bluuebunny/crossref_metadata_2025 huggingface dataset:
Treatment of a venous leg ulcer with a honey alginate dressing
Authors: van der Weyden Elizabeth A
Published: May 2014

The management of chronic wounds such as venous ulcers is a common and long-term issue with the aging population. Non-standard treatment that is both medically and financially effective needs to be identified. Honey has been used for its healing properties for centuries and has been used to successfully heal wounds including pressure-ulcers in our care facility. However, there is not much evidence for its use in treating venous ulcers. To this end, I trialed the use of a honey-impregnated alginate dressing on a man who had a long-standing history of venous ulcers on his leg with the aim of evaluating the effectiveness of honey as an alternative treatment to the current wound management therapies. The honey seemed to act as an effective antibacterial, anti-inflammatory and deodorizing dressing, with total healing of the ulcer achieved. This result, together with past successes with the use of honey alginate on ulcerated wounds, has led to this product becoming mainstream in the treatment of chronic wounds within our care facility.
From costly treatment to cost-effective prevention: using Waterlow
Authors: Waterlow Judy
Published: May 2014

The Waterlow pressure ulcer risk assessment system has been in use for 20 years. In this article, Judy Waterlow describes how it can be used in the community, discusses the recent update to the system and explains how pressure ulcer risk assessments should be conducted.
Guidance on delivering effective group education
Authors: Rodgers Jill
Published: May 2014

Group education is increasingly being advocated in place of the traditional one to one approach in health care. Using the example of diabetes, this article describes why group education is effective, and outlines a process that can help shape a group education programme. Identifying the purpose of a programme, understanding how people learn, and behaviour change techniques, all help the educator identify what are the important elements to include. Planning the process of a programme to enhance its success, and developing an evaluation strategy to measure success, are also included.
The use of topical diclofenac for pain in osteoarthritis of the knee: a review
Authors: Banning Maggi
Published: May 2014

Osteoarthritis (OA) is a common complaint that affects millions of people worldwide. As there is no cure for OA, drug treatment is the main form of management. This can be achieved through the use of analgesics and anti-inflammatory drugs such as the NSAID diclofenac sodium. The chronic use of diclofenac sodium can lead to adverse gastrointestinal problems. The use of a topical formulation of diclofenac sodium aims to reduce this problem. Evidence from four randomized controlled trails of the efficacy and safety of topical diclofenac sodium as a method of pain relief for the treatment of OA of the knee is presented and discussed. Findings imply that topical diclofenac sodium is an efficacious and safe method of pain control in patients with OA of the knee.
Empowerment in nursing homes: lessons for district nursing?
Authors: Sletteb Åshild
Published: May 2014

Empowerment in nursing homes is seldom discussed, although patient empowerment is a key policy objective in many countries. This study explored strategies nurses in nursing homes and district nursing may use in order to empower themselves and the nursing home residents. Fourteen nurses from three nursing homes in Norway were observed and interviewed. The main finding was that the nurses where striving for the best outcome for the residents, and used strategies including negotiation and raising awareness to empower reidents and each other.
Tracheostomy care for community nurses: basic principles
Authors: Feber Tricia
Published: May 2014

This article is intended to give a practical overview of the management of the patient with a tracheostomy in the community. It will describe the difference between temporary tracheostomy and laryngectomy, and outline the basic practical management of each, covering tube care and changing, humidification and suction. Sources of equipment and further information will be identified.
Effectiveness of intermediate care delivered in nurse-led units
Authors: Griffiths Peter
Published: May 2014

This mini-review provides an overview of evidence regarding the effectiveness, costs and patient experience relating the intermediate care in nursing-led units. The core of the evidence is derived from a high quality systematic review of 10 controlled trials involving 1669 patients. Other studies on patient experience and costs not included in the review are also considered. There is some evidence of patient benefit in the short term in terms of independence. However this does not seem to be sustained. Total inpatient stay is increased and hence overall costs of the initial episode are increased with no evidence of longer-term savings. The approach seems to be broadly acceptable to patients. Provided it is not simply used to house patients who cannot benefit, nursing-led units may be a viable alternative to acute care for some patients. However, the core features of the units that provided the evidence must be considered in order to maximize the potential for delivering quality care.
A new look at constipation management in the community
Authors: Emly Marian , Rochester Patsy
Published: May 2014

Constipation affects the quality of life of many ‘at risk’ groups of people. Laxatives are the dominant management strategy whose long-term use is ineffective and very costly to the NHS prescription bill and in the use of health staff resources. The development of a user-friendly, evidence-based clinical guideline (The effective management of constipation in primary care) has the potential to change the present situation by providing healthcare practitioners with an aide-mémoire to assist clinical reasoning, in order to re-evaluate current practice and suggest combined alternative treatment strategies. Early indications of use of the guideline suggest holistic individualised bowel management programmes can significantly reduce laxative use and nursing interventions and lead to improved quality of life.
Becoming a community matron: the transition from acute to primary care
Authors: Clegg Angie , Hamilton Sheena , White Lynne
Published: May 2014

Community matrons are an important part of the policy of community-based management of long-term conditions. In contrast to some early conceptions of the role, community matrons can come from all areas of nursing. This article draws together two personal accounts by nurses from one primary care trust who have made the transition from acute care to community matron, and highlights the learning process they and their colleagues have undergone.
Avoiding allergic contact dermatitis in patients with venous leg ulcers
Authors: Beldon Pauline
Published: May 2014

The management of venous leg ulcers is frequently problematic, usually as a result of the patient's existing co-morbidities, but often because of problems in skin management, such as hyperkeratosis or skin sensitization and resulting contact dermatitis. Good leg ulcer management practice includes skin care, protection from excessive exudate and from potential sensitisers. This article explores how the practitioner can recognize allergic contact dermatitis in a patient with a venous leg ulcer and avoid the use of avoid potential skin sensitizers during management.
Skin cooling, pain and chronic wound healing progression
Authors: Muldoon Jeannette
Published: May 2014

There are many areas of wound care where theory does not always match the practical experiences of the patient. This article discusses the effects of two factors – skin cooling and pain – on chronic wound healing, and the role of pain and inflammation on the overall wound healing process.
We listen but do we hear? The importance of patient stories
Authors: Hawkins Jen , Lindsay Ellie
Published: May 2014

Patients’ perspectives on their illness and care are increasingly recognized as the focus for the organization of health care, yet patient stories are rarely examined on their own. Mostly, they are dissected for data, and so the impact is lost.

This article presents a number of story tellers, all patients with leg wounds attending a social clinic. Reading their stories helps us understand the experience of being a patient and living with difficult and painful leg wounds. They also show how nurses can play a critical role in optimizing the power of the story in the patient's journey towards physical and psychological healing.
Mixed lymphovenous oedema with leg ulceration: a case study
Authors: McCann Melanie , Ovens Liz , Louison Pauliona , Elliott Violet
Published: May 2014

Chronic oedema presenting in the community is not always typical lymphoedema. It may have a more complicated aetiology, or can be complicated by other problems. This case study presents an example of such a case. The patient was affected by lymphovenous oedema, complicated by large bilateral leg ulcers. Management by the district nurses had kept the ulceration in check, but improvement was only achieved through multidisciplinary cooperation between district nurses, tissue viabililty nurses and the lymphoedema team.
Maggots ‘n’ chips: a novel approach to the treatment of diabetic ulcers
Authors: Lodge Angela , Jones Mary , Thomas Stephen
Published: May 2014

The management of diabetic ulcers presents a particular problem to the healthcare professional as these wounds become easily infected and often show little propensity to heal, leading in many cases to an amputation. The application of sterile maggots in a new presentation called the Biofoam Dressing transformed a longstanding MRSA infected amputation site into a clean granulating wound in one treatment. Further multiple applications of maggots to the newly cleansed wound were associated with the rapid development of granulation tissue and the elimination of the MRSA. Based upon our experience, it is proposed that, in the absence of effective conventional treatments for infected diabetic foot ulcers, the use of this technique should be considered as a first line therapy for all such wounds.
Defining the unique role of the specialist district nurse practitioner
Authors: Barrett Anne , Latham Dinah , Levermore Joy
Published: May 2014

Due to the reorganization of primary care trusts across the country, certain trusts proposed a reduction in the specialist district nurse practitioner numbers in favour of less qualified community nurses and health care assistants. Such proposals in one PCT were blocked, partly in response to documentation compiled by practitioners at the sharp end of nursing practice. With the new agenda of practice based commissioning, it is imperative that commissioners and management alike are aware of the scope of specialist district nurse practitioners. This is the first of a series of articles looking at specific case histories where the role of the district nurse is highlighted. It is the intention to stress the importance of the clinical expertise and confidence required by the district nurse to care for patients with complex needs in the community.
Care of people with Multiple Sclerosis in the community setting
Authors: Barnes Fiona
Published: May 2014

Approximately 85,000 people live with Multiple Sclerosis (MS) in the UK. The majority are self-caring, with or without some specialist in-put. A minority, approximately 10-15%, have severe disability and are in receipt of more extensive care from health and social services. This article provides an overview of MS and discusses its management in the community.
Screening for depression in older district nursing clients: feasibility study
Authors: Nunn Russell , Annells Merilyn , Sims Jane
Published: May 2014

Depression is a common condition among older district nursing clients. This two-cycle feasibility study trialled a process for depression screening by using the 15-item Geriatric Depression Scale (GDS) with a sample of older clients in an Australian district nursing organization. An education session about depression and use of the GDS preceded the screening process. The trial found that a number of barriers existed among participant nurses regarding screening for depression, although generally they acknowledged depression as a common problem among older clients and most believed that they potentially had a important role in the identification and support of clients with this condition. Lack of knowledge emerged as a major constraint, as did uneasiness about entering the mental health area, with some reluctance to use the GDS because of the type of questions included and not wanting to be intrusive regarding the ‘emotional matters’ of clients. Recommendations are offered about screening for depression with this client population.
Carers’ health clinic initiative in Edinburgh: pilot evaluation
Authors: Jarvis Alison , McIntosh Gwenne
Published: May 2014

Unpaid carers see the Primary Health Care Team as an important source of help, information and support. A pilot Carers’ Health Clinic to address the health needs of carers was set up in SouthWest Edinburgh. The Clinic offered carers an assessment of their own health needs and information on a range of support services available to them including referral to a stress management therapist, if appropriate. Although physical health problems identified were mainly minor, the clinic findings indicate that many carers experienced emotional costs which they perceived to have an impact on their health. The Carers’ Health Clinic pilot was a successful model, targeting carers who had not previously been in touch with carer support organizations and improving the awareness of carers of their own health needs.
Dispelling myths concerning the humble compression stocking
Authors: Davies Rhian
Published: May 2014

This article aims for greater understanding at pre and post-graduate level training of the clinical and economic benefits of using appropriate quality compression hosiery. In particular it focuses on differences between the various types of stockings, their clinical indications and the expected results. This conservative, non-invasive therapy can be managed independently by most patients with vascular or lymphatic problems to improve their quality of life when their functional abilities are assessed and application aids are used appropriately.
Why do district nurse prescribers alter their prescribing patterns?
Authors: Hall Jason , Noyce Peter , Cantrill Judith
Published: May 2014

This paper describes how district nurses decide what products to start prescribing and explores the reasons why prescribing patterns change. It is based on semi-structured interviews with fourteen nurses from one primary care trust. The first products prescribed immediately following qualification depended on the route taken to becoming a prescriber. These were either the same products they had been using before qualifying as a prescriber or if prescribing was included with their district nurse training then it was the same products that their mentor prescribed. The two drivers for changes in prescribing patterns were patients, whose current therapy was ineffective, and products, where patients were selected to try new products on. Representatives from the pharmaceutical industry and fellow nurses had the greatest influence on product selection for those prescribers that changed their prescribing. The nurse’s own experience had the greatest impact on the decision to continue prescribing a new product.
Understanding schizophrenia: a guide for newly qualified community nurses
Authors: Gillam Tony , Williams Robin
Published: May 2014

Schizophrenia is a complex and severe mental illness affecting 1% of the UK’s population. For those affected, interaction with a mental health educated community nurse may prove invaluable in terms of increasing the chance of an early diagnosis and preventing future relapse. NICE guidelines issued in 2002 support this theory, giving recommendations such as getting help early for those suffering and making sure that the community mental health teams work in partnership with patients and carers. The guidelines also advocate the use of atypical antipsychotics for the treatment of schizophrenia, which are available as both oral medication and long-acting injectable preparations. The use of psychosocial interventions has developed alongside medication: discussion of symptoms with a community nurse can be beneficial in identifying early signs of relapse. This information can then be fed back to the wider community mental health team. Considering that 25–40% of long-term mentally ill people refuse specialist care, combined care between mental health specialists and community nurses ensures that individuals are seen more regularly, enhancing the quality of care that they receive.

Treating this condition within the community for a group of nurses with little or no experience poses professional challenges. This article is intended to inform and explain in more detail how treatment can be delivered by a broader group of individuals.
The clinical management of dysphagia in primary care
Authors: Nazarko Linda
Published: May 2014

Dysphagia: difficulty eating because of swallowing problems is a symptom that affects 15% of hospital inpatients, older people, people with neurological disease, cancers of the head and neck and people with severe reflux. This symptom affects a person’s ability to remain well nourished and hydrated and increases the risks of ill health. Effective dysphagia management requires an interdisciplinary approach and can make a huge difference to the quality of life experienced by the person with dysphagia.
An exploration of exercise training effects in coronary heart disease
Authors: Piperidou Eleana , Bliss Julie
Published: May 2014

Coronary Heart Disease (CHD) remains the most common cause of death and disability in many developed and developing countries. The evidence presented so far, clearly shows that exercise training leads to favourable improvements in exercise capacity, lipid levels, weight and psychosocial variables for CHD patients. Nevertheless, despite recommendations and government support, the lack of physical activity remains a major health problem, particularly for people with established CHD. The aim of this review was to explore the effects of exercise training on physical and psychosocial function among CHD patients, by analysing the content of relevant research reports. The findings showed that although there is sufficient evidence that exercise training has a number of effects that are beneficial in treatment and secondary prevention of CHD, different aspects of exercise characteristics (mode, frequency, intensity and duration) for different cardiac patient groups, warrant additional investigation.
Does social support impact on venous ulcer healing or recurrence?
Authors: Brown Annemarie
Published: May 2014

Much of the leg ulcer literature focuses on clinical assessment and management of chronic venous leg ulceration in order to achieve healing. Chronic venous leg ulceration, however, should be classed as a chronic or long term condition, defined as a condition, ‘that is currently not curable and therefore can only be managed’, although it is not generally acknowledged as such. There is an extensive body of literature which focuses on the psychosocial issues that impact negatively on the quality of life of patients with long term conditions, such as diabetes or arthritis. These include the emotional impact of pain, social support, coping mechanisms and response to stress and treatment adherence. Health care professionals are becoming increasingly aware of the impact psychosocial issues may have on wound healing in general, but particularly, in chronic venous leg ulceration and prevention of recurrence. This article reviews the current literature on the role of social support and its impact on venous ulcer healing/recurrence and concludes that health professionals caring for patients with chronic venous ulceration need to consider alternative outcome intervention measures for patients for whom healing may not be a realistic option.
Using the TIME framework in wound bed preparation
Authors: Dowsett Caroline
Published: May 2014

This article discusses the concept of wound bed preparation and the associated TIME framework, as a systematic approach to wound assessment. Successful outcomes for patients with wounds relies on identification and treatment of the underlying cause of the wound and management of issues at the wound bed that impact on healing. This systematic approach can improve wound assessment and assist with treatment choices for patients, so as to optimize wound care for patients.
An overview of caring for those with palliative wounds
Authors: Stephen Haynes Jackie
Published: May 2014

This article aims to clarify the principles of palliative wound care. It will outline the types of wounds within palliative care; the importance of the management of exudate; the importance of the prevention of maceration; the assessment and management of malodour; professional accountability and personal responsibility.
An overview of assessment and management in COPD
Authors: Barnett Margaret
Published: May 2014

Chronic obstructive pulmonary disease (COPD) is a highly prevalent disease, which has a huge impact on both families and individual patient’s lives. Even though COPD is largely a preventable disease, it is increasing worldwide. Therefore, healthcare professionals working within primary care are likely to come into daily contact with patients with this condition. However, statistics tell us that there are many more patients that are undiagnosed. The aim of this article is to provide an overview of this condition and to identify the various drug therapies that are available to ensure patients are receiving optimal treatment to control their symptoms of COPD.
Structured patient education: the X-PERT Programme
Authors: Deakin Trudi , Whitham Claire
Published: May 2014

The X-PERT Programme seeks to develop the knowledge, skills and confidence in diabetes treatment for health-care professionals and diabetes self-management. The programme trains health-care professionals to deliver the six-week structured patient education programme to people with diabetes. Over 850 health-care professionals have attended the X-PERT ‘Train the Trainer’ course and audit results document improved job satisfaction and competence in diabetes treatment and management. National audit statistics for X-PERT implementation to people with diabetes illustrate excellent attendance rates, improved diabetes control, reduced weight, blood pressure, cholesterol and waist circumference and more confidence in self-managing diabetes that has impacted positively on quality of life.
The lived experience of community nurses treating clients with leg ulcers
Authors: Walsh Eileen , Gethin Georgina
Published: May 2014

Chronic leg ulceration impacts negatively on the quality of life of the sufferer and has financial implications for the economy. Government health policy aims to tackle long-term conditions and restructure services from acute to community care. Community nurses play a pivotal role in managing and co-ordinating care to leg ulcer patients, yet their personal experience in this clinical situation is poorly explored. This qualitative study aims to gain an understanding of community nurses’ personal experience of treating clients with leg ulcers; this is necessary to develop leg ulcer services which are effective, efficient and client-centred.
Breast cancer-related lymphoedema: implications for primary care
Authors: Harmer Victoria
Published: May 2014

As more women are surviving breast cancer, long-term complications of treatment that affect quality of life, such as lymphoedema, gain greater importance (Tsai et al, 2009). The various approaches to treating lymphoedema include skin care, elevation of the affected arm, the use of compression hosiery, multi-layer bandaging, massage (manual lymphatic drainage), and sometimes surgery.

The increasing number of women who survive breast cancer partnered with the tendency to care for more patients in the community mean that community nurses may find themselves at the forefront of the management of this patient group, becoming more responsible for side-effects of treatment and the disease.

This article will discuss lymphoedema, its treatments along with relevant evidence, illustrating current practice.
Implementing KSF competency testing in primary care. Part 1: developing an appraisal tool
Authors: Bentley Jenny , Dandy-Hughes Harlene
Published: May 2014

The delivery of an effective community nursing workforce relies on competent staff. Commissioners will need to be assured that their providers employ competent, efficient staff who give value for money. The Knowledge and Skills Framework (KSF) was introduced as part of Agenda for Change to identify the competences required, but competency testing using the KSF has not been fully implemented across the UK, and measuring competency, using the KSF indicators, still leaves much room for variation and a non-standardized approach. In the first of this two-part article, the authors discuss the process through which the provider services of one London PCT developed standardized competences using the KSF which were linked to staff performance and which provided clear areas for individual development.
Staff flu vaccination: A patient safety necessity?
Authors: Nazarko Linda
Published: May 2014

The nights are drawing in, winter is fast approaching, and occupational health departments are already beginning staff flu immunization programmes. Vaccinated staff protect both vaccinated and unvaccinated patients from flu (van den Dool et al, 2008; 2009), and improve staff health, reduce sick leave, as well as set the public a good example.
The older person: management of constipation
Authors: Kyle Gaye
Published: May 2014

Despite being a major concern for the older person, constipation is not given the attention it needs as other conditions are often deemed as more pressing. This article explores the symptom of constipation in the older patient; established management and treatment options are discussed within the context of available evidence together with new contipation managemet modalities.
Home enteral nutrition NICE guidelines and nutrition support in primary care
Authors: Ojo Omorogieva
Published: May 2014

The Home Enteral Nutrition team provides support to patients who are being fed via enteral feeding tube in the community. The use of the recently developed policy in combination with the National Institute for Clinical Excellence (NICE) guideline on nutrition support will change the way care is provided to patients and enhance service delivery. However, there are difficulties in the implementation of policies and guidelines which often militate against the delivery of high standard of care.

This paper was an attempt to apply the Kotter’s eight-step change management model in the implementation of the HEN team policy and NICE guideline on nutrition support through training of district nurses, liaison with colleagues and carrying out a clinical audit. The clinical audit was aimed at institutionalizing the new approach for the delivery of quality care.

The Kotter’s model recognized the urgency needed and it enabled the building of coalitions that is essential in meeting the desired standard in today’s NHS.
Palliative care provision for older people in care homes
Authors: Dobie Jan
Published: May 2014

There is a paucity of research in relation to district nurses’ (DNs) experiences of palliative care provision in adult care homes (CHs) despite their substantial involvement. The aim of this study was to demonstrate the current involvement of DNs in CHs and identify the potential implications for future practice in providing palliative care in this setting.

The findings suggested that even experienced DNs, wanted support and education about when to commence palliative care. They also wanted earlier involvement with CH residents who have a life-limiting condition and CH managers were seen as being essential contributors towards planning care. There was concern among DNs as to how the Liverpool Care Pathway could be introduced into CHs with untrained carers and finally, DN alignment to CHs was shown to improve continuity of care for residents and produce more effective partnership working between DNs, general practitioners and CH staff.
Chronic leg ulceration in the community: changing the focus
Authors: Brown Annemarie
Published: May 2014

Compression therapy is considered the gold standard for healing chronic venous leg ulceration, and impressive healing rates are achievable for many patients. Unfortunately, this condition is chronic, characterized by frequent recurrences and, for some patients, ulcer healing may never occur. Within community services, commissioners of nursing services tend to focus on complete ulcer healing within a defined timescale as quality indicators. The challenge, therefore, will be for community nurses to demonstrate alternative but equally effective patient-centred outcome measures for nursing interventions when healing is delayed or does not occur. The current government health policy encourages active patient involvement in treatment, with an emphasis on self-care/management for patients with chronic conditions. Self-management interventions, such as the Expert Patient Programme (Department of Health, 2001) for chronic conditions, have been positively evaluated and have demonstrated considerable benefits for patients in terms of pain reduction and improved psychosocial wellbeing.

This article briefly discusses the outcomes of such interventions and suggests that nurse-led self-care programmes could be adapted for leg ulcer patients in order to provide alternative outcome measures for nursing interventions when ulcer healing may not be achievable. This article also gives an overview of current innovations developed to encourage patient involvement and self-care in this client group.
A process for developing a principle- centred district nursing service philosophy
Authors: Clarkson Quinten
Published: May 2014

While it is well known that team vision and values statements in nursing can promote person-centred care, practitioner role clarity and empowerment, and service effectiveness, especially during times of change, their use in district nursing is limited. Accepted practice is to formulate vision and values statements ‘from the top’, and then seek buy-in from other staff groups, however, this inhibits practitioner engagement. This paper describes the use of group facilitation, based on principle-centred leadership practices, to engage practitioners in all the creative aspects of developing a values statement. Increasing practitioner engagement would be expected to provide the above benefits by improving communication with service-users and other key stakeholders and by motivating performance evaluation and improvement.
Is training in solution-focused working useful to community matrons?
Authors: Simm Rebecca , Hastie Laura , Weymouth Emma
Published: May 2014

This article evaluates the usefulness of a small initiative to train community matrons (CMs) in solution-focused (SF) approaches, from the perspective of the CMs. A SF approach is a psychologically sophisticated, yet relatively easy-to-use psychological model for enhancing care and wellbeing which can help to empower patients and promote self-care. Data from questionnaires completed by CMs immediately post training and from qualitative interviews conducted 12 months later suggest that training in SF approaches is considered useful, useable and relevant by the nurses themselves. More specifically, CMs reported that SF approaches allowed them to work alongside patients to investigate and amplify patients' own expertise in ‘living well’ despite their difficulties, contributing to improved patient self-management, less reliance on the CM, and greater job satisfaction for the CM. SF approaches seem to resonate with the current NHS drive for greater efficiency and better patient-centred care.
Drawing breath: promoting meaning and self-management in COPD
Authors: Fraser Jean , Page Sonia , Skingley Ann
Published: May 2014

The prevalence of chronic obstructive pulmonary disease (COPD) is rising and its associated cost to the NHS is not sustainable. Health policy supports the promotion of self-management programmes for long-term conditions, which build on a person's strengths, interests and preferences. This article presents an account of how one individual with COPD was able to harness her artistic skills and health interests, both to manage her own condition and also to contribute more broadly to health promotion and COPD prevention.
Driving with diabetes: the automatism defence
Authors: Griffith Richard , Tengnah Cassam
Published: May 2014

The tragic case of a district nurse killed when a car driven by a man in a hypoglycaemic state struck her while she took her regular evening walk highlights the dangers that can occur when a person with diabetes drives without regard to their condition. The man was later jailed for four and a half years for causing death by dangerous driving having been found criminally responsible for his actions because he failed to control his blood sugar levels during the journey. In this article the authors set out the likely consequences for people with diabetes who fail in their duty to ensure that they are able to drive safely and are unlikely to be affected by the adverse effects of their illness or the medication taken to control it.
Determining a patient's best interests
Authors: Griffith Richard , Tengnah Cassam
Published: May 2014

Best interests is the standard by which the law judges the propriety of care and treatment for adults who lack decision-making capacity. Since the introduction of mental capacity legislation, determining best interests has moved from a paternalistic risk benefit analysis by the district nurse providing care to an incapable patient to a more holistic approach where the wishes, views and values of the patient and their relatives must be considered. This article discusses how district nurses should approach the assessment and determination of best interests to meet the requirements of the law.
Nutrition in the care of patients with cancer cachexia
Authors: Holmes Susan
Published: May 2014

Cancer cachexia, a progressive wasting syndrome experienced by approximately 80% of patients, is characterized by loss of adipose tissue and lean body mass. This complex metabolic process reflects both reduced nutrient availability and increased nutritional demand. Though cachexia is most commonly associated with particular tumours, no patient or tumour are excluded. This article provides an overview of cachexia and its pathophysiology and the factors contributing to its development before considering its impact on individuals. Emphasis is placed on the nutritional aspects of its management.
Modernizing public health law
Authors: Griffith Richard , Tengnah Cassam
Published: May 2014

The rapid spread of a mutant strain of Escherichia coli throughout Europe highlights the need for modern and flexible public health laws to identify, control and treat infections and contamination that give significant concern for the health of the population. In this article, Richard Griffith and Cassam Tengnah outline the amendments to the Public Health (Control of Disease) Act 1984 that adopt an all-hazards approach to threats to public health.
Resuming a normal life: holistic care of the person with an ostomy
Authors: Burch Jennie
Published: May 2014

A community nurse may often encounter an ostomate (person with a stoma) but may not be regularly involved in their stoma care. This article explains the main types of stoma, stoma appliances and indications for some operations. Explanations are provided on some of the stoma appliances and accessories and when these might be useful to the community nurse and the ostomate. Stoma care is explained, including how to undertake a basic stoma appliance change. Issues that community nurses might be questioned about, such as diet and driving, are explored to assist the community nurse in providing holistic care for ostomates.
Link mentorship: improving support for pre-registration students and mentors
Authors: Gurling Jo
Published: May 2014

A very distinct policy change has, over recent years in the UK, prompted a marked cultural change and a transition of health services from the acute sector to the community setting. This transition has a direct implication for current and future pre-registration nursing students and, therefore, for the mentors who support them in community placements. This article will explore and discuss an initiative to introduce a link mentor role to support and develop mentorship within community district nurse settings in respect of adult pre-registration nursing students. The role was implemented collaboratively between a Higher Education Institution (HEI) and practice. Initially 15 community nurses undertook the role which was evaluated after 6 months. Feedback from mentors was overwhelmingly positive and plans are in place to develop the initiative further.
District nurses' use of social networking sites: caution required
Authors: Griffith Richard , Tengnah Cassam
Published: May 2014

Although an increasingly popular form of online communication and social interaction, social network sites have to be used with caution by district nurses. In common with all health professionals, the scope of a district nurse's accountability extends to their online presence, and inappropriate remarks or pictures posted online can call into question the fitness to practise of the individual. In this article, Richard Griffith and Cassam Tengnah review your accountability, as it applies to your online presence, and discuss the Nursing and Midwifery Council's new advice to nurses and midwives on acceptable use of social networks.
Working together to tackle malnutrition: a report from the Patients Association
Authors: Murphy Katherine
Published: May 2014

Malnutrition represents a significant health risk to the UK population, in particular to vulnerable patients in the community, and costs the UK economy up to £13 billion pounds per year. With the significance of the social and economic burden of malnutrition very much in mind, the Patients Association conducted a survey to ascertain the current level of patient understanding of malnutrition, and of the help and information currently available. Among the challenges to successfully addressing malnutrition are raising awareness of the condition itself, among both the public and health professionals. Family members and carers, as well as GPs, have an essential role to play in identifying those most at risk, but can not do this if they do not know the signs and symptoms of malnutrition. Once identified, patients and their carers need to be educated in terms of what constitutes good nutrition, and how to get it. They also need to be provided with up-to-date and easily accessible information on the subject. If the situation is to improve, it is essential that health professionals work closely together and with patients and carers to provide information, education and effective support: to do so will no doubt reduce the burden of malnutrition, a condition which we ignore at our peril.
Assessing and managing venous leg ulcers in the community: a review
Authors: Martin Fiona , Duffy Anita
Published: May 2014

According to the Health Service Executive, 24 000 people are currently affected by leg ulceration in Ireland. The NHS also claims that venous leg ulcers (VLUs) are not uncommon, affecting 1 in 500 people. However, VLU rates rise rapidly with age, and 1 in every 50 individuals over the age of 80 years consequently suffer. The development of leg ulcers can have a negative impact on peoples’ quality of life, and researchers maintain that leg ulcers cause a financial strain worldwide. Nurses employed in the community often practise in isolation, which may hinder their ability to access, understand and implement the most up-to-date research findings into their everyday clinical practice. This article describes the current research relating to assessing and managing VLUs in the community. A literature search was undertaken using the electronic databases CINAHL, Internurse and ProQuest. Sixteen research studies and one literature review were included, where three key themes emerged (education in VLU assessment and management, effective resource management in VLU assessment and management and the impact of VLUs on patients’ quality of life). The majority of VLUs are being managed effectively in the community; however, ongoing training is crucial to continue to improve healing rates and quality of life for individuals presenting with VLUs, and deliver high-quality, evidence-based and cost-effective care.
Does complementary therapy have a place in wound care?
Authors: Knight Susan
Published: May 2014

In general, it is accepted that chronic wounds will increase as the population becomes more obese, elderly and frail. In the UK complementary and alternative medicine (CAM) is, in the main, still on the fringe of patient treatment. The increased use of the internet and the general rise in interest in alternative health has led some patients to seek alternatives to current treatments.

Therapies used in wound care are traditional plant-based topical oils and ointments. Other herbal remedies are associated in the treatment of disease patterns and associated problems of chronic wounds. This article aims to review the current position of CAM therapies and how they may link in to patients with wounds.
Chronic oedema of the lower limb: pathophysiology and management
Authors: Newton Heather
Published: May 2014

The causes of chronic oedema are not well understood. It is therefore important that staff undertake a thorough assessment in order to plan appropriate and effective care. This article discusses the pathophysiology, prevention, assessment and management of chronic oedema in order to increase awareness of this debilitating condition.
Nutritional care and the Malnutrition Universal Screening Tool (MUST)
Authors: Parsons Emma
Published: May 2014

Malnutrition is a common and costly problem in the UK. Prevalence varies according to setting, from 5% in GP surgeries to 42% in care homes; however, malnutrition is frequently undetected. A variety of nutrition screening tools have been produced, measuring a range of nutritional parameters. Guidance from the National Institute for Health and Clinical Excellence (NICE) recommends the use of a tool such as the Malnutrition Universal Screening Tool (MUST) to screen for malnutrition risk in both hospitals and the community. This article discusses the prevalence of malnutrition according to MUST both in hospitals and the community. It also considers the association between malnutrition and deprivation, healthcare outcomes and cost, and the role of training in increasing nutritional screening use and appropriate care plans. There is a need to ensure that all people accessing healthcare services are screened for malnutrition, and that nutritional care plans and interventions are initiated, monitored and reviewed in order to improve health outcomes for malnourished people in the UK.
The role of Eclypse Adherent Sacral® in managing sacral pressure ulcers
Authors: Lloyd-Jones Menna
Published: May 2014

The cost to the NHS of treating pressure ulcers is estimated at £1.4–2.1 billion per annum ( Bennet et al, 2004 ). This does not take into consideration the cost to the patient in terms of loss of dignity and pain. It is estimated that between 4–10% of admissions to acute hospitals have pressure ulcers. The most common location for pressure ulcers is the sacrum, and the management of sacral pressure ulcers can be problematic ( Beldon, 2008 ). As a result of the location, the risk of infection from faecal matter is high. Wound infection can result in increased exudate production, and although exudate is an important factor in wound healing, excess exudate can be very problematic for both the nurses and their patients. The aim of this article is to discuss the benefit of Eclypse Adherent Sacral dressing in the management of excess exudate and dressing related pain associated with sacral pressure ulcers. As the majority of patients with pressure ulcers are elderly a suitable secondary dressing should be able to manage excess exudate be easy to apply and pain free on removal. Soft silicone technology is capable of meeting all theses challenges.
Identifying a deprivation of liberty: a guide for community nurses
Authors: Griffith Richard , Tengnah Cassam
Published: May 2014

The ability to identify situations that amount to a deprivation of liberty is crucial to a district nurse's role in protecting the vulnerable adults in their care. The courts acknowledge that the elements that have to be applied when assessing if there is a deprivation of liberty are complex and technical, so it is essential that district nurses apply the elements is a methodical manner and inform their decision-making by reference to the case law and the Mental Capacity Act 2005, Deprivation of Liberty Safeguards Code of Practice.

This article reviews the European Court of Human Rights and UK domestic case law on deprivation of liberty and highlights the elements district nurses must take notice of when identifying situations that amount to a deprivation of liberty.
Deprivation of liberty: the Mental Health Act or the Mental Capacity Act?
Authors: Griffith Richard , Tengnah Cassam
Published: May 2014

Both the Mental Health Act (1983) and the Mental Capacity Act 2005 now have provisions that authorise the care and treatment of a person in circumstances that amount to a deprivation of liberty. In accordance with the requirements of article 5 of the European Convention on Human Rights both regimes require a person to be suffering from a mental disorder before they can be subject to a deprivation of liberty.

This article rebuts the assumption that practitioners can pick and choose which method to use when authorising a deprivation of liberty. It goes on to highlight the primacy of the Mental Health Act (1983) when a deprivation of liberty is necessary to treat a mental disorder in hospital or care home.
Maintaining skin integrity in bariatric patients
Authors: Rush Anita , Muir Mary
Published: May 2014

The skin is the largest organ in the body, accounting for 16% of total body weight. Individuals who are obese face particular dermatological challenges, and health professionals working in the community setting should be alert to these risks. Skin assessment should be undertaken by a competent practitioner within a holistic framework. If assessment and treatment is not undertaken in a timely manner there is risk of tissue damage with associated cost and care implications. This article discusses aspects of skin care that apply particularly to bariatric patients, and draws on best practice guidance from the literature to help nurses ensure that the patient is appropriately managed in relation to their skin care, wound treatment and body dynamics.
Chemotherapy in the community: the importance of patient assessment
Authors: Bloomfield Jacqueline G , Tanay Mary Anne L
Published: May 2014

The use of chemotherapy has expanded considerably in the UK in recent years, with an increase of around 60% in the amount of chemotherapy delivered over a four-year period ( National Chemotherapy Advisory Group (NCAG), 2009) . This has led to an increased demand for the delivery of chemotherapy, putting pressure on existing cancer services. Combined with the current political agenda which aims to improve the convenience and experience of health for patients’ this has prompted the reorganisation of chemotherapy services, with a movement away from the delivery of chemotherapy in dedicated cancer centres to community-based models of care. This article discusses the implications of these changes for community nurses with regard to their role in the assessment of patients receiving chemotherapy.