bluuebunny/crossref_metadata_2025 huggingface dataset:
The role of alternative medicine in treating postnatal depression
Authors: Mantle Fiona
Published: May 2014

Postnatal depression is a serious and debilitating condition. Due to the perceived stigma of mental illness, the incidence of it is under-reported and many mothers refuse psychiatric help either assuming postnatal depression to be normal or because of the potential consequences of having a psychiatric history. Community practitioners who are in contact with new mothers may welcome additional interventions which can enhance the supportive care they give to these women. This article discusses the evidence for a number of these interventions which mothers may find more acceptable than orthodox treatment.
Providing seamless community health and social services
Authors: Doran Tim
Published: May 2014

This article reviews a variety of Government community health policies and initiatives, from the NHS and Community Care Act 1990 to the emergence of primary care groups (PCGs). The Labour administration abolished GP fundholding and has placed considerable emphasis on its commitment to partnership with the care professions. The Government is also expecting a commitment to partnership between the community care professions in order to reflect the entwined social and health-care needs of the individual requiring care in the community. The role of the district nursing service has been brought into focus with the opportunity of representation at PCG board level. Evaluating how a district nursing service may integrate with social services is, therefore, an appropriate strategy for assessing whether recent policy initiatives go far enough at grass roots level in facilitating collaboration and quality community care.
An historical overview of the use of silver in wound management
Authors: White Richard J
Published: May 2014

While silver and its compounds have been medically used for thousands of years, the recent research focus on this element has led to a resurgence in interest, particularly in the field of wound care product development. The increasing problems of antibiotic resistance, combined with concerns over the safety and toxicity of topical antiseptics, has highlighted the need for a safe agent which can be used to treat colonized and infected wounds effectively. Wounds, notably chronic wounds, can support a wide variety of microorganisms, many of which are pathogens, and act as a source for cross-infection. While systemic antibiotics are justifiably recognized as the first-line treatment of choice for chronic wounds with spreading cellulitis and infected wounds in ‘at risk’ patients, not all infected wounds merit this treatment. There is now a rationale for the judicious use of suitable topical antisepsis in certain colonized, critically colonized, and infected wounds. The increasing evidence available on products containing silver suggests that this element can fulfil a valuable role in wound care. This review of the history of silver as an antibacterial covers the mode of action of preparations containing silver and concludes with a focus on silver as a component of the modern wound management products: Arglaes, Acticoat, Actisorb Silver 220 and Avance.
Actisorb Silver 220: a unique antibacterial dressing
Authors: Hampton Sylvie
Published: May 2014

The antibacterial function of the unique dressing Actisorb Silver 220 (manufactured by Johnson & Johnson Medical) is growing in importance as methicillin-resistant bacteria increase in prevalence and as the efficacy of antibiotics becomes more limited. Consequently, practitioners need to look elsewhere for solutions to managing wound colonization and in prevention of clinical infections. Actisorb Silver 220 assists with cleansing the wound, reduces malodour, and has the ability to reduce bacterial colonization in wet and dry wounds: all are vital functions for wound healing, improvement of patients’ quality of life, and in reducing healthcare costs.
The Profore (TM) multilayer compression bandaging system
Authors: Hampton Sylvie
Published: May 2014

Multilayered bandaging has been shown to be extremely effective in the treatment of venous ulcers. The Profore™ multilayered compression bandaging system was developed so that all bandages required in the multilayer system could be provided in one kit, thereby reducing workload for district nurses. Clinical governance will ensure that treatment for venous ulceration is highlighted and compression therapy will be the gold standard required for monitoring healing rates. The Profore™ multilayered compression bandaging system supports the ideal of clinical governance as it has been shown to be a clinically-effective treatment with excellent healing rates.
Nurses’ experiences of working in emerging primary care groups
Authors: While Alison , Dyson Elizabeth
Published: May 2014

Primary care in England is being restructured and reorganized around primary care groups and primary care trusts, and a new system of clinical governance has been put in place to standardise levels of clinical care. There has been little exploration of the effect of these changes on the working practices of nurses in primary care. Telephone interviews were conducted with 20 nurses working in two primary care groups. The participants described an involvement in traditional roles within primary care. Access to information was problematic, with poor information technology support a particular problem. The respondents reported limited engagement with the primary care groups and the implementation of clinical governance. Ongoing staff shortages and the resulting increased workloads were identified as ‘disablers’ that need to be addressed as they will limit the capacity of the nurses to embrace new ways of working and prevent full engagement in the primary care trusts
The distress experienced by people with type 2 diabetes
Authors: West Christina , McDowell Joan
Published: May 2014

With diabetes an ever-increasing problem across the developed world, a great deal of research has been carried out into the effects of the disease on the patient. Yet despite the fact that type 1 diabetes accounts for only a relatively small proportion of worldwide cases, it has been the focus of research attention. This study aimed to investigate the distress associated with type 2 diabetes, whether gender differences existed in the impact of type 2 diabetes and how men and women viewed dietary management. A multi-method, two-stage research approach was taken. Quantitative data were obtained using the Problem Areas in Diabetes (PAID) questionnaire, and no statistically significant gender difference was identified. Worrying about the future, the possibility of complications and feelings of guilt or anxiety when ‘off-track’ with diabetes management were sourcces of significant distress. Treatment mode, length of time diagnosed with diabetes and age were significant factors which impacted on the emotional distress experienced by the individual. A subsample of respondents took part in gender-specific focus group interviews which explored issues identified in the survey. Behavioural impact, emotional impact and fear of complications were major themes identified in the interviews. Views of the dietary management of diabetes were also explored within the focus groups and three broad categories identified: dietary restrictions, value judgments and the influence of others. Awareness by health-care professionals of factors influencing adaptation to diabetes is recommended.
The most effective products available to facilitate ear syringing
Authors: Somerville Gael
Published: May 2014

Loss of hearing from accumulation of cerumen (ear wax) is a commonly seen problem. Treatment for this condition often involves use of a wax softening or dispersing agent (cerumenolytic) before syringing. A mini-review was undertaken to find out what is the best preparation to use before syringing to facilitate the procedure. Five databases were searched using subject searches combined with methodological filters to find the highest level of evidence to answer the question. Nine randomised controlled trials (RCTs) were found and seven in vitro studies that researched the efficacy or effectiveness of a range of products. The RCTs do no show any one product to be more effective. The in vitro studies show Waxsol to be better at dispersing wax followed by sodium bicarbonate. This needs to be demonstrated with in vivo testing comparing all products for effectiveness. Many of the studies suffered from a lack of information. Side-effects were not adequately investigated.
Drink and drugs: overlooked, underfunded
Authors: Pollard Tom
Published: May 2014

Two recent reports have highlighted the continuing and increasing toll which alcohol and drug abuse are taking on the UK. The reports are a wake-up call to government and the health service.
Mind the gap: voluntary sector pregnancy advice service
Authors: Dyson Liz , While Alison
Published: May 2014

This article describes a voluntary pregnancy advisory service in a deprived inner city area and summarizes some descriptive statistics kept relating to one year (2000). The evidence suggests that this service was acceptable to women in the local area and frequently used by them. Possible reasons why the service may be acceptable are discussed, followed by an attempt to explore how such voluntary sector organizations could work in partnership with the health services, both by supplementing them, and also by providing an interface between the local community and the health services to encourage appropriate and effective use of the statutory services by more marginalized members of the communities which they serve.
Community infection control: what is the evidence?
Authors: Ward Deborah
Published: May 2014

Evidence-based practice is the conscientious use of current best evidence in decision-making about care or the delivery of health services (National Institute for Public Health, 1996). Evidence-based health care is one aspect of the quality improvement activities of clinical governance as a main component of the programme of quality in the NHS (Hek, 2000). Practitioners working in clinical areas are therefore being required to deliver care that has been shown to be effective (Playle, 2000).
Promoting nursing participation within primary care groups
Authors: Goodman Claire , Wall Alison , Reavey Sheilagh
Published: May 2014

This article describes the evaluation of a scheme to improve communication between primary care nurses and newly established primary care groups. Findings suggest that the successes of the scheme were in part attributable to the appointment of experienced practitioners to a facilitator/link nurse role and the sustained support of the scheme by the NHS community trust. The article concludes by suggesting that, in a time of constant change within primary care, innovations such as these contribute to the development of practitioner participation in the organization and delivery of primary care services.
Malignant fungating wounds: assessment and management
Authors: Dowsett Caroline
Published: May 2014

Approximately 5–10% of patients with metastatic cancer will develop a fungating wound. The disfiguring or unpleasant nature of these wounds can lead to complex psychosocial problems in patients, which mean that many will seek medical assistance only when the wound is advanced. Curative treatment is often not an option, although a range of palliative treatments may be tried. When the tumour does not respond to these treatments the patient will be left with a chronic complex wound with local wound management as the only option. It is at this time that the community nurse usually becomes involved with the patient. This article discusses the assessment of patients with fungating wounds in the community, taking into consideration the immense psychological distress that they can cause. It highlights factors that need to be taken into consideration when assessing these complex wounds. Many of them are heavily exuding, malodorous and bleed easily. Strategies that focus on managing these symptoms are explored and recommendations for clinical practice are made.
GPs’ perceptions of the nurse practitioner role in primary care
Authors: Carr Jacqui , Armstrong Sarah , Hancock Beverley , Bethea Jane
Published: May 2014

The role of nurse practitioner (NP) is increasingly integrated into the primary health-care team, yet there remains some confusion among general practitioners about what the role entails. Following on from previous work (Carr et al, 2001), this study indicates that the majority of GPs surveyed were supportive of the integration of the NP role in primary care, both to help reduce the GPs’ workload and more importantly to give the patient a choice of who to consult. However, there was some difference in opinion as to what tasks were most appropriately linked to the NP role. This may be due to the GPs’ lack of knowledge and experience of the role. There were also some reservations about the financial cost of training and employing NPs. If the health needs of the population are to be met and high quality, seamless care provided, the NP could provide a solution.
Divided by a common tongue: getting policy into practice
Authors: Gibson Louise
Published: May 2014

Language and communication have recently been highlighted as problem areas within nursing. This has been due in part to overseas nurses coming to work in the NHS, or the difficulties people have in understanding regional accents. The Government and Nursing and Midwifery Council (NMC) have decided to rectify the former by testing overseas nurses’ English before they start work. Having recently moved from London to Glasgow I was anxious about the latter, and worried that colleagues, patients and carers would not be able to understand my northern accent. Thankfully I feel that I am generally understood although there have been a few misunderstandings, particularly when discussing wound care products with colleagues. Do I need to sit an English/Scottish language test? Before you all shout ‘yes’ let’s pause for a moment and think about how and why we communicate, particularly in relation to wound care.
Microbiology, wound infection and healing
Authors: Kingsley Andrew
Published: May 2014

Welcome to the third Silver Supplement, a publication aimed at raising the profile of silver-containing dressings in wound care. Use of any product, including silver, must take place with underpinning knowledge to ensure appropriate application, as it is accepted that no single dressing can provide all the answers to the problems and requirements of a wound throughout its life. In her two articles, Rose Cooper provides the crucial backdrop to the subject area by discussing the complexities of wound microbiology and its relationship to infection.
The contribution of microbial virulence to wound infection
Authors: Cooper RA
Published: May 2014

Although microorganisms such as bacteria are known to be present colonizing chronic wounds and are responsible for infections, little is known about the virulence factors of wound pathogens and how they impact on wound infection. With reference to our understanding of these mechanisms in other infected tissues it is possible to extrapolate their function to wound infection. Factors such as biofilm formation, endotoxins and exotoxins, quorum sensing and synergy all play their part in the bacterial colonization of wounds and the development of wound infection.
Does the use of pacifiers shorten breast-feeding duration in infants?
Authors: Ullah Sharin , Griffiths Peter
Published: May 2014

Breast-feeding has a number of benefits for both mother and baby, which appear to increase with longer duration of breast-feeding. The use of pacifiers has been negatively associated with shortened breast-feeding duration. The aim of this review was to determine whether the use of pacifiers actually shortens breast-feeding duration in infants. The Cochrane library, Medline, CINAHL and Embase databases were searched for systematic reviews, randomized controlled trials and cohort studies examining the effect of pacifier use on breast-feeding duration. After applying appropriate inclusion criteria only two cohort studies were identified. In one the overall breastfeeding duration was longer in non pacifier-using infants compared to those given pacifiers (10 months vs 7.5 months). The mean breast-feeding duration in children who were given pacifiers before 6 weeks of age months was 168.5 days compared to 196.0 days for children who had a pacifier introduced later or never. However, there is no evidence to suggest any effect of occasional pacifier use, and it remains unclear whether pacifiers are an independent causal factor for reducing breast-feeding duration in infants.
So you want to do research? 3. An introduction to qualitative methods
Authors: A Meadows Keith
Published: May 2014

This article describes some of the key issues in the use of qualitative research methods. Starting with a description of what qualitative research is and outlining some of the distinguishing features between quantitative and qualitative research, examples of the type of setting where qualitative research can be applied are provided. Methods of collecting information through in-depth interviews and group discussions are discussed in some detail, including issues around sampling and recruitment, the use of topic guides and techniques to encourage participants to talk openly. An overview on the analysis of qualitative data discusses aspects on data reduction, display and drawing conclusions from the data. Approaches to ensuring rigour in the collection, analysis and reporting of qualitative research are discussed and the concepts of credibility, transferability, dependability and confirmability are described. Finally, guidelines for the reporting of qualitative research are outlined and the need to write for a particular audience is discussed.
Use of Entonox in the community for control of procedural pain
Authors: Evans Andrea
Published: May 2014

Nitrous oxide gas, mixed 50:50 with oxygen, is an effective and safe analgesic which, although widely used in many areas of clinical practice, has not been fully recognized in the community setting for painful procedures. The reasons why it has not been implemented and used to the patient’s advantage have been suggested as apathy, lack of confidence, lack of knowledge and lack of resources. The author describes how, following a review of the literature pertaining to its use in other clinical areas, she has successfully introduced nitrous oxide/oxygen into her trust, with positive results.
Communication must improve for success
Authors: Pollard Tom
Published: May 2014

It is time to spread the good news. A new report from the Nuffield Trust confirms what everyone who works in the health system has long hoped for, but couldn’t always entirely convince themselves was happening: health care in England is getting better.
Older people as health service consumers 3: obstacles to access in the village
Authors: Bentley Jenny
Published: May 2014

Faster access to hospital services, swift advice and treatment in GP surgeries and quicker access to information at home are among the improvements brought about as a result of recent Government policies in England. These developments have increased the infrastructure, such as walk-in clinics and extended surgery hours, but the responsibility lies with the patient to present themselves. Although older people use NHS services proportionately more than other age groups, they also tend to normalize disease symptoms, attributing them to ageing (Tod et al, 2001). This article, the third in a series which addresses older people’s beliefs and behaviour in relation to health care, discusses the factors which influence the accessing of health services within an older, white village community in South England.
Giving thanks for nurses in difficult times
Authors: Pollard Tom
Published: May 2014

I have found it difficult to concentrate on anything but the war in Iraq over the last couple of weeks. Like many others, I have been sucked in by the relentless war coverage, and engaged in long and heated discussions with colleagues on both sides of the Atlantic on the merits and substantial demerits of the Anglo-American adventure. War is a brutal and brutalizing undertaking, for those watching from afar as much as those taking part. Endlessly repeated images of movie-style bombing spectaculars or dusty, depersonalized corpses on the battlefield or bomb-site disengage the watcher from the horror of what they are seeing. The media’s studied avoidance of the harsh reality of battle deaths and ‘collateral damage’ – the image of the Iraqi child with half its head missing being a case in point – emphasizes the remoteness of war.
The role of district nurses in public health: a discussion
Authors: Band Samantha
Published: May 2014

The government has challenged community nurses, through recent policy changes, to become more involved in improving the health of local populations. However, very little has been written about the role of district nurses within this agenda. This article explores these opportunities and discusses some of the challenges facing district nurses if they are to embrace this new agenda. A model is examined which details four approaches to public health in which district nurses could contribute: individual advice-giving, personal support, environmental control and community development. District nurses have many valuable skills and attributes that could be utilized within all four approaches; it is important that they use these skills in collaboration with others. There will be implications for the future education and leadership of district nurses.
Piecemeal policy may stop nurse prescribers fulfilling their potential
Authors: Mazhindu Dr Debbie , Brownsell Mike
Published: May 2014

In this article we discuss how the lack of visionary forward planning and muddled policy making regarding nurse prescribing has caused role ambiguity and disaffection within community nursing. We explore elements of the development of nurse prescribing and discuss some of the terms that are currently being articulated, which are ill conceived, conceptually flawed and often misleading. We also discuss some of the current issues we perceive in relation to nurse prescribing, including the benefits and limitations for community practice. There are a number of professional issues that need to be clarified regarding the role if nurses who take on the prescribing mantle are to fulfil their potential to benefit patient care.
Jobst® UlcerCARE™ compression hosiery for venous leg ulcers
Authors: Hampton Sylvie
Published: May 2014

Chronic venous insufficiency affects the productivity and wellbeing of millions of people worldwide and is the most common cause of leg ulcers. Treatment of leg ulcers currently accounts for 22% of district nurses’ time and places a major financial burden on NHS resources. Compression bandaging has been recognized as the optimum approach for venous ulcers but is not always applied effectively. It is also costly and may lead to non-compliance. Compression hosiery is an alternative treatment approach. Review of relevant research shows JOBST UlcerCARE to be an effective treatment that is easy to apply, thereby maintaining patient independence. It also provides a major potential for cost savings to the NHS.
What can we learn from the Finnish experience?
Authors: While Alison
Published: May 2014

A brief stay as a visiting scholar can leave a lasting impression. I have just returned from Finland and it was a pleasure to be in a country where both the President and Prime Minister are women.
More change, but a bright outlook
Authors: Pollard Tom
Published: May 2014

The acceptance by the vast majority of GPs of the new general medical services (GMS) contract heralds, implementation notwithstanding, the biggest shake-up of primary care since the foundation of the NHS. It will not only bring in massive investment, but also a major restructuring of care delivery. Quite what this means for nurses remains to be seen. While practice nurses will be encouraged to take on new roles and responsibilities, other nurses working in primary care have a less clear-cut role. There is a fear among some that GPs will use the contract to opt out of some services that they currently provide and so shift the burden to other health professionals, with guess who in the firing line.
A hidden problem: identifying depression in older people
Authors: Hope Kevin
Published: May 2014

This article, based on a paper presented at the Current Issues in Primary Care Nursing conference in Manchester in March 2003, presents an overview of depression in older people and considers the community nurse’s role in identification and response. It aims to raise awareness of and promote activity in this area and considers the presentation and incidence of the condition. The mental health of older people is a policy priority, yet recognition of depression in older people is problematic. The case is made that community nurses have an increasingly important role in identifying depression in older people and the use of the Geriatric Depression Scale is promoted. The possibility that the further development of community nurse’s role towards targeted interventions is outlined.
Blocked urinary catheters: solutions are not the only solution
Authors: Williams Cath , Tonkin Sharon
Published: May 2014

The use of catheter maintenance solutions to manage clients whose catheters block has long been a subject for debate. An understanding of the causes of blockage, and awareness of appropriate management may reduce frequency of blockage and reduce unnecessary interruptions to a closed urinary drainage system.
World faces a diabetic future: what hope?
Authors: Pollard Tom
Published: May 2014

As more than 10000 delegates from around the world congregated in Paris for the International Diabetes Federation (IDF) congress, we were given the news that more than 300 million people worldwide are at risk of developing diabetes, over and above the nearly 200 million who currently suffer from the disease. Grave news indeed. Worse still, the greatest increase in future years will be in the developing world, necessitating a dramatic rethink of the provision of diabetes care.
Health facilitation for people with learning disabilities
Authors: Corbett Jo , Thomas Caron , Prior Maxine , Robson Rick
Published: May 2014

Health facilitation is a concept introduced in the white paper, Valuing People: A New Strategy for Learning Disability for the 21st Century (DH, 2001a). A project was set up in the West Midlands region to look at what Primary Care Trust and specialist learning disability services were planning to do in respect of health facilitation in learning disabilities and to develop a resource tool for use by individuals working in this role. This article reiterates the extent of unmet health need experienced by people with learning disabilities and suggests that everyone involved in a caring role should be responsible for addressing their health needs. Primary and secondary care staff from across the region were consulted, and a range of educational needs were identified for these professionals. Recommendations were made for health facilitators to support the primary and secondary care teams to enable improved access to mainstream health services for people with learning disabilities. The recommendations can be applied nationally.
Dissemination, coordination: keys to a strong nursing voice
Authors: Vernon Tracy
Published: May 2014

This fourth edition of WoundCare marks the end of a year of which the Wound Care Society (WCS) committee is very proud. Judging from the feedback that I have been getting from colleagues and readers, WoundCare has been a great success.
District nurses: relationships in nurse prescribing
Authors: Fisher Rick
Published: May 2014

Although nurse prescribing has been established in the UK for approximately 8years, little is known about the effect this additional role is having on those who are involved in its processes. This article reports on the early phases of an ethnographic study which is aiming to discover how prescribing is altering the ways in which district nurses relate to general practitioners, pharmacists, other community nurses, patients and carers during the experience of nurse prescribing. Using qualitative methodology the project has revealed that some relationships have improved, while others appear to have deteriorated slightly. Preliminary indications are that the introduction of prescribing, along with many other centrally driven initiatives, is altering the face of district nursing practice.
Urostomy products: an update of recent developments
Authors: Burch Jennie , Sica Jo
Published: May 2014

This article provides an overview of the recent developments in appliances for people with a urostomy. Following a short background, the products that may be useful for this patient group are discussed.
From abstraction to reality: changes in primary care
Authors: Pollard Tom
Published: May 2014

A lot of the talk about how district nursing must adapt to the changes taking place in primary care has been rather vague. Some of it has been almost incomprehensible. But the pressure is piling on for change, and a clearer picture is now emerging of what district nursing services will have to do in the future.
Taking steps to ensure personal safety
Authors: Bentley Julie
Published: May 2014

Every year thousands of employees encounter some form of violence or aggression during their working day. Sadly this includes those whose work involves caring for others, such as community nurses.
Women’s experiences of faecal incontinence: a study
Authors: Collings Sarah , Norton Christine
Published: May 2014

Community nurses are often involved in the assessment of symptoms of incontinence and the provision of continence aids. However, it is less clear to what extent they can and do provide ongoing support and discuss with their patients the everyday experience of living with incontinence. This article focuses on what it means to live with faecal incontinence and, based on the findings from a small study, discusses the range of experience women with this chronic condition have.
The district nurse radio star who hasn’t let fame go to her head
Authors: Pollard Tom
Published: May 2014

They say it’s not what you know, but who you know that matters. So when a radio producer was commissioned to develop two programmes for the BBC following the lives of district nurses, he didn’t have to look much further than the mother of his son’s ex-girlfriend. It proved a good choice. ‘He was originally going to do one programme on city district nurses and one in a more rural area, but in the end we had so much material that he did both of them on us. He wanted to do three, but the BBC only wanted two, although they wished they’d done three when the programme came out.’
An introduction to the law of death and the body as property
Authors: Griffith Richard
Published: May 2014

District nurses often encounter the death of patients as part of their primary care role. Patients with serious illness frequently wish to continue their rehabilitation at home and those with terminal illness often return home to die surrounded by their families and supported by district nurses.
The challenges of managing dysphagia in brain-injured patients
Authors: Mayer Victoria
Published: May 2014

Dysphagia, or the inability to swallow normally, is a feature of a number of neurological conditions. It is found in both paediatric and adult populations, but the scope of this article is limited to the adult neurogenic population. The normal swallow is a complex and highly coordinated activity, any part of which may be disturbed by neurological illness or injury. Assessment of dysphagia is normally undertaken by speech and language therapists in conjunction with the multidisciplinary team. A bedside screening assessment may be augmented by instrumental assessment, such as videofluoroscopy, in cases where silent aspiration of food or liquid into the lungs is suspected. Dysphagia is treated using a variety of strategies, depending on the presenting symptoms. Individuals with dysphagia following traumatic brain injury present with particular difficulties, relating to impairments of cognition, communication and behavioural control. A description of the normal swallow is presented below with a review of dysphagic disorders, assessment methods and management. This is followed by a case account of a young man with dysphagia subsequent to traumatic brain injury to highlight some of the difficulties which can be encountered in the management of dysphagia.
A multidisciplinary team approach to public health working
Authors: Dion Xena
Published: May 2014

For several years the government’s health agenda has provided a strong directive for primary care professionals to work in a more public, health focused way. There remains, however, the constant challenge to incorporate a public health focus into existing clinical practice and caseload commitments in an achievable and manageable way, while at the same time impacting on ill-health. This article explores a pragmatic public health approach to addressing some of the common health needs of people, as identified collectively in the national service frameworks for mental health, coronary heart disease, diabetes, older people and cancer. A practical example of facilitating collaborative working between disciplines and agencies is offered using the author’s successful experiences from a review and modernization project of health visiting services in East Somerset (Dion, 2003).
Narrative approaches for research in community nursing
Authors: Frost Sue , Cliff Dallas
Published: May 2014

As community nurses become more actively involved in practice-centred enquiry, they are increasingly exploring ways of understanding the lived experience of clients. Narrative approaches are becoming particularly prominent as these methods of enquiry closely connect with the regular interactions between client and nurse. In this article the nature of narrative and its use is outlined and illustrated with an example of narrative exploration. Additionally the article identifies some of the arguments for developing narrative approaches in primary health care and concludes with some discussion on challenges in using this approach.
Childhood immunization: public health or parental choice?
Authors: Griffith Richard
Published: May 2014

Childhood immunization is a key tool in disease control and the main instrument in the government’s campaign to achieve the World Health Organization target for interrupting transmission of a range of indiginous diseases (Spika et al, 2003). However, rates of immunization have fallen over public concern about the safety of the combined measles, mumps and rubella (MMR) vaccine. Statistics show immunization uptake at around 85% (Department of Health (DH), 2004a) nationally, up from a low of 78%, and still much lower than the 95% rate required to achieve the population or herd immunity needed to effectively interrupt the transmission of the diseases (Carlowe 2003).
Priorities in nursing management of fistulas in a community setting
Authors: Burch Jennie
Published: May 2014

The aim of this article is to discuss care in the community of patients with a fistula. Areas considered include definition and classification of fistulae, potential causal factors and associated diseases. The article concentrates on enterocutaneous fistulation and the care of patients, but also includes a summary about caring for a patient with an anal fistula. The essential elements of nursing in a community setting are described, and information given on skin care, nutrition, fluids and appliances.
Wound-related osteomyelitis: a case of containment not cure
Authors: Patel GK , Llewellyn M , Harding KG
Published: May 2014

Community nurse need to be aware that some patients with osteomyelitis are treated with antibiotics alone. Such patients often have co-morbidities and quality of life issues that directly impact on the decision to treat osteomyelitis surgically. However, adopting a conservative approach to osteomyelitis management is associated with an increased risk of osteomyelitis recurrence. The rationale for managing chronic wound-related osteomyelitis with antibiotics is discussed. Community nurses caring for patients that have received antibiotics alone to treat osteomyelitis need to be aware of the potential for osteomyelitis recurrence and how to make the diagnosis.
Diabetes and peripheral neuropathy: keeping people on their own two feet
Authors: Walker Rosie
Published: May 2014

Peripheral neuropathy is one of the most common forms of diabetes-related neuropathy, and most commonly affects the feet. Loss of sensation leaves the feet at risk of damage – from environmental hazards, incorrectly fitting footwear or un-felt pressure damage – which can lead to the need for amputation. This article discusses how to reduce the risk of peripheral neuropathy through glycaemic control, and the steps that need to be taken to reduce the risk of injury on the neuropathic foot.
Eczema and dry skin in older people: identification and management
Authors: Ward Sue
Published: May 2014

Skin conditions affect up to 70% of older people. Among the commonest are those which are caused by or present as dry, itchy skin. This article discusses the three most common of these – asteatotic, gravitational and discoid eczemas – and offers straightorward advice that nurses can pass on to their patients for how to mitigate and manage these conditions. Central to this is avoidance of soaps and the use of emollients.
Application of standard precautions in the community setting
Authors: Rankin Annette , Kean Laura
Published: May 2014

Health-care associated infections (HAI) are a major source of morbidity, as well as being a significant cause of concern for patients and health-care workers. Nurses have a duty to prevent infection wherever possible. This article provides an overview of the standard precautions that all community health-care workers must implement to reduce the incidence of HAI.
Removing indwelling catheters: trial without catheter in the community
Authors: Robinson John
Published: May 2014

Indwelling urinary catheters are inserted to drain the bladder for a variety of reasons, but are an intervention of last resort. Unless contraindicated, patients with an indwelling catheter should therefore have at least one trial without catheter to assess if they can pass urine without having a catheter in situ. The commonest method in undertaking trial without catheter is to remove a indwelling urethral cathete and monitor urinary output over a period of time. Another method is when the catheter is not removed in patients who have a suprapubic catheter. Instead the catheter is clamped, and urethral urine output monitored. This is followed by immediately measuring any residue of urine drained via the supra-pubic catheter. This article looks at undertaking a ‘trial without catheter’ using both methods and examines the arguments concerning when to remove catheters, midnight or early in the morning.
Getting the most out of your clinical placement in district nursing
Authors: Dracup Lynn
Published: May 2014

The community placement is a vitally important part of any nurse’s training, and the student has a responsibility to be proactive in their learning from it. To this end, Northumbria University has pioneered a portfolio of learning opportunities (POLO) to provide students with a structured overview of the opportunities available to them during a placement and how to make the most of them. The POLO also assists mentors in framing their support of the student. In this article, a practice placement facilitator outlines the structure of a POLO, and argues for a more coherent approach to student placements.
Hypertension management: the primary care nursing role
Authors: Khan Ehsan Ullah
Published: May 2014

Hypertension is a prevalent chronic illness that is implicated in many cardiovascular diseases. Practice nurses and the district nursing team have a major role to play in its management. In this article, current British Hypertension Society guidelines are presented and discussed with regards to their evidence-base. Implications for nursing practice are highlighted.
Coronary heart disease: an update on progress of the NSF
Authors: Peacock Shelley
Published: May 2014

Coronary heart disease (CHD) is a preventable disease, yet is kills over 100000 people a year in the UK. CHD was among the first conditions to be addressed by a national service framework (NSF), published in 2000. Five years on, this article discusses the key tenets of the NSF that apply to primary care and how they should be being implemented, and discusses what else the Government is doing to tackle this common and costly condition.
Bringing hope and care to the poor, dispossessed and homeless of Russia
Authors: Daniel Karen
Published: May 2014

Post-Soviet Russia has seen the collapse of many of the social services and support structures which provided a safety net for many of its poorest citizens. For millions of needy people in the Russian Federation it has meant great hardship. But the quality of life of hundreds of Moscow citizens has been transformed through the work of Vera Lebedova, Director of Nursing at the Moscow branch of the Red Cross and recent recipient of a Queen’s Nursing Institute Fellowship.
Cancer pain in palliative care: why is management so difficult?
Authors: Hemming Laureen , Maher David
Published: May 2014

Pain is the major source of anxiety and distress at the end of life, particularly in cases of end-stage cancer. However, pain management is not always effective or effectively implemented. This article identifies several barriers to effective pain relief in terminal cancer – the complexity of pain; difficulties in physical, emotional and spiritual assessment; difficulties in the delivery of medication – that challenge the skills of all professionals involved in palliative care. There are no simple answers, but awareness of the breadth of the issues may help focus nurses’ minds on the patient in every encounter.
Towards understanding of non-compliance
Authors: While Alison
Published: May 2014

Many people with chronic illnesses do not take the medications that they are prescribed. Among the consequences of this are increased health care costs (resulting from failure to achieve optimal therapeutic benefit) and avoidable health care contacts and hospital admissions. Patients may also experience reduced quality of life and psychosocial complications. Yet there is a growing gap between health care users and health care providers: prescriptions are increasing, despite patients’ preferences for other approaches such as alternative therapies and behavioural interventions (Harrison, 2003).
Assessment and management of fungating wounds: a review
Authors: Wilson Vicky
Published: May 2014

Fingating wounds always present a management challenge. Not only is it often difficult to manage the physical aspects of the wound – pain, bleeding, exudate and odour – but also the psychological impact of a fungating wound on the patient and their family or carers is often considerable. This review examines current practice in relation to fungating wounds, and emphasizes the central important of assessment, communication and sensitivity in nursing management.
Amputation and the diabetic foot: learning from a case study
Authors: Wilson Deborah J
Published: May 2014

Diabetic foot disease causes more amputations than any other lower limb disease. Management of the diabetic foot requires a thorough knowledge of the risk factors for ulceration and amputation, the most common of which are neuropathy, ischaemia and infection. Amputations are not inevitable, however; early detection and appropriate treatment of ulcers can prevent up to 85% of amputations. This has been demonstrated in the formation of multidisciplinary diabetic foot clinics, which have been shown to reduce the number of amputations across the world. Adherence to a systematic regime of organization, education, screening and intervention can improve communication between patients, GPs, community nursing and diabetes sub-specialists to facilitate appropriate treatment and prevention of complications. The case discussed here demonstrates how inadequate and disjointed management through lack of communication, education and knowledge of diabetic foot disease can lead to complications requiring amputation and debridement.
Supporting older people: Death and bereavement
Authors: Ellis Jonathan
Published: May 2014

In this article, brought to you in association with Help the Aged, Jonathan Ellis discusses the important role nurses can play in helping older people at the end of their lives, and calls for better training.
Catheter valves for indwelling urinary catheters: a systematic review
Authors: van den Eijkel Esther , Griffiths Peter
Published: May 2014

This mini-review aimed to systematically review the evidence on the effect of catheter valves compared to free drainage into a bag for patients with indwelling urinary catheters. Data sources used were Medline, British Nursing Index, CINAHL, Ahmed, EMBASE, EBM Reviews, the Cochrane Library and reference lists of relevant papers. Papers considered were controlled trials comparing the use of a catheter valve with the catheter bag that were published as a full report, or detailed abstract (containing sufficient information to critique) in Dutch, German or English. Two studies with a total of 122 subjects were identified. The main outcome measures considered were reduction of incidence of bladder spasm and urinary tract infection (UTI) and patient preference. No statistically difference in the incidence of bladder spasm or UTI was demonstrated but patients showed a clear preference for the valve. Further research into catheter valves is needed, with larger study groups, which include housebound male and female patients, and longer follow-up period.
District nurses’ involvement in mental health: an exploratory survey
Authors: Lee Soo , Knight Denise
Published: May 2014

This article reports on a survey of district nurses’ involvement in mental health interventions in one county. Seventy-nine questionnaires were sent and 46 were returned. Descriptive analysis was carried out using statistical software. The DNs reported encountering a wide range of mental health issues and interventions in practice: dementia, anxiety and depression featured highly. Over half (55%) of the respondents reported involvement in bereavement counselling, and 28% and 23% of respondents reported encountering anxiety management, and problem solving and alcohol advice respectively. A large proportion, however, reported no involvement in mental health interventions. Among the psychiatric professionals, district nurses tended to have most frequent contacts with social workers. GPs were the most likely person to whom DNs made referrals, followed by community psychiatric nurses. Despite the apparent awareness of the values of psycho-social interventions, DNs were equally influenced by the medical model of treatment. In order to realize the potential contribution of district nurses in mental health interventions, there is a need for primary care teams to foster a closer working relationship with mental health specialist services.
Community nurse: the expanding role
Authors: Cook Rosemary
Published: May 2014

Community nurses have always been adaptable and responsive. They work in the wide variety of places that people call ‘home’, with all the variations in space, privacy, hygiene, time and cooperation that entails. Systems, organizations and regional boundaries come and go, but the fundamental role and work of community nurses has remained fairly constant. Until now, when many community nurses believe that they are being called on to adopt a range of new, and sometimes conflicting, roles as a result of government policy in primary care. As a result of recent policy initiatives, community nurses are expected to take on as many as 10 different roles: