bluuebunny/crossref_metadata_2025 huggingface dataset:
Leg Clubs®: a clinically and cost-effective approach to lower limb management
Authors: Lindsay Ellie
Published: May 2014

Leg ulcers affect 55 000–90 000 people, predominantly aged over 65, in the UK at any one time. Traditional care, delivered in people’s homes by district nurses or in GP clinics, is costly and often not effective, with slow healing rates and a high incidence of recurrence. A social model of leg ulcer clinics developed by the author has been shown to improve healing and reduce recurrence within a highly cost-effective framework that delivers genuine patient empowerment, public health education and social outreach. This paper outlines the rationale for the Leg Club, its clinical and social impact, and the infrastructure behind it. It also considers the challenges to establishing and running a Leg Club.
Management of the bariatric patient with lymphoedema: South West Wales
Authors: Coveney Elizabeth
Published: May 2014

Twenty-four percent of adults (age 16 and over) in England are classified as obese. This represents an increase from 15% in 1993. (NHS Information Centre, 2008). As obesity rates increase across the UK lymphoedema services face increasing numbers of obese patients in their clinics. This short article will explore some ideas of how we manage this patient group at present in our lymphoedema service.
Skin changes at life's end: SCALE ulcer or pressure ulcer?
Authors: Beldon Pauline
Published: May 2014

Pressure ulceration causes much distress to patients and family, and can be taken as an indication of poor nursing care. It is vital that both parties understand when pressure damage can be prevented, and those circumstances when skin failure at the end of life cannot be avoided. Appropriate risk assessment, provision of all appropriate care, and use of pressure relieving equipment to minimize the risk of any loss of skin integrity are required. The recognition of Skin Changes at Life's End (SCALE) ulcers may herald the imminent demise of a loved one. Families require support and good communication from nursing staff at this difficult time.
Meeting the policy agenda, part 2: is a ‘Cinderella service’ sufficient?
Authors: Dickson Caroline AW , Gough Helen , Bain Heather
Published: May 2014

This is the second of two papers that examine district nursing within a changing health policy and service environment. The first paper explored the current UK policy context and the way in which district nursing and community nursing services within each country are changing to meet the challenges posed. This article considers the current district nurse (DN) role, which has constantly evolved over the past 150 years, and considers the educational framework that underpins the preparation of these specialist community practitioners in relation to community colleagues such as specialist community public health nurses (SCPHNs). In the context of the current economic climate, there is concern that the apprenticeship model of staff development is replacing specialist practitioner education for DNs, solely on the basis of resource. This article explores the current challenges for DN education within the UK. The underpinning educational preparation of DN programmes is examined and key issues such as safeguarding the public are discussed. The need to develop a cohesive approach to education for post-qualification nurses in the community is advocated. These are important considerations for the future of a discipline which currently feels under threat.
Focus on Parkinson's: causes, treatment and support
Authors: Heisters Daiga
Published: May 2014

Parkinson's is a progressive neurological condition which can affect everyday activities such as walking and talking, with symptoms ranging from tremor, slowness of movement and muscle stiffness. Other non-motor symptoms include problems with sleeping, depression and anxiety and it is these that people with Parkinson's often find most debilitating.

People with Parkinson's will have a carefully balanced combination of medication to control and manage their symptoms. The timing of this medication is crucial.

Parkinson's can affect each person differently and is a fluctuating condition, the symptoms and effects of the condition the district nurse may see on one visit may not be representative of how the person is affected so it is vital that she speaks to family, friends and carers of the person with the disease.
Safer care at home: use of simulation training to improve standards
Authors: Unsworth John , Tuffnell Chris , Platt Alan
Published: May 2014

One of the fundamental problems facing providers and commissioners of health services is how to maintain the skills and knowledge of the workforce during the initial development and implementation of home care services. This small-scale project sought to ascertain if it was possible to use human patient simulation scenarios to educate community nurses about how to recognize when care at home is appropriate and when it is not. A series of scenarios were developed and delivered to small groups of community nursing staff. A total of 18 qualified nurses took part in the project. Participants were asked to report their level of confidence in the diagnosis, management and recognition of patient deterioration for each of the scenarios prior to and after the session. The results show increased confidence across all participants in each of the scenarios.
Wound assessment: exploring competency and current practice
Authors: Cook Leanne
Published: May 2014

Management and treatment of wounds is costly to health care. As such, accurate wound assessment is an essential skill required to enhance the wound healing process. Wound assessment tools are available to assist practitioners to ensure that wounds are correctly assessed, healing is documented, and factors that could delay healing are identified and appropriately managed. In an attempt to understand current practices a survey was undertaken of delegates attending the Wound Expo 2011 wound assessment zone to provide a clearer insight into today’s practises and opinions relating to wound assessment. The results were collated and are presented in this article.
Maggots and their role in wound care
Authors: Jones Julie , Green Julie , Lillie Alison Kate
Published: May 2014

Leg ulcers caused by chronic venous insufficiency affect a great many of the population, costing the NHS an estimated £200 million per year. The clinical use of sterile maggots under the brand name LarveE has increased steadily in the UK since they were introduced in the UK in late 1995. Maggot therapy breaks down necrotic tissue within a chronic wound, transforming it into an acute wound; subsequently beginning the healing process a lot quicker, thus reducing overall costs to the National Health Service. A literature review was conducted on studies that explored the use of maggot therapy in the management of chronic wounds. Four key themes were identified and analysed from this search, including infection control, promotion of healing, cost-effectiveness and the ‘yuk’ factor.
Audit of tissue viability knowledge and practice among mental health nurses
Authors: Stephen-Haynes Jackie , Greenwood Michelle
Published: May 2014

The integration of Worcestershire community services with the mental health trust brings with it many opportunities for developing services, with tissue viability being one of them. Mental health trusts have limited access to wound care specialists, frequently relying on Registered Mental Health Nurses who have a limited knowledge in tissue viability to deliver wound care to this client group. To obtain baseline information an audit was undertaken across Worcestershire mental health services. The aims of the audit were to review current wound care practice including the delivery of all clinical care provided, preventative tissue viability approaches and the current knowledge and skills of the staff. The audit results indicated a lack of tissue viability knowledge and skill, and that the tissue viability service needs to deliver and prioritize education to mental health staff and measure the clinical and financial outomes.
Improving sleep management in people with Parkinson's
Authors: Gregory Pamela , Morgan Kevin , Lynall Anna
Published: May 2014

This article considers the practicality and patient benefits of transferring evidence-based sleep management skills to community health professionals. Sleep disturbances are among the most frequently reported and poorly managed non-motor symptoms in Parkinson's. But, despite their prevalence, sleep problems in Parkinson's are often under-recognized, under-diagnosed and inadequately treated. To raise awareness and improve patient care in Parkinson's, a three-day sleep management course was developed for Parkinson's disease nurse specialists (PDNSs) practising within NHS Scotland. The course aimed to transfer skills in health education as applied to sleep and insomnia; the assessment of sleep; the practice of sleep hygiene; delivering relaxation methods; the use of stimulus control and sleep restriction procedures; and cognitive approaches to insomnia management. Between June 2010 and July 2011, 38 PDNSs and practising occupational therapists undertook the course. Interviews and evaluations with patients and professionals were carried out afterwards. Patients reported a reduction in anxiety over sleep problems, feeling able to manage their sleep, and having a sense of control over their sleep. Programme outcomes suggest that the training model used is feasible and practical; the resources designed for clinical use are practical and relevant; and that the initiative as a whole represents a valid and affordable investment in patient wellbeing.
An evidence-based approach to diagnosis and management of cellulitis
Authors: Nazarko Linda
Published: May 2014

Community nurses are involved in caring for people who are at risk of cellulitis. The community nurse may be involved in dressing leg ulcers and may refer a patient with suspected cellulitis for appropriate treatment. Community nurses are also increasingly involved in delivery of outpatient antibiotic therapy (OPAT). As the role of the community nurse expands to encompass diagnosis, prescribing, delivery of OPAT and in some cases the decision on when to switch from IV to oral antibiotics, it is essential that the nurse is aware of the evidence base for diagnosis and treatment of lower leg cellulitis. This paper discusses the reasons for the increasing incidence of lower leg cellulitis and explores the evidence base for treatment.
A silent epidemic: community nursing and effective pain management
Authors: Ogston-Tuck Sherri
Published: May 2014

Effective pain management presents challenges to health care practitioners, particularly in the community setting. This is evident from the complexities associated with the phenomenon of pain and the circumstances for those patients suffering from pain. An overwhelming amount of literature and research surrounding pain exists in an effort to improve our understanding of pain, assessment and management strategies. But patients in pain are not managed well in the community or acute setting. Health care professionals continue to underestimate and under treat pain, failing to meet the patient's individual needs. Pain management it is not about cure, nor is it as simple as reporting zero on a pain score- it is about knowledge, expertise and understanding. Pain is a subjective and very personal experience, wherein health care professionals must listen to the patients' story. Myths and fears surrounding pain remains a barrier to effective management and care. This article aims to dispel the myths and improve clinical practice, particularly in effective pain assessment so patients in the community presenting with pain can be managed individually and effectively. Nurses need to be proactive in their approach, through effective communication and decision making, trusting in our patients' and their pain experience. This is key to a successful approach to managing patients' pain effectively.
Living with heart failure without realising: a qualitative patient study
Authors: Andersson Lena , Eriksson Irene , Nordgren Lena
Published: May 2014

Heart failure is an important problem in Swedish primary healthcare as in the UK. In spite of that little is known about how people with heart failure experience support from primary healthcare. This paper investigates how people with heart failure experience support in primary healthcare. Semi structured interviews were conducted with five men and five women, born 1922-1951. The interviews were analyzed with qualitative content analysis in accordance with Graneheim and Lundman (2004) . The participants experienced they had not received information about their diagnosis or about the cause of their condition. They had not been informed they had heart failure. Instead the participants believed their symptoms were caused by age, thus being part of normal ageing. They did not experience they needed care or support to cope with illness or disease. Instead their main needs for support in daily life concerned help with practical matters.There is a risk primary healthcare abandons people with heart failure meaning the patients are forced to develop strategies on their own in order to manage symptoms. When inadequately informed there is also a risk they make up their own explanations signifying possible difficulties to handle their health situation.
Rehabilitation needs following stoma formation: a patient survey
Authors: Taylor Claire , Azevedo-Gilbert Robert Lopes de , Gabe Simon
Published: May 2014

This article reports the findings from a patient survey which examined rehabilitation needs following stoma formation at an acute NHS trust within Greater London. Of the 203 questionnaires sent, 100 were returned (49% response rate). Two-thirds of the sample (71%) reported experiencing stoma-related complications, and a third of the sample (33%) experienced difficulties receiving their stoma prescriptions on time. Information and support requirements were reported to be most acute during the first six weeks following discharge. Additionally, return to work was a major transition for those of working age, testing their physical health and social confidence. Accessible specialist support is essential during the first few weeks of this rehabilitation process and much perceived benefit is gained from continued nursing support in the community.
Using referral guidelines to support best care outcomes for patients
Authors: Bowers Ben , Cook Rosemary
Published: May 2014

District nurses play a pivotal role in individuals’ care pathways by meeting their needs in the community. However, district nurses are frequently referred patients for whom other interprofessional colleagues have more suitable skills to help in achieving their optimum care outcome. Various major reports have identified a clear need to define what district nurses do and how they will respond appropriately to patients’ needs. However, there remains only tacit understanding of district nurse referral criteria across the country and within community organizations. This article discusses how a set of facilitative district nurse referral guidelines have been devised to support individuals in achieving their best care outcome. We also debate approaches to managing referrals to district nursing services and the pressing need to ensure these are effectively managed in practice.
Leading service improvement in changing times
Authors: Norman Kay
Published: May 2014

Leadership within community nursing needs to be embraced and redefined to ensure it is inherent within the profession, not just adopted by a few. As healthcare organisations continue to change and develop to meet new political agendas, meeting the needs of patients and associated improvements to service will be shaped by those who are willing to take ideas forward. This article looks at ways all community nurses can develop their leadership skills in order to affect change.
Thinking falls – taking action: a falls prevention tool for care homes
Authors: Robertson Kate , Logan Pip , Ward Marie , Pollard Julia , Gordon Adam , Williams Wynne , Watson Julie
Published: May 2014

Falls in older people resident within care home settings are common and serious, often resulting in injury and mortality. Yet there is no standardised approach within UK care homes to assessing the risk of falls for individuals or identifying risk factors relevant for that person. The Guide to Action for Falls Prevention Tool – Care Homes (GtACH) was developed with local care homes in Nottinghamshire. Ten care homes were selected to participate in the study, four withdrawing before data collection commenced. Fourteen care home staff across six care homes tested the tool for usability and found it quick (20 minutes) and easy to use, yet only 53% of the recommended interventions highlighted were completed. The GtACH needs further evaluation to test whether its use prompts actions which reduce the number of falls, and the barriers to these actions being taken.
Mentoring community-based trainee assistant practitioners: a case study
Authors: Griggs Chloe
Published: May 2014

The healthcare workforce is changing, and the introduction of assistant practitioner roles in the community presents exciting opportunities for the unregistered workforce. Healthcare assistants wishing to become assistant practitioners are undertaking foundation degrees. During this period of study, they require support and supervision from a mentor to perform competencies; however, mentors are often poorly prepared for this role. This small-scale qualitative exploratory study sought to gain trainee assistant practitioner (TAP), mentor and management perspective on the level of support needed. Findings indicate that TAPs struggle for recognition and student/learner status; there was an assumption that mentors would be adequately equipped to mentor TAPs, and poor mentor preparation was linked to negative student experiences. This article considers the key factors, time and commitment, required to support TAP learners in the workplace. Further, it questions who is best placed to mentor TAPs. Recommendations include an increased level of preparation for mentors, a joint induction programme for TAPs and mentors, a raised profile of the assistant practitioner role within the wider healthcare team, recognition of the TAP as a learner, and allocated time for quality mentorship.
The role of psychological factors in inflammatory bowel disease
Authors: Schoultz Mariyana
Published: May 2014

Evidence-based practice is one of the cornerstones of contemporary community nursing, and conflicting research evidence can therefore have serious implications for nurses' decision-making. A debate about the role of psychological factors in inflammatory bowel disease (IBD) has been going for over 80 years without reaching consensus and is cause for concern among clinicians. This article discusses the barriers to reaching consensus in the debate about the role of psychological factors in IBD, and why reaching a consensus to this debate is important for practitioners supporting IBD patients in the community. The aim is to raise awareness among community nurses when making sense of the contradictory evidence. The absence of clear and consistent research or guidelines can make it difficult to carry out evidence-based practice, and patient-centred care based on individual assessment of every person presenting with symptoms of IBD becomes even more important.
Selecting compression garments for treating chronic oedema
Authors: Lee Natalie , Wigg Jane
Published: May 2014

The article focuses on the use of compression for chronic oedema and lymphoedema. It will provide information and advice to community nurses to aid the decision making process when selecting compression garments. It will discuss the extensive options available from the Veni range of compression garments for lower limb swelling from Haddenham Healthcare and through case studies demonstrate its versatility in practice.
The experiences of young people with primary lymphoedema
Authors: Harding Jane E
Published: May 2014

This article presents the findings of a study investigating the experiences of seven young people who were diagnosed with primary lymphoedema before the age of 25.

A phenomenological approach was taken and data collected using audio-taped conversational interviews, which were transcribed and analysed using a thematic framework.

The findings revealed that young people had struggled to secure a diagnosis and find appropriate treatment, which appeared to be caused by a general lack of professional awareness of lymphoedema. Evidence of a desperate need to keep the lymphoedematous limb hidden became apparent which affected all aspects of their lives - fashion, education, relationships with family, friends and peers and physical activities - and caused difficulties with self-esteem and self-image.

Children and young people with lymphoedema all differ because of intrinsic (genetic makeup) and extrinsic (family, surrounding environment, life experience) factors. Therefore each must be considered an individual and the experience unique to them.
Challenges to effective treatment of lower-limb oedema
Authors: Cook Leanne
Published: May 2014

The incidence and prevalence of lymphoedema and chronic oedema is increasing as a result of the aging population and increased obesity rates. Oedema is frequently recognised but not promptly treated ( Hedger, 2006 ). Practitioners must remember that oedema is a symptom and the cause needs to be established to ensure that appropriate treatment can be initiated. Successful management of chronic oedema involves a continuing partnership between the patient and practitioner to promote self-management. This article describes the progression of chronic oedema and subsequent skin changes, and highlights some of the challenges faced by the practitioner in facilitating effective care.
The health-care needs of the older gay man living with HIV
Authors: Peate Ian
Published: May 2014

Human immunodeficiency virus (HIV) was once thought of as a condition predominately affecting the young. However, HIV among the older population is increasing. Older gay male adults living with HIV have received little attention from those who provide and commission services. However, with effective treatment, those gay men aged over 50 are the fastest growing group of people with HIV in the UK. Nurses will be required to offer care in a number of ways to this cohort of patients. In so doing, nurses will need to develop innovative and effective ways of supporting this growing group of people. This article provides an overview of the issues that can impact on the health and wellbeing of the older gay man living with HIV. The article discusses the epidemiology, the issue of HIV stigma, comorbidities and mental health and wellbeing needs.
Self-care management education models in primary care
Authors: Lillyman Sue , Farquharson Natalie
Published: May 2014

Self-care management for people living with long-term conditions aims to assist the individual in taking responsibility for their own health. This literature review explores the value and content of the large range of educational models currently in use. Although no single model was found that addressed all the issues, several themes arose. These included the observation that educational models should be based on self-efficacy principles and patient-centred. Method of delivery favoured small groups, using a variety of approaches supported with written information. Duration of the programmes was mainly 6–8 weeks with a follow-up. Programmes should be offered when the patient is ready and not determined by the condition or at diagnosis. Debate remains over whether group leaders should be laypeople and professionals; however, a mixture of both offered the best outcomes. Programmes should not be problem-focused, offering space for support and experience sharing.
Alcohol misuse: the need to take a preventative approach
Authors: Holmes Mark , Currid Thomas J
Published: May 2014

Consuming alcohol within moderate and recommended amounts can have its benefits. These include: social inclusion, socialising, positive impacts it can have on providing employment and to the economy. However, not all people drink in moderation. Alcohol misuse (AM) is increasingly becoming a cause for concern in public health, medical reports and criminal justice systems. Reports and strategies continue to highlight the risks and dangers that AM poses for those who engage in harmful drinking. Alongside the risks to the individual, other costs include discord within families and society and further financial pressure on healthcare systems. However, often AM does not come to the attention of health practitioners until it is in its advanced stages, yet it is preventable and is an issue that impacts all age groups from children to older people. Community nurses can play a pivotal, proactive and preventative role in detecting and offering information and brief advice for those in their care. Though this may be challenging and requires innovative thinking in identifying the most suitable approaches to best match the needs of their patients, it is an issue that can be prevented and have untold benefits for individuals, families and societies
Measuring the clinical effectiveness of district nurses
Authors: Bowers Ben , Pellett Candice
Published: May 2014

This paper helps district nurses to understand how and why existing quality measurement tools can be used as part of everyday practice to demonstrate clinical effectiveness. We consider how productivity has historically been used to crudely indicate district nurses’ clinical effectiveness and why this is now being balanced alongside a range of more robust clinical effectiveness measurement tools. Evaluating clinical effectiveness and improving future care involves examining a number of indicators alongside each other. These include patient safety indicators, patient satisfaction, productivity measurement tools, and how effective clinicians are in supporting people to achieve their best clinical outcomes.
Treatment for lymphorrhoea in limbs and in advanced disease
Authors: Board Jane , Anderson Julia
Published: May 2014

Supported by the NHS Lymphoedema Service Administrator, this article reports on a project undertaken by a clinical nurse specialist in Lymphoedema (CNS) and in part fulfilment of an MSc in Skin integrity skills and treatment, achieved from the University of Hertfordshire, September 2011. The need for the project was generated by the 5-day delay experienced by terminally ill patients in a hospice while waiting to receive treatment for lymphorrhoea from the community-based CNS. The training and assessment of healthcare assistants in a cost-effective treatment enabled the instigation of care within 3 hours of the development of lymphorrhoea in a patient and an evaluation of its competent delivery.
Getting the right fit: Made-to-measure garments for lymphoedema management
Authors: Lee Natalie , Wigg Jane
Published: May 2014

The purpose of this article is to discuss the use of custom made compression garments in the management of lymphoedema and chronic oedema. Patients often present to therapists with inappropriate, ill-fitting garments that can contribute to an increase in oedema and poor limb shape. Patients frequently report garments as being uncomfortable and therefore intolerable leading to a lack of concordance with wearing garments. The selection and fitting of the correct garment can affect outcomes and the patients' quality of life. The focus of this article is to increase the health professionals' knowledge and skills in the selection, measurement and fitting of custom made garments to ensure correct fit and increased concordance when compression garments are prescribed.
Dysphagia and quality of life
Authors: Vesey Siobhan
Published: May 2014

Swallowing difficulties can be a symptom of many different disease processes, and are associated with adverse health outcomes; malnutrition, dehydration, pneumonia and death. The use of feeding tubes directly into the stomach as in percutaneous endoscopic gastrosomy (PEG) is an increasingly common treatment option for these patients with more and more being cared for in the community. Living with a gastrostomy tube brings physical and emotional impacts and direct consequences for quality of life. Guidance from the Royal College of Physicians recommends ‘nil by mouth’ should be a last resort even when swallow function is deemed unsafe. Impaired swallowing can cause increased anxiety and fear. Many patients avoid oral intake leading to malnutrition, isolation and depression. Understanding and balancing the risks and potential benefits of continuing oral intake or choosing gastrostomy makes this a complex and challenging area of health care.
District nurses' experiences with the free-choice system in Swedish primary care
Authors: Hollman Djana , Lennartsson Sandra , Rosengren Kristina
Published: May 2014

This article aims to describe the experiences of district nurses regarding their work situation after the free-choice system in primary care in Sweden was implemented. The study comprised a total of 17 semi-structured narratives with district nurses. The narratives were analysed using manifest qualitative content analysis. One category, ‘being an underused resource’, and three subcategories, ‘being financially aware’, ‘being flexible’ and ‘being appealing’, were identified. A focus on economic benefit can limit the cooperation and exchange of experiences within and between different care units, which could have a negative impact on the quality of care due to competition between different care providers. Underused resources and restrictions in terms of improvement skills have an impact on job satisfaction and the working environment, and affect the quality of care as a result.
Should assisted dying be lawful?
Authors: Griffith Richard
Published: May 2014

Calls for a change in the law to allow strictly controlled forms of assisted dying in the UK have resurfaced following a much-publicised storyline on the subject on the TV soap opera Coronation Street and the impending debate on Lord Falconer's Assisted Dying Bill in the House of Lords. This article reviews the current stance of the law on euthanasia and assisted dying and considers Lord Falconer's attempts to reform the law through the Assisted Dying Bill.
Disclosing personal health information relating to adults who lack capacity
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 adults who lack decision-making capacity but it has to be balanced against the right to confidentiality. Like other health professionals, district nurses have a duty to maintain the confidentiality of patient information, and incapable adults have the right to expect their personal health information to be kept private. This right is guaranteed by the common-law duty of confidence, the Data Protection Act 1998 and the NHS Care Record Guarantee and confidentiality policy. This article discusses the district nurse's legal obligations when considering sharing information in relation to an incapable adult
Domestic Violence Disclosure Scheme: a guide to Clare's Law for district nurses
Authors: Griffith Richard
Published: May 2014

The Government is rolling out a national Domestic Violence Disclosure Scheme from March 2014 that will allow people who are worried that they may be at risk of violence from their new partner to ask police whether they have a past history of domestic abuse. This article considers the value of the scheme and the role that district nurses must take in promoting the scheme as part of their intervention and support in domestic violence cases.
Using a complex audit tool to measure workload, staffing and quality in district nursing
Authors: Kirby Esther , Hurst Keith
Published: May 2014

This major community, workload, staffing and quality study is thought to be the most comprehensive community staffing project in England. It involved over 400 staff from 46 teams in 6 localities and is unique because it ties community staffing activity to workload and quality. Scotland was used to benchmark since the same evidence-based Safer Nursing Care Tool methodology developed by the second-named author was used (apart from quality) and took into account population and geographical similarities. The data collection method tested quality standards, acuity, dependency and nursing interventions by looking at caseloads, staff activity and service quality and funded, actual, temporary and recommended staffing. Key findings showed that 4 out of 6 localities had a heavy workload index that stretched staffing numbers and time spent with patients. The acuity and dependency of patients leaned heavily towards the most dependent and acute categories requiring more face-to-face care. Some areas across the localities had high levels of temporary staff, which affected quality and increased cost. Skill and competency shortages meant that a small number of staff had to travel significantly across the county to deliver complex care to some patients.
Causes, prevention and treatment of bowel problems
Authors: Nazarko Linda
Published: May 2014

People who are unwell are at increased risk of developing bowel problems such as constipation. The care assistant's role in enabling people to maintain privacy, dignity and a healthy bowel habit is of great importance. This article explores normal bowel function and how to detect and prevent bowel problems.
Care of a patient following a head injury
Authors: Barnett Helen
Published: May 2014

Patients who have sustained a head injury may experience a range of physical, psychological, emotional and behavioural problems. Healthcare assistants are often involved in both the immediate and long-term care of these patients in a range of clinical settings. This paper considers some of the key aspects of care for these patients.
Tissue viability: topical negative pressure
Authors: Roberts Denise
Published: May 2014

This article will discuss the mechanics of topical negative pressure (TNP) in order to give healthcare assistants (HCAs) and assistant practitioners (APs) a better understanding of this particular type of therapy in wound healing. It concentrates on its application and both advantages and disadvantages of using such a therapy. Most importantly, it looks at the role HCA and AP in looking after patients who are receiving it.
Book reviews
Authors: Barber Christopher , Lovell Sandra
Published: May 2014

The NVQs and their Scottish counterparts have been around since 1988. In these decades since, the NVQ has evolved and changed almost beyond recognition.
Implementing the assistant practitioner foundation degrees
Authors: Pratt Gary
Published: May 2014

Newham University Hospital NHS Trust in London has successfully introduced the new role of clinical assistant practitioner (CAP) roles within sexual health, medicine, surgery, theatres and intensive care unit. This article explains the process of developing and implementing the role and considers the benefits it produces for healthcare.
Stroke: environmental barriers
Authors: Swann Julie
Published: May 2014

A stroke can have a devastating effect not only on a person's physical function but also on their cognitive and perceptual abilities. This article concentrates on difficulties that can occur for people who have suffered from a stroke that cause problems managing their environment. It will describe ways to make access easier and facilitate the management of tasks.
The importance of uniform policy
Authors: Nazarko Linda
Published: May 2014

Some healthcare workers may consider uniform policies to be controlling and may not always comply with policy. This article explains the rationale behind uniform policies and their importance in preventing infection and presenting a professional image that inspires confidence.
Malnutrition: identification and treatment
Authors: Nazarko Linda
Published: May 2014

Many people who are admitted to hospital are malnourished. Illness can further increase the risks of malnutrition which increases the risk of infection and impedes recovery. Assessing a person can enable staff to identify those who are malnourished and those who are at risk of malnourishment. This enables the healthcare team to act to address problems and enable the person to recover.
Understanding strokes
Authors: Swann Julie
Published: May 2014

This article discusses how and why a stroke happens. It aims to encourage healthier lifestyles to reduce the risk of a stroke. A mini-glossary is provided in Box1.
Learning disabilities
Authors: Megson Denise
Published: May 2014

As we enter 2009, it is timely to reflect on the changes in learning disability care and some of the challenges that primary care trusts and acute secondary care services face when providing care for people with learning disabilities.
Osteoarthritis part 3: living with the condition
Authors: Swann Julie
Published: May 2014

There are many ways of minimizing practical problems that arise when a person suffers from osteoarthritis. This article concentrates on how healthcare assistants and assistant practitioners can facilitate management of general mobility and daily living activities. The roles of other professions and methods that they use to enable people to be as independent and pain-free as possible are discussed.
Hush! Let's talk confidentiality
Authors: Peate Ian , Potterton Joan
Published: May 2014

Confidentiality is a hugely important legal and professional issue. It can also be very emotive. This article provides you with an outline of some of the key issues of confidentiality. The authors discuss the meaning of a duty of confidentiality, explain what confidential information is, how it is protected by law, and how you can help to protect it. We also look at what happens if confidentiality is breached, or when there are exceptions that mean information needs to be disclosed.
A guide to record keeping for healthcare assistants
Authors: Peate Ian , Culpin Clare
Published: May 2014

Regardless of how effective care delivery has been, good care is often judged on the provision of documentation and record keeping that is timely, clear, full and complete. Documentation of care is the primary source of reference and communication between healthcare workers. This article provides an overview of record keeping and offers guidance to the healthcare assistant and assistant practitioner who are often involved in the maintenance of records in a variety of settings.
Understanding hearing and causes of hearing loss
Authors: Swann Julie
Published: May 2014

Hearing helps us to understand and negotiate the environment and assists in communication with others. Even a mild hearing loss causes problems with identification of everyday sounds such as voices, the doorbell and the telephone ringing. Severe hearing loss profoundly affects a person's ability to communicate effectively and to participate in many leisure activities.

Many of the UK's population experience hearing problems, but some may be unaware of the extent unless it is brought to their attention. This article explores the process of hearing and some of the causes of hearing impairments.
A journey of affirmation
Authors: Megson Denise
Published: May 2014

This is a personal account of how being on a Different Leaders programme affirmed my belief that my Chinese culture can contribute positively to my employer in the forthcoming period of uncertainty and change brought on by the economic recession.
Diagnosing diabetes
Authors: Nazarko Linda
Published: May 2014

Diabetes can develop slowly. Early diagnosis improves health, reduces complications and saves lives. This article outlines common diabetic symptoms, why then occur and how diabetes is diagnosed. It explains how healthcare assistants (HCA) can contribute to identifying people who may have diabetes. Clinical features and diagnostic tests are described.
Preventing shingles: symptoms, treatment and management
Authors: Peate Ian
Published: May 2014

Shingles, also known as herpes zoster, is a viral disease that infects the nerves and the areas of skin supplied by them. It is a painful condition that can also have a negative effect on a person's body image. For those people who are immunocompromised, it can sometimes be fatal. The aim of this article is to give the healthcare assistant (HCA) and assistant practitioner (AP) an understanding of the condition, its symptoms and treatment, to enable them to care safely and effectively for people suffering from it. A glossary of terms is included.
Ask the Board: Blood, guts and more!
Authors: Hand Tanis
Published: May 2014

Should I take blood from people under the age of 16?
What if...? Reflective practice: the importance of teamwork
Authors: Grainger Angela
Published: May 2014

This is the third scenario in the reflective practice series. It looks at how health care assistants (HCAs) and assistant practitioners (APs) play their part in ensuring effective team working, and what actions are appropriate for when team cohesion breaks down and there is general ill feeling. Effective team working is vital for the continuity of good quality patient care. Every member of a health or social care team has a responsibility to communicate effectively and to work collaboratively with others.
Celebrate carers all year round
Authors: Barber Chris
Published: May 2014

As I sit here in the garden, enjoying the cool evening breeze after a hard day decorating the bedroom, I flick through a list of national and world days that have landed in my email in tray. Yes, I know that this is sad. However, a number of interesting—if not rather bizarre-days and weeks swim into view, including National Noodle Day (5 March) and Be Nice to Nettles Day (19 May). I kid you not. However, while having a laugh at some of the more bizarre national days and weeks, I did notice one rather important omission: National Carers' Week, which began on 14th June and seemed to pass by almost unnoticed. Why such little attention?
A new White Paper for health
Authors: Hughes Rhidian
Published: May 2014

Since coming to power, the Secretary of State for Health, Andrew Lansley, is said to have walked into his office every morning and asked his officers ‘Where is my White Paper?’ Having worked for 6 years as Shadow Health Secretary, he has had longer than most to think about his ideas for the future of the NHS. Less than 50 days into the coalition, the White Paper, Equity and excellence: liberating the NHS, was published (Department of Health (DH), 2010). The new coalition government is clearly set to make policy changes at a real pace.
Understanding rheumatoid arthritis: causes and treatment
Authors: Swann Julie
Published: May 2014

Rheumatoid arthritis (RA) is a chronic progressive disease causing inflammation and swelling of various joints of the body. This results in pain and stiffness, and can produce a marked reduction of functioning, affecting daily life. This article describes RA and its treatment, with relation to the role of healthcare assistants and assistant practitioners.
Early defibrillation: the role of the HCA and AP
Authors: Mulryan Chris
Published: May 2014

Cardiac arrest, the stoppage of the heart and breathing, is a medical emergency that requires immediate and skillful intervention if the patient is to survive. Currently, best science indicates that one of the few resuscitative treatments with proven effectiveness is defibrillation. However, the window of opportunity in which this treatment must be given is tremendously small, and the chances of successful resuscitation from cardiac arrest decline with each second that passes. Thankfully, the relatively recent advent of automated external defibrillators means that defibrillation can now be performed safely by healthcare assistants (HCAs) and assistant practitioners (APs), ideally before the arrival of the resuscitation team or ambulance. This article explains the use of automated external defibrillators and examines the role that HCAs and APs have in early defibrillation.
Energy-saving techniques to help manage fatigue
Authors: Swann Julie I
Published: May 2014

Excessive fatigue produces physical and psychological difficulties that can affect a person's ability to manage daily living activities. This article outlines common causes of fatigue and energy-saving methods that can help patients to manage their symptoms.
Falls: A momentary slip and a lifetime of consequences
Authors: Nazarko Linda
Published: May 2014

Falls can cause death, disability, pain and distress. Falls are a major health issue for older people. Each year, 1.57 million older people fall more than three times and 75 000 fracture their hips. As our population ages and frailty levels increase, the rate of hip factures is predicted to double within the next 40 years (National Institute for Health and Clinical Excellence (NICE), 2011a). This article is the first in a series aiming to explore this important health issue and to enable readers to understand why older people are at risk of falls and what can be done to reduce risk factors and enable people to remain healthy and well. This article explains how ageing affects the risk of falls, how falls affect older people and how to identify those at risk of falls.
Caring for the patient with angina: causes and treatment
Authors: Peate Ian
Published: May 2014

Angina is a cardiac condition that can have a significant influence on a person's ability to carry out independent living activities.In addition, this condition can have a high impact on a person's health and wellbeing. Healthcare assistants (HCAs) and assistant practitioners (APs) must have an understanding of the cardiac system, signs of angina and the possible treatment options available in order to act confidently and competently. This article provides HCAs and APs with an overview of the heart, its structures and the coronary blood supply. The causes of angina are discussed, along with the risk factors associated with cardiovascular disease. Signs and symptoms are outlined and the potential investigations required to arrive at a diagnosis are provided. Potential treatment options are also described with an emphasis on pharmacological interventions. Additionally, advice that may be given to people to help prevent angina is discussed. Finally, there is a glossary of the key terms included.
Basic nail care: to cut or not to cut?
Authors: King Theresa , Callaghan Tessa
Published: May 2014

Who trims patients’ toenails if they are unable to cut their own? If nail trimming does not take place, the consequences of untrimmed nails can be considerable, and ultimately, reduce an individual's quality of life. Simple nail care procedures implemented by trained healthcare support workers (HCSWs) can reduce and even eliminate the risk of patients developing potentially serious problems. This article describes the development of a basic foot care training programme in Wales, which was established to implement basic foot care by HCSWs. As a result of enrolling onto the programme, health professionals can become competent in cutting toe nails for the low risk foot.
Applications and interviews: preparing for success
Authors: Jackson Carolyn , Thurgate Claire
Published: May 2014

Those being considered for entry onto a foundation degree will most often need to fill out a formal application and take part in an interview with a prospective college or university. In addition, support workers will have to undergo applications and interviews periodically as part of their career progression. Many of the techniques used in interviews and applications can also be of use in other professional situations, such as appraisals or applications for funding. This article will provide advice on how to fill out applications and prepare for an interview, particularly focusing on foundation degrees.
Health and cultural sensitivity in a diversifying society
Authors: Alexis Obrey
Published: May 2014

This article focuses on cultural diversity. It uses an anonymized, true-life case study to highlight the challenges that can be created when support workers make assumptions or stereotype individuals based on their ethnicity or background. It offers insight into the key area of cultural competence and discusses its relevance in providing care for individuals of different cultural orientations.