bluuebunny/crossref_metadata_2025 huggingface dataset:
Living with postural orthostatic tachycardia syndrome
Authors: Busmer Lornar
Published: May 2014

Lorna Busmer explains how this condition has affected her daily life, and outlines some of the frustrations involved in getting a diagnosis and reducing the severity of symptoms
Managing the risk of cardiac arrhythmias in patients with worsening renal function
Authors: Elliott Kay , Bolton Amanda
Published: May 2014

This article explores key issues for management of patients with worsening renal function and cardiac arrhythmias, to enable clinicians to provide relevant support and monitoring for these relatively high-risk patients.

The implications for arrhythmia inherent to renal failure, haemodialysis and peritoneal dialysis are reviewed, as is the higher prevalence of atrial fibrillation (AF) in those with renal failure—medication and treatment options are outlined. Recommendations are given around dialysis in terms of managing fluid volumes to reduce potential complications of dialysis such as left ventricular hypertrophy, heart failure and hyper/hypotension. In terms of ICD implantation the current evidence is reviewed, along with the role of the nurse in helping patients understand the risk versus benefit of device therapy. The opportunity to work collaboratively across specialisms is recommended and discussed; this may take the form of shared decision making, agreement of optimum follow-up/ monitoring schedules and provision of education.
Rapid access chest pain clinics: putting NICE guidance into practice
Authors: Pottle Alison
Published: May 2014

Rapid access chest pain clinics (RACPC) were introduced nationally following the publication of the National Service Framework for Coronary Heart Disease in 2000. The aim is to ensure that people with new onset chest pain, thought to be angina, receive prompt treatment and investigations following evidence based guidelines. In 2010 the National Institute for Clinical Excellence (NICE) published new guidance on the assessment and diagnosis of new onset chest pain which suggested changes in how most RACPC are run. This paper presents an audit that examined putting this NICE guidance into practice and discusses various issues that arose relating to its clinical application.
Fondaparinux and acute coronary syndrome
Authors: Hamedi Nadya , Wright Paul
Published: May 2014

Fondaparinux is widely used as the anticoagulant of choice in the initial treatment of acute coronary syndrome (ACS). This uptake is largely driven on the results from a large randomized control trial which demonstrated non-inferiority with respect to ischaemic end points but a significant reduction in major bleeding events when compared to enoxaparin in the treatment of ACS. The reduction in bleeding observed is thought to lead to lower mortality rates over time. NICE guidance for the treatment of unstable angina (UA) and non-ST elevation myocardial infarction (NSTEMI) suggests that once a diagnosis of UA or NSTEMI is made, a subcutaneous dose of 2.5 mg fondaparinux should be offered (in addition to antiplatelet therapy) to those without a high bleeding risk, and continued daily for a maximum of eight days or hospital discharge if this occurs earlier. For patients where coronary angiography is planned within 24 hours, fondaparinux should be withheld and another heparin (usually unfractionated heparin) considered due to a small but significant risk of catheter related thrombus.
An introduction to fractional flow reserve
Authors: Ruchat Gillian , Bergeron Marie-Paule , Colet Julieta , Dondenaz Ellsabeth , Muller Ollvier
Published: May 2014

Fractional flow reserve (FFR) is an index derived from coronary pressure measurements to assess the functional significance of a coronary stenosis. It is performed during coronary angiography for patients with stable angina when a moderate coronary stenosis is found. The coronary pressures are measured during maximal hyperaemia, which is provoked by administering a hyperaemic drug. If the fractional flow reserve indicates that a patient does not have a haemodynamically significant stenosis there are no benefits gained from percutaneous coronary intervention (PCI).

This review discusses the principles of FFR with the aim of assisting cardiac nurses involved in the procedure by explaining nursing intervention for patient care. It also aims to help all cardiac nurses understand FFR so they can provide preprocedural explanations to patients and understand decisions made after the procedure.
Management of diabetes and acute coronary syndromes
Authors: O’Donovan Kate
Published: May 2014

Diabetes is one of the leading risk factors for the development of acute coronary syndromes with an increased inherent risk for mortality and morbidity. Rather than the classic symptom of chest pain an atypical presentation or silent ischaemia is common. This atypical presentation can be attributed to the presence of autonomic neuropathy. Glycaemic control and evidence-based treatment strategies decrease this risk. Aside from acute management once stabilised secondary prevention should be aggressive with the aim of preventing future events. Cardiovascular nurses have a central role in the acute management and secondary prevention in this patient population.
The patient pathway for mitral valve surgery
Authors: Bartley Tara
Published: May 2014

Mitral valve disease can present as mitral regurgitation or mitral stenosis, causing the valve to leak or to narrow. In extreme cases the papillary muscle can rupture and the patient presents as an acute emergency. Patients with mitral disease will develop congestive heart failure and associated arrhythmias. The condition requires pharmacological intervention for symptom control and careful monitoring to assess when surgical intervention is indicated.

Decisions regarding appropriate timing of surgical intervention should be made following discussion among the whole multidisciplinary team and patients should have the opportunity to learn about all their surgical options.

Once a decision to operate (whether repair or replacement) has been made, the patient embarks on a process of preoperative screening and assessment, which is outlined in this article together with postoperative care.
Counterpulsation in cardiogenic shock: the belief is there but where is the evidence?
Authors: Smith Duncan
Published: May 2014

In the context of acute myocardial infarction (MI) cardiogenic shock remains a serious complication associated with high mortality. European heart failure guidelines recommend the use of an intra-aortic balloon pump (IABP) as a beneficial adjunct in the supportive management of patients who develop shock following acute MI. Despite the high levels of ‘clinical belief’ in IABP therapy a review of the literature reveals a less than compelling body of evidence to support its use; specifically in reducing 30-day mortality in those treated with percutaneous intervention. Conversely, patients who have received fibrinolytic drug therapy may benefit from the ‘bridging support’ of an IABP, in the absence of immediate and definitive revascularisation.

In light of the conflicting evidence surrounding the use of IABP, attention has been drawn to the potential of left ventricular assist devices (LVAD). However, small randomised studies have yet to reveal improved 30-day mortality in patients supported with LVAD compared with IABP, in the context of cardiogenic shock.

More critical and individualised consideration is required regarding which patients may benefit from such support systems. This decision-making may be supported by prognostic biomarkers, specifically interleukin-6, which has been correlated with increased mortality in several small cohort studies. Education for nurses surrounding the holistic management of cardiogenic shock and a broader understanding of the complex sequelae is also required.
Heart failure challenges relating to age at the BSH study day
Authors: Masters Jayne
Published: May 2014

Jayne Masters reports on the British Society for Heart Failure (BSH) nurses study day, held in Glasgow on 21 March 2014
Shaping the future healthcare workforce
Authors: Bagnall Pippa
Published: May 2014

So you think the NHS has changed in the last 10 years? Read ‘The Future Healthcare Workforce’, the report of the project steering group chaired by Professor Michael Schofield of Manchester University, and you will realise that you have probably only seen the tip of the iceberg.
Screening for diabetic retinopathy in the community
Authors: Vinall Helen , Terry Anne
Published: May 2014

Diabetes affects approximately 1-2% of the population and diabetic retinopathy is now the leading cause of blindness in the 20-74 age group.

This paper outlines the various approaches that can be used to screen for diabetic retinopathy and describes an approach taken in the West Midlands to address the problem through the implementation of community diabetic eye screening. Optometrists received specific training and over 1000 patients have now been screened, with those identified as needing treatment referred to appropriate ophthalmology services.

An audit of the clinic demonstrated that optometrists are sensitive screeners of diabetic retinopathy and the project team have identified the critical managerial and operational factors for success, in this and other similar projects.
The Value for Money Unit study and the district nursing service
Authors: Rapport Frances
Published: May 2014

An emotive issue in nursing literature is the Value for Money Unit’s study ‘The Nursing Skill-Mix in the District Nursing Service’ (NHS Executive 1992). Challenged by a variety of respondents, the study is strongly denounced for its conclusions that higher-grade nurses should utilise their roles as managers of care, leaving lower grade nurses to deliver hands-on care. This paper explores the implications of the study’s conclusions, and considers the contribution nursing could make to the debate about changing professional boundaries.
Nutritional knowledge, dieting, and pattern of exercise in adolescents
Authors: Rabiee Fatemah
Published: May 2014

A survey of 625 pupils aged 14-15 years was conducted in Birmingham in 1991. The survey was part of a larger study to develop programmes for the promotion of a healthy heart in young people. Nutritional knowledge, attitude to body weight, dieting and pattern of exercise were explored.

Of the pupils studied, 7% were overweight and 1% were obese. Although more boys than girls were overweight, the proportion of girls who were currently dieting was significantly higher than boys (11% versus 2%). The proportion of girls claiming to be dieting at the time of the study, or being on a diet at some point in their life (34%), is alarmingly high. Gender, ethnic and social class differences were observed in pupil’s nutritional knowledge, dieting behaviour, body weight and pattern of exercise. Only 52% of pupils followed the recommended level of exercise.

This paper will discuss the implications of those findings for nutrition education and school health education programmes.
Home parenteral nutrition: present management, future options
Authors: Holden Christine , Brook Gill , Wills Julie , Paul Lesley , Sexton Elaine
Published: May 2014

Home parenteral nutrition (HPN) is increasingly being used for paediatric patients with intestinal failure, providing a remarkable improvement in quality of life. To enable the institution of HPN and its subsequent management these patients need to be looked after by both specialist centres and the primary care team. Information sources about this group of patients is available on a British Registry, run by the British Association for Parenteral and Enteral Nutrition. HPN is a complicated technique, which carries risks that may be life-threatening. Avoidance of complications depends primarily on the child’s management by multidisciplinary teams. Whilst families can manage this treatment at home, many psychosocial problems arise – fatigue and financial problems are common. Bowel transplantation is now recognised as an option for some children with severe irreversible gastrointestinal failure who develop complications of parenteral nutrition.
Development of the Read Code Thesaurus for community nursing
Authors: Thirkettle Barry
Published: May 2014

Paper-based documentation systems have been found to be time consuming to maintain and do not necessarily support and enhance the care provided by nurses, midwives and health visitors. There is evidence that computerised clinical information systems can improve the quality and completeness of care planning, assessments, evaluations and audits, in addition to improving resource utilisation.

An important infrastructural component of the Information Management and Technology Strategy for the NHS in England is the development of a multiprofessional national thesaurus of coded clinical terms, utilising Read Codes for use in computerised clinical information systems. The contribution made by community nurses, midwives and health visitors reflects how their work focuses on prevention, health promotion and health education, involving the whole community.

Feedback from real working implementations of the thesaurus in operational clinical information systems is required in order to fully evaluate its comprehensiveness and usability.
Sexual health promotion general practice
Authors: Dilloway Mark , Hildyard Sarah
Published: May 2014

This paper is the first in a series relating to the Sex and Health Project in East London. The work presented here is concerned with the basis of sexual health promotion and the objectives of the project. A semi–qualitative study of general practitioners (GPs) has identified a number of specific barriers to the promotion of sexual health, including prejudice, ignorance of patients’ sexual histories, problems of transcultural working and the need for protected time. This component of the project has provided evidence that GPs alone cannot provide effective sexual health promotion and that multidisciplinary working practices are necessary.
Greedy institutions
Authors: Bamford Margaret
Published: May 2014

I have recently been reading a book with this title; an interesting read which prompted me to think of different examples. During my career I have seen and worked in many greedy institutions or organisations. This book covered examples of greedy institutions from ‘The Political Functions of Eunuchism’ to ‘The Royal Mistress as an Instrument of Rule’, through to ‘The House Wife and her Greedy Family’ (Coser 1974). The book is divided into three categories: serving the ruler, serving the family and serving the collective.
A student's of view of creative partnership in action
Authors: Kent Michele
Published: May 2014

The aim of this paper is to bring a student's perspective to the discussion paper presented by MacLellan in the British Journal of Community Health Nursing (1996:8) and illuminate the issues that the assessment process, by means of a specialist practice profile, has raised for me as a student on the BSc (Hons) course in community nursing.

This reflection will be personal, although some aspects may be shared by the peer group. It will also be formative, as any summative evaluation can only take place after July when the degree programme is complete. Also, since one of the factors determining the development of the assessment tool was given in the article as, ‘a plea from service managers that graduates should be ‘fit for purpose’ that is, ready to function as community nurses’ any evaluation programme would have to assess whether this outcome has been achieved.
Time for reflection
Authors: Allen Mark
Published: May 2014

The first year anniversary of the launch of British Journal of Community Health Nursing coincided with the Labour Party victory in the May general election and a new government in power after 18 years of Conservative rule. Time perhaps to provide a progress report of the first 12 months of this journal and to also look at the aspirations of the government regarding health care and, in particular primary care, and to see if these aims coincide with those of this journal.
Nursing a dream: How The Queen’s Nursing Institute Award Scheme is helping nurses turn that dream to a reality
Authors: Daniel Karen
Published: May 2014

Six years ago, the staff and members of the Queen’s Nursing Institute (QNI) sat down to assess how the organisation could influence and contribute to the development of primary health care.
Anatomy and physiology of pain
Authors: Dobson Fiona
Published: May 2014

Community nurses have a pivotal role to play in managing pain. Sound knowledge of nervous system structures and physiological mechanisms involved in the perception, transmission and interpretation of pain signals, provides an important background to the decision-making processes underpinning effective pain treatment.

Traditional explanations of the mechanisms involved in pain perception focus on a ìhard-wiredî system of specific pain receptors, connecting nerve pathways and centres of interpretation in the thalamus and somatosensory cortex. Whilst this approach offers helpful insights into the subject, recent scientific advances have served to expand and clarify many, previously inadequately explained, aspects of pain perception. Better understanding of primary and secondary hyperalgesia, ìwind-upî and central sensitisation has encouraged the use of pre-emptive balanced analgesic techniques, whilst identification of a whole host of neurochemical transmitters and modulators has potentiated the search for new analgesic agents.

Traditional and current explanations of pain perception can enhance community nursesí understanding of acute and persistent pain problems and illustrate how to select pain therapies according to the underlying pathophysiology.
The use of syringe drivers & Hickman lines in the community
Authors: Smith Elaine Coleridge
Published: May 2014

Caring for patients with life threatening illnesses places great demands on both health care professionals and family members. Community nurses in particular will find themselves caring for these patients while they remain in the community. During this time these patients may be receiving drugs via a syringe or Hickman line.

The holistic and family focussed nature of community nursing means that psychological and social implications of the use of such devices can be taken into account, as well as the technical skills necessary to operate and maintain them.
Community nurses and IT: harnessing the potential
Authors: Bagnall Pippa
Published: May 2014

Twenty years ago, the idea of pushing a piece of plastic into a machine and getting cash out any time, day or night, was still a novelty. Nowadays, we think nothing of handing over our reward card at Sainsbury’s, collecting points and giving away all sorts of information on our shopping habits - from our favourite washing powder to how many bottles of wine we get through a week.
Developing databases to inform service delivery
Authors: Dilloway Mark
Published: May 2014

Databases offer healthcare professionals at all levels the opportunity of collecting robust data that can inform service development through audit and the commissioning process.

Using diabetes as an example, this paper shows how a simple database can be developed and used to collect robust data for the development of services. Taking a random sample of 256 patients attending a weekly diabetes clinic, the data show the distribution of the patients by district of residence and their treatment.

These databases benefit from clinical input at the development stage and can be designed to assess adherence to clinical guidelines, process audit and produce information to influence the commissioning process, either with GP fundholder or GP commissioning groups. In addition, they can be used to inform continuing professional development activities.

The approach outlined here is a generic one and can be applied to most clinical situations.
“A hospital treats patients. It does not provide care”
Authors: Dimond Bridgit
Published: May 2014

The title of this editorial is a quotation taken from the distressing book by Joan Brady Death Comes For Peter Pan (1996). In it she traces the last months of the life of Peter who becomes the victim of the business centred American health care system with its rules for length of stay, demarcation between hospital, nursing home and hospice care and the desperate determination of his wife, Alice to obtain the treatment, care and support which he needs. It is written in the form of a novel, because Brady was unable to obtain the support necessary to publish it as a non-fictional account of what was taking place. She points out in an afterword that there are signs that the UK is going the same way. For example, the UK guidelines published in August 1994 allow hospitals to evict patients to nursing homes, using ‘a largely meaningless and easily manipulated distinction between treatment and care.’
Screening and management of diabetes discovered during pregnancy
Authors: Hill Caron E
Published: May 2014

Diabetes discovered during pregnancy, or gestational diabetes mellitus (GDM), requires strict control and close monitoring to ensure a normal outcome. Diagnosis in groups of women who are ‘at risk’ is important. This is particularly relevant if pregnant women are considering shared care with their primary care team. Who should be screened, when and how, has been a much debated question. Practice nurses and midwives play an important role in the screening process, and should be aware of the features of ‘at risk’ women. At risk factors include obesity, previous large baby, family history of diabetes mellitus (DM), older women, certain ethnic groups and a previous adverse obstetric outcome. Combined obstetric and diabetes management provides the most effective means of controlling blood glucose levels, and therefore the best outcome of pregnancy. Follow up of these women by the primary care team is recommended because there is an increased risk of established diabetes mellitus developing later in life.
Emergency admission of elderly people: a social care problem?
Authors: Phelps Kay , Shepperdson Billie
Published: May 2014

Health professionals in the NHS may overestimate the influence of social factors on the emergency admissions of elderly people to the acute sector and, consequently, they may be too optimistic about the ability of social care services to prevent such admissions. In this study, general questioning of health professionals revealed that, in their opinion, social factors often influence the decision to admit an elderly person to hospital. However, when the same professionals were asked about actual patients who had been admitted as emergencies the data showed that in practice this is not the case, i.e. most patients were considered to need medical and/or nursing care. Consequently, improving community nursing and medical services for elderly people rather than social care services may be a more effective way of reducing emergency admissions to acute hospitals.
Mental health and physical illness in older people
Authors: Armstrong Elizabeth
Published: May 2014

Older people are acknowledged as being high users of health care and social services. Older people with physical health problems are more than twice as likely as people who are physically healthy to suffer a depressive illness. Nevertheless, most elderly people do not suffer from depression and it is not an inevitable consequence of being old and physically disabled or ill. Depression at any age whether in the presence of other illness or not is a highly treatable illness; treating it effectively will improve the level of functioning and the quality of life for both patients and carers. Community nurses provide a good deal of what may be termed supportive care for people with mental health problems, however, they may be ill prepared by their training to provide this care in the best possible way. This article examines the facts about mental ill-health in older people and points to some of the ways in which generalist community nurses, practice nurses, health visitors and district nurses may be able to improve their practice with this important and potentially vulnerable group.
Diabetes care in the community: dietary advice for the late 1990s
Authors: Aitken Gillian
Published: May 2014

Diabetes mellitus is a chronic condition which is increasing in incidence. Dietary management is central to good blood glucose control. Recent dietary guidelines from the British Diabetic Association reflect current healthy eating guidelines for the general population. It is recognized that carbohydrate containing foods have varying effects on blood glucose levels. The concept of the glycaemic index is discussed and suggestions for its practical application are made. Good dietary advice should take into account all aspects of the diet including the individual circumstances of the person at whom the advice is aimed. Nurses have an important role to play in the management of the person with diabetes and it is the responsibility of each nurse to ensure that his/her knowledge is up to date.
The challenge of leadership in community health care nursing
Authors: DeBell Diane
Published: May 2014

Community nurses have been presented with a unique window of opportunity thanks to the combination of new legislation in the NHS (Primary Care) Act, the government white paper published in December of last year (The New NHS - modern and dependable), and the January green paper which shifts the focus of public health issues to an emphasis on health improvement programmes based within the community. The question, however, is how community nurse leaders will respond to the opportunities available.
User views of the district nursing service
Authors: Cusick Karen
Published: May 2014

The aim of this exploratory study was to obtain user views of the district nursing service within the city of Sheffield. A postal questionnaire was devised and distributed by the author to 515 previous service users on a city wide basis. A combination of 'open' and 'fixed choice' questions were used to identify user perceived strengths and weaknesses within the service and suggested changes for improvement. The responses indicated most patients were happy with the service which they found friendly, caring and flexible engendering confidence within the patient and their families. However, dissatisfaction was expressed in particular regarding an uncertainty of visit times, a perception that services were more service rather than patient led and the existence of barriers to service accessibility. Service evaluation should focus on areas of improvement to be useful and responsive to clients' views, therefore the conclusion will focus on service development and potential areas for change.
Depression and the primary health care team
Authors: Ford Kelvin , Rigby Paul
Published: May 2014

Depression is one of the most common single reasons for visiting the GP and the majority of individuals who receive treatment do so in the primary care setting (Goldberg and Huxley, 1991). Indeed, it is estimated that one in ten attenders at the GP surgery will meet the diagnostic criteria for a depressive disorder (Hunter, 1994), and as relatively few people with depression are referred to mental health services, consequently, it is primary health care workers, who will most frequently encounter the illness. There is however, some evidence to suggest that GP's alone detect only half of all major depressive disorders presented to them and therefore miss the opportunity to offer therapeutic interventions (Tylee et al, 1993). This article describes depressive disorder, discusses the recognition, management and treatment of the illness in primary health care settings, and the implications that this has for the education and training of primary health care workers.
Communication issues in diabetes care
Authors: Pattersone Ruth
Published: May 2014

With the increasing prevalence of diabetes, and the direct and indirect cost to the individual with diabetes having a profound effect on society, the challenge for managers and health care workers has never been greater. To meet the goals and targets of the St Vincent Declaration, diabetes education to empower the patient/client is the key to the prevention and treatment of diabetes. With the government focus now on primary care, it is important to have a well structured programme of care embracing both primary and secondary care. Communication and collaboration within the multi-disciplinary team is fundamental to provide a more effective and integrated diabetes service. In this paper communication issues will be discussed and the importance of this subject will be illustrated using two case studies.
Dementia: the difficulties experienced by carers
Authors: Challenger Jayne , Hardy Billy
Published: May 2014

This article examines some of the difficulties experienced when caring for people with dementia in the community. Family carers play an important role in the provision of care for this client group. In the UK millions of people are currently caring for a relative in the community (Nolan, 1992). Caring for people suffering from mental illness requires the ongoing and continuous support of family and relatives. Community psychiatric nurses (CPNs) like many other community nurses, are often reliant on family carers to support and care for their relatives at home. However, caring for a relative is not without its difficulties and the changes that occur as a result of a family member developing dementia place new and unexpected demands on relatives and close family members. The role of the CPN is considered as CPNs frequently become involved in complex family relationships and often help to facilitate the caring relationship.
Zacin: a new topical analgesic cream
Authors: Lithbridge Zena
Published: May 2014

Zacin is the brand name of a new topical analgesic cream produced by Bioglan Laboratories. Its active ingredient is capsaicin, a naturally occurring alkaloid purified 1000–fold from red chilli peppers. This article discusses its use in the treatment of joint pain which is directly attributable to osteoarthritis.
Consultation on a strategy for nursing
Authors: Bagnall Pippa
Published: May 2014

The Government, in its recent White Paper The New NHS: Modern, Dependable, announced the forthcoming consultation on the development of a strategy for nursing and stated that NHS trusts would be expected to strengthen the contribution made by nursing (Department of Health (DoH), 1997). As part of this process, the Chief Nursing Officer, Yvonne Moores, has issued a new consultation document entitled A Consultation on a Strategy for Nursing, Midwifery and Health Visiting (NHS Executive, 1998).
Under-nutrition in older adults living in the community
Authors: McLaren SG
Published: May 2014

Recent evidence concerning the prevalence of under-nutrition in older adults living in the community is lacking, but values of 5–12% have been reported across the UK, with wide regional variations exceeding this. Under-nutrition is associated with increased risks of morbidity and mortality following illness. Ageing, poverty, social isolation, depression, specific chronic diseases and the side-effects of drugs or other treatments are known to contribute to the risk. Conversely, under-nutrition can contribute to the development of chronic health problems. Screening and assessment are vital for early identification of at-risk individuals, so that nutritional support can be provided to improve client outcomes. Nutrition support teams, social services and voluntary organizations also play a crucial role in the prevention and treatment of under-nutrition.
New recommendations for eldelry care provisions
Authors: While Alison
Published: May 2014

The plight of the forgotten elderly seems to be of no great concern and yet surely we have a duty to care for this generation who has reared us or our parents. The NHS and Community Care Act 1992 was heralded as the panacea which would overcome fragmentation and ensure effective case management. However, the reality has turned out rather differently with ongoing confusion concerning what constitutes social care vs what situations and cases warrant health care. Many questions regarding care of the elderly remain unanswered, i.e. with whom or to which organization does the responsibility for care provision rest?
Sun awareness for children: be cool — know the rules
Authors: Burgess Linda
Published: May 2014

Of the two types of skin cancer, malignant melanoma is the most dangerous and the incidence appears to be doubling every 10–15 years (Katsambas and Nicholaidou, 1996). Twenty per cent of those diagnosed as having malignant melanoma will eventually die. Statistics such as these highlight the importance of raising awareness about the harmful effects that sun exposure has on the skin. The factors associated with increasing the risk of developing malignant melanoma are discussed. This article also examines strategies that can be implemented to help prevent this disease occurring. Children appear to be a particularly vulnerable group within society; however, health educators can promote positive behaviours through education and by developing an awareness of how individuals can adopt a change in behaviour. This article details a newly devised teaching resource, and early evaluation of the project has been encouraging.
The palliative care needs of people with learning disabilities
Authors: Read Sue
Published: May 2014

This article examines many of the issues and difficulties associated with caring for people with learning disabilities who require palliative intervention. Providing palliative care for this client group is both complex and challenging for all those involved in the patient's care. The Composite Model of palliative care is outlined and the needs of the person with a learning disability, those of the carer and the family are discussed. Finally, recommendations are made to help health professionals address the challenges posed by this client group and to assist them in providing more effective care for people with a learning disability who require palliative care.
The rationale behind the selection of ear syringing equipment
Authors: Kent Michele Anne
Published: May 2014

There is an apparent lack of conformity in the practice of ear syringing. Community nurses are divided in their use of ear syringing equipment, i.e. metal syringes or electric irrigators. This article details the results of a survey undertaken to ascertain how many and how frequently community nurses perform this procedure. The study aimed to establish the diversity of the approaches used and explored some of the reasons that determine the use of equipment. One of the main aims of the study was to establish how competent nurses perceive themselves to be in carrying out ear syringing. A further aim was to establish the unmet training needs of nurses. Ear syringing is an under-researched and pertinent area for community nurses. This study showed that 90% of the 80 nurses in this sample currently carry out ear syringing. Sixty per cent of these nurses indicated that they would like further training in this area. It would appear from this study that nurses do not base their practice on the literature available and the need for further scientific research on the safety and comfort of current practice is highlighted. The value of this procedure in current nursing practice is not, however, examined in this article.
A ‘Modern and Dependable’ NHS needs nurses
Authors: While Alison
Published: May 2014

The staffing crisis facing the NHS is at last being recognized. However, the surprise announcement of a new breed of ‘super’ nurse, namely, the nurse consultant was as unexpected as it is unnecessary if reports are to be believed. More importantly, the current staffing crisis will require a sound strategy to bring about a resolution rather than rhetoric, however, well meaning.
Managing change in the community 1: the case of PCGs
Authors: Parkin Paul
Published: May 2014

The government's White Paper The New NHS; Modern, Dependable (Department of Health, 1997) proposes a major change in the way primary care is organized and managed through the development of primary care groups (PCGs). It emphasizes that community nurses and GPs should work in partnership and play a lead role in both the strategic and operational levels of PCGs. Significant strategic change such as this can be a dynamic force for innovative and cooperative developments which enhance the community's health but it also threatens core occupational beliefs and values especially within multidisciplinary groups. Such threats to professional territories can create barriers to successful change as political manoeuvres and power relations are employed which aim to dominate the change agenda. This article discusses the major influencing factors in the change process and proposes models of implementation. It emphasizes that although participation and involvement of all parties is required for a successful outcome, this represents a significant challenge for community nurses to act as partners because of nursing's historical and enduring subordinate relationship with the medical profession.
Legal issues arising in community nursing 2: registered homes
Authors: Dimond Bridgit
Published: May 2014

Community nurses working for Roger Park Community NHS Trust were aware that their workload was increasing because of the fact that many residents who had been placed in residential care homes required more intensive nursing than was appropriate. Some residents required several visits a day. Had they been placed in nursing homes, then staff in the home would have been attending to their nursing needs. What action can the community nurses take?
Care provision for elderly people in the independent sector
Authors: Fox Robert D
Published: May 2014

Since the mid 1980s, there has been a proliferation of nursing home beds for elderly people and from 1993 the provision of long-term care has moved rapidly, and almost entirely, from the NHS to the independent sector. This shift, brought about to reduce expenditure, occurred at a time when the number of registered nurses was declining as a result of reduced entrants into training and an increased drop-out rate from the profession. More older people are now living longer and may have greater disabilities and therefore the needs of this client group have increased. People who would previously have been cared for in long-stay hospitals are now accommodated in nursing homes having access to NHS services through their GPs. Statutory regulation of nursing and residential homes has historically focused on inputs, and little attention has been given to outcomes or good nursing practices (RCN, 1996a). A major challenge currently facing qualified nurses is how to maintain high quality professional care to increasing numbers of older people at a time when the supply of nurses is decreasing. The Registered Homes Act 1984 legislates specifically for residential and nursing homes, but is now 14 years old and has a number of limitations. Modification of such statutory controls is long overdue.
Is there a case for euthanasia in palliative care?
Authors: Goodman Margaret L
Published: May 2014

Healthcare professionals working in palliative care may be increasingly confronted with requests for euthanasia from patients, their relatives and friends. Euthanasia is a complex and emotive subject and difficulties arise for those working in palliative care particularly when a request for euthanasia is viewed as a failure on the part of carers. Palliative care aims to relieve distress and suffering but problems may arise from unrealistic expectations of what can be achieved. It is argued that euthanasia is not a morally acceptable way to alleviate suffering in terminally ill patients and that providing knowledgeable, patient-focused and sensitive palliative care while acknowledging the limitations can offer a viable alternative.
Qbitus Products: a range of pressure-relieving and postural aids
Authors: Moody Marion
Published: May 2014

Pressure ulcer prevention and management continue to be a major challenge for healthcare professionals. The problem is frequently compounded by a lack of access to appropriate resources, especially for those caring for patients in their own homes or in residential and nursing homes (Moody, 1998). Qbitus Products comprise a comprehensive range of static, pressure-relieving and postural control cushioning which is available at reasonable cost. Qbitus has the ability to produce virtually anything possible in foam, from sketches or drawings, to meet a specific patient care request. The production facilities enable the company to provide a rapid customer-focused service that includes the provision of additional covers in a wide range of materials and colours, as well as a range of special purpose control aids designed for comfort and support such as harnesses.
Adopting a positive approach to urinary continence
Authors: Booth Frank
Published: May 2014

Many people suffer from urinary incontinence and associated social and psychological problems, which may have detrimental effects on their self-esteem and quality of life, preventing some from leading a normal and healthy lifestyle. By adopting a positive approach to continence promotion, awareness, education and training many of these problems can be appropriately treated and/or cured. This article discusses ways in which health professionals can promote such an approach by raising general awareness, providing continence services and by acknowledging the very real possibility of cure. An increased awareness of the issues surrounding continence may encourage clients who were previously too embarrassed or afraid to overcome these feelings and seek the clinical support and help they need to manage their problems of incontinence.
Managing change in the community 2: partnership in PCGs
Authors: Parkin Paul
Published: May 2014

In order to successfully achieve the changes proposed for primary health care in the ‘new NHS’ (Department of Health, 1997) implementation papers from the NHS Executive have emphasized the need for all interested groups to work under a duty and spirit of partnership. The term ‘partnership’ has had limited definition in the literature and it is argued that as a concept it is more determined and compelling than ‘participation’ and is significantly stronger, linguistically, than the usual terms of ‘collaboration’ and ‘team working’. The arena of primary health care is an ideal medium for participation and partnership between health professionals with the overall aim of improving the health of the community. Historically, however, research shows that GPs, community nurses and social services have not achieved the levels of joint working required. If the apotheosis of partnership, seen as shared corporate governance, is to be achieved, health professionals working in primary care need to re-examine their fundamental beliefs and values of shared and integrated care. The concept of partnership is examined and strategies and mechanisms for working in partnership are suggested.
The management of chronic adult asthma in the community
Authors: Leyshon Jane C
Published: May 2014

Asthma currently affects at least 1.9 million adults in the UK and despite recent advances still continues to result in a heavy burden of morbidity (National Asthma Campaign, 1998). The majority of people with asthma receive all their care in the community from members of the primary health care team (PHCT). Even though in many general practices nurses with appropriate training have largely taken on the routine management of asthma, it is essential that all members of the PHCT remain up to date if patients are to receive consistent care. This article provides an overview of current recommended practice for the management of chronic adult asthma. This should enable health professionals who come into contact with patients with asthma during the course of their work to reinforce educational messages, identify potential problems and refer to more specialist support where appropriate.
Lessons from the Stephen Lawrence Inquiry
Authors: While Alison
Published: May 2014

The NHS was established to meet the health needs of a fairly homogenous population but much has changed since the end of World War II. Britain is now a multicultural society with 6% (3.4 million) of the total household population in 1996/97 belonging to an ethnic minority group (Office for National Statistics, 1998). The NHS must change to reflect the reality of the society it serves. In this context, the death of Stephen Lawrence and the subsequent Inquiry (Home Office, 1999) has lessons for everyone. The great danger is that the Inquiry is seen as only reflecting issues of pertinence to the police rather than British society and its institutions as a whole.
Treatment of deep vein thrombosis in the community
Authors: Harber Jan
Published: May 2014

Deep vein thrombosis (DVT), which affects approximately one person in every thousand in the UK, is a painful condition that can lead to life-threatening complications such as a pulmonary embolism. DVTs are usually treated with continuous intravenous infusion of unfractionated heparin which necessitates hospital admission for 7–14 days before discharge on oral anticoagulant therapy. The development of low molecular weight heparin which can be given in a weight-related dose as a subcutaneous injection once or twice daily has meant that patients can now be treated as outpatients. There is pressure on service providers in an increasingly cost-conscious NHS to look for ways of saving bed days. The Royal Surrey County Hospital developed a protocol for community management of patients with DVT, which was introduced in March 1998. An audit undertaken on the 60 patients treated using this protocol at the end of a 6–month trial demonstrated not only a saving of two beds per day but also high levels of patient satisfaction.
Professional attitudes towards parent-held child health records
Authors: Davies Alyson
Published: May 2014

This article, the second in a two-part series (Davies, 1999), describes the qualitative component of an investigative survey carried out to assess the attitudes of GPs, health visitors and community medical officers regarding the introduction of parent-held child health records. Parent-held child health records were introduced to children, parents and professionals in two general practices in Pembrokeshire. One hundred children were involved in the study. Parents and professionals were instructed to use the record whenever they had contact with each other. Professional attitudes were assessed through semi-structured interviews. The data revealed that while there were several common areas of concern, the majority of professionals were in favour of permanently introducing the record following further training. The record was viewed as a positive innovation in promoting mutual respect and trust in the professional–parent dyad.
Foot care in diabetes: developing the role of community nurses
Authors: Spencer Sue
Published: May 2014

Foot ulceration in patients with diabetes is a major cause of morbidity and mortality. The aim of this article is to inform readers of the major causes of foot ulceration in people with diabetes and to explore the role of community nurses in the assessment, treatment and prevention of foot problems in diabetes. It is argued that with the recent development of primary care groups, community nurses are well placed to become more proactive in the provision and commissioning of services for this group of patients.