bluuebunny/crossref_metadata_2025 huggingface dataset:
Clinical history versus the exercise ECG in assessment of stable coronary artery disease
Authors: McLean Scott
Published: May 2014

Reports highlighting the benefits of ‘nurse-led’ services invariably emphasize the importance of education and training. There is however a dearth of literature describing the training in or quality of clinical history-taking among cardiovascular nurses. Recent publications and forthcoming national guidance will re-emphasize the importance of clinical history-taking, and that the diagnosis of angina pectoris can be made solely on the basis of the presenting patient history. Furthermore, evolving guidance will discourage clinicians from using the exercise ECG as the primary diagnostic test for myocardial ischaemia. This will result in a significant shift in practice in the majority of centres across the United Kingdom, many of whom have chest pain assessment services led by cardiovascular nurses. If cardiovascular nurses are to claim the contemporaneous role of ‘clinician’, critical appraisal and preparation for these shifts in practice will be crucial.
Respiratory assessment 1: Why do it and how to do it?
Authors: Massey Debbie , Meredith Tara
Published: May 2014

Debbie Massey and Tara Meredithdescribe a practical, step-by-step approach for respiratory assessment, and outline why it is key that cardiovascular nurses are able to spot problems
Applying for research funds
Authors: Bogg Jan , Flynn Maria , Prescott Julie
Published: May 2014

In part 5 of a series on practical aspects of research, Jan Bogg, Maria Flynn and Julie Prescott outline some considerations for cardiovascular nurses to address when seeking funds for their research. They also offer general guidance to nurses planning to submit a grant application
Research Roundup
Authors: Linden Belinda
Published: May 2014

Patients who require aortic valve replacement are faced with the decision on the most appropriate type of replacement valve for them. The options include the mechanical valve, bioprosthetic valve, homograft valve, or the pulmonary autograft or Ross procedure, but there is not yet an ideal substitute for the aortic valve. The Ross procedure is a cardiac surgical operation where the diseased aortic valve is replaced with the person’s own living pulmonary valve (autograft), and a pulmonary homograft (which is a pulmonary valve taken from a cadaver) is used to replace the patient’s own pulmonary valve. The Ross procedure has been the technique of choice for small children and infants, because the pulmonary autograft grows and because there is no need for the patient to take anticoagulants as there would be with mechanical valves.
Use of the GRACE score by cardiology nurse specialists in the emergency department
Authors: McLean Scott , Phillips Alyson , Carruthers Kathryn , Fox Keith AA
Published: May 2014

Suspected cardiac chest pain is responsible for a significant number of emergency department attendances and 999 calls to ambulance ser vices in the UK. Differentiating patients with acute coronary syndrome (ACS) is a major diagnostic challenge. The GRACE risk prediction tool provides a validated method of calculating the risk of in-hospital death, 6-month death and myocardial infarction. This study aimed to determine whether systematic application of the GRACE risk-score by cardiology nurse specialists predicts long-term outcome in unselected patients with chest pain. Seven-thousand patients had a GRACE score recorded between September 2005 and April 2008. A random sample of 504 patients was extracted and their outcomes analysed. Incidence of death by April 2009 was recorded, with a follow-up period ranging from 31 to 44 months. Median length of hospital stay, confirmation of ACS and cardiac catheterization on index admission were recorded. There were significant differences in confirmation of ACS, length of hospital stay, inpatient cardiac catheterization and death at follow-up, over low, moderate and high-risk GRACE scores, with patients in the high-risk group suffering the worst outcomes. This study demonstrates the feasibility and the potential additional utility of objective risk scoring in a busy and challenging clinical environment.
Discharge from hospital: The importance of planning
Authors: Goodman Helen
Published: May 2014

Excellent cardiac care in hospital can be undermined if patients are not adequately prepared to leave the hospital environment. Good discharge planning needs to be started early, cover psycho-social as well as physical care needs and requires clear communication amongst all parties involved. Patients and their carers also need specific information to ensure they understand the after care for their specific cardiac condition or procedure. Some discharge plans are more complex than others, requiring liaison with primary care and local social services to ensure the patient returns to a safe environment.
Health research in context, defining the research question and designing the study
Authors: Flynn Maria , Watmough Sarah , Wright Angie , Fry Kathryn
Published: May 2014

In this first part of a series on practical issues in research from the point of view of the cardiac nurse, Maria Flynn, Sarah Watmough, Angie Wright and Kathryn Fry introduce the wider context of research in the NHS, and highlight the importance of a clearly defined research question
Postural tachycardia syndrome
Authors: Busmer Lorna , Kavi Lesley , West John
Published: May 2014

Postural tachycardia syndrome (PoTS) should be considered in the differential diagnosis of patients who present to a cardiology clinic for investigation of palpitations and syncope. Patients may present with symptoms of orthostatic intolerance including dizziness, fatigue, tiredness, syncope and pre-syncope and there is an associated tachycardia on standing. They are frequently misdiagnosed with anxiety, depression or chronic fatigue syndrome. PoTS is a type of dysautonomia, a dysfunction of the autonomic nervous system. To diagnose PoTS, a stand test or head-up tilt table test is performed. There should be a rise in heart rate from supine to upright position of greater than 30 beats per minute and often to higher than 120 beats per minute within 10 minutes of standing. The exact aetiology remains unclear and is currently the focus of much research. Management is challenging and incorporates a combination of non-pharmacological and pharmacological approaches resulting in improved quality of life for the sufferer.
Stroke prevention in primary care: optimising management of AF through nurse specialist support
Authors: Fox-Wilson Gillian , Cruickshank Stephanie
Published: May 2014

Atrial fibrillation is the most common heart rhythm disturbance. It is associated with a five-fold increase in stroke. Warfarin is an effective anticoagulant for the prevention of stroke but is underused.

This article describes a pilot which found that providing general practices with expert advice and education from an arrhythmia nurse increased the numbers of patients with atrial fibrillation being prescribed warfarin to reduce their risk of stroke.

Closer links were forged between primary and secondary care and the pilot also demonstrated savings both financially and in terms of strokes prevented
The pharmacology of coenzyme Q10: its relevance to health
Authors: Mantle David
Published: May 2014

Coenzyme Q10 (CoQ10) is a vitamin-like substance that plays a key role in the metabolic process, supplying all cells with energy. Tissues with a high energy requirement, such as the heart, are particularly dependent on maintaining an adequate supply of CoQ10 for normal functioning. Deficiency of CoQ10 has been identified as a risk factor for a variety of disorders, including cardiovascular and neurological diseases. The objective of this article is therefore to provide a brief overview of the pharmacology of CoQ10, with particular emphasis on its role in the prevention and treatment of cardiovascular disorders.
Care study: a cardiovascular physical assessment
Authors: Doyle Mary , Noonan Brendan , O'Connell Elizabeth
Published: May 2014

Patient assessment has always been an integral part of the nursing process. However, the physical aspects of a nursing assessment has been traditionally limited to the recording and interpretation of vital signs, whilst systematic physical assessments has been part of the doctor's role ( West, 2006 ). As nurses are now expanding their roles into areas of advanced practice and prescribing, they need to be able to provide effective holistic care and respond to changes in their patient’ status. This care study will describe a framework for conducting a comprehensive cardiovascular assessment which will include history taking and a particular focus of the physical assessment skills of inspection, palpation, percussion and auscultation.
Temporary pacing: clinical indications and techniques
Authors: McNaughton Amanda
Published: May 2014

Patients suffering bradycardia and haemodynamic compromise may require implantation of a temporary pacemaker as a bridge to permanent cardiac pacing. This article provides an insight into such temporary pacing, the indications for pacing, the types of pacing most commonly used and some of the key issues surrounding this intervention.
Gender bias and help seeking in coronary artery disease
Authors: Stain Nolan , Unsworth Beth
Published: May 2014

Coronary artery Disease (CAD) is one of the leading causes of death in both men and women worldwide. Despite the common misconception that CAD is a ‘man's disease’ it is now well known that women endure much worse clinical outcomes than men following CAD-related events. A number of studies have explored whether gender differences exist in patients presenting with CAD, and specifically whether women do indeed delay seeking help for cardiac conditions. Understanding the difference between help-seeking decisions made by men and women is complex. Many UK and overseas studies suggest that women with cardiac symptoms often delay help seeking or making help-seeking decisions, but more work is needed. Women may not present with the same ‘classical’ chest pain symptoms but this should no means imply a low risk of CAD.
No immediate haemodynamic effect of reflexology in CAD
Authors: Jones Jenny , Thomson Patricia , Laude William , Howie Kate , Leslie Stephen J
Published: May 2014

Reflexology is one of the most popular forms of complementary therapy in the UK and cardiac patients are seeking reflexology treatment. This study measured the immediate haemodynamic effects of reflexology treatment applied to specific areas of the feet (which are thought to correspond to the heart) in patients with coronary artery disease, and compared this with treatment applied to other areas that are not. This study found no acute (immediate) specific changes in any of the haemodynamic parameters measured. While long-term treatment effects are uncertain, the results indicate that reflexology is safe for use by patients with coronary artery disease.
Is there a need for automated external defibrillators in supermarkets?
Authors: Bailey Kristopher
Published: May 2014

The government white paper Saving lives: Our Healthier Nation ( Department of Health (DH), 1999 ) was the first of its kind to set the standard for decreasing social inequalities in health care. In particular it placed emphasis on reducing the number of deaths in England from coronary heart disease (CHD). Sudden cardiac arrest accounts for 60% of adult deaths from CHD in Europe ( Resuscitation Council (UK) 2011 ). It is estimated that 60 000 out-of-hospital cardiac arrests (OHCA) occur in the UK each year and the outcome remains poor ( Resuscitation Council (UK), 2011 ). In order to reduce the number of deaths from OHCA in the UK, the government implemented a national defibrillator programme ( Davies et al, 2002 ). Its success was such that many workplaces in the UK are considering having public-access automated external defibrillators (AED) on site. Currently, no research exists regarding the use of AEDs in supermarkets but studies have been carried out in areas which have a similar footfall on a daily basis and a clientele and workforce of various ages. Despite the lack of research, many large supermarket chains have carried out individual risk assessments and have consequently began to install AEDs on site. This article aims to explore this requirement further, taking into consideration cost-effectiveness and training requirements, as well as the legal aspects of having an AED in the workplace.
Anticipatory grief work with children
Authors: Saunders Jayne
Published: May 2014

This paper discusses the work undertaken with children who have a significant person in their family in the final stages of a life threatening illness. The paediatric nurse works alongside members of both the primary health care team and the educational team in helping the family to prepare the child through the various stages of illness and, ultimately, for the expected death of that person.

The aims are to form a relationship of trust with the child in order that he/she feels that there is someone available to talk to and discuss fears and anxieties that they may not be able to share with their parents. It is hoped that the child will then be able to make choices about his/her involvement in the actual care of the parent, with the support of those around them.
The Changing use of nursing skills in general practice
Authors: Rink Elizabeth , Ross Fiona , Godfrey Emma , Roberts Geoff
Published: May 2014

The focus of primary health care as a driving force for change in the NHS means that the most appropriate deployment of nursing skills in primary care is a challenge for general practitioners (GPs), managers and nurses themselves.

In order to assess primary care nursing workload and attitudes to changes in nursing skillmix, an audit of nurse work was carried out at a fundholding practice in which management changes were being instigated. Use of each nurse’s time and related skills was assessed by generating an activity profile. Interviews were carried out with the 14 primary health care nurses and five GPs.

Although the audit detected a 17 per cent increase in the number of patients seen over the year, little change in the use of nursing time was detected. The views of nurses and GPs indicate that this review may have had an enabling effect on the primary health care team, by nurturing a questioning and evaluative approach to the changing organisation of nursing roles and skills.
Oral health needs: how may they be met?
Authors: Gallagher Jenny E
Published: May 2014

Oral health has improved greatly since the early 1970s due to a decline in dental caries, largely attributed to the inclusion of fluoride in toothpaste. Improvements are most evident in children and young adults. Variations in oral health persist, however, with those from lower socio-economic groups having most disease. Dental caries and periodontal diseases continue to have significant impact on oral health, along with conditions such as oral cancer and tooth wear. Community nurses play a valuable role in providing oral health and facilitating access to appropriate dental services where signs or symptoms of oral disease exist. General dental practitioners remain the main providers of primary dental care with community and salaried dental services providing a complimentary service, focusing on patients with ‘special needs’ in the community. The main messages for the prevention of oral disease stress a healthy diet, good mouth hygiene, the use fluoride and regular dental visits.
The prevention and management of violence in the community
Authors: Chaplin Eddie , Allison Graham
Published: May 2014

Although there is little research regarding the violence nurses experience at work recent surveys suggest that violence is becoming an increasing problem for healthcare professionals (Poyner and Warne, 1986; Standini and Nicolini, 1997). Managing violence in the workplace is problematic given the diversity of community settings and the variety of specialist nurse roles. Recent surveys carried out in the community indicate the extent of this problem and have assisted health professionals in the management of risk by enabling them to predict and target high-risk situations and areas (Mirless-Black et al, 1996). This article examines the management of violence and associated risks in five key areas. These include clients, staff members, treatment/interaction, the healthcare setting and the organization as a whole. The article focuses on how violence at work can be managed and explores the role of the employer in providing assistance to healthcare professionals in this area.
Self-inflicted wounding 1: psychosomatic concepts and physical conditions
Authors: Moffatt Christine
Published: May 2014

Patients who deliberately harm themselves present a difficult challenge for health professionals involved in their care. Rates of self-harm appear to be on the increase; self-cutting is the second most common form of self-harm after drug overdose (Schmidtke et al, 1996). However, patients who wound themselves suffer a variety of conditions ranging from anxiety states resulting from psychosocial stress to severe psychotic states. Patients who self-harm are frequently labelled ‘difficult’ or ‘manipulative’ and as a result they often fail to receive appropriate care. The successful management of patients with self-inflicted wounds is dependent on identifying the underlying cause and building a therapeutic relationship between health professionals and patients. Only then is it possible to break the crippling cycle of maladaptive behaviour.
Group clinical supervision in district nursing
Authors: Griffiths Jane
Published: May 2014

There is growing evidence that clinical supervision is a useful means of developing practice in nursing (Butterworth et al, 1997). There is, however, little in the way of research evidence to support various approaches to supervision for district nurses. This article reports a practice development initiative in which clinical supervision was implemented in a community trust. The rationale which underpinned the decision to implement group supervision is explored and the supervision techniques described. Recommendations are made for further work in this area, most notably in relation to evaluation.
Use of the syringe driver in the community setting
Authors: Kennedy Catriona , Lockhart-Wood Karen , Fielding Helen
Published: May 2014

Supporting patients with cancer and their family carers in the community setting presents a considerable challenge to healthcare professionals. As more patients with advanced cancer are cared for at home, family carers are assuming greater responsibility for managing a range of physical, emotional and psychological consequences of advanced malignant disease. Pain remains one of the most common and feared symptoms of advanced cancer and it is estimated that two-thirds of patients have pain in the terminal stages of illness. The syringe driver is a useful device for controlling cancer pain for many patients at home. This article explores a range of practical issues relating to the use of the syringe driver in the patient’s home. It is suggested that professional carers need to understand the complex nature of the caring role often assumed by family carers so that they can meet their needs for information and support. Good pain management can be achieved by using the syringe driver to deliver continuous pain-relieving medication but is dependent on collaboration between health professionals, the patient and family carers.
Recent developments in community leg ulcer management
Authors: Cave Jayne
Published: May 2014

Leg ulceration is a common chronic condition which can have a significant impact on the patient’s quality of life. This article discusses recent developments and nurse-led initiatives in the assessment, treatment and aftercare for patients with leg ulceration. The importance of establishing community-based leg ulcer services and adopting a multidisciplinary team approach to leg ulcer management is examined. The article also discusses the role of the tissue viability specialist in relation to effective care provision, education and quality of life issues in patients with leg ulceration.
A risk assessment and management strategy for community nursing
Authors: Dale Colin , Woods Phil
Published: May 2014

Many nursing interventions carry risks of harm to the patient, the nurse or the general public, and the potential for subsequent litigation or censure. This article proposes a six-point risk management strategy which, if implemented, could reduce the chance of potential harm and litigation within a community nursing service. The strategy encompasses organizational, cultural, clinical, employee, environmental, and incident-reporting issues. A policy statement is proposed from which a risk management strategy could be developed. This is underpinned by the acceptance and ownership of risk management by all managers and clinicians, which is best achieved through a culture of honesty and openness, and where the management of risk is considered one of the fundamental duties of every member of staff. The strategy aims to enable the creation of a more coordinated, systematic and focused approach to the management of risks.
Health promotion in leg ulcer management in the community
Authors: Warren Wendy , Alstrom Carol
Published: May 2014

This article acknowledges the substantial progress that has been made in leg ulcer management in recent years. However, there needs to be greater emphasis on health promotion, quality of life, general patient wellbeing and promoting health within illness. Incorporating health promotion activities within venous leg ulcer management strategies may serve to empower patients to participate more fully in their care. Nurses’ awareness needs to be raised to ensure that the assessment process is used as a tool to promote holistic care and not merely as a check list to provide baseline information on the patient’s health status. A series of factors highlighted during assessment are explored to demonstrate the potential for health promotion.
Legal issues arising in community nursing 9: confidentiality
Authors: Dimond Bridgit
Published: May 2014

The duty of confidentiality is absolutely clear in community nursing. However, there are a number of situations in which confidentiality may be justifiably breached. This article reviews these situations, and offers guidance to community nurses on judging when breach of confidentiality is appropriate and legally permissible.
Family support by lay workers: a health visiting initiative
Authors: Perkins Elizabeth R , MacFarlane Joan
Published: May 2014

There has been considerable research on the effectiveness of intensive professional home visiting schemes in improving parenting; lay visiting schemes, however, although often popular with clients are under-researched. This article focuses on a lay visiting scheme set up and supported by health visitors in a deprived inner city area of Sheffield between 1998 and 2000. Although this scheme was designed to run for 2 years, an interim evaluation has taken place to track its effectiveness. This mainly qualitative evaluation has not only shown benefits to clients but also identified a number of issues for safe practice. The scheme has now been awarded core funding. It illuminates the kind of relationships that can develop between lay workers and clients, and enables a discussion of the benefits of this project and the challenge such schemes can present to both policy and practice.
Facing the challenge of practice development in community nursing
Authors: Hayes Lindsey , Savage Yvonne
Published: May 2014

The large number of job titles associated with practice development within nursing can cause confusion as to the exact role of the person working within the development sphere. However, there is a recognized need for these development roles in the absence of clinical managerial positions and within the climate of continuing change in the NHS. This article explores the skills required for practice development and is, in part, a reflective account of the work achieved over a 2–year period. The authors argue for clarity of purpose and continuing commitment from within the organization in order for these roles to achieve some degree of recognition, with specific reference to a community health care setting.
Diagnosis and treatment of osteoporosis
Authors: Wilson Alexandra
Published: May 2014

Osteoporosis is a serious, debilitating and potentially fatal chronic disease which places a major burden on both the patient and the NHS. In order to tackle this growing problem successfully, it is essential that it is diagnosed in its early stages so that fractures can be prevented. Nurses in particular can make a big difference, as they are ideally placed to proactively identify those who may be at risk from osteoporosis. This article explains the essential role the nurse can play, highlights the risk factors and symptoms nurses should be looking out for, and provides a brief summary of all the management options available, so that nurses can make informed recommendations on the most appropriate treatment
Continence assessment in primary care: what is the next step?
Authors: Winder Ann
Published: May 2014

There are many assessment ‘forms’ available for the collection of information in relation to bladder dysfunction. In many cases such forms have not been fully validated and should only be considered on a face validity basis. Validated symptom scores are available but these are generally used within specific areas of urology, e.g. Iower urinary tract symptom scores for prostate screening. This article explores the need for an improved validated assessment and symptom scoring tool for nurses within primary care, to enable nurses to establish a preliminary diagnosis in adult patients presenting with bladder symptoms.
Developing a framework for primary palliative care services
Authors: Daniels Lilian , Linnane John
Published: May 2014

Practice and empirical data indicate concerns regarding the delivery of primary palliative care, particularly the provision of a multidisciplinary approach. A collaborative study was undertaken between an academic unit and primary care practice to evaluate current care provision and explore methods of developing services. A two-phase study was carried out over a period of 18months using an action research approach, in order to facilitate concurrent service evaluation, change in practice, and the involvement of professionals in research and practice development. The first phase highlighted the need to enhance primary palliative care services; a number of practice changes were identified and implemented during the second phase and evaluated using quantitative and qualitative methods. Data demonstrated the enhancement of services, benefits to patient care and professional working and the viability of an innovative model of palliative care delivery – that of a surgery-based clinic for palliative care patients and carers. A framework for the provision of multidisciplinary palliative care in the community was developed.
Hand washing for health-care workers in domestic care settings
Authors: Carroll Anne
Published: May 2014

Hand washing is recognized as the single most important practice in reducing the spread of infection. Infection problems, such as an increase in antibiotic resistant organisms, have now made apparent the need to return to such basic practices. Although optimum facilities and practices for hand washing in an inpatient setting have been described, these are rarely available for health-care workers providing increasingly more complex care to patients and clients in their own homes. Therfore, community staff need to adopt a risk assessment approach and strategies to ensure that adequate decontamination of their hands is achieved in order that care can be given with the minimal risk of cross-infection between patients, clients and staff.
The decision-making process in a district nursing assessment
Authors: Kennedy Catriona
Published: May 2014

Assessment is a key element of district nursing practice and a cornerstone of community care. Yet very little research has been undertaken in this area. Given the current emphasis on evidence-based practice in health care, there is a need to ensure that district nurses, nursing students and educators can draw from an empirically derived and sound knowledge base. This article explores the relationship between knowledge and decision-making in district nursing assessment. It is based on a case study of one district nurse participant from a qualitative study of district nursing assessment. The case study material illustrates key findings from this study in order to examine the relationship between theoretical perspectives and everyday decision-making, based on the stages of decision-making identified by Carroll and Johnson (1990).
Altered body image: the psychosocial needs of patients
Authors: Rumsey Nichola , Clarke Alex , Musa Mayrem
Published: May 2014

The psychosocial consequences of a disfiguring condition are well recognized. However, severity does not predict distress, and conditions in which the disfiguration is relatively minor can be disturbing. While the appearance-related concerns of patients with so-called ‘minor’ conditions such as acne are gradually being reported, body image changes that occur as a result of other conditions and/or their treatment are often overlooked. This article describes an audit of the appearance-related concerns of patients with rheumatic disease and outlines ways in which community nurses might elicit their concerns and address their needs.
Managing recurrent urinary catheter encrustation
Authors: Getliffe Kathryn
Published: May 2014

Recurrent blockage of the urinary catheter is a common problem in around 40–50% of long-term catheterized patients, leading to problems which are distressing to patients and costly to health services in both time and resources. Blockage is frequently caused by the build-up of mineral deposits on the catheter surface following precipitation from the urine under alkaline conditions. The presence of urea-splitting bacteria in the urine promotes a strongly alkaline urine and their adhesion to the catheter as a biofilm makes them extremely difficult to remove. This article addresses strategies for early identification of potential ‘blockers’; proactive approaches to care; and the evidence for use of catheter maintenance solutions.
Do baby walkers delay onset of walking in young children?
Authors: Burrows Patricia , Griffiths Peter
Published: May 2014

Baby walkers have been a source of considerable controversy. Some people suggest developmental benefit from their use while others focus on the potential harm that stems from accidents and even suggest developmental delay. This mini-review aimed to determine if use of a baby walker delays affects the onset of walking. The Cochrane library, Embase, CINAHL and Medline were searched for randomized controlled trials (RCTs) and cohort studies, which compared the onset of walkers walking in infants who used baby walkers with a group who did not. Two RCTs and two cohort studies were identified and available for consideration. All of the studies examined the effect of infant walkers on the onset of walking. The results of the two RCTs did not demonstrate a significant effect on the onset of walking. The cohort studies suggest that the use of infant walkers delayed the onset of walking in young children and a pooled analysis of the four studies suggested a delay of between 11 and 26 days. Although the quality of the studies was relatively poor these studies lend no support to the argument that walkers aid the development of walking. The significance of a delay of this magnitude is however unclear. Further work is required to determine whether walkers are an independent causal factor in accidents.
The role of the health visitor in the uptake of cervical smear testing
Authors: Athi Regender
Published: May 2014

This article discusses one of the dilemmas health visitors have in promoting the uptake of cervical smear testing. Should health visitors carry out the procedure in the home? In some areas of the country, following many campaigns and efforts the uptake of smear tests remains low whereas in other areas where women are well informed and educated, the uptake is much better. The aim of this article is to give an overview on what has been tried before as well as to discuss the contentious issue of what role the health visitors have in this area of practice.
Promoting Excellence in Primary Care 2002: conference report
Authors: Pollard Tom
Published: May 2014

The inaugural British Journal of Community Nursing conference, organized in association with King’s College London, took place on 4-5 March. A broad range of speakers and the keen participation of all the delegates ensured that the event was a great success. Promoting Excellence in Primary Care 2002 aimed to explore the current state of primary care nursing and to explore future developments. The delegates themselves represented a cross-section of the present and future of primary care nursing, with representatives from established specialties and newer structures such as NHS Direct, the public and private sectors, and education and practice.
Smoking cessation: a role for every practitioner
Authors: Roberts June
Published: May 2014

Despite the long-term efforts of governments and health professionals, smoking is still the single most important public health problem in the UK today. The addictiveness of nicotine means that very few unsupported attempts to quit are successful. This article provides an overview of the public health implications of smoking in the UK, the benefits of stopping smoking, and examines what community nurses can do to help and support people who want to quit.
Disseminating weaning messages: an intervention trial
Authors: Hoare K , Wright CM , Wilson P , Weaver LT
Published: May 2014

This article reports a non-randomised intervention study conducted in two market towns to find out whether participant-centred health education discussions improve parents’ knowledge and actions concerning infant feeding. Following an initial quiz, parents of 8-week-old infants attended a discussion on weaning (intervention) or home safety (control). They were then asked to complete a questionnaire about their knowledge and actions concerning weaning when their infants were 7-9months old. A total of 61 parents took part in the intervention and 49 in the control. In the post-intervention questionnaire, the intervention group reported using more home-cooked foods and less commercially-prepared baby foods and knew the optimum time to register their infants with the dentist. These results suggest that participant-centred discussions are an effective way of disseminating public health messages concerning infant feeding.
Pharmacological management of smoking cessation
Authors: Percival Jennifer , Milner Dawn
Published: May 2014

There is evidence that pharmacological management of smoking cessation, together with advice and support, is very cost-effective and increases success rates of quit attempts. Community nurses are in a good position to intervene with smokers. All nicotine replacement therapy products are now on the Nurse Prescribers’ Formulary. This article covers the scientific evidence, the guidelines on smoking cessation and the role of the health professional. Treatment options are described and useful contacts for further information are provided.
Verification of expected death by district nurses
Authors: Ayris Wilma W
Published: May 2014

Pressures on a local out-of-hours GP deputizing service led to lengthy delays before a doctor could visit to verify the (expected) death of patients under the care of the district nursing service. This resulted in distress to the relatives and delayed transfer of the body to a funeral home. This article explores an initiative to enable community nursing staff to verify those expected deaths and to provide more effective support to relatives at a difficult time. The article highlights the benefits of multidisciplinary collaboration in the development of an appropriate protocol and provides an overview of its implementation in one area. The initiative contributes to the Government’s agenda to improve access to primary care and to create more patient friendly services.
Nutrition and diabetes control: advice for non-dietitians
Authors: Dyson Pamela
Published: May 2014

Diabetes mellitus affects 2–4% of the UK population and its prevalence is predicted to double by 2010. It has been widely acknowledged that dietary therapy can reduce the risk of complications in people with diabetes. However, as there are insufficient diabetes specialist dietitians to deliver dietary advice to all people with diabetes, the burden of care will fall on the primary care team. Dietary advice given to people with diabetes by health-care professionals needs to be consistent. As recommendations change with new evidence, professionals have a duty to update their knowledge. This article reviews current nutritional recommendations from the UK, Europe and the USA and offers suggestions for translating dietary theory into practice. It emphasizes the importance of an individual approach, taking into account usual eating patterns, lifestyle, age, culture and medication.
Perceptions of pressure ulcers among young men with a spinal injury
Authors: Gibson Louise
Published: May 2014

About 1000 younger people each year suffer a traumatic spinal cord injury that leaves them wholly or partly paralysed. The majority of these individuals are male. Paralysis leads to a host of physical and often psychological problems. Among the major challenges is the management of pressure and the maintenance of skin integrity. Long periods of immobility and loss of sensation make people with a spinal cord injury prone to developing pressure ulcers. While specialist spinal injury units have pioneered a holistic approach to the rehabilitation of those with spinal cord injuries, there has been little research conducted in the UK on the experiences and coping mechanisms of these patients. The study reported here sought to examine the perceptions and experiences of a sample of young men with a spinal cord injury in relation to pressure management and skin integrity, and their experiences of care. The results suggest that these men were knowledgeable about pressure management and highly motivated to look after themselves, but there was an over-reliance on the specialist unit for support.
Use of sugar in the treatment of infected leg ulcers
Authors: Lisle Jackie
Published: May 2014

Mrs R is an 84-year-old retired shop-keeper with a 17-year history of recurrent leg ulceration. She has received treatment in both primary and secondary care settings, including specialist dermatology and vascular clinics. Mrs R has a long history of non-compliance to treatment regime, removing bandages and rucking them down causing compression injuries that almost resulted in amputation of her right leg. On assessment by the author, she had two partial thickness ulcers to each leg, signs of venous insufficiency and malnutrition, and swabs cultured positive for a range of bacteria. Resistance to topical antimicrobials and allergy to systemic antibiotics meant that another solution had to be tried to relieve the bacterial load on Mrs R’s wounds.
Pulse oximetry vascular assessment in patients with leg ulcers
Authors: Bianchi Janice , Douglas Stewart
Published: May 2014

Arterial screening of the lower limbs is recommended before compression therapy is initiated in patients with ulceration or dermatitis. Hand-held Doppler ABPI is the accepted assessment tool but, has limitations. Pulse oximeters have potential as alternative screening instruments with some advantages over Doppler. This article reviews the mode of action, application and limitations of pulse oximeters. A pulse oximetry toe/ finger arterial screening index, which may be used as an alternative to Doppler ABPI, is described. Case studies are reported in which arterial blood flow which was easily detected by pulse oximetry but could not be detected by Doppler.
Debridement of necrotic tissue and eschar using a capillary dressing and semi-permeable film dressing
Authors: Lisle Jackie
Published: May 2014

When managing wounds it is essential that a holistic approach to patient management be adopted that takes into account intrinsic and extrinsic factors that may prevent wound healing. Once the ‘healability’ of the wound has been established, appropriate management of the patient may proceed (Krasner, 2001).
Pressure relieving equipment selection in the community: rising to the challenge
Authors: Scanlon Liz , Eaves Abi
Published: May 2014

Due to changes in health care provision district nurses are increasingly called on to assess for more specialised pieces of equipment from an ever increasing choice of products. Eligibility criteria for the ordering of equipment have been developed in Leeds to assist district nurses in ensuring that the equipment they assess for is the most appropriate and suitable for its purpose and that it will be used safely and correctly. The use of the criteria is demonstrated through their application to pressure relieving equipment. Use of the eligibility criteria will hopefully improve the overall quality of service for the patient and carers throughout the process of equipment provision, from assessment through to delivery and it subsequent use.
The wound healing continuum
Authors: Gray David , White Richard J , Cooper Pam
Published: May 2014

Wound classification systems have been devised in an attempt to provide simple frameworks for non-specialist nurses to assess and manage wounds. However, most have been seen to fail, probably due to over-simplification and failure to validate their usefulness. We have devised a classification system of healing that is based on colour and is an extrapolation of some of those that have gone before. We have taken the time to address the needs of the less experienced carer and have a more inclusive scheme. This is intended to aid identification of the main prognostic feature of the wound, which will serve as an indicator for healing or non-healing and provide the basis for selection of treatment. When used in conjunction with the wound infection continuum, we believe this system will provide an accurate framework sufficient to guide classification and management of most acute and chronic wounds.
New insulin analogues and their impact on diabetes care
Authors: Hill Jill
Published: May 2014

The rising incidence of diabetes means that it is no longer viable for patients to be treated solely within the secondary care setting and primary health-care professionals, including community nurses working within community-based diabetes clinics, are likely to continue to take on greater responsibility for the assessment and management of patients with diabetes. This article discusses recent advances in insulin therapy – namely the advent of the new insulin analogues – and examines their likely impact on community nurses in terms of improved time management and quality of care for patients with diabetes. on patients in terms of improved quality of care.
Does exclusive breast-feeding reduce the risk of coeliac disease in children?
Authors: Nash Samantha
Published: May 2014

The aim of this review was to identify if exclusive breast-feeding reduced the risk of coeliac disease (CD) in children. Medline, Embase and CINAHL databases were searched for cohort studies and case control studies that compared exclusive breast-feeding rates with formula or mixed (breast and formula) of the same duration. Three case control studies met the review criteria and were included in the review. he results from these studies show that there is a reduced risk in the onset of CD in those children who were exclusively breast-fed compared to those who were not. However, the design of these studies did not allow a causal relationship to be established. he evidence from these studies suggests a delay in the onset of CD in breast-fed children, however it cannot be ruled out that breast-feeding continues to have a protective factor in adolescence and adulthood. The exact role of breast-feeding is CD prevention needs to be clarified: is it a protective factor against CD, or does it delay the appearance of clinical symptoms? Parents should continue to be encouraged and supported with breast-feeding, as it is the best form of infant nutrition and protective against short and long-term health outcomes.
An evaluation of clinical tools to measure pain in older people with cognitive impairment
Authors: DeWaters Trudy , Popovitch Judith , Faut-Callahan Margaret
Published: May 2014

Pain in older people with cognitive impairment is often untreated or under-treated despite the fact that the likelihood of having pain increases with advanced age. One reason that pain is poorly managed in older people is that it is not detected. Assessing pain is an integral part of clinical practice and is required for effective pain management. However, systematically measuring pain intensity and location with standardized tools in older people has not been well studied. This article will summarize tools used to assess pain in older people, including self-report scales measuring pain intensity, the presence or absence of pain, pain location and pain behaviour scales. Identifying the advantages and disadvantages of these clinical assessment tools has implications for nursing practice, research and education.
Primary care nurses’ attitude to sickness absence: a study
Authors: Plant Marilyn , Coombes Sharon
Published: May 2014

Nurses are under more pressure than ever before in a fast-changing NHS. Staff shortages and spiralling workload have led to escalating levels of stress in community care, while managers look to minimize the cost of sickness absence. However, the causes of sickness absence are complex and poorly understood. The authors report on a small-scale qualitative research study on the attitudes of primary care nurses to sickness absence. In-depth interviews were conducted with a small sample of volunteer nurses working in a west London primary care organization. Interviews were transcribed, coded and analysed into six main themes. It was found that psychological issues and values are very important but good management and the role of the team are also key factors in the decision to take sick leave. Workplace characteristics, personal issues, and local factors also play a very significant role.
Putting the record straight: the importance of documentation
Authors: Griffith Richard
Published: May 2014

Record keeping is a crucial aspect of a community nurse’s duty. The case of the Coventry nurse shows that failing in this duty can lead to your name being removed from the professional register.
Cross-boundary working: a generic worker for older people in the community
Authors: Hek Gill , Singer Lorna , Taylor Pat
Published: May 2014

The care of older people often crosses the boundaries of health and social care. The new role of a health and social care-trained generic worker was developed to provide comprehensive care for older people living at home. The role is a cross between a nursing auxiliary, health care assistant and a community support worker. The evaluation of the 1-year pilot project demonstrated that clients were very satisfied with the care they received, particularly the emotional aspects of care. A high proportion of the generic workers time was spent listening and responding to their client’s mental health needs, and providing comfort and emotional support. Having been trained by local health professionals, the generic workers felt valued and respected, better able to communicate with their health colleagues, and therefore able to provide holistic care to their clients.