bluuebunny/crossref_metadata_2025 huggingface dataset:
Attracting and retaining nurses in primary care
Authors: Drennan Vari , Andrews Sarah , Sidhu Rajinder , Peacock Richard
Published: May 2014

There is increasing demand for nurses to work in primary care. This is driven in part by the need to retain current levels but also by the modernisation plans for primary care services, which require new roles for nurses, new ways of working and more nurses in primary care settings. While campaigns for increased recruitment of hospital nurses and doctors has been largely successful in recent years, primary care has still to see the impact. This article reports on a Department of Health (England) funded project that aimed to identify strategies and exemplars to assist primary care trusts (PCTs) and the workforce development confederations (WDCs) in strategic health authorities in attracting and retaining nurses to primary care at registered nurse level. It reports on the range of initiatives identified, the perceived benefits and challenges. It concludes by proposing a strategic model for planning for the recruitment and retention of primary care nurses.
New, improved Kerraboot: a tool for leg ulcer healing
Authors: Harvey Dee
Published: May 2014

Lower limb ulcers can be debilitating to the individual affected, and are costly for the NHS to treat. The aim of treatment is to address the underlying pathology that caused the ulcer, and to create a warm, moist wound environment that promotes wound healing. This article discusses the improved Kerraboot®, which effectively draws excess moisture away from the wound, but also keeps the wound warm, moist and clean. Although evidence of cost-effectiveness has yet to be collected, anecdotal reports suggest that the device heals wounds quickly and reduces input from health professionals.
Evaluation of the NMC community specialist practitioner award
Authors: Chambers Claire , Goodman-Brown Jane , Horn Sue , Ryder Elaine
Published: May 2014

This paper discusses the evaluation of the NMC community specialist practitioner (CSP) programme over a period of four years. The purpose of the evaluation was to assess if the programme produced practitioners who were fit for purpose and fit for practice as well as assessing whether they were supported in their new roles. The evaluation took place eight months after qualification at a workshop where the practitioners discussed their experiences in focus groups. The evaluation is presented using Kirkpatrick’s model and the results indicate the importance of collaboration between HEI’s and their sponsors in meeting students needs. Issues about support and work life balance are also highlighted as areas that were addressed as a result of the evaluation. Continued development of the programme through collaboration is desirable to produce effective practitioners who are able to function in the changing primary care arena.
The complexities of managing breast oedema
Authors: Linnitt Nina Linnitt , Young Helen
Published: May 2014

This article looks at the problems surrounding breast oedema and the complexities that surround this condition. The psychological impact, the distress that it causes, and the absolute need for appropriate referral to a specialist centre when it is diagnosed. There is a case study within this article which clearly identifies how painful the condition is, and how after conservative intervention, the patient feels relief and can resume living again.
Pain in older adults should not be seen as part of ageing
Authors: Cann Paul
Published: May 2014

A life in pain is something no one should have to face but a new report from Help the Aged shows how many older people are doing just that. Giving dignified, high quality care should be the first priority of all working in the care sector. The role pain management plays in delivering this goal is essential.
PCT suffer the death of 1000 cuts
Authors: Pollard Tom
Published: May 2014

The BBC Radio 4 Today programme has recently run a series of reports looking at where all the money that has been pumped into the health service since 2000 has gone, and whether we have better health, and a better health service, as a result. One report looked at the thorny question of PCT finances in a period of constant reorganization.
Review of standard precautions and sharps management in the community
Authors: Cutter Jayne , Gammon John
Published: May 2014

Standard precautions are imperative for staff and patient safety and provide a basis for sound infection control practice in all health-care settings. One key element of these precautions relates to the safe handling and management of sharps to prevent occupational acquisition of blood-borne viral infection. Many inoculation injuries could be avoided by following standard precautions whenever contact with blood or body fluids is anticipated. However, evidence suggests that compliance with standard precautions is inadequate. With the modernization of the health service in the UK, community health care is becoming more complex, potentially increasing the risk of inoculation injury to community nurses. Although compliance with standard precautions in hospitals is well documented, there is limited research specific to community nurses. This review examines compliance with standard precautions by community nurses and discusses some strategies aimed at improving compliance with one of the key elements of standard precautions, i.e. sharps management.
The new Queen’s Nurse: aims and benefits
Authors: Cook Rosemary
Published: May 2014

The Queen’s Nursing Institute (QNI) announced the re-instatement of the title of Queen’s Nurse in January 2007, nearly 40 years after it was last awarded to nurses who trained at the Institute. This article explains why we chose to take this step, and what is involved in becoming a new Queen’s Nurse.
Stepping off the roller-coaster
Authors: Pollard Tom
Published: May 2014

I hope you’ll indulge me a little as you read this. This is my last issue as editor of the BJCN, as I am handing the reins to Jonathan Dawes. In fact Jonathan has done most of the work on this issue, and I’m just stepping on stage for my swan-song.
Can primary care identify an ‘at risk’ group in the older population
Authors: Drennan Vari , Iliffe Steve , See Tai Sharon , Lenihan Penny , Deave Toity
Published: May 2014

The promotion of health and independence for older people through preventative strategies is rising up the public health agenda in many countries and has been made a government policy objective in the UK. Despite forty years of experimentation, community nursing and general practice involvement in this field has been characterized by a lack of evidence to support broad screening and surveillance programmes and a failure to reach consensus on the most effective approaches to health promotion in later life. One initiative brought together community nursing, general practice and the voluntary social welfare sector in an inner urban setting to proactively identify and address unmet need and promote health through short term case management in an older population. This paper reports on the ability of the primary care teams to identify ‘at risk’ groups in the older population, which can then be targeted for comprehensive assessment.
The use of a clinical algorithm for urinary catheterization
Authors: Booth Frank , Clarkson Melanie
Published: May 2014

Urinary catheterization is undertaken for a number of clinical conditions. Debate continues as to whether clinicians use catheters appropriately following thorough assessment or if they sometimes catheterize as it makes for easier clinical management. This article looks at the nursing process concerning safe and clinically relevant catheterization. PCTs have local algorithms for effective catheterization, an example of which is given here. Mention is made to the correct catheterization technique, with a look at commonly available catheter types.
Older people’s access to goods, facilities and services
Authors: Jopling Kate
Published: May 2014

This article, brought to you in association with Help the Aged, highlights the problem of older people’s access to goods, facilities and services and looks at how age discrimination impacts on it.
Depression and older people: securing wellbeing in later life
Authors: Swan Amy
Published: May 2014

This article, brought to you in association with Help the Aged, looks at the factors that can contribute to depression in older people and highlights the information available from the Charity.
Developing a career pathway within community nursing
Authors: Roberts Sally , Kelly Chris
Published: May 2014

There has been much anxiety regarding the levels of competence and confidence of newly qualified nurses. This article will describe the developments within one primary care trust of newly qualified student nurses through to the development of a robust career pathway. Within this PCT previous recruitment into community nursing posts had been unpredictable and some newly qualified nurses had found the transition from pre-registration to qualified nurse within primary care very difficult, often choosing to pursue an alternative career pathway. This resulted in a high turn over of staff. It therefore became imperative that the organization reviewed not only its placement experience but ensured a robust comprehensive career pathway that supported and mapped out for nurses the clinical experience they could expect and support continuing professional development.
Dignity starts at home
Authors: Dawes Jonathan
Published: May 2014

This month the Observer has launched its Dignity at Home Campaign in response to the alarming rationing that is taking place across the social-care sector. With an increase in the older population, coupled with marching advances of modern medicine, people are living longer and the requirement for care provision has skyrocketed.
Infection control: worlds apart primary and secondary care
Authors: Cole Mark
Published: May 2014

Healthcare associated infection continues to be a major cause of morbidity and mortality in healthcare. The fact that most of what has been written on the subject of infection control and prevention relates to the hospital setting is perhaps understandable given the proximity and immune status of patients in secondary care. However, the change of term from hospital acquired infection to healthcare associated infection acknowledges that a similar burden may exist in community settings. Influential reports suggest that community infection control is ill defined and there is ongoing debate whether community based infection control nursing involves the same or different approaches to hospital infection nursing. This paper explores some of the differences between infection control practice in primary and secondary care and examines the reasons for this.
Urinary catheterization: selection and clinical management
Authors: Pomfret Ian
Published: May 2014

Urinary catheterization is a common medico-nursing procedure in both acute and primary care. There is a variety of catheters and associated equipment available on prescription in the UK, how do nurses and other healthcare staff ensure that patients are able to access the most appropriate products for their individual needs?

This article will look at the common reasons for catheterization and the rationale for the selection procedures in selecting the optimum method of catheterization, equipment selection and management options to ensure best practice for patient care.

Different methods of catheterization, intermittent and indwelling, both urethral and suprapubic, will be considered in regard to preventing infection and providing optimum catheter management.
Managing a common dermatological problem: incontinence dermatitis
Authors: Nazarko Linda
Published: May 2014

Incontinence dermatitis is an under-recognized and under-researched problem that mostly affects older people who have continence problems. Nurses who are aware of the risk factors can provide care that reduces the risk of this distressing problem. If incontinence dermatitis occurs evidence-based care can be used to treat the person and reduce the risks of further complications.
Making the most of good medicines management
Authors: While Alison
Published: May 2014

The growing population of older people coupled with ever improving therapeutic regimens pose real challenges for effective medicine management. Good medicine management is important for several reasons including the avoidance of iatrogenic disease and its toll upon individuals and healthcare budgets. The NSF for Older People (Dept of Health, 2001) acknowledged that the rise in co-morbidity with increasing age, in addition to inevitable cognitive and physical problems, predispose older people to medicine mismanagement. Indeed, Standards 2, 4, 5 and 6 relate to different aspects of medicine management in older people and resulted in the management of medicines document (Dept of Health, 2004) which is a useful resource for practitioners especially regarding the development of concordant partnerships.
The Leg Club model in the Australian context
Authors: Gibb Michelle
Published: May 2014

Leg Clubs are an innovative approach to the holistic treatment of leg ulcers. They are run in a social context by community nurses who deliver ongoing support and treatment for a wide spectrum of lower limb pathology. This article looks at how the Leg Club model has been established in Australia.
The hidden epidemic
Authors: Moffatt Christine
Published: May 2014

Over the last few years awareness of the hidden epidemic of lymphoedema/chronic oedema has begun to emerge. We now can estimate that there are at least as many patients with this condition as there are leg ulcer patients. Some of the most complex and challenging patients are treated in their homes by district nurses. They face daily visits to control the leakage from the patients’ legs and prevent tissue breakdown. The impact on the patients’ quality of life is high, leading to social isolation, depression and loss of role. District nurses report the burden they feel in treating these patients as many continue to deteriorate.
Understanding overgranulation in tissue viability practice
Authors: Hampton Sylvie
Published: May 2014

Overgranulation is a difficult condition to deal with and is thought to be due to possible infection or to use of occlusive dressings. The overgranulating tissue can be soft and oedematous with a shiny appearance. The fastest route to treatment (steroids or silver nitrate) may be aggressive and should be used sparingly (if at all). This article provides an outline of the process of tissue overgranulation in wounds and its appropriate clinical management.
Best practice in managing scrotal lymphoedema
Authors: Whitaker Justine
Published: May 2014

Managing lymphoedema of the male genitals is challenging, distressing and potentially life-threatening if not managed appropriately. Consideration is made of the classification, clinical presentation, lymphatic anatomy and management of genital lymphoedema in clinical practice. The article addresses the issues raised when caring for patients suffering from this condition. A case history demonstrates the use of a novel innovation. The Whitaker Pouch, which can relieve and manage symptoms facilitating self-management and appropriate best practice.
The evolving role of the community nurse specialist in palliative care
Authors: Husband Jacqueline
Published: May 2014

The community clinical nurse specialist in palliative care role has evolved in an uncoordinated manner resulting in a variety of grades of nurse with differing role expectations. In general the CNS role consists of a clinical, educational, strategic and managerial remit. The reality of working with such a diverse role creates tension and conflict for the CNS between personal, organization and practical expectations. Despite this the community palliative care CNS is central to the future development of palliative care services in the community generating a culture of sharing knowledge and expertise. This will however require further investigation into the impact these demands will have on the individual.
The new national framework for NHS funded continuing care
Authors: Klee Deborah
Published: May 2014

This article outlines the new National framework for NHS funded continuing care and NHS funded nursing care (Department of Health, 2007) and the implications for community nurses. Successful implementation is dependent upon good multidisciplinary assessment and person-centred care planning. Good practice in these areas is described. The role of the registered nurse in carrying out an assessment for NHS funded continuing care, the importance of record keeping and professional accountability are discussed.
How do you start a social enterprise?
Authors: Dawes Jonathan
Published: May 2014

After the publication of Lord Darzi’s Next Stage Review (2008), many asked why such scant attention was given to mapping out the future role of the district nurse and district nursing services. The response given to this question was that community nurses would be encouraged to create their own social enterprises. But what exactly are these ‘social enterprises’ that everyone in Whitehall seems to be talking about? More importantly, how does a nurse go about starting her own business and offering her services for tender?
World class commissioning
Authors: While Alison
Published: May 2014

There is much talk about world class commissioning as the panacea to raising the quality of care and promoting improved integration of health services. What exactly constitutes ‘world class’ remains somewhat nebulous and, indeed, after the fatal interdependencies revealed in the ‘world class’ financial markets, perhaps more caution should be taken in the adoption of attractive banners which overnight can turn toxic. Many would argue that the UK’s involvement in the global financial markets has had serious consequences for the economy and will inevitably impact upon what we can afford in terms of healthcare expenditure.
Why abandon the district nurse title?
Authors: While Alison
Published: May 2014

District nurses are enduring a puzzling assault on their job title at the moment with some PCTs choosing to abandon the title of ‘district nurse’. There would be an outcry if the title ‘ward sister’ was similarly open to debate.
Does using a hospital bed have an impact on the meaning of home?
Authors: Bowden Gerard , Bliss Julie
Published: May 2014

During the end of life care of patients with cancer, hospital beds are often introduced into the home setting. The impact of this intervention is not known. Clinical experience of the phenomena indicates that two components may be relevant in this scenario – the preference for home care and the meaning of home. A review of related literature revealed that there is a high preference for being at home at the end of life and that ‘home’ has multiple meanings for people such as familiarity, control and biography. The meaning of home has implications for community nursing practice.
Mental Capacity Act 2005:Lasting Powers of Attorney
Authors: Griffith Richard , Tengnah Cassam
Published: May 2014

In their final article on the Mental Capacity Act 2005, Richard Griffith and Cassam Tengnah consider the impact on district nurse practice of Lasting Powers of Attorney that allow a person to appoint one or more people to make decisions concerning their personal welfare, property and affairs, should they become incapacitated in the future. This can include for the first time in England and Wales since 1959 the ability to appoint another to make consent to treatment decisions on their behalf that will be legally binding.
When Big Brother is looking out for you
Authors: Dawes Jonathan
Published: May 2014

The nursing press has been abuzz recently, with news of emerging technologies, designed to make the provision of care ‘quicker and slicker’. Telemedicine, for example is being hailed as a growth area that is already delivering some fantastic innovations.
Non-elective demand management: the renaissance of district nursing?
Authors: Unsworth John , Danskin Julie , Taylor Maureen
Published: May 2014

Despite the fact that the majority of district nurses are grasping opportunities to provide care to increasingly complex patients at home there have been concerns expressed recently that district nursing as a discipline is in decline. This is partly attributed to a lack of leadership and focus (Lowe, 2006). This alleged decline is set against a backdrop of rising rates of emergency admissions with associated cost pressures for many primary care organizations. This paper presents an overview of a programme which targets district nursing services at the avoidance of non-elective (emergency) admissions. The programme used a model to match staff capacity with demand to free up capacity within teams to tackle admissions from a range of client groups. Using care pathways staff were able to provide structured care for individuals at home. Teams were set targets for the number of admissions they needed to try and avoid. Within the first five months staff reduced non-elective admissions by 17% and achieved savings of £668,000. At a time when community services are being opened up to competition as a result of the changes proposed by Commissioning a patient-led NHS, district nursing is capable of playing a key role in demonstrating the value of the services to commissioners.
Should people have the right to end their life?
Authors: Dawes Jonathan
Published: May 2014

Belgium has joined its Benelux brothers in enacting new legislation that will allow euthanasia. This group of forward-thinking European countries are said by many to be ahead of their time not just socio-economically but also in terms of their healthcare agenda.
Proposals for legal reform in the coronial process 3
Authors: Griffith Richard , Tengnah Cassam
Published: May 2014

In the final article reviewing the role and function of the coronial service Richard Griffith and Cassam Tengnah consider the proposals for reforming the system to take account of the recommendations of the Shipman Inquiry and the Bristol Royal Infirmary Inquiry.

The Government’s proposals are in the form of a Draft Bill that allows district nurses to consider the impact of the reforms on their practice and provides an opportunity to contribute to the debate on reform before it is presented to parliament.
The care of vascular access devices in community care
Authors: J Kelly Linda
Published: May 2014

Infusion therapy is now an integral part of the majority of nurses’ professional practice (RCN, 2006). Infusion therapy is no longer confined to secondary care, and home intravenous therapy is becoming more commonplace (Keyley, 2002). As nurses, we are responsible for maintaining our skills and knowledge in relation to all aspects of patient care (RCN, 2006). This article provides an overview of the types of vascular access devices used in primary care, and provides guidance and recommendations to ensure best practice. Although there are many complications associated with vascular access devices (Docherty, 2006) this article will focus on the prevention of infection and maintainace of catheter patency in vascular access devices. Infection is one of the most serious complications that can result from the presence and use of a central venous catheter (Humar et al. 2000), however careful management of these devices can minimize the complications associated with infusion therapy.
Case-finding in the community: the results 2
Authors: Kane Kay
Published: May 2014

Improving the health and well-being of the population is at the centre of policy development, and the vision is to involve individuals, families and communities. The Case-finding in the Community Project was designed to build upon the established relationship between district nursing and the local community of East Belfast, working together to improve the health of adults in the community using a case-finding approach. The aims were to improve the early detection of long-term conditions, to increase access to primary care and the specialist nursing services, and to further develop the working partnership with East Belfast Community Health Information Project. Between September 2006 and March 2007, 351 people attended 17 health fairs in East Belfast at a range of venues. There were 115 people with identified risk factors for respiratory, cardiac, diabetes and hypertension. From the results of this project, there is a need for ‘case-finding’ patients with the potential to develop chronic disease management.
Mental Capacity Act 2005: assessing decision-making capacity 2
Authors: Griffith Richard , Tengnah Cassam
Published: May 2014

In last month’s article on the Mental Capacity Act 2005 Richard Griffith and Cassam Tengnah outlined the statutory principles and key powers that underpin the Act. This month’s article considers one of the fundamental requirements of the Mental Capacity Act 2005, how and when should district nurses assess decision making capacity.
Understanding and treating a common dermal problem: pruritus
Authors: Nazarko Linda
Published: May 2014

Although dermatological problems are common in older people, health professionals do not always have the skills and knowledge to identify and treat such problems. Pruritus is the most common skin condition older people experience. It is often linked to systemic disease. This article explains how to identify and treat the causes of pruritis and improve quality of life for the older person.
All change please! NHS apathy or quality reform?
Authors: Dawes Jonathan
Published: May 2014

A number of clinicians I have been talking to raised an eyebrow and gave a sigh when I sought their views on Lord Darzi’s Review of the NHS (Darzi, 2008). I found that many nurses were thinking ‘we’ve heard it all before’ and I heard several times ‘how is this any different from Our Health, Our Care, Our Say or the The NHS Plan?’ There is a sense that it is more political rhetoric which was not backed by enough consultation. However, in my view the report contains much to be applauded and its content is built on previous reviews with impressive plans for NHS reform.
How personal health budgets may affect community nursing teams
Authors: Hewitt-Taylor Jaqui
Published: May 2014

In social care, there has for some time been the option for individuals to use direct payments to manage their own support, and more recently individual budgets have been piloted. While this approach has not been available for healthcare payments, there is the potential for this to change.

This paper outlines the implementation of direct payments and personal budgets and then discusses some of the issues which should be considered if such arrangements are introduced in healthcare. These include: preparing existing staff for such changes in funding and the implications for them; clarifying the new roles and responsibilities of community nursing teams, training opportunities for staff who are employed directly by individuals; staff recruitment and retention, and designing evaluation mechanisms which assess quality as well as cost.
Experiences of older women increasing fruit and vegetable intake
Authors: Sandison Rena , MacDonald Helen
Published: May 2014

Many studies have investigated diet in relation to disease and other aspects of health, although there is little information for health professionals on conveying practical ways for people to improve dietary intakes. There is thought to be a positive link between bone health and fruit and vegetable intake. This paper reports on the experiences of older women increasing their fruit and vegetable intake while participating in a randomized controlled trial to assess the influence of fruit and vegetables on bone health. How the women achieved increases in fruit and vegetable intake is described.
Wound Care Alliance: a new charity
Authors: Toner Louise , Beldon Pauline
Published: May 2014

It is with great excitement that we announce the birth of a new charity. The Wound Care Alliance UK has risen, phoenix-like, from the ashes of the Wound Care Society (WCS) and Tissue Viability Nurses’ Association (TVNA). Many people belong to both societies, and members have voted overwhelmingly in favour of dissolving the WCS and TVNA to form a single new organization to provide help and support both educationally (which the WCS has always been proud to do) and professionally; (a key aspect of the TVNA).
Poor nutritional standards in our hospitals
Authors: Harrop Andrew
Published: May 2014

Food is one of the most basic human needs for healthy wellbeing and survival, yet too many hospitals fail to give nutritional care enough priority in their day-to-day practice. So, why isn’t more being done to stamp out this problem once and for all? Three years on from the launch of Age Concern and Help the Aged’s Hungry to be Heard campaign to raise awareness of this issue, we’re still hearing shocking stories from relatives about older people still not getting the right food and support they need to eat in hospital.
Nurses serving on the front line
Authors: While Alison
Published: May 2014

For the first time since World War II (WWII) the nation is being faced with the consequences of warfare upon previously healthy people in the armed forces. It is not only the soldiers and others engaged in combat who will bear the long-term sequelae but also those engaged in the medical rescues in the field.
Evaluation of a community nursing initiative: palliative care
Authors: Plumb Marlis
Published: May 2014

It is estimated that one in five people over 65years old will die in a care home in the UK. These residents require palliative care that is often delivered by social and voluntary care workers. This paper aims to evaluate a palliative care programme that has been running for the past few years and is facilitated by community nurses. An anonymous questionnaire was distributed to 50 carers within four care homes who had undertaken the programme since its implementation two years ago. A total of 38questionnaires were returned giving an above-average response rate of 77%. Results showed that the majority of participants found the course very valuable and stated that it had improved their delivery of palliative care. The programme was positively evaluated and has proved to be a valuable way of improving integrated care and meeting the Scottish Government recommendations of improving the delivery of palliative care irrespective of diagnosis and care setting.
Consent to organ donation part 1: the current arrangements
Authors: Griffith Richard , Tengnah Cassam
Published: May 2014

The debate over how best to seek consent from people for the donation of their organs after death continues unabated. Despite a significant change in approach in seeking consent for donation introduced by the Human Tissue Act 2004 there has been little improvement in the numbers of harvested organs. This has led to calls by various organizations to adopt a more radical approach to consent for organ donation. The Welsh Assembly Government favours a presumed consent approach where a person is assumed to have consented unless they formally opt out, while more recently the Royal College of Physicians has changed its stance and is now calling for a system of mandated choice where a person is compelled to decide if they want to donate their organs.

District nurses see first hand the need for an increase in the number of donated organs as they provide the care for those waiting for a transplant and so it is essential that they inform this debate.

In the first of a short series of articles the current arrangements for consenting to the donation of organs are considered.
Chronic heart failure: promoting quality of life
Authors: While Alison , Kiek Fiona
Published: May 2014

There are growing numbers of people with heart failure, which is disabling for the individuals and costly for the health services. Heart failure is often associated with anxiety and depression. Nurses can improve patients’ well-being by promoting regular exercise and self-care. Palliative care, which includes specialist heart failure services improves end-of-life experiences. This article reports the findings of a literature review derived from a search of 5 electronic databases to identify studies relating to the promotion of quality of life in chronic heart failure.
Does a hospital bed impact on sexuality expression in palliative care?
Authors: Bowden Gerard , Bliss Julie
Published: May 2014

During end of life care for patients with cancer, hospital beds are often introduced into the home setting. The impact of this intervention on sexuality and intimacy expression for couples is not known. A review of related literature revealed that intimacy expression at the end of life is important for patients but is generally regarded by nurses as a difficult and complex area of care. The relationship between sexuality expression and the provision of a hospital bed has implications for nursing practice.
Skin care considerations in chronic oedema
Authors: Doherty Debra
Published: May 2014

This article addresses dermatological considerations in patients with chronic oedema. Best practice guidance on skin care is discussed, as well as skin assessment and use of emollients. Management issues and the use of other dermatological preparations are also highlighted.
An interview with Paul Chadwick
Authors: Chadwick Paul
Published: May 2014

As a podiatrist wound care formed only a small part of my undergraduate training (I qualified in 1990). Theory as it existed at the time was taught but practical experience was minimal and restricted to post-operative dressings and for the lucky ones maybe a foot ulcer on clinical placement. My first exposure to diabetic foot ulceration came about 3 months after qualification when I was asked to cover sickness at the local hospital. It was very nearly my last I was thrown in single-handed and not prepared in terms of experience and knowledge. Unsurprisingly, I stayed away from wounds for about 3 years. When in a new role, as part of my personal development I asked to shadow the foot ulcer clinic at the Royal Hallamshire in Sheffield. From this I developed a keen interest and applied for a job in Salford where I continue to work which had a strong wound component. This has grown and now forms the majority of my clinical work.
Dermatology and the community nurse: actinic (solar) keratosis
Authors: Watkins Jean
Published: May 2014

Community nurses are in daily contact with patients and, in the course of their day’s work, have every opportunity of recognizing those patients who are more vulnerable to the sun’s rays, and noticing actual sun damage and actinic keratoses. They are then able to check other sun-exposed areas such as the face, ears, scalp, back and limbs to discover any other lesions or more serious problems of basal cell carcinoma, squamous cell carcinoma or malignant melanoma the would require referral, sometimes urgently, to a dermatologist for full assessment and treatment. In any case, sound advice about further protection from the sun, both for themselves and their families may help to reduce the likelihood of further problems
Elder abuse and the community nurse: supporting the patient
Authors: Phelan Amanda
Published: May 2014

This article explains what elder abuse is. It details difficulties in definitions, terminology and the challenges which community nurses face when addressing elder abuse. Guidelines are given which enable clarity regarding elder abuse in the home and the discussion highlights issues specific to elder abuse in the home. This article also includes a review of the role of the community nurse in primary prevention as well as secondary and tertiary care.
Potential benefits of probiotics – main findings of an in-depth review
Authors: Weichselbaum Elisabeth
Published: May 2014

Media reports on probiotics have been conflicting which has led to increased confusion among the general population and also among health professionals. To disentangle myths and reality, the British Nutrition Foundation has carried out a review on probiotics and health. There is good evidence that probiotics are effective in preventing antibiotic-associated diarrhoea and, although only few studies have been carried out so far, probiotic microorganisms also seem to have the potential to prevent the potentially fatal Clostridium difficile-associated diarrhoea. A limited number of studies that are available on the effectiveness of probiotics on constipation have shown conflicting results, but promising results have been found for certain strains. Irritable bowel syndrome symptoms have been found to be reduced by consuming probiotic strains, although a high placebo effect has been observed in some of the studies. The field of probiotics is relatively new and more studies will be needed to allow firm conclusions on the effectiveness of probiotic microorganisms for certain health issues.
Continence problems in the house-bound patient: causes and treatment
Authors: Burch Jennie
Published: May 2014

This article provides an overview of faecal continence with a focus on the house-bound patient. To understand incontinence it is essential to understand how continence is achieved. Causes of faecal incontinence are discussed, including anal sphincter damage. Finally the nursing, medical and surgical treatment options are explored. This includes medication, biofeedback and the formation of a colostomy.
Stroke survivors with aphasia: personal experiences of coming home
Authors: Pringle Jan , Hendry Charles , McLafferty Ella , Drummond John
Published: May 2014

Although communication difficulties affect a significant number of stroke survivors, specialist stroke follow-up in the community may not always be available. It is therefore vital that community nurses have the skills and confidence not only to engage well with stroke patients with communication difficulties in their daily work, but also to encourage their inclusion in research and other projects.

This article reports on the experiences of a small sample of stroke survivors and their carers during the first month at home following discharge from hospital. Their journey involved discovering and adapting to new situations and abilities. The article also details how participants with virtually no speech can be included in research studies.
District nurse role in end-stage COPD: a review
Authors: Disler Rebecca , Jones Anne
Published: May 2014

District Nurses (DNs) are core providers of end-stage care in the community but appear to have little contact with patients suffering from non-malignant diseases, such as chronic obstructive pulmonary disease (COPD). This review found limited literature describing the role of DNs in end-stage COPD care, and the studies that did touch on the subject restricted their discourse to the frequency of interaction. A clear bias of end-of-life services to patients with malignancy was noted, as well as a call for community services to extend care to all end-stage patients regardless of underlying disease. In addition, there was a further call for DNs to apply a more holistic approach to care, as described in the literature. Finally, it was clear that while ongoing community intervention is necessary for end-stage COPD patients, support and training is essential to equip DNs to care for these vulnerable patients.
Is wound management training in primary care good enough?
Authors: Beldon Pauline
Published: May 2014

Wound care dressings account for more than £120 million in England each year with more than £25 million being spent on silver dressings alone (Nurse Prescribing Centre, 2010). This is an astonishing amount of the tax payers money and begs the question, is this reasonable? Is it realistic? The answers is of course that we simply don’t know. I wonder how many nurses reading this actually participate in regular audits, to determine how many patients they treat with different wound aetiologies, how many are acute wounds, how many long-standing wounds or ulcers owing to complicated co-morbidities and how effective are the treatment regimes they employ? I suspect the answer to be, very few. There are undoubtedly tissue viability nurses (TVNs) who, with community nurses do audit, however, by no means do all do so, otherwise a wealth of data would exist which could be employed to generate evidence for practice and would give rise to research questions for further examination.
Change is afoot, are you ready?
Authors: Pike Cheryl
Published: May 2014

Treatment starts with a patient’s willingness to take on board the basics of lymphoedema management, without this, their commitment to further treatment would be in question. However, most services are now over-prescribed and many are looking into referral criteria, but to deny a person treatment based on their BMI is not sound practice; to exclude anyone on the grounds of their size or weight would be unethical and may result in legal repercussions. To avoid such situations, community nurses can encourage GPs to teach their patients the importance of skin care and exercise. If a patient does not take this advice on board, you can explain to the GP that you can only commence treatment once the patient has complied with the advice given.
A literature review of two laxatives: lactulose and polyethylene glycol
Authors: Carlin Alexandra , Justham David
Published: May 2014

This paper presents a literature review of two commonly used osmotic laxatives, lactulose and polyethylene glycol (PEG). With increasing numbers of nurses in the community being non-medical prescribers, informed decisions on choice of laxatives is required. Nurses who do not prescribe will often have a view for the benefit of their patients. Following a literature search, eight papers were selected for review. The review leads to the conclusion that, while both preparations are useful, PEG is more effective in many instances and should be the laxative of choice unless there are contraindications arising from the assessment of the patient. Non-pharmacological approaches to the management of constipation should be addressed before considering laxative use.
Legal issues surrounding consent and capacity: the key to autonomy
Authors: Griffith Richard , Tengnah Cassam
Published: May 2014

With campaigns from the RCN, Nursing Times and Patients' Association promoting dignity and choice in healthcare district nurses need to be aware of the legal principle that lie at the heart of autonomy, consent. In the first of a series of articles on the principles of patient consent Richard Griffith and Cassam Tengnah outline the elements of a valid consent and how important obtaining consent is to the propriety of a district nurse's practice.
Help-seeking behaviour for the treatment of chronic pain
Authors: Cornally Nicola , McCarthy Geraldine
Published: May 2014

There are more people living with chronic pain than cardiovascular disease and cancer combined. Many people with chronic pain do not seek help from health professionals and suffer in silence for many years. Untreated chronic pain can lead to increased disability, increased risk of fall, depression, sleep deprivation, reduced quality of life and social isolation. The aim of this review is to determine the factors associated with help-seeking for chronic pain in an effort to highlight potential reasons why help may or may not be sought. A total of 23 studies were included in the review. On the whole the review has demonstrated that the most significant demographic and clinical factors associated with help-seeking were increasing age, female gender, pain severity and disability. Psychosocial factors included past help seeking, outcome expectancy, age-related beliefs, social cost and social influence. While the evidence presented appears promising, some conflicting results were found and methodological limitations were noted. Further research needs to examine the underlying determinants of help-seeking behaviour for chronic pain underpinned by theory. The information derived from such research will augment the development of a complex nursing intervention to improve help-seeking for chronic pain.
Professional identity and the culture of community nursing
Authors: Drew Dee
Published: May 2014

Using an ethnographic approach, data collection was carried out using participant observation and semi-structured interviews. Two teams of nurses from one primary care trust in the West Midlands participated in this study. Data were analysed using James Spradley's (1979) thematic cultural analysis.

Findings include: sharing information and planning ahead, helping across teams and busyness and how other professions view community nursing. Issues of community nurses invisibility and the articulation of expertise are presented.

Conclusion: Although many studies have been carried out exploring the handover, there is a dearth of work focusing upon community nursing. In the current social and financial climate it is essential to make the case for continuity of care to be safeguarded. Additionally, the importance of protecting reporting time for community nurses is suggested. The reporting time serves to enhance group identity, reduce anxieties and relieve isolation. Finally, report time crucially encourages the articulation of expertise between community nurses at a time when they are feeling professionally devalued.
Addressing the health needs of the homeless
Authors: John William , Law Kate
Published: May 2014

Several authors have alluded to the complex health needs of the homeless population in the UK. The correlation between homelessness and a wide range of health problems has been explored in the literature. This paper presents a literature review exploring the biological, psychosocial and sexual health needs of single homeless people. The relationship between health and homelessness is analysed in relation to theories of health inequalities, which suggest that being homeless may be both a cause and a consequence of ill health. The contemporary nurse can play a vital role in helping to overcome the barriers that homeless people face when accessing health services. This paper explores the skills and approaches that nurses in a wide variety of settings can employ in addressing the health issues of homeless clients.
Use of emollients in the treatment of dry skin conditions
Authors: Dyble Tina , Ashton Jennifer
Published: May 2014

Dry skin conditions are often not considered important by health professionals, and as a consequence treatments are frequently under-prescribed. As a result of this, problems with untreated dry skin can lead to a variety of issues. Conditions such as pruritus and ichthyosis vulgaris can be distressing, while ezcema and psoriasis can lead to more serious consequences such as fissures and infections and can result in a reduced quality of life and social isolation. However, with appropriate treatments such as emollient therapy, the incidences of these conditions occurring can be reduced. Despite a wide range of choice available on the market, choosing an effective emollient which will help aid concordance is often difficult. In order to achieve this, several factors need to be considered in conjunction with the product selection. This article discusses the various factors that nurses need to consider when advising patients on which emollient to use as part of their skin care regimen, in order to improve concordance and patient outcomes.
Infection control in the community: a pragmatic approach
Authors: Swanson John , Jeanes Annette
Published: May 2014

Infection can have a detrimental and potentially life-threatening impact on the health and wellbeing of patients. Infection control and prevention is as important in the community as it is in an acute hospital. This article summarizes the key infection and prevention issues in community nursing. It offers a pragmatic approach as community settings may be challenging to both infection control and community healthcare professionals. Patient safety is the top priority, and ensuring that safe practices are followed to reduce the risk of infection regardless of healthcare setting is paramount. There are many external factors that may impede infection control practices when delivering care in a patient's own home, and this article sets out the factors that must be considered in order to manage the risk.