bluuebunny/crossref_metadata_2025 huggingface dataset:
District nursing and social work: palliative and continuing care delivery
Authors: Bliss Julie , While Alison
Published: May 2014

The growing number of older people has seen a concomitant increase in the number of people with chronic conditions who require continuing and palliative care increasing the need for the relevant professional groups and organizations to work together. This paper reports on a multiple case study which explores the different ways that district nurses and social workers work in delivering palliative and continuing care. Each professional group operationalized their care differently across five themes: assessment, care delivery, focus of care, place of care and funding of care. The balance between care organization and care delivery needs to be addressed within emerging primary care delivery structures as primary care nursing moves towards case management for long term conditions.
A call for greater flexibility in the use of public transport
Authors: Burnett Alan
Published: May 2014

This article, brought to you in association with Help the Aged, looks at the difficulties involved in using public transport for the older person. Help the Aged is calling for a flexible transport system which provides a free bus pass or travel tokens depending on what works for individuals.
Over prescribing of antibiotics continues
Authors: Dawes Jonathan
Published: May 2014

Following the unseasonal rain and recent flooding across the UK, like many others I found myself caught short without a brolly. A few days passed and I found myself shivering with cold or pouring with sweat. A swift visit to the GP was quickly met with the usual dolling out of antibiotics. I didn’t take them as I was convinced that I had a virus. What are the consequences of such a knee-jerk prescription?
Commissioning for tomorrow’s healthcare
Authors: While Alison
Published: May 2014

Despite the weather travails, the usual business of the NHS continues. Reconfiguration of health services continues apace with practice based commissioning being led by general practices identifying their population healthcare needs. The new Prime Minister is unlikely to change the direction of the NHS as can be seen by the recently published blueprint for London (NHS London, 2007) which emphasized the centrality of primary care and polyclinics as the intermediary between specialist hospitals and primary care. Ara Darzi is now charged with examining the whole of the NHS structure and has said that he will employ the same methodology which he used for London.
Why care homes can and should learn to love the Human Rights Act
Authors: Gould Jean
Published: May 2014

This article, brought to you in association with Help the Aged, shows that the care sector has nothing to fear from the Human Rights Act. New legislation from the Joint Committee on Human Rights shows existing legislation does not sufficiently promote and protect the rights of older people in healthcare.
The different methods of wound debridement
Authors: Stephen-Haynes Jackie , Thompson Geoffrey
Published: May 2014

The debridement of wounds is a key aspect of wound healing. There are a number of different methods of wound debridement which the practitioner can opt for. A full wound and patient assessment is integral to ensure good clinical outcomes. This article addresses the different methods of debridement. It incorporates the TIME acronym and the wound healing continuum as a tool that practitioners can use in their daily practice. Methods include Larval therapy, sharp debridement, surgical intervention and topical applications. Debridement can also be achieved by using chemical methods such as codexomer iodine and related products.
Compression hosiery : donning aids and garment removal
Authors: Wassall Ali
Published: May 2014

Compression hosiery is a central management treatment option for Lymphoedema/chronic oedema. This article focuses on the application and removal of compression hosiery, aids used with compression hosiery and how to obtain them. It will cover their correct applications, and problems the practitoner can encounter in their use. Tips and techniques, which may be useful in helping the patient to apply hosiery and gain a better rate of compliance will be discussed.
Legal requirements for conducting clinical trials
Authors: Griffith Richard
Published: May 2014

Clinical trials are crucial to the development of new medicines as they test the safety and effectiveness of the drug on human subjects. However, trials do pose a risk to the participants. To minimize this risk all clinical trials must meet the requirements of the Clinical Trials Directive (Council Directive (EC) 2001/20 2001) and the Medicines for Human Use (Clinical Trials) Regulations 2004. In this article Richard Griffith discusses the legal framework that regulates clinical trials in the United Kingdom.
Doing well but room for improvement
Authors: While Alison
Published: May 2014

The recent report from CHAI (2007) provides an upbeat view of the health services and a reminder that much good practice exists despite the occasional depressing headlines relating to failures in services like Maidstone and Tunbridge Wells. Importantly the report noted that primary care services and GPs remain ‘the bedrock of healthcare in England and Wales and the main point of contact for most people’ and therefore crucial to the health experience of the population.
The art of the possible: reforming community health services
Authors: Parker Helen , Glasby Jon
Published: May 2014

In England, there has been a long standing tendency to seek to reform health services via large-scale structural reorganization and via seeking (at least in principle) to boost the power of health care commissioners to redesign services. Based on a review of community nursing services in an urban Primary Care Trust, this paper argues that such an approach has led to a situation where positive service development has stalled as senior managers prepare for the next reorganization (rather than focus on service improvement); where the underlying causes of failure to bring about universal transformation of community health services have not been addressed by ongoing organizational changes; and where providers now seem to look to commissioners to change services (rather than changing them themselves). In contrast, the paper argues that there is significant scope for those working in and managing community health services to focus on what is within their power to change—rather than waiting for others to do it for them.
Providing outpatient antibiotic therapy for cellulitis in primary care
Authors: Nazarko Linda
Published: May 2014

Outpatient parenteral antimicrobial therapy (OPAT) is becoming more widespread. OPAT therapy can be used to treat certain patients who have cellulitis. The decision as to which patients to treat at home must be based on local PCT guidelines—not all patients are suitable for OPAT. OPAT improves patient quality of life by delivering care in the patient’s home. This is highly skilled work and the community nurse must have appropriate training and support in order to gain the skills required.
Nurse prescribing has come of age
Authors: Cook Rosemary
Published: May 2014

Nurse prescribing has a convoluted history. We are now at a point where nurse prescribing is well respected but not deified, where prescribing makes expert nurses not mini-doctors
Informing patients of risks inherent in treatment
Authors: Griffith Richard , Tengnah Cassam
Published: May 2014

Consent to treatment lies at the heart of autonomous decision making by patients who are entitled to make a free choice about whether to accept or refuse treatment. To help patients arrive at their decision district nurses must ensure that they give sufficient information about the nature and risks inherent in the treatment to allow an informed choice to be made.

This article considers how much information regarding risks needs to be disclosed. It discusses how the law requires a different level of disclosure for patients who ask no questions about risks, those who make general enquiries about risks and those who ask specific questions about the risks inherent in treatment.
Double standards in new NHS addiction service
Authors: Dawes Jonathan
Published: May 2014

How would you feel if you knew the GP you were working for was addicted to alcohol or hard drugs? More importantly, how do you think a GP would feel about a district nurse he employed with a similar addiction problem? The Shipman enquiry forced the authorities to look into the state of healthcare professionals’ mental health and has opened Pandora’s box on this murky issue.
Where is the community nursing research workforce?
Authors: While Alison
Published: May 2014

There are many explanations for the almost total absence of a community nursing research workforce; they include the limited nursing research workforce in general and additionally the low priority given to research in PCTs. Indeed, the continual restructuring of PCT workforces over recent years, together with the relatively small size of PCTs compared to acute NHS Trusts, means that developing the nursing workforce beyond delivering the immediate service demands has squeezed out ambitions for the longer term. However, the need to think beyond the immediate service needs cannot be eschewed if community practice is to be evidence-based and if nurses are to be full participants in the research activities of primary care organizations.
An overview of chronic kidney disease management and CAPD in the home
Authors: Jain Neerja , Simoyi Pat
Published: May 2014

Chronic kidney disease (CKD) is a common, harmful, but treatable long term condition. An overview of CKD is provided in this article. Kidney Research UK, www.kidneyresearchuk.org a national charity dedicated to research, has developed the A Better Life through Education and empowerment (ABLE) programme which seeks to research and raise awareness of the issues among ‘at risk’ groups as well as among relevant health professionals. Part Two of the renal NSF suggests many actions that can be taken in primary care to prevent CKD. In the event of Established Renal Failure (ERF), there are a number of treatment options available including continuous ambulatory peritoneal dialysis (CAPD), described here. Kidney Research UK’s Patient DVD module two (complimentary copy attached to this issue) provides more detail using case studies. The DVD offers practical help, support and guidance on how to overcome some of the challenges.
The changing face of manual handling in the community
Authors: Alexander Pat
Published: May 2014

The changing manual handling needs of staff must be reflected in their training. In order to allow for professional development, it is essential that community nurses have dedicated time to attend educational sessions on manual handling, where problem solving is encouraged. A variety of familiar handling situations are discussed, and strategies to overcome them are suggested. The article focuses on several methods of assisting a patient from sitting to standing. Confusion may arise when selecting appropriate equipment or a method to assist. Guidance to aid selection of appropriate equipment is given in the form of an algorithm to aid community practitioners.
Health improvement through dietary management of type 2 diabetes
Authors: De Kleijn Antoinette
Published: May 2014

Diabetes is found to be one of the fastest growing chronic diseases with a high incidence among older people, and in residential care homes the prevalence of diabetes can be as high as 25% percent. A range of complications can develop following the onset of the disease. The prevention of these complications is in line with the emphasis that is being placed on health promotion and the prevention of ill health in current health strategies. This article will discuss a district nurse’s approach to health improvement through dietary management of diabetes for elderly residents with type 2 diabetes living in a care home. The PRECEDE-PROCEED health promotion model chosen to assess the learning needs of the residents and to structure the implementation and evaluation of the health promotion project was good guidance and will form the structure for this article.
Patient perceptions having suffered a stroke in Galway
Authors: Casey Dympna , Murphy Kathy , Cooney Adeline , O’Shea Eamon
Published: May 2014

Of the estimated 10000 people annually who have a stroke in Ireland, about 7?500 will continue to live with some residual disability. This study explored older people’s perceptions of health, level of independence as well as the factors that enhanced or diminished ability to maintain quality of life after stroke. A grounded theory approach was used and 20 stroke survivors were interviewed. Analysis of the data revealed three main themes: concepts of health and independence, sense of loss, and environmental factors. Despite their disability most participants continued to have a positive concept of health. Participants overall adopted a functional approach toward independence and those with severe disabilities felt less independent. Many reported a profound sense of loss in terms of identity and role function. Environmental factors including availability of transport and social connections had a significant impact on quality of life. Most participants appeared to be struggling to adapt to their disability and subsequent experiences in a rather unsupportive environment.
Recognizing your skills
Authors: Billingham Rebecca
Published: May 2014

Successful chronic oedema management depends wholly upon accurate assessment, diagnosis, clinical support, patient involvement and education. This long term condition continues to be largely mismanaged and ignored in the vast majority of cases. The increased number of places available on courses offering education pertaining to chronic oedema management has not yet led to the average health care professional being routinely trained. Thus, often there is a feeling of ‘being out of one’s depth’ and unsafe to practice ‘new’ techniques. These thought processes must be challenged, of course one needs to be aware of one’s own limitations, but as advocates for our patients we must take responsibility for what we can do rather than what we cannot.
Understanding body image in patients with chronic oedema
Authors: Green Tracy
Published: May 2014

Chronic oedema is a complex, long term condition which can affect individuals on many levels. Body image is an important issue which can have implications on patients’ ability to adjust to living with a long term chronic condition, accept appropriate treatment and remain motivated in their self management programmes. Healthcare Professionals are ideally placed to help identify and support patients with altered body image issues so that patients can adapt to and accept their condition.
Policy analysis: report of the review of community nursing in Scotland
Authors: McAskill Heather
Published: May 2014

Policy making is a very complex area to those that are not directly involved in it, however it is essential that nurses understand the process, how it impacts on professional practice, and have the ability to analyse relevant policies. The aim of this paper is to encourage nurses to undertake a policy analysis by providing a ‘real’ example while examining research utilization and policy-making theory. A six stage approach developed from Benton and Cormack’s (2000) framework to review literature is used to analyse the policy, Visible, Accessible and Integrated Care—a report of the review of community nursing in Scotland (Scottish Executive, 2006a).
A district nurse’s guide to the Forced Marriage (Civil Protection) Act 2007
Authors: Griffith Richard , Tengnah Cassam
Published: May 2014

The government considers forced marriage to be a form of domestic abuse with some 3?000 cases reported to the forced marriage unit each year in the UK. Both the Home Office and the Foreign and commonwealth office consider health professionals, such as district nurses, to be ideally placed to identify, help and support the victims of forced marriage. To do this effectively district nurses must be aware of the provisions of the Forced Marriage (Civil Protection) Act 2007.
Measuring nursing quality
Authors: While Alison
Published: May 2014

What outcomes distinguish good nursing care from poor nursing care vexed Florence Nightingale and many subsequent nurses. Indeed, much activity has been devoted to desirable attitudes, behaviours and actions of nurses but relatively little activity has been devoted to distilling out indicators which measure the nurse’s contribution to clinical outcome. This is an important deficit for nursing because it undermines claims from nurses that they make an indispensable contribution to patient care.
The influence of human rights on district nurse practice
Authors: Griffith Richard , Tengnah Cassam
Published: May 2014

In the decade since its introduction, the Human Rights Act 1998 has had a profound effect on the way district nurses practice. New laws underpinning the principles and obligations of human rights law have seen a gradual legalisation of health care and a reigning in of the discretionary powers of health professionals such as district nurses. This article reflects on the Human Rights Act 1998’s influence on district nurse practice.
Management of Norovirus gastroenteritis in the community
Authors: Gould Dinah
Published: May 2014

Noroviruses are the most common cause of infectious gastrointestinal disease in the community. This article explores the epidemiology of Noroviruses and discusses strategies for prevention and control in community settings. Noroviruses are spread by the faecal-oral route and are highly infectious. Sound hygiene in kitchens, bathrooms and thorough hand washing and careful environmental cleaning with bleach are important to prevent spread.
Why the NHS needs to be inoculated against discrimination
Authors: Mitchell Michelle
Published: May 2014

Research by Help the Aged reveals the NHS is institutionally ageist. The Government will attempt to address this with legislation in the Equality Bill, but currently the regulations covering health and social care will not be included. Michelle Mitchell from Age Concern and Help the Aged, argues why this needs to be addressed.
Understanding commissioning for non-commissioners
Authors: Baldwin Moyra , Wilson Frances
Published: May 2014

Commissioning is vital to a patient-led NHS. The knowledgeable practitioner, a non-commissioner, can become involved to influence commissioners to improve the population’s health and well-being. Commissioning and the activities related towards improving the health and wellbeing of a given population follow a decision-making model. Depicted as a cyclical process each stage of commissioning is examined. At the centre of commissioning are service-users for whom commissioned services are tailored. Securing the service-user at the centre enables people to become involved and have their voices heard. This article provides an exploration of the issues surrounding commissioning and provides examples of how practitioners can engage with the concept of commissioning to inform and influence commissioners.
An overview of maggot therapy used on chronic wounds in the community
Authors: Jones Mary
Published: May 2014

Maggot debridement therapy was re-introduced to clinical practice in the UK in the mid 1990s. While at first it was slow to be used by health care professionals, in recent times the therapy has enjoyed an upsurge in use, which has benefited both patients and the NHS. At the same time there has been some resistance to use from clinicians. This led to the introduction of a new presentation of maggots for use in wound care, which has proved popular with both patients and clinicians and has led to increasing use of maggot therapy for the treatment of chronic wounds.
The use of Atrauman® non-adherent wound dressing in tissue viability
Authors: Stephen-Haynes Jackie
Published: May 2014

This product focus considers the characteristics and application of Atrauman®, a non-adherent dressing, in relation to the different aspects of wound healing. Atrauman® has many characteristics that make it an ideal dressing choice in a number of clinical scenarios, including: pain free removal; promotion of healthy granulation tissue; cost effectiveness and versatility.
Tackling obesity as part of a lymphoedema management programme
Authors: Stigant Andrea
Published: May 2014

All lymphoedema services are faced with the challenge of managing an ever-increasing caseload of obese patients, at an ever increasing cost to the NHS. This article explores some of the issues around the problem, reflecting on the need for careful assessment and support for this group of patients, including an assessment of their willingness to make significant lifestyle changes. Patients, and sometimes their carers, must be motivated to take responsibility for self-care if their lymphoedema problems are to be successfully resolved.

Using a case-study approach the management of an individual is discussed and conclusions drawn as to a helpful approach to take when devising an individual management plan
Hypertension management in older people
Authors: Luckson Manju
Published: May 2014

This article provides an overview of the blood pressure (BP) in elderly, how it is assessed and its management. It explains the need of multiple BP measurements as well as the standing measurement and use of ambulatory blood pressure monitoring for assessing blood pressure in elderly. Some years ago elderly people were seen as a different group of population who needed to be managed differently for BP and this view is now changed. The management can be pharmacological or non-pharmacological, which includes weight reduction, salt reduction, reducing alcohol consumption, carrying out regular exercise and physical activity, healthy diet and smoking cessation. This article explains on how the anti-hypertensive medication should be started on an elderly patient and what measures should be taken while they are on this medication.
Safeguarding research subjects who lack decision-making capacity
Authors: Griffith Richard , Tengnah Cassam
Published: May 2014

In keeping with the Declaration of Helsinki, health-care research generally requires the informed consent of those who participate in the study. This approach upholds the autonomy of the participants but restricts research to subjects who have decision-making capacity.

In order that people who lack decision making capacity can benefit from properly conducted research, the Mental Capacity Act 2005 introduced safeguards that enable researchers to investigate the care and treatment of people with incapacity while protecting this vulnerable patient group.

This article outlines the requirements that must be met when conducting research with subjects who lack decision-making capacity
The use of professional portfolios and profiles for career enhancement
Authors: Casey Deborah C , Egan Dominic
Published: May 2014

Since 1995, registered nurses and midwives have been obliged to develop and maintain a professional portfolio of evidence reflecting the learning activities that they have undertaken and how these have informed and influenced their practice. The aim of this article is to demonstrate that rather then just a retrospective account of continuing professional development activities, a portfolio can be used as a vehicle for engaging in self-assessment and personal development planning. Possible structures and type of evidence are explored and portfolios in the context of gaining accreditation for prior experiential learning, and in particular for those nurses in advanced clinical roles, are discussed.
Community matrons and long-term conditions: an inside view
Authors: Cubby Arlene , Bowler Mandy
Published: May 2014

This paper sets out to assess the impact of the community matron as perceived by those undertaking this relatively new nursing role. With the incidence of people living with long-term conditions continuing to rise and subsequently the costs of care set to increase, the role of community matron was identified as one approach to improve the management of these individuals living with chronic conditions. This included anticipating, coordinating and joining up care of specific high intensity patients with complex long-term conditions while supporting new ways of working to reduce unplanned hospital admissions and contain costs.

Local primary care trusts (PCTs) were given guidance for the development of the community matron role with supporting frameworks for competency expectations and the use of case management techniques along with targets to achieve and a minimum case load criteria.

Following the implementation of this role in 2005 a small scale study was conducted to evaluate the role using nine community matron participants working across NHS South of Tyne and Wear PCTs. Following in-depth interviews results were analysed and findings suggestive of many positive aspects of the role and areas still requiring further support and development.
Focus on negative pressure: exploring the barriers to adoption
Authors: Ousey Karen , Milne Jeanette
Published: May 2014

Recent government documents have identified the move from hospital-based care into the community and have suggested that more complex wound care can now be provided in the community setting with therapies such as negative pressure wound therapy (NPWT).

This focus group interview explores community tissue viability specialists’ experiences and attitudes towards the use of NPWT in community settings. The study was conducted in compliance with relevant ethical guidelines. Data analysis identified various themes but this paper concentrates on three; untimely referrals; cost implications and mutual benefit and understanding
eHealth and nursing Informatics
Authors: Kane Kay
Published: May 2014

This week Gordon Brown referred to a web-based portal from which people will remotely access public services, including the NHS, just like internet banking. Strategically it is right up there, because we know the advances in technology can save time and money, we know that our population is growing older with fewer people of working age and the public are more becoming more aware of their choices in care. Internationally and nationally, there is a strategic vision for connected health, and as technology becomes ever more advanced, we need to be creative in our thinking to ensure community nursing contributes to this technology-driven health-care environment.
The care of patients with complex long-term conditions
Authors: Kempshall Natalie
Published: May 2014

The innovation of case management has been a controversial issue since nationwide implementation in 2005. The long-term condition (LTC) agenda remains prominent within all primary and secondary care services and the importance of patient-centred care is paramount.

This article outlines the development and implementation of case management within a case study of a patient with the LTC chronic obstructive pulmonary disease. Key topics such as holistic care, individualized care planning and quality of life are reviewed to give awareness of the success of case management within the care of patients with complex LTCs.
The future of nursing begins at home: qualification is key
Authors: Cook Rosemary
Published: May 2014

The pace of change to community services is now frighteningly fast. Pressure from the demographic profile of community nursing has been growing for years, as has the impetus of the ageing population and their care needs, and the growth of new technologies to transfer care into people’s homes. But the added pressures of the financial crisis and a looming election have speeded up change, not least to the structural arrangements that will see most community services in England move out of primary care trusts and into other organizations.
Prescribing and administering unlicensed medicines
Authors: Griffith Richard , Tengnah Cassam
Published: May 2014

This article considers the impact on district nurse practice of changes to medicines law introduced by the Medicines (Exemptions And Miscellaneous Amendments) Order 2009 that allows independent nurse prescribers to prescribe unlicensed medicines. These changes include the right to mix medicinal products so that they can be administered together as a single dose in, for example, a syringe driver.
Understanding wound bed preparation and wound debridement
Authors: Ousey Karen , McIntosh Caroline
Published: May 2014

Wound bed assessment and optimum local wound care are essential to facilitate the wound healing process. The presence of devitalized tissue, for instance necrotic tissue or slough, is common in hard-to-heal wounds and acts as a barrier to healing. There are several debridement options available to the practitioner with the choice of wound debridement technique being made following a holistic assessment of the patient and the wound. The method of debridement should be discussed with the patient and family where appropriate and consent to treatment obtained prior to the procedure being undertaken.
Welcome to your supplement!
Authors: Todoveric Vera
Published: May 2014

Welcome to the first nutrition supplement of BJCN. We hope you will find the supplement of interest to your clinical practice and we would like to encourage all of you to think about contributing (email the editor at bjcn@markallengroup.com for more details).
Using FRAX to assess the risk that an older person will suffer a fragility fracture
Authors: Vernon Sue , King Rachel
Published: May 2014

A challenge of planning for local health services is how to prevent the effects of diseases of older age in order to reduce individual suffering and also wider economic costs to society. This article discusses FRAX® (Fracture Risk Assessment), a computer-based algorithm that allows 10-year probability of a hip and osteoporotic fracture calculation in people aged 40–90 years. The inclusion of FRAX within the portfolio of risk assessment measures available to community nurses is recommended to aid identification and referral of clients at risk of fragility fractures.
Prescription of controlled drugs by non-medical prescribers
Authors: Griffith Richard , Tengnah Cassam
Published: May 2014

The Government has again promised to end the confusion over the range and use of controlled drugs by non-medical prescribers (NMPs). A recent written answer suggests that regulations allowing district nurses who are NMPs to prescribe the full range of controlled drugs will be in place by the end of October 2011. This is the third time successive governments have made such a commitment, and until it is confirmed district nurses who are independent nurse prescribers must limit their use of controlled drugs to those set out in the British National Formulary and Drug Tariff. This article sets out the limitations on an independent nurse prescriber's right to prescribe controlled drugs under current legislation.
Stoma management: enhancing patient knowledge
Authors: Burch Jennie
Published: May 2014

Community nurses are likely to encounter people with a stoma, most commonly a colostomy. An appliance is used to collect and contain the stomal output. There are various appliances available, each designed to specifically care for a particular type of stoma. Ostomates (people with a stoma) are trained to care for their stoma while they are in hospital by the stoma specialist nurse. However, it is possible that complications can occur, such as sore peristomal skin, and in this instance a stoma accessory can be used to good effect. There are many accessories available, which can make choice difficult. However, an understanding of why accessories are used can assist in the assessment and treatment choice. It may be necessary to request the assistance of the stoma specialist nurse.
Nurses' needs in delivering palliative care for long-term conditions
Authors: Tomison Gillian , McDowell Joan RS
Published: May 2014

This study addressed the question ‘What are the needs of community nurses in delivering palliative care to people with long-term conditions?’ A qualitative exploratory descriptive design was employed. Ten community nurses (Band 5-7) were recruited from a purposive sample following a process of randomised stratified sampling, according to geographical area and Band for matched numbers. Semi-structured interviews were undertaken and audio recorded with written informed consent. The interviews were transcribed verbatim and analysed using an adapted Burnard's framework. The study found that establishing therapeutic relationships, having access to resources, co-ordination and provision of clinical care and collaborative working were all highlighted by the community nurses as needs in delivering palliative care. If these four needs were met, the community nurses believed they could deliver palliative care to their patients. Issues around a lack of resources, community nurses' educational needs and the late referral of patients with non-malignant long-term conditions to community nursing were also identified.
Care in the community: what would happen if the lights went out?
Authors: Smallbone Carolyn , Staniland Karen
Published: May 2014

This article reports on a student nurse project carried out on a community placement in respect to patients dependent on medical devices in the event of power cuts. The project was designed to identify relevant literature to establish what emergency and preparatory procedures and protocols are in place in a primary care trust for this type of emergency and to identify what action a nurse in the community should take to ensure the safety and welfare of their patients if a there was a prolonged power failure. The literature and knowledge of community staff for the correct procedures to follow in the event of a power cut in the community established that there was some cause for concern, and identified that a loss of power to a patient with a medical device poses a serious risk. Recommendations are that an initial risk assessment of power failure needs to be undertaken and included in the appropriate documentation and guidance plans prepared for community staff and should include the listing of the patient as vulnerable. The limited research identified within this project also indicates that contingency plans to ensure the safety and well-being of patients in the community clearly need to be included in disaster and emergency planning.
The Bribery Act 2010: An overview for district nurses
Authors: Griffith Richard , Tengnah Cassam
Published: May 2014

The Bribery Act 2010 has been in force for a little over a year and has already served to reinforce the need for NHS organisations to adopt a proactive approach to preventing any suggestion that their staff are accepting inducements, in the form of gifts or hospitality, that could influence their performance.

The robust policies on the acceptance of gifts and hospitality demanded by the 2010 Act require district nurses to be very cautious when offered a gift by a patient or commercial organisation. This article considers the implications of the Bribery Act 2010 on district nurse practice and the implications of failing to meet its provisions.
Optimising productivity, quality and efficiency in community nursing
Authors: Holland Agi , McIntosh Bryan
Published: May 2014

By 2014 the NHS is expected to make £21 billion in efficiency savings and increase productivity by 6% per annum, while maintaining or improving the quality of care. Given that the cost of the 1.7 million strong workforce represents 60% of the NHS budget, changes are likely. This context of innovation and cost-effectiveness has resulted in an ever greater emphasis to fully engage and support community nursing.
A new model of care for ‘leaking legs’ (lymphorrhoea) in the community
Authors: Delon Marianne
Published: May 2014

A Macmillan-funded lymphoedema/chronic oedema service was commissioned in an inner-London primary care trust (PCT) at the end of 2006 following a scoping exercise. A handful of patients were known to the PCT who had lymphoedema. It was expected that most lymphoedema patients would have lymphoedema secondary to cancer or its treatment. The PCT has a population of 202 000, 51% female and 49% male, 16% of those are 55 or over, compared to a national average of 20.45%, therefore having a younger population than average. Anecdotal information was gathered by the lymphoedema specialist about a large number of patients with wounds on their legs. Nurses often reported their dislike in seeing them, often going off sick with back pain related to treating these patients, and the managers need to allocate different nurses to these patients to spread the perceived heavy workload these patient generated. The average dressings consisted of alginate dressings and crepe bandages. To ascertain the extent of the ‘leaking legs’ population a prospective audit was carried out by the lymphoedema specialist. The results showed a large number of patient affected by leaking legs, cared for by community nurses with poor healing rates. A business case was successful in funding a nurse to treat this population and a new model of care was introduced, with excellent results, resulting in savings to both the nursing and the dressing budget, as well as improved patients outcome.
Juxta-Fit™ compression garments in lymphoedema management
Authors: Mullings Julie
Published: May 2014

This article explores the use of Juxta-fit™ compression garments in the management of lymphoedema patients within a community setting. Compression garments form the foundation of lymphoedema and chronic oedema management and maintenance. The lack of specialist services determines that patients with non-cancer related lymphoedema diagnosis are often managed by community nurses with no specialist knowledge. This innovative adjustable compression device is easy to use and patient friendly, it conforms to limb shape and delivers constant graduated pressure with a similar action to short stretch bandages. The adjustable interlocking bands allow the patient to tighten the garment throughout the day without removal. The Juxta-Fit™ can be used independently or in conjunction with compression hosiery, the lower leg garment is now available on FP10. This device has provided a cost effective essential tool for community nurses in the management of such patients, educational requirements are minimal and impact on nursing time reduced.
Young people with type 1 diabetes and their transition to adult services
Authors: Kime Nicky
Published: May 2014

More than 85% of children and young people with type 1 diabetes are not achieving the recommended target of <7.5% HbA1c and are at risk of developing long-term complications. The delivery of care, including the transition process, is a potential contributory factor towards such poor outcomes. The emphasis needs to be on joint multi-disciplinary working across all health sectors, including primary and secondary care, in order to ensure that young people receive the right support.

This has important implications for the community nurse, who needs to take a more active role in the transition of young people with type 1 diabetes to adult services, especially given the emphasis on managing long-term conditions in the community. This article focuses on the results of a research study that examined the transition of young people with type 1 diabetes and looks at the role of community nurses in young peoples' diabetes care.
A service pathway for patients at risk of peripheral arterial disease
Authors: Tadej Martin
Published: May 2014

Every year in the UK 100,000 people are diagnosed with peripheral arterial disease (PAD) ( Belch et al, 2007 ). Those who are diagnosed are likely to suffer from cardiovascular complications and are six times more likely to die within 10 years, compared with people without PAD ( Belch et al, 2007 ). This medical condition gives no symptoms at early stages and can develop manifesting itself through various degrees of intermittent claudication. This critical analysis will focus on the literature describing peripheral vascular problems with associated symptoms. It will also analyse current understanding of the quality of the vascular assessment within the primary care sector. As a natural consequence this piece of work will aim to highlight the role and significance of Healthcare Professionals within a new service pathway design for the community.
Assessing capacity to consent to sexual relations: a guide for nurses
Authors: Griffith Richard , Tengnah Cassam
Published: May 2014

The right to marry and found a family is a fundamental freedom bestowed on adults under the European Convention of Human Rights ( Council of Europe 1950 ). Engaging in sexual activity is an essential component of that right and should be free from state interference. Community nurses, however, often express concern over the possibility that adults with learning disabilities or other impairments of the mind cannot give a real consent to participate in sexual relations and so should be prevented from doing so in their own best interests.

In this article Richard Griffith and Cassam Tengnah review the case law in relation to the capacity to consent to sexual activity. They set out how a community nurse should approach an assessment of decision making capacity in relation to engaging in sexual relations and what steps can be taken to protect a person who lacks capacity to participate.
Differences between heart failure clinics and primary health care
Authors: Andersson Lena , Erikson Henrik , Nordgren Lena
Published: May 2014

There is a paucity of knowledge concerning how people with heart failure experience differences between specialised heart failure clinics and primary healthcare in Sweden.

This study aimed to describe differences regarding information and follow-up in heart failure clinics and primary healthcare.

The study was conducted in Sweden in 2011. Four people (three men, one woman; aged 60 to 84) with heart failure (NYHA II) were interviewed. The interviews were analysed with qualitative content analysis.

The findings revealed after referral from the heart failure clinic to primary healthcare, follow-ups were omitted. Still, the patients needed care, support and information. The findings are illuminated in four themes.

The patients' varying and individual needs can be difficult to recognise and manage unless they are followed-up from either HFC or PHC on a regular basis.
Nasogastric feeding in the community: safe and effective practice
Authors: Best Carolyn
Published: May 2014

A small percentage of patients receiving enteral tube feeding in the community receive feed via a nasogastric tube. There are risks associated with this method if the correct procedures for monitoring tube displacement are not in place. Guidance for checking tube position has been provided by the National Patient Safety Agency (NPSA). Nurses caring for patients with nasogastric tube feeds need to be aware of how NPSA alerts impact on practice and the advice and support they may need to offer patients.
Lymphoedema management in breast cancer-related lymphoedema
Authors: Jones Joanne
Published: May 2014

Due to developments in diagnosis and treatment of breast cancer, survival rates are rising. This leads to a population of mainly women, who also experience breast cancer-related lymphoedema (BCRL). Long after the cancer has been treated, lymphoedema persists at a time when individuals have returned to work. Large limb volumes can present a problem to these individuals and innovative treatments are needed, in order to retain as much normality as possible and reduce excessive limb volumes that patients can experience with lymphoedema long after treatment. It is also important that these treatments do not disrupt daily living and, for some, work-life balance. With the introduction of wrap around compression systems and collaborative working with the patient, it is possible to achieve an acceptable outcome to those patients with these issues. This approach leads to patient satisfaction and stabilisation of limb volume to within acceptable limits for these patients, in conjunction with the therapist.
Use of the ostomy baseplate in negative pressure wound therapy
Authors: Shah Ajul , Lopez Raquel , Pallikaras George , Jandali Shareef , Pfaff Miles J , Tereb Denis
Published: May 2014

The advent of the negative pressure wound therapy (NPWT) has been a significant advancement in wound-healing practices. However, as the therapy has gained popularity and increased usage in all areas of the body, obstacles have arisen. In certain areas of the body, namely those with crevices and folds, or an abundance of apocrine glands, the application of NPWT can be problematic. This study presents a novel technique for the application of the NPWT in the treatment of wounds in areas difficult to achieve an appropriate vacuum seal. This method eliminates the traditional problems encountered when applying the NPWT to areas with clefts and folds by utilising an ostomy baseplate to provide a more secure and accessible surface area. The patient is an 84-year-old male with a category IV sacral decubitus ulcer. Traditional methods of NPWT application initially proved inadequate due to difficulty sustaining negative pressure; however, subsequent use of an ostomy baseplate with NPWT successfully secured a seal and allowed for wound healing. Our technique allows for the preservation of a proper seal near clefted areas, provides ease of application, reduces the burden of dressing changes and reduces cost, benefiting both the patient and health care providers.
SSKIN bundle: preventing pressure damage across the health-care community
Authors: Whitlock Joy
Published: May 2014

The SSKIN bundle is an evidence-based set of interventions that help to prevent pressure damage. This article describes a scientific approach using the Model for Improvement (MFI) and a collaborative style of learning to quickly and reliably implement the SSKIN bundle across an integrated health-care organisation including primary and community care. Teams used the MFI and took a pragmatic approach to adapt the SSKIN bundle to make it fit for purpose in many different clinical settings. Quick wins, long-term gains and challenges are discussed. Ideas for future adaptations of the SSKIN bundle for use in the community are offered.
Cost-effective non-surgical treatmentof chronic pressure ulcers in the community
Authors: Dale Megan , Cox-Martin Bill , Shaw Paula , Carolan-Rees Grace
Published: May 2014

The Salisbury Pressure Ulcer Outreach Service successfully treats patients with chronic pressure ulcers that have not healed during routine community treatment. These patients have grade 4 pressure ulcers, involving extensive destruction, or damage to muscle and bone. A combination of scientific, seating and tissue viability expertise with a holistic approach results in non-surgical healing for 70% of patients. For those who still require surgery, outcomes are more successful with this approach, resulting in low recurrence rates. Prior to creation of the outreach service, patients were referred directly for surgical closure, resulting in high recurrence levels and long waiting lists. The authors compared costs of the Pressure Ulcer Outreach Service with the previous system of surgical closure. The model base case found that the Pressure Ulcer Outreach Service saved £8588 per patient, and that cost savings could be even greater if the outreach service was extended into preventative work.
An exciting start to the BJHCA
Authors: Grainger Angela , Jones Menna Lloyd
Published: May 2014

It was very exciting to see a dream become reality with the publication and launch of the first edition of the British Journal of Healthcare Assistants. We trust that you found that the contents and standard of the Journal met your expectations. As this is the first journal specifically for non-registered nurses it is important that you, the readers, tell us what you would like to see included and at which level. The comments we have already received have been really positive and we thank you for taking the time to write. We value your input and look forward to even more letters and emails.