards that ensure protection of the public. The influences of education and development from professional and organizational perspectives will be examined.
Understanding patient reported outcome measures (PROMs)
Authors: Ousey Karen , Cook Leanne
Published: May 2014

Patient-reported outcome measures (PROMs) have been identified as being measures of a patient's health status or health-related quality of life, allowing for health status information to be collected from patients before and after an intervention through completion of a questionnaire. The information collected will provide an indication of the outcomes or quality of care delivered to NHS Patients. The collection of data commenced in April 2009 for specific conditions; NHS-funded unilateral hip replacements, unilateral knee replacements, groin hernia surgery or varicose vein surgery. PROMs will be developed for further conditions in the future, however, at present there are none relating to tissue viability or leg ulceration.
Body mass index knowledge of older adults and motivation to change
Authors: Wills Teresa , Fehin Patricia , Callen Bonnie
Published: May 2014

Worldwide, 1.6 billion adults are overweight and 400 million are obese. For older adults, being in these categories exacerbates multiple chronic diseases and leads to frailty. The aim of this study was to explore the knowledge of older adults in Ireland and the USA about their body mass index (BMI) category and motivation to change. A quantitative descriptive research design was used in the study. Two convenience samples of community-dwelling older adults, one in Ireland (n=70) and one in the USA (n=70) participated in the study. Data was collected in the form of questionnaires and BMI was calculated. This study found that fewer Irish participants knew their BMI category. In both groups, measured BMI differed greatly from self-perceived BMI. These findings suggest that older adults are unaware of their weight status and therefore do not know that they are in a BMI category with multiple health consequences.
Risk assessment and management tools for constipation
Authors: Kyle Gaye
Published: May 2014

Constipation is a distressing condition that can happen to anyone, but is of particular concern in the elderly and less mobile, people with neurological impairments, and those in institutional care. The causes of constipation are multifactorial, and can be influenced by physical, psychological, physiological, emotional and environmental factors. This article discusses definitions, symptoms and types of constipation, and provides guidance on risk factors and assessment using the Norgine Risk Assessment Tool for Constipation.
Should antibiotics be prescribed when urinary catheters are removed?
Authors: Nazarko Linda
Published: May 2014

Each year around one million urinary catheters are inserted in NHS hospitals. In around 60% of cases prophylactic antibiotics are prescribed prior to removal. This practice aims to reduce infection risks, but is not supported by evidence. Inappropriate prescribing increases antibiotic resistance, already a serious and worsening problem, and exposes patients to the hazards of antibiotic prescribing. This practice also costs an estimated £1.35–£2.7 million pounds annually. Nurses at all levels can have a huge influence on catheterization rates and catheter management. This can reduce the risks of harm and infection and improve quality of care.
The impact of nurse prescribing on patients with osteoarthritis
Authors: Creedon Rena , Weathers Elizabeth
Published: May 2014

Osteoarthritis (OA) is now considered one of the ten most disabling diseases in developed countries and it is estimated that worldwide, 18% of women and 9.6% of men aged over 60, suffer from OA. It is, therefore, vital to take into consideration the demographics of this disorder, including the health needs of this age group and associated problems, such as reduced mobility or immobility and the inability to perform everyday tasks associated with chronic pain. Older patients, however, are sometimes able to accept their condition and adopt a positive outlook towards their OA as a coping strategy. This association with and acceptance of pain by the patient as a normal part of the ageing process may compromise the patient's ability to undertake activities of daily living and impact their psychological wellbeing.
Protecting the health of offenders in prison and other places of detention
Authors: Peate Ian
Published: May 2014

The care of prisoners (offenders) in England lies with the Department of Health (DH) and the ability of the PCTs to commission services. In other countries of the UK this differs; in Scotland the Scottish Prison Service manages the responsibility of offender health, with responsibility resting with local health boards in Wales and the South Eastern Health and Social Care Trust in Northern Ireland. This article provides the community nurse with an overview of health protection in England's prisons and places of detention along with a review of communicable disease, immunization and infection prevention and control. General advice on legal obligations is provided with infection control principles and a discussion concerning incident and outbreak management. The role of the community nurse in the prison setting is no different to the role being undertaken in any other situation or environment where people require health care. Offenders are entitled to the same standards of healthcare as the general public.
Use of compression bandaging in managing chronic oedema
Authors: Todd Marie
Published: May 2014

Compression bandaging is a major component of most community nurses' practice in the management of venous leg ulcers. For lymphoedema practitioners, compression therapy is the linchpin in the management of chronic oedema and lymphoedema. There are several types of compression bandage available, with some being part of a recognized system of compression delivery. In order for nurses to select and apply the correct type and level of compression bandaging, there needs to be a substantial level of knowledge of the principles of compression theory and competence in the application of bandaging. There are also issues surrounding patient concordance, and nurses need to be able to assess and address any barriers to concordance to ensure the most effective regimen of treatment is delivered.
Managing exudate and the key requirements of absorbent dressings
Authors: Stephen-Haynes Jackie
Published: May 2014

Tissue viability is a challenging area of care and relates to prevention, healing or managing symptom in a variety of wounds. The annual expenditure on wound care in the NHS is estimated at f2.3–f3.1 bn per year, accounting for 3% of NHS spend ( Drew et al, 2007 ). From the initial concept of moist wound healing the application of dressings has been influenced by the level of exudates within a wound. While the production of exudate is a normal part of moist wound healing it is often viewed as undesirable as it can prove difficult to manage for the clinician. This article considers the use of the super-absorbent dressing DryMax Extra. Managing exudates and the key performance requirements of absorbent dressings are considered with an analysis made of the clinical data relating to DryMax Extra.
The psychological effects of living with chronic oedema
Authors: Creedon Rena
Published: May 2014

Chronic oedemas are life-long conditions that may have a number of coexisting causes. The true incidents of non-cancer related chronic oedema / lymphoedema is not certain and is generally thought to be underestimated. The impact of this condition on a person's life is multifaceted and is an individual experience for each patient which should not be underestimated. Social support for patients with chronic oedemas can be viewed as the emotional or tangible assistance that one receives or can expect from others in times of need and is theorized to buffer against illness providing the person with coping strategies. Such support can help reduce psychological distress such as depression and anxiety and helps promote psychological adjustment to this chronic condition.
Wound debridement in the community setting
Authors: Young Trudie
Published: May 2014

Debridement is the removal of non-viable tissue from a wound bed which is necessary to achieve wound healing and symptom control. Non-viable tissue has a variety of clinical presentations which differ in their content, appearance, depth and level of hydration. There may be the risk to the individual of systemic infection if the non-viable tissue is not removed in a timely fashion. A variety of methods of debridement exist and all have their own advantages and limitations. The competence of the individual undertaking the debridement is crucial and is a key consideration along with availability of the necessary equipment and the provision of the optimal environment. Client choice and involvement are paramount to the debridement process. There should be no hierarchy of debridement methods and the chosen method should achieve timely optimal pain free removal of non-viable tissue.
Managing a venous leg ulcer in the 21st century, by improving self-care
Authors: Yarwood-Ross Lee , Haigh Carol
Published: May 2014

This paper examines the context of managing a long-term condition within the community environment using appropriate evidence-based literature. It is a case study that focuses upon concordance with compression bandaging in treating venous leg ulceration and preventing ulcer recurrence through a well leg clinic. The challenges of this episode of care and the interventions put in place to improve concordance and promote self-care will be explained and analysed.
Providing holistic support for patients with inflammatory bowel disease
Authors: Todorovic Vera
Published: May 2014

Inflammatory bowel diseases such as ulcerative colitis and Crohn's disease are life-long, complex conditions. They are characterised by periods of exacerbation and remission and surgical intervention may be required in severe cases. Drugs employed in the management of IBD are used to induce remission and maintain remission. IBD has a physical, psychological and sociological impact on individuals and IBD quality standards have been developed to provide a framework for addressing the services and care that should be available for them. Complementary and alternative medicine (CAM) therapies play an important role in the holistic approach to management of IBD as they are being increasingly used alongside conventional medical treatments. Community nurses have an important role to play in the management and care of individuals with IBD and in supporting them in making informed and appropriate choices that support their wellbeing and quality of life.
Research to support evidence-based practice in COPD community nursing
Authors: Kirkpatrick Pamela , Wilson Ethel , Wimpenny Peter
Published: May 2014

Evidence-based practice (EBP) is a requirement of nurses through the generation of evidence to implementing it, in a bid to to improve clinical practice. However, EBP is difficult to achieve. This paper highlights an approach to generating evidence for enhancing community nursing services for patients with chronic obstructive pulmonary disease (COPD) through a collaborative partnership. A district nurse and two nursing lecturers formed a partnership to devise a systematic review protocol and perform a systematic review to enhance COPD practice.

This paper illustrates the Joanna Briggs Institute (JBI) systematic review process, the review outcomes and the practitioner learning. Collaborative partnerships between academics, researchers and clinicians are a potentially useful model to facilitate enhanced outcomes in evidence-based practice and evidence application.
Medication administration in the domiciliary care setting: whose role?
Authors: Bradford Jennie
Published: May 2014

Unqualified social care workers are increasingly delegated the responsibility of both assisting with and administering medication in the domiciliary care setting. This article discusses the considerations required before the delegation of these roles by both commissioners and nurses. In particular, variations in training, policies and provision are explored with reference to the Care Quality Commission guidance and Nursing and Midwifery Council standards. The levels of support and their definitions are clarified for use in policy documents, and the effectiveness of devices used to support self-care are critiqued within a legal framework. The importance of joint working to provide a seamless medication management service are highlighted using reflections on examples from practice
Extending an approach to hospital malnutrition to community care
Authors: Moynihan Paula , Macdonald Alastair , Teal Gemma , Methven Lisa , Heaven Ben , Bamford Claire
Published: May 2014

This feature investigates the potential relevance to community care of a new food provision and nutritional management system for older hospital patients. A qualitative study identified the core factors contributing to inadequate food intake in older patients in hospital, including: poor mealtime ambience; lack of necessary mealtime assistance; inflexible meal provision; lack of monitoring of nutrient intake and absence of accountability in nutritional care. Many of these factors are also relevant to older people living in the community.

To address these issues, we designed a new system for the nutritional care of the older patient: ‘hospitalfoodie’. Hospitalfoodie facilitates: patient nutritional screening; patient-tailored food choice; and information exchange among the healthcare team. The system introduces a more flexible approach to provision of food, including the development of nutrient-dense ‘mini meals’ for older patients. The system facilitates monitoring of patient food intake against their nutrition targets and alerts staff of nutrition shortfalls. The relevance of components of hospitalfoodie to community nutritional care was explored through qualitative interviews and focus groups with a range of care providers.
Managing constipation: a focus on care and treatment in the palliative setting
Authors: Connolly Michael , Larkin Philip
Published: May 2014

Constipation can cause unnecessary discomfort and suffering for patients, and there appears to be a lack of awareness among nurses and doctors about its cause, impact and management. A large proportion of the evidence for the assessment and management of constipation in the context of palliative care is derived from the perspective of advanced cancer and from guidelines developed at a European level. Although constipation remains a problem for palliative care patients, early intervention combined with continuous and impeccable assessment can assist in its management and improve patient comfort at the end of life.
Consent to care: assessing patient decision-making capacity
Authors: Griffith Richard , Tengnah Cassam
Published: May 2014

Decision-making capacity has been described as the ‘key to autonomy.’ A person who is capable of making a decision about their health care must have that decision respected by a district nurse, as to proceed against the person's wishes would amount to the tort of trespass to the person and, in some cases, a criminal assault. It is essential, therefore, that district nurses are able to assess the decision-making capacity of their patints.
Considerations for managing stoma complications in the community
Authors: Williams Julia
Published: May 2014

Complications related to stoma surgery can occur immediately post surgery or following discharge from hospital, and will either resolve spontaneously or become a difficult management problem for both the stoma patient and healthcare practitioner. In the early stages of rehabilitation, the patient with a stoma relies heavily on the expertise of the healthcare practitioner to assist them in returning to the lifestyle they once enjoyed. Literature acknowledges that adjustment to life with a stoma depends largely on whether complications following the creation of a stoma are persistent ( Bekkers et al, 1996 ; Taylor, 1999 ; Cottam and Richards, 2006 ). Evidence demonstrates that prolonged unresolved stoma problems hinder adaptation and adjustment to the stoma ( Bekkers et al, 1996 ; Williams et al, 2010 ), therefore, it is important for the healthcare practitioner to be well informed and skilled regarding common stoma problems. This article aims to highlight common stoma complications and offer guidance on evidence-based management of such problems to inform healthcare practitioners working in the community setting.
Maximising psychiatric nurses' contribution to interdisciplinary working
Authors: Walsh Francis , Cleary Anne , Dowling Maura
Published: May 2014

Internationally, the deinstitutionalization of psychiatric care has resulted in expanded roles for mental health nurses within a community interdisciplinary team setting. This presents an opportunity for mental health nurses to improve service delivery. This opportunity also results in a more empowered nursing team. This article identifies change issues within one community psychiatric nursing team and the team's contribution to an improved service delivery where service users can avail of same day assessment for crisis referrals, a reduction in waiting times for assessment and co-ordinated delivery of care with an identified key worker utilizing a recovery model philosophy.