bluuebunny/crossref_metadata_2025 huggingface dataset:
Implantable cardioverter defibrillator therapy: An overview
Authors: Bowden Tracey
Published: May 2014

Sudden cardiac death (SCD) is a major clinical and public health problem in the United Kingdom. Most deaths are related to ventricular tachycardia (VT) or ventricular fibrillation (VF). The implantable cardioverter defibrillator (ICD) actively senses and can terminate life threatening arrhythmias automatically, preventing sudden death. Expanded indications for ICD therapy is likely to result in an increase in the number of ICD patients requiring treatment and receiving care in a variety of health care settings therefore it is important that health care professionals dealing with these patients have an understanding of the device. The purpose of this article is to provide an overview of ICD therapy.
Assessing exercise intensity in cardiac rehabilitation: the use of a Polar heart rate monitor
Authors: Bethell Hugh , Letford Sandra , Evans Julia , Turner Sally , Maskell Joe , Culliford David
Published: May 2014

Objective: To assess the accuracy of a Polar heart rate monitor in measuring heart rate in exercising cardiac rehabilitation patients.

Design: Simultaneous heart rate recordings comparing results from the Polar monitor with those from Holter monitoring and intermittent pulse rate as measured by radial artery palpation.

Setting: Exercise sessions in a community-based cardiac rehabilitation centre.

Patients: Twenty phase III cardiac rehabilitation patients recovering from an acute cardiac event.

Main outcome measures: Comparison of heart rates recorded by the two systems and by pulse rate measurement.

Results: The Polar monitor gave results very similar to those from Holter monitoring. Intermittent pulse rate measurement gave a limited and less accurate view of the intensity of the exercise session.

Conclusion: The Polar heart rate monitor gives accurate readings during cardiac rehabilitation exercise sessions at low cost. It is a useful tool which allows assessment of exercise intensity which is not available from intermittent radial pulse rate measurement.
ECG of the month
Authors: Bowbrick Steve
Published: May 2014

Steve Bowbrick presents an ECG for you to analyse. The answer and management plan are given on page 86
Atrial fibrillation: an update on care provision
Authors: Chalkley Sarah
Published: May 2014

Atrial fibrillation (AF) is the most common cardiac arrhythmia, increasing mortality and impairing quality of life (Khaykin, 2007). The publication of chapter 8 of the National Service Framework for Coronary Heart Disease (DH, 2005), and the National Institute for Health and Clinical Excellence guidelines (NICE, 2006) have highlighted the importance of individualized case management in the treatment of AF. This article will summarize recommendations in the management of AF in relation to the NSF and NICE guidelines and assess the implications for practice.

The associated symptoms, risk factors and classification of each type of AF will be defined. Different investigations will be discussed in relation to symptoms of AF, highlighting treatment options specific to each presentation. Consistent and effective management of AF can have a significant impact on an individual’s quality of life and be cost-effective for health care providers.
Service redesign of a rapid access chest pain clinic: Reducing waiting times
Authors: Tough Jackie , Morley Robert
Published: May 2014

Rapid access chest pain clinics have been introduced nationally to identify patients with new onset chest pain, thought to be angina, and investigate and treat according to evidence-based guidelines. The service improvement model used in this study has shown a dramatic reduction in waiting times for medium and high risk patients in referral for angiography and percutaneous coronary intervention using specific electrocardiographic criteria linked to the Bruce Protocol exercise tolerance test. Outcome data has shown that by using these criteria, patients can be listed directly for planned revascularization from the rapid access chest pain clinic thereby considerably reducing waiting times.
Engrossing electrophysiology
Authors: Khan Ehsan
Published: May 2014

This is an exciting text that merges the pure and clinical science of cardiac electrophysiology well.
Looking out for the ‘lost’ congenital heart patients
Authors: Greenaway Beth
Published: May 2014

Beth Greenaway shares her personal thoughts on some of the reasons why so many congenital heart patients drop out of the system as adults, and why it is important for them to re-enter it
8th Annual Spring Meeting on Cardiovascular Nursing
Authors: Astin Felicity
Published: May 2014

Felicity Astin gives us a flavour of events at the annual meeting of the ESC Council on Cardiovascular Nursing and Allied Professions, held on March 14–15 2008
Stepping outside your comfort zone
Authors: Stuart-Jones Vicqui
Published: May 2014

Friday 25th April was the night of the second Cardiac Nursing Awards, held by the journal in association with the British Association for Nurses in Cardiovascular Care. Those in the audience for the ceremony were treated to a rousing address by none other than Dr Ian Jones, which somehow managed to cram politics, popular culture, poetry, embarrassing medical conditions and the importance of timing into just 20 minutes. Pity the person who (having managed to muffle snorts of laughter without any serious damage to internal organs) has to follow an act like that. You can read about all the winners and runners-up on pages 253–260 of this issue.
In support of cardiac physiologists
Authors: Keenan Jan
Published: May 2014

Jan Keenan outlines the reasons why cardiac nurses should support mandatory professional registration for cardiac physiologists
The impact of the ‘18 weeks’ target on cardiac services
Authors: Jones Fiona
Published: May 2014

Fiona Jones discusses the impact of the English waiting times target from an operational point of view
Research Roundup
Authors: Astin Felicity , Meth Fiona
Published: May 2014

This section presents a synopsis of a selection of recently published articles of interest to those nurses working in the field of cardiovascular nursing. The aim of this round-up is to provide a brief overview, rather than a detailed critique, of the research papers selected. A full reference is provided for those who wish to look at the research in further detail.
Valvuloplasty and transcatheter heart valve replacement: the end of conventional surgery?
Authors: Chukwuemeka Andrew
Published: May 2014

Heart valve disease predominantly affects older people and the number of people surviving to old age is predicted to increase sharply in coming years. Many elderly patients are not currently considered for conventional heart valve replacement surgery because of the risks associated with such major surgery. Less risky interventions such as valvuloplasty, transcatheter heart valve replacement and minimally-invasive valve surgery may be more suitable alternatives. These new techniques need to be rigorously evaluated before they can be applied in mainstream clinical practice and collaborative team-working will be the key to achieving success in this field.
The Ultimate Choice: An end-of-life care conference
Authors: MacCallum Annie
Published: May 2014

Annie MacCallum relates some of the key points from a regional conference ahead of the launch of the Department of Health’s End of Life Strategy
Gifts with strings attached
Authors: Stuart-Jones Vicqui
Published: May 2014

A story from the national newspapers that has stuck with me this month related to the revelation that 50 liver transplants in a year were performed on patients from outside the UK, when there were so many British patients waiting for treatment. Most of these were from Greece and Cyprus, under reciprocal treatment agreements, but a small number were from outside the EU (Templeton, 2009). Truthfully, it was not so much the story as the comments posted online by readers that caught my attention. Many of them were horrified at the idea that their organs might not go to someone from the UK, and as a result were indignantly ripping up their donor cards in protest. (Very few mention withdrawing from the register, as an aside, so this public declaration that they have destroyed their cards is really the protest.)
Cholesterol and the menopause: Dietary recommendations for improved patient care
Authors: Williams Christine
Published: May 2014

For postmenopausal women and those undergoing menopause, the risk of developing cardiovascular disease is significantly elevated. Changes to cholesterol and lipid profiles in women at this time can lead to a number of deleterious effects including abdominal fat deposition, reduced glucose tolerance, and increased blood pressure. As a result, cardiovascular disease has become the leading cause of morbidity and mortality in postmenopausal women, accounting for nearly 50% of all female deaths in developed countries.

In response to the current situation, a panel of women’s health and nutrition experts have developed a new, six-step plan of dietary recommendations to support cholesterol management during the menopause. The importance of developing such recommendations has been supported by research demonstrating that nearly half of women surveyed stated that they would prefer to take control of their menopausal symptoms through alterations to their diet and lifestyle rather than by medication.
Chest X-ray case study 1
Authors: Ash-Miles Janice , Calloway Mark
Published: May 2014

Following on from their introduction to chest X-ray interpretation, Janice Ash-Miles and Mark Calloway present two chest X-rays for you to analyse. The answers and discussion are given on page 33.
Rehabilitation for patients with chronic heart failure: How do we deliver it to all?
Authors: Burgess Janet , Whitfield James
Published: May 2014

The Community Hear t Failure Team based in South West Essex identified a need to provide cardiac rehabilitation for patients with stable chronic heart failure (CHF) as these patients were excluded from the standard cardiac rehabilitation programme. The aim was to assess whether a home-based programme could provide similar outcomes to a group programme and provide demonstrable improvements in physical and or psychological health, providing a better quality of life to patients with stable CHF.

Patients were assessed before and after the programmes using 6 minute walk test, deltoid muscle strength, Hospital Anxiety and Depression (HAD) scale and the Minnesota Living with Heart Failure Questionnaire (MLHFQ). A total of 18 patients completed the programmes, 6 on the home programme and 12 on the group programmes.

Results from physical measures were positive and all patients reported improvements, however results from the HAD Scale and the MLHFQ were equivocal. From this small scale study, the home-based programme appears to be as beneficial as a group-based programme and when run concurrently with the group programme will enable the Community Hear t Failure Team to offer patients the most appropriate programme to meet their needs.
ECG of the month
Authors: Regan Claire
Published: May 2014

Claire Regan presents an ECG for you to analyse. The answer is given on page 536.
Providing chronic heart failure education in primary care
Authors: Bell Suzanne
Published: May 2014

Suzanne Bell describes her role as a heart failure nurse educator, working directly with practice nurses and providing education to professionals around chronic heart failure.
ECG of the month
Authors: Regan Claire
Published: May 2014

Claire Regan presents an ECG for you to analyse. The answer and management plan are given on page 79
Community engagement for health improvement
Authors: Capper Gerri
Published: May 2014

Gerri Capper outlines the aims of the Healthy Communities Collaborative projects to aid early identification and management of people at increased risk of cardiovascular disease
Takotsubo cardiomyopathy: A transient phenomenon in the cardiac catheter laboratory
Authors: Duke Zoe
Published: May 2014

Takotsubo cardiomyopathy is a rare stress-induced cardiomyopathy, most often seen in post menopausal women after an emotional stressor. The syndrome usual presents with anginal type chest pain. The electrocardiogram typically shows precordial ST-segment elevation and/or T-wave inversion suggesting left anterior descending coronary artery occlusion. Cardiac ischaemic markers are elevated but coronary angiography reveals a lack of significant coronary artery disease. Left ventricle angiography demonstrates hypokinesis and ballooning of the apex. Wall motion abnormalities resolve over weeks and overall prognosis is favourable. Two case studies are reported here that demonstrate typical presentation of the transient cardiomyopathy.
Advanced guide to EP mapping
Authors: Meredith Tara
Published: May 2014

This text provides a comprehensive, in-depth insight into current electrophysiological mapping techniques and is written by eminent specialists in the field.
ECG of the month
Authors: Regan Claire
Published: May 2014

Claire Regan presents an ECG for you to analyse. The answer and management plan are given on page 247
Physical self-efficacy, anxiety and depression following a 6-week cardiac rehabilitation programme
Authors: Barker Alexis , Tsakirides Costas , Carroll Sean , Ingle Lee
Published: May 2014

Aim: To conduct a preliminary study to evaluate gender differences in psychological health status and physical activity (PA) levels in male and female patients following completion of 6 weeks of phase III cardiac rehabilitation (CR).

Methods: Cardiac patients who had completed structured hospital-based CR were invited to participate in the study. Patients completed three questionnaires which evaluated current and past PA levels, physical self-efficacy, and anxiety and depression.

Results: Sixteen male participants (mean age 55±8 years), and six females (mean age 55±7 years) were recruited. Males were significantly more active (12±9 hours of total PA per week) than females (8±4 hours of PA per week; P=0.018). Females with social support during exercise engaged in more weekly PA than those who exercise alone (P<0.05). Conversely, males performed more PA alone (14±9 hours) than with others (11±9 hours; P<0.05). Patients (males and females) who exercised in groups had higher physical self-efficacy than those that engaged in exercise alone (P<0.05). The HADS scores revealed that overall males and females were not anxious or depressed (depression sub-score: 3.0±2.4 versus 1.7±2.8; P=0.33; anxiety sub-score: 5.7±2.3 vs 4.3±3.5; P=0.37). A signifi cant gender by exercise environment (exercise alone or undertaken some group exercise) interaction was evident (P=0.045) for depression, but not for anxiety (P=0.122).

Conclusion: These preliminary results indicate that gender differences in psychological well-being and physical activity status may exist following standardized short-term phase III cardiac rehabilitation. We recommend that CR services should consider the differing needs of both males and females.
Preventing premature death in people with learning disabilities
Authors: Ross Cathy
Published: May 2014

Cathy Ross discusses a project to make coronary heart disease prevention and lifestyle management messages more accessible
Resuscitation in the community: Surviving cardiac arrest
Authors: UK SADS
Published: May 2014

SADS UK outlines why wider provision of automated external defibrillators and training, and awareness of the warning signs of rhythm disorders, could save lives
Supporting families through screening
Authors: Firman Eileen
Published: May 2014

Lucy Jolin talked to Eileen Firman about her role in screening for inherited arrhythmias, and caring for families who have experienced a sudden cardiac death
HEART UK puts lipid hypothesis on trial
Authors: Butler Diana
Published: May 2014

Diana Butler reports on some of the presentations from the HEART UK annual conference, held in Liverpool on 24–26 June 2009
Challenging established thinking
Authors: Kirk Mary
Published: May 2014

Lucy Jolin talked to Mary Kirk about ‘challenging the status quo’ and the variety of her role as a nurse consultant in the community.
Minimizing the risk of infection in patients with central venous catheters
Authors: Poole Debbie
Published: May 2014

Central venous catheters (CVCs) are increasingly commonplace in health care and provide an integral part of medical management in the acutely ill patient. They are in frequent use in the cardiac setting for haemodynamic monitoring, administration of drugs and intravenous fluids and for venous blood sampling.

CVCs pose a serious risk of infection with potentially lethal consequences. The resulting infection has implications for increased length of stay and financial costs as well as the physical and emotional effects on the patient. Nursing practice in the care of these invasive devices must be in line with evidence-based guidelines ensuring optimum safe practice to prevent complications from sepsis.
The impact of depression on recovery and rehabilitation following STEMI
Authors: Martin Fiona
Published: May 2014

The risk of major depression is significantly increased following the diagnosis of coronary heart disease and it remains high. Depression can have a major impact on the rehabilitation and recovery process after a myocardial infarction—a depressed person may not have the motivation to meet the core components of a cardiac rehabiliation programme.

This article describes how depression can affect the recovery process, who is at risk of depression, and discusses key features of depression that may prompt referral for further specialist assessment.
Venepuncture: A practical guide
Authors: Bowden Tracey
Published: May 2014

Tracey Bowden describes a practical, step-by-step approach for venous blood sampling, which will assist practitioners to per form the skill safely and competently.
Acute care reference texts
Authors: Yaldren Jo
Published: May 2014

This practical guide for nurses is provided in a format that engages the reader from the onset. There are 27 chapters covering topics ranging from assessment to secondary prevention. Each chapter covers relevant theoretical concepts and key points are highlighted throughout the text.
Changing practice: A nurse and physiologist-led tilt-testing service
Authors: Sampson Michael , Lovegrove Amy , Gillam Laura
Published: May 2014

Tilt testing is used to investigate syncope, dizziness and falls. It may also be used to test a diagnosis of epilepsy. This article discusses the rationale for tilt testing, and the method used. Practical considerations and recommended practice are outlined. Interpretation of results is also considered, and the common conditions for which tilt testing can aid diagnosis. These include reflex syncope, orthostatic hypotension and postural or thostatic tachycardia syndrome. This provides the background to the redesign of a tilt-testing service at a metropolitan hospital. The physician-led service was inefficient, with frequent delays, overruns and cancellations. Waiting times were long, and adherence to recognized test protocols was variable. The service was redesigned to be led by nurses and physiologists and the test protocol set out in a formal policy document. Test reporting was improved, and service capacity increased. An audit carried out after 12 months showed that the new service had reduced waiting times, increased adherence to the test protocol and increased patient satisfaction. Safety was not compromised by the removal of direct medical supervision.
Research Roundup
Authors: Linden Belinda
Published: May 2014

Migraine with aura has been associated with an increased risk of stroke, angina, and cardiovascular events such as myocardial infarction (Kurth et al, 2008). However, the mechanisms linking migraine with vascular events are unclear and it is uncertain whether the association with cardiovascular disease is specific to migraine with aura.
Pocket reference
Authors: Potts Katherine
Published: May 2014

This book is a collection of normal values for various tests including laboratory tests, diagnostic tests such as echocardiography and lung function and clinical classifications used for disease states. It provides a pocket-size text for use in clinical practice as a diagnostic aid for test interpretation of the normal values used.
Front Line Care: The future shape of nursing?
Authors: Riley Jillian
Published: May 2014

Jillian Riley outlines the key recommendations from the Prime Minister’s Commission on the Future of Nursing and Midwifery in England, and considers what they might mean for cardiac nurses.
Familial dilated cardiomyopathy: Effective management of the family to improve prognosis
Authors: Oliver Janet , Skirton Heather
Published: May 2014

Dilated cardiomyopathy is a disorder of the cardiac muscle characterized by dilation and impaired contraction of the left or both ventricles. The disease is defined as familial if there are two or more affected individuals in a family. It is generally inherited in an autosomal dominant pattern, therefore if one parent has the condition there is a 50% probability that each child of that individual will inherit the gene mutation that causes it. However, there is considerable clinical variability of expression, with incomplete penetrance, making prediction of the course of the disease in any individual difficult. First-degree relatives of patients with idiopathic dilated cardiomyopathy should be assessed to ensure early disease is identified and managed. Despite the importance of a family history in identifying those at risk, very few cardiologists discuss genetic information with patients and this is essential to detect early disease at a presymptomatic stage.
Haemodynamic assessment in the catheterization laboratory
Authors: Edmond John , Turner Mark , Carson Kevin , Baumbach Andreas
Published: May 2014

Haemodynamic assessment in the catheterization laboratory is the process by which various aspects of a patient’s haemodynamics are measured invasively, with parameters such as the pressures in various cardiac chambers, blood flow and oxygen saturations being recorded. These data, along with information from other non-invasive tests, are used to assess the cardiac status of the patient and can be vital in planning treatment strategies. This article looks at the utility of such assessments, and discusses the clinical importance of this aspect of work in the catheter laboratory.
ECG of the month
Authors: Regan Claire
Published: May 2014

Clare Regan presents an ECG for you to analyse. The answer is given on page 384
Pharmacology for PCI and more
Authors: Duke Zoe
Published: May 2014

This text is a very useful and comprehensive guide to pharmacological agents used in the cardiac catheter laboratory and covers a wide range of drugs used within the interventional cardiology setting.
Audit of a multidisciplinary, nurse-led, beta-blocker clinic
Authors: Chester Tim
Published: May 2014

Heart failure (HF) is a growing public health problem. Modern beta-bloker therapy for HF improves life expectancy and reduces morbidity. HF and lung disease regularly coexist. Beta-blocker therapy is often denied to HF patients who have lung disease because it is perceived to be contraindicated. This article reports the findings of a small audit, conducted in a busy district hospital, examining the practice of a beta-blocker clinic wherein beta-blockers are prescribed in specific circumstances for HF patients with concurrent chronic obstructive pulmonary disease.
NICE guidelines for new chest pain
Authors: Rabasse Praba , Johnson Collette , Malik Nadim
Published: May 2014

In 2000 the National Service Framework for Coronary Artery Disease (CAD) prompted the development of rapid-access chest pain clinics (RACPCs). The aim of such clinics is to provide prompt assessment of chest pain to identify CAD with the use of an exercise tolerance test. In 2010, the National Institute for Health and Clinical Excellence (NICE) guidelines recommended using imaging studies based on CAD risk scoring and not an exercise tolerance test to exclude angina in patients with no previous history of known CAD. A comparison of the use of the 2010 NICE guidelines for the management of new-onset chest pain within a well-established exercise-based RACPC service is undocumented. The new recommendation moves the focus towards discharging low-risk patients, imaging studies/invasive procedure (angiogram) for the moderate-risk group and initiating anti-anginal treatment for the high-risk group. To phase the new recommendations into clinical practice in a district general hospital, the new guidelines were implemented in one out of three RACPC sessions per week. A retrospective assessment was carried out over a 4-month period to evaluate the new service implementation. A total of 160 patients attended the RACPC service, of which 56 (35%) were offered treatments according to the newer NICE guidelines and 104 (65%) were managed with the aim of exercising on the treadmill. This review gives an insight into the benefits of the new recommendations in practice, as well as highlighting some of the immediate limitations and barriers encountered.
ECG of the month
Authors: Regan Clare , Regan Martin
Published: May 2014

Clare Regan and Martin Regan present two ECGs for you to analyse. The answers are given on page 381
Management of acute coronary syndrome
Authors: Linden Belinda
Published: May 2014

Here, Belinda Linden discusses the Scottish Intercollegiate Guidelines Network guideline on the management of this group of coronary artery disorders
Electrophysiology study in patients with tachycardia
Authors: Lee David , Linker Nicholas John
Published: May 2014

An electrophysiology study tests the electrical properties of the heart, recording intracardiac electrograms. It is useful in patients presenting with palpitations associated with paroxysms of a regular narrow complex tachycardia. This article discusses the indications, risks, benefits and peri-procedural management of electrophysiology studies in this group of patients.
Developing clinical pathway documentation to enhance care for TAVI patients
Authors: McCalmont Gemma
Published: May 2014

Transcatheter aortic valve implantation (TAVI) is a relatively new procedure for patients who present with symptomatic aortic stenosis but for whom conventional surgery is not an option. When TAVI was introduced at James Cook University Hospital in Middlesbrough, steps needed to be taken to ensure that care of this vulnerable patient group was at an optimum. A clinical pathway was developed to streamline patient care with the aim of improving standards and reducing length of stay in hospital. This article discusses the processes for service improvement, the development and implementation of the pathway.
Older people and long term care: Is there a role for community health care nurses?
Authors: Nolan Mike
Published: May 2014

This paper considers the contribution that community health care nurses can make to supporting frail older people and their carers. It is suggested that distinctions between community care and long-term care are becoming increasingly spurious and misleading. Rather the need to adopt an holistic approach to the needs of frail older people is advocated. It is argued that unless community health care nurses engage in a constructive debate about their role with older people that they will become increasingly marginalised.
Service brokerage: an innovation for people with learning disabilities
Authors: Thomas Caron
Published: May 2014

This paper examines the implications of service brokerage for nurses working in the field of learning disabilities and within the context of the 1990 National Health Service (NHS) Community Care Act. With the acceleration of service developments – due to the planned closures of long stay hospitals – there is a need for innovative funding arrangements which are relevant and timely and these are outlined in this paper. The philosophies underpinning service brokerage are based on the work of Wolfensberger (1972, 1983) and O’Brien (1981). These are shared by nurses in learning disabilities and form the basis from which they work. In order for nurses to be able to adapt to brokerage framework, they need to market their knowledge and skills more effectively.
Bereavement and the older person: a community nursing perspective
Authors: Faulkner Micheline
Published: May 2014

The intention of this paper is not to discuss bereavement in general terms, but rather to focus upon the specific needs of older people. In particular, the paper will describe a bereavement support project designed to identify and work with older people who may be at risk of a poor bereavement outcome. Specific attention will be given to those who have been identified as carers of a chronically ill dependant, and those who have been suddenly or unexpectedly bereaved.

A description is given of the Good Grief Project which is one of the 1995 Queen’s Nursing Institute Innovation Awards.
The use of strong opioids for cancer pain in the community
Authors: Daniels Lilian , Faull Christina , Blackshaw Carole
Published: May 2014

District nurses have been identified as catalysts for change in facilitating the improvement of terminal care at home (Jones 1995). Good pain management is one key element of quality terminal care in the community setting. The emphasis on the primary care team as the focus of continuing patient care, and the ever developing technology and pharmaceutical market for pain management, pose increasing pressures on community health care professionals to ensure practice is evidence-based.

A large amount of literature and guidelines exist in the field of pain management. Interpretation of this information and its practical application is essential in order to ensure equitable, individualised and quality focused care.
Development of nutritional risk screening in the community
Authors: Gilford Ann , Khun Khun Resham
Published: May 2014

A district nurse and community dietitian joint initiative has resulted in the development of a community-focused nutritional screening tool. The purpose of the tool is to standardise community nurses’ practice in the patient’s own home when screening for risk of malnutrition.

The tool has a matrix format containing eight categories. A score is given in each category which cumulatively relates to low, moderate or high risk. An action plan has been formulated to relate to these scores.

A pilot study has been undertaken using a repeated measures method on a total of 27 patients. Two community nurses screened each patient using the tool under development. A dietitian then reassessed patients using a mix of clinical judgement and a pre-validated nutritional risk tool.

Statistical analysis of the pilot study data has shown a high degree of correlation between the two nurses, the tool under development and the pre-validated tool. It is recommended that a more extensive study is required to confirm these results. Research is also required to investigate patients’ perception of the suitability of the nutritional action plans.
The role and function of the school nurse
Authors: DeBell Diane , Everett Gil
Published: May 2014

The findings of an in-depth study of school nurse services in East Norfolk have revealed major challenges for the definition and organisation of school nursing. The multi-perspective research for this study offers a model for research use by school nurse services elsewhere, because it involves detailed external and internal analysis of the service. The Norfolk research, carried out between January and August 1996, was a study of school nursing, not a study of either the school health service or the health needs of school age children. These broader issues are the context in which school nurse services operate.

This paper summarises the key issues that school nurses across Britain are confronting. These are the macro issues. The full research report includes a case study of the school nurse services commissioned by Norfolk Health Authority for delivery from two community health NHS Trusts.
Postnatal mental health: a view from the inside
Authors: Stillman-Lowe Catherine
Published: May 2014

In response to the article Postnatal mental health: co-operation in community care (British Journal of Community Health Nursing 1996: 7) the author draws on her own experiences of postnatal depression to suggest additional ways in which community nurses may offer effective care for clients with this condition.
The value of a single structured bereavement visit
Authors: Monroe Barbara , Smith Penny
Published: May 2014

This article outlines the value of a single bereavement visit and suggests that district nurses are well placed to give such supportive help through their established relationship with the carers/family. The article proposes a structure for the visit and approaches to on-going needs assessment.
Practice: the focus of learning
Authors: Coles Lesley , Wilkins Vivian
Published: May 2014

The specialist programme for the preparation of Community Health Care Nurses at degree level presents many challenges for educationalists and Community Practice Teachers (CPTs). This article describes the development of a programme designed to support and enable CPTs in their new role.

It includes an overview of Situational Analysis (Skilbeck 1975) as a means to provide an analytical framework to encourage the development of enquiry, reflection and critical appraisal of the practice environment. In addition, assessment of practice at degree level is explored through the use of a Theory to Practice Portfolio to encourage and enhance reflective practice.
Public health nursing in primary care
Authors: Billingham Kate
Published: May 2014

Public health is a collective, or population, view of health needs and health care rather than one which focuses on individuals (NHS Executive 1997; Royal College of Nursing 1994). While public health nursing is currently the subject of considerable attention, it is also the subject of considerable confusion, with many nurses in primary care unsure of how current debates impact on their work. This article examines the context within which modern public health nursing is set and goes on to describe, using case studies, what public health nursing looks like in practice. While it is acknowledged that there are many barriers to developing this work, these are identified and suggestions made for how individual nurses can begin to overcome them. However, a note of caution is also sounded. Public health nursing should not escape critical scrutiny; practice should still be evidence based, work carefully evaluated and an awareness of the wider issue of public health as a mechanism of social control is necessary.
Chronic pain: the cognitive behavioural approach
Authors: Ralphs Judith , Corcoran Mike
Published: May 2014

The specialist area of chronic pain has developed in Britain since the 1980’s to respond to the un-met need of those whose distressing intractable pain has not been helped by conventional treatments. Cognitive behavioral therapy is now the treatment of choice to help improve sufferers quality of life despite continuing pain.

The paper examines the consequences of this often disabling condition and describes the enabling self management approach undertaken at INPUT at St Thomas’ hospital in London.
Nursing in primary care: lessons from St Petersburg
Authors: Carey Lynda , Jones Ann
Published: May 2014

The purpose of this paper is to undertake a comparative examination of nursing within the primary care setting in both Russia and Britain. The paper outlines the value to both nurses currently working within primary care, and purchasers of nursing care, by drawing upon the experiences of nurses working in the less economically advanced environments of the former eastern bloc.

It is suggested that this more global perspective will contribute to the re-appraisal of the development of British nursing in primary care. The authors will argue that given the opportunities afforded to nursing in the new Primary Care Act (1997), and specifically the explicit recognition of nursing to healthcare provision, British nurses should seize the opportunity to develop their practice.
A framework to assist with the application of the principles of scope of practice in a community trust
Authors: Riley Rebecca , Barrett Anne , Friedman Stacey , Gates Gill
Published: May 2014

This article describes how Fosse Health NHS Trust, a large community trust, has applied the principles of The Scope of Professional Practice locally. This has been achieved by developing a local framework, which is described in some detail, to help practitioners consider some of the issues that may need to be addressed when expanding or developing roles. These include risk management, guideline development, identification of training needs and reflective practice. This framework has been applied in minor injury units in the trust to help define areas of expanded practice, to define training needs, to consider risk management issues in these units and, finally, to identify the need for guideline development.
Developments within a community HIV/AIDS nursing service
Authors: Gregory Siobhan
Published: May 2014

HIV/AIDS remains one of the leading causes of death within the UK and was identified as a key area in the Government’s Health of the Nation Strategy (DOH, 1992). By the end of December 1996, 28,447 reports of people infected with HIV had been reported. A total of 1,862 AIDS cases were reported in 1996. (Communicable Disease Report, 1997). This paper will give an overview of a community based service for clients with HIV/AIDS concentrating on how, by working within a multi-disciplinary team, care in the community can be improved. Specific reference will be made to the employment of a specialist health visitor to provide specialist support to the growing number of families affected by HIV/AIDS in this field.
Teamwork in community mental health care
Authors: Machin Tony
Published: May 2014

The policy and practice context of community mental health service delivery has been subject to continuous change, particularly in the last decade. This has had implications for the development and direction of community multidisciplinary team working. Problems of role overlap and lack of role clarity can occur if teams are not established with clearly defined operational policies. A framework of role adequacy, legitimacy and support is discussed in relation to 'theory of' and 'theory for' the disciplines involved in the delivery of community mental health care. It is suggested here that 'theory for' disciplines (contributing to role adequacy) constitutes common ground, whilst 'theory of' the various disciplines, though often not easily articulated, more clearly delineates the defining differences between disciplines (contributing to role legitimacy). When applied at both individual and team levels, the framework can be useful in exploring and clarifying issues of role overlap.
User involvement and collaboration in supported housing
Authors: Ryrie Iain , Breanach Sorcha , Grundy Adrian
Published: May 2014

A central feature of contemporary mental health care policy is a desire to work collaboratively with users in the development and delivery of services. This study sought to describe the nature of collaboration between residents of supported houses and their carers, and to explore the relationship between social functioning and involvement in care. A measure of global social functioning was collated for each resident of 3 supported houses in South London. A semi-structured questionnaire was administered to staff which sought their views on resident involvement in care. Mean social functioning scores varied between the houses and there was evidence to suggest that the levels of resident involvement were positively associated with social functioning although this was not consistent. Other factors which may mediate resident staff collaboration are explored and recommendations are made to enhance this aspect of care.
Primary health care: are student nurses prepared?
Authors: Chambers Karen I , Luker Karen A , Bramadat Ina J
Published: May 2014

Primary health care is proposed as a key strategy for improving the health of the world community and nurses are acknowledged as the prime health care professionals in providing primary health care. The aim of this study was to describe students' self reports of their experiences with primary heath care (PHC) during classroom learning, clinical placements, and written assignments. Data were collected using a self administered questionnaire and analysed using content analysis procedures. Four hundred and twenty-seven (N=427) students from four types of programmes were surveyed including: i) undergraduate degree, ii) project 2000 diploma, iii) health visitor, and iv) district nursing courses. Students in all programmes had been exposed to the philosophy and principles of PHC through classroom learning, clinical experiences, and assignments. PHC experiences focused primarily on disease prevention, health promotion and health teaching. Differences were found between students in the first and final year courses, in degree and diploma programmes, and in degree and post basic programmes.
Update from the British Diabetic Association
Authors: Turner Bridget
Published: May 2014

The British Diabetic Association (BDA) is a registered charity that represents and promotes the health and welfare of people with diabetes.
Clostridium difficile infection in nursing homes
Authors: Gammon John
Published: May 2014

For a number of reasons elderly individuals being cared for in a nursing home are more susceptible to infection. A common type of infection in nursing homes is infective diarrhoea, and an example of an organism associated with infective diarrhoea, that is very prevalent amongst the elderly, is Clostridium difficile. This organism spreads via the faecal oral route and is readily transmissible because it is able to produce spores which can remain in the environment for a few months. In addition to the characteristic 'explosive diarrhoea', severity of the infection may result in complications such as shock, dehydration, and bowel perforation. Untreated elderly individuals show a 10-20% mortality rate. The infection, which is a toxin–mediated disease, is conventionally treated with metronidazole or vancomycin. However, yeast tablets and live yoghurt have been used successfully also. For patients in nursing homes prevention of C.difficile toxin infection relies on ensuring that individuals do not become susceptible through disruption of their normal gut flora, eg by broad spectrum antibiotics and on preventing, as far as possible, their exposure to the organism. Therefore careful antibiotic prescribing is important in conjunction with the implementation of rigorous infection control procedures ie enteric precautions, handwashing, and efficient cleaning of the environment to remove spores is also vital.
Children with HIV/AIDS: the community nursing response
Authors: Finlay Elspeth
Published: May 2014

The community nurse’s role in delivering care for the growing number of children with human immunodeficiency virus (HIV) infection/acquired immunodeficiency syndrome (AIDS) must be addressed. However, children cannot be considered in isolation as the complex psychological, physiological and social ramifications of this chronic disease affect all family members. There appears to be a huge social stigma attached to the diagnosis of HIV/AIDS, even among healthcare professionals (Gibb et al, 1991), and Issues such as confidentiality and the optimal place in which to nurse these children must be carefully considered. A multidisciplinary approach to family care is essential. The community children’s nurse cannot work in isolation: care has to be planned in partnership with the family, specialist nurses, district nurses and other members of the multidisciplinary team. Optimum care for these complex conditions can only be achieved by maintaining an integrated and non-judgmental approach to patient management.
Good news from the Health secretary
Authors: While Alison
Published: May 2014

Frank Dobson, Secretary of State for Health, at the annual congress of the Royal College of Nursing, combined kind words about the value of nurses to the provision of 24–hour care throughout the year with the announcement that £14 million of national funding is to be allocated to extending nurse prescribing to all areas of the community.
Primary healthcare development: the Teamcare Valleys’ experience
Authors: Bryar Rosamund Mary
Published: May 2014

Primary healthcare (PHC) services are the centre and foundation of the healthcare system. PHC practitioners are being called on to play an active role in the commissioning of health care and to ensure that their practice in the promotion of health and treatment of illness is evidence based. In fulfiling these expectations there is a need to establish a PHC development infrastructure in order to support the development of PHC practitioners and services. PHC services have for too long been characterized by poor development opportunities and wide variations in standards of practice. This article describes the experiences of one prototype PHC development unit — Teamcare Valleys (TCV). TCV, using a multifaceted approach combining communication, education and training, research activities, support and advice, provided a resource utilized by 95% of the PHC practices in a deprived area in South Wales.
Managing cancer pain at home: the WHO guidelines in perspective
Authors: Dows Karen , Booth Katie , Beaver Kinta
Published: May 2014

This article addresses some of the challenges facing community nurses in helping patients to manage their pain at home. The focus is on adults who suffer cancer pain, concentrating on physical management. The World Health Organization (WHO) guidelines on cancer pain relief (WHO, 1996), are described and evaluated in the light of recently published evidence on their efficacy. Evidence concerning the under-management of cancer pain by healthcare professionals is considered. Strategies to help ensure adequate pain relief at home taking account of the patient's perspective are examined. The article identifies the need for interdisciplinary cooperation in the management of cancer pain in order to promote effective pain relief for patients at home.
Community care for people with a learning disability
Authors: Parrish Alan
Published: May 2014

Good quality health services should be available to all. The right of individuals with learning disabilities to share the same quality of service as anyone else in society needs to be addressed. However, opportunities are now available for this client group to use and access primary health care services in the same way as other clients in the community. Nursing now provides opportunities for people with learning disabilities to express their needs and encourages them to become involved in the decision making that affects their lives. This article examines some of the ways in which people with a learning disability can be assisted in accessing these services and highlights the key role that learning disability and practice nurses play in providing care for people with learning disabilities in the community. It also addresses some of the issues arising from the recent document Signposts for Success (DoH, 1998) which offers extensive guidance on the strategic development of services for people with a learning disability over the next decade.
‘Hospital at home’ schemes: an effective alternative?
Authors: While Alison
Published: May 2014

Current economic imperatives demand the development of alternative healthcare models both to complement and replace the more traditional type of health care provision, i.e. inpatient hospital stays. Consequently, a variety of ‘hospital at home’ schemes have emerged in recent years. However, despite having similar labels, there are often important differences between the schemes which reflect their different ambitions and intentions. This poses a major challenge for those who seek to evaluate the effectiveness of such schemes since it is only meaningful to compare different models of care which attempt to achieve similar goals for a similar population.