bluuebunny/crossref_metadata_2025 huggingface dataset:
Housebound patients with coronary heart disease
Authors: Ellen Julie , Barrett Marie
Published: May 2014

The care of people with long-term conditions is a priority for the NHS.While there are many strategies in place in primary care to support the management of patients with long-term conditions, there is a paucity of services for people who are housebound. Coronary heart disease (CHD) is the most common cause of death in the UK and costs more than £9 billion every year ( British Heart Foundation, 2012 ). This article describes a pilot project set up by a nurse, working under an honourary contract within a general practice. The project's aim was to deliver a service, to housebound patients with CHD, which would provide an annual review of their condition in the home. This pilot provided some justification for the expansion of the service to all housebound patients who have a long-term condition, ensuring that they receive the same equitable assessment, treatment and health promotion advice afforded to those able to come into the practice.Some of the findings from the patient visits are discussed and a case is made for the expansion of the project beyond the pilot.
Writing a business plan to support a cardiac service
Authors: Hatchett Richard , Coady Elaine
Published: May 2014

Increasing financial constraints on cardiac services and the NHS, coupled with the need to demonstrate positive service outcomes, has heightened the emphasis on producing a clear business plan/case to support development or re-design of many services before commencing any patient initiative. Creating a business plan can appear a daunting task, but it can be made easier by following some basic steps which can be divided into clear headings. This article discusses the reasons for creating a business plan and discusses the important steps to be included in any proposal. To make things easier, it is suggested that support should be sought from those experienced in creating business plans, relevant supporting evidence should be accessed, and the whole team affected by the subsequent service should be involved in order to increase the validity of the exercise.
Interventional guidance for treating resistant hypertension
Authors: Linden Belinda
Published: May 2014

This month, Belinda Linden reviews the recent National Institute for Health and Care Excellence guidance on the use of percutaneous transluminal radiofrequency sympathetic denervation of the renal artery in order to reduce blood pressure in patients with resistant hypertension
Maximising the benefits of cardiac rehabilitation
Authors: Sage Shelley
Published: May 2014

The inverse care law is demonstrated in those who access cardiac rehabilitation and those who are most likely to adhere to the prescribed programme. Cardiac rehabilitation has been demonstrated to improve survival and reduce morbidity and hospitalisation, and this article describes the importance of participation by the elderly, women, people from ethnic minorities and those from areas of social deprivation. It also discusses how to mitigate some of the perceived barriers to rehabilitation. The emphasis is on the importance of person-centred assessment, concordant relationships with health professionals and individualised rehabilitation programmes.
ECG of the month
Authors: Regan Clare , Regan Martin
Published: May 2014

Clare Regan and Martin Regan present an ECG for you to analyse.
Macitentan: A new option in the treatment of pulmonary arterial hypertension
Authors: Gin-Sing Wendy
Published: May 2014

Wendy Gin-Sing explains how treatment for pulmonary arterial hypertension has improved over the years and is still evolving
Patient care on the agenda at BANCC study day
Authors: Tagney Jenny
Published: May 2014

Jenny Tagney gives an overview of the British Association for Nursing in Cardiovascular Care (BANCC) study day, which took place on 7 March 2014 in Manchester
The relationship between diabetes and atherosclerosis
Authors: Beckwith Sue
Published: May 2014

Diabetes is characterised by accelerated atherosclerosis with widely distributed vascular lesions. Both the risk and rate of development of these lesions are directly influenced by the glycaemic fluctuations and lipid imbalances characteristic of diabetes. This article looks at the mechanisms leading to atherosclerosis, the association of atherosclerosis with metabolic syndrome, and both type 1 and type 2 diabetes and the manifestations of the macrovascular manifestations of atherosclerosis.
Developing partnerships for practice: Using the Edinburgh postnatal score
Authors: Sheldrake Doreen , Sillman Christine , Notter Joy
Published: May 2014

Postnatal depression occurs in about 10% of women following childbirth, and prevention detection and early treatment are key aspects of the health visitors role. This study used the Edinburgh Postnatal Depression Score as a systematic tool for the identification of women at risk of developing postnatal depression. Over 200 women, mainly of Caucasian origin, were involved in the study, and the results demonstrate that not only is identification of women at risk possible, but that increased health visiting intervention can significantly reduce the risk of factor score. Also that the EPDS increases client understanding and, hence, appropriate use of health visiting services and acts as a basis for the development of client-led services.
Development of a community cardiac liaison nurse service
Authors: Fisher Sarah
Published: May 2014

Coronary heart disease (CHD) is the leading cause of death and ill-health in the United Kingdom (UK), accounting for a large proportion of NHS expenditure (Department of Health (DoH) 1993). Reducing mortality from CHD has been identified as a key area in the government's Health of the Nation strategy (DoH 1992).

This paper will present an overview of acommunity-based cardiac liaison nurse service and its role in the management of individuals with established CHD. The service is based within a community NHS trust in North London, serving a population of 470000 people, 34 per cent of whom belong to ethnic minority groups and 13 per cent of whom are aged over 65 years.
Patients’ tolerance of leg ulcer treatments
Authors: Brereton Louise , Morrell Jane , Collins Karen , Walters Stephen , Peters Jean , Brooker Charles
Published: May 2014

Little has been published about patients’ tolerance of their venous leg ulcer treatments. That which has, fails to clearly distinguish between ‘tolerance of’ and ‘compliance with’ treatment. As part of a pragmatic randomised trial, treatment tolerance was monitored in a sample of patients with venous leg ulcers receiving either four-layer compression bandage system in a clinic setting (Clinic Group n 120) or receiving their ‘usual’ leg ulcer treatment at home from the district nursing service (Home Group n113). Data were collected weekly for twelve weeks using a structured questionnaire. Log-linear modelling was used for statistical analysis where appropriate. There was a trend for Clinic Group patients overall to be slightly more tolerant of their leg ulcer treatment, although the results were not statistically significant. Overall, Home Group patients had more frequent ulcer dressings; suffered more ulcer infections; suffered more ‘strike through’; dressings allergy, dressings pain and dressings discomfort. Nurses also reported overall worse health status, more illness and a greater number of referrals for the Home Group patients, although again, the results were not statistically significant. The costs associated with these problems have an impact on the cost effectiveness of leg ulcer treatments for patients. Patient’s tolerance of, and compliance with, venous leg ulcer treatments should be monitored. Further investigation is required into patients’ tolerance of compression therapy.
Extending the role of the community mental health nurse
Authors: Barker Phil , Walker Louise , Pearson Pauline
Published: May 2014

Community mental health nursing is a diverse activity, which operates mainly from a community mental health team base, and commonly focuses on visiting discharged patients at home. This article discusses some of the implications of the development of a community mental health nurse consultant (CMHNC) role, which was the key recommendation of a recent study on the 'required role' of the mental health nurse in primary health care (Barker, Walker and Pearson, 1998). The need for a CMHNC role, specific dimensions and user perspectives are examined. To what extent the CMHNC may be able to bridge the gap between primary and secondary services and further develop the concept of nursing the mental health needs of the whole community is also explored.
Practice-based education: the nurse practitioner in primary care
Authors: Reveley Shirley , Money Brian
Published: May 2014

The education of nurse practitioners in both primary and secondary care is becoming an increasingly important issue for nurse educators. The role of the nurse practitioner is in itself contentious, and the statutory body has yet to arrive at a definition of the role and standards of education and practice. However, the employment of nurse practitioners continues despite the lack of a clear statement regarding the education and practice of nurse practitioners from the UKCC. The University College of St Martin offers a 3-year BSc (Hons) Nurse Practitioner Degree incorporating the Royal College of Nursing Institute's Professional Nurse Practitioner Diploma. The role of the nurse practitioner is viewed as being a specialist rather than an advanced practitioner role. A programme comprising 50% theory and 50% practice, with practice-based teaching and assessment being an integral part, has been devised in line with the UKCC’s Post Registration Education and Practice policy for specialist practice in the community (UKCC, 1994). The practice-based teaching was undertaken by GPs and coordinated by one GP who liaised with the college lecturers. This article describes the model of practice-based education developed by the Maryport Group Practice in Cumbria and the University College of St Martin. This model was used during a 2–year pilot study which involved introducing the triage role of the nurse practitioner into general medical practice.
Management of obesity in the primary care setting
Authors: Green SM , Passway TJ
Published: May 2014

The prevalence of obesity in the UK population is increasing. Management of obesity commonly takes place in the primary healthcare sector. This article reviews the role of the dietitian and community nursing professionals in the treatment of obesity in the community. With the guidance of the dietitian, community nursing professionals can give advice on dietary and lifestyle changes that promote weight loss. Dietitians can also improve the knowledge, skills and confidence of community nursing professionals in dietary and lifestyle counselling of people with obesity through education, training and support. Community nursing professionals are in a good position, through group work or on a one-to-one basis, to provide psychological support and follow-up consultations for people with obesity who are trying to lose weight.
District nurses and home carers 2: colloborative education
Authors: Redworth Fiona , Jones-Tatum Lisa , Atkin Jackie
Published: May 2014

This article, the second in a series of three, outlines an initiative in North Wales which developed a programme of education provided by a district nursing team for social service home carers. The main aim of the project was to improve collaborative working between social services home carers and district nurses. This article describes the rationale for and the progress of the project drawing on relevant literature to justify the approaches used. The approaches undertaken to evaluate the work in terms of structure, process and outcome for patients, home carers and district nurses are discussed.
Nutritional support for elderly people in the community
Authors: Noble Louise
Published: May 2014

The prevalence of malnutrition among chronically ill elderly people and its effects on morbidity and mortality are well documented (McWhirter and Pennington, 1994). However, there is now increasing evidence that even apparently well elderly people may be suffering from nutritional deficiencies. This article outlines the reasons why the elderly are particularly vulnerable to malnutrition and examines how nutritional requirements alter with age. The role of the community nurse in nutritional assessment is considered and practical ways of improving nutrient intake, including the use of supplements and enteral tube feeding, are discussed.
Job satisfaction in community and hospital nursing development units
Authors: Redfern Sally , Murrells Trevor , Christian Sara
Published: May 2014

This study compared job satisfaction in staff working in community nursing development units (NDUs) with staff working in hospital NDUs. The data were drawn from a questionnaire survey of all staff in 28 NDUs awarded pump-priming funds by the Department of Health. Eight were community NDUs (n=142) and 20 (n=657) were hospital NDUs. Response rates were 77% and 70% respectively. Levels of satisfaction were not high for either group but community staff were significantly less satisfied than hospital staff with many issues including staffing, resources, continuing education and professional development. The effects of change in workforce configuration and nurse morale on standards of care and patient outcome are considered.
A joint health and social services initiative for children with disabilities
Authors: Caan Woody , Streng Isabelle , Moxon Rachel , Machin Alison
Published: May 2014

The children’s disability team in Cambridge provides an integrated health and social care service for children with complex learning and physical disabilities and their families. The team uses a multidisciplinary and multi-agency teamwork approach to care provision. The effectiveness of the team was evaluated using a cooperative review of its functions, in which all the ‘subjects’ were active participants in defining and delivering the evaluation. This was combined with individual questionnaires regarding the team’s perceived strengths and weaknesses. Particular implications for training and supervision emerged from the findings. This article discusses the ways in which the team has successfully refined its practice of collaborative working in a developmental way between 1992–1998.
Promoting nutrition in older people in nursing and residential homes
Authors: Copeman June
Published: May 2014

Malnutrition and dehydration are serious and common problems among older people in nursing and residential care homes. The situation is exacerbated because staff may not be trained to recognize the signs and symptoms of malnutrition and dehydration and hence opportunities for early intervention are missed. A nutrition assessment should form part of the admission process to identify whether an individual has, or is at risk of developing, malnutrition and dehydration. This article suggests key questions that should be asked to assist this process. The individual and organizational risk factors that affect nutrition and health status are discussed, and practical suggestions given to help address any problems recognized. The causes and consequences of dehydration are explained and practices that place an individual at risk of dehydration considered. Suggestions are given to help identify when a person is not drinking sufficient, so that early, rapid intervention can be initiated. Helping an older person to eat and drink independently is a practical activity that is often undervalued. Its importance needs to be recognized in all nursing and residential care settings.
Nurse prescribing in practice: patient choice in stoma care
Authors: Lee Janice
Published: May 2014

In the first of a new series, Janice Lee examines the choices facing nurse prescribers when selecting items for stoma management. Studies have estimated that there are up to 100000 people with a stoma in England and Wales, and stoma care therefore forms a significant part of community nursing caseloads. The enormous range of available items means that both patient and prescriber are likely to have difficulty selecting the correct device. Patient preference, comfort and pricing all play a part in stoma appliance selection.
Common stoma problems: a brief guide for community nurses
Authors: Lee Janice
Published: May 2014

It is estimated that there are 100000 people in the United Kingdom who have a stoma, some 47% of whom will suffer at least one complication (Lyon and Smith, 2001). District nurses work in tandem with specialist stoma care nurses to manage the majority of these complications, so it is vital that they maintain their knowledge. This article reviews some of the stoma complications that may arise, and uses two case studies to illustrate how these may be dealt with in the community.
A charcoal dressing with silver in wound infection: clinical evidence
Authors: White Richard J
Published: May 2014

Silver, in elemental and compound forms, has a long and successful history as an antimicrobial. In particular, silver has been widely used in wound care, notably the treatment of burns. The relatively recent development of dressings containing silver has led to a resurgence of interest and more widespread use. In order to satisfy the need for clinical evidence on which practice may be based, this review has been compiled using published and unpublished clinical trial data on the most commonly-used silver dressing in the UK. The focus on clinical effectiveness and adverse events associated with treatment interventions in a range of chronic and acute wounds serves as a basis for guidelines on good clinical care of colonised, critically colonised, infected and malodorous wounds. Actisorb Silver 220 is, according to the available evidence from comparative and non-comparative trials involving over 12000 patients, effective in reducing wound malodour, effective in promoting wound healing, and safe.
Self-monitoring of glucose levels for people with type 2 diabetes
Authors: Holmes Valerie , Griffiths Peter
Published: May 2014

To determine the most effective way of monitoring glucose levels as an indicator of glycaemic control in people with type 2 diabetes in the community, we conducted a criteria-based review of randomized controlled trials and systematic reviews of randomized controlled trials that studied the efficacy of various glucose monitoring strategies. We searched the Cochrane Library, Medline, Embase, CINAHL and BNIPlus databases for relevant studies. The journals Diabetes, Diabetic Medicine, Diabetologia, Evidence-Based Medicine and Evidence-Based Nursing were hand searched. The outcome of interest was glycaemic control, as measured by glycated haemoglobin (HbA1c). A total of 642 titles were identified from the search; three studies answered the question criteria and only one study met all the quality criteria. The study that met the criteria was a systematic review of four trials measuring the efficacy of self-monitoring of glucose levels. The reduction in HbA1c in those who monitored glucose levels was estimated to be −0.25% (95% CI −0.61−+0.10) this result shows a small improvement, but it is not statistically significant. A meta-analysis was also performed on three studies (n=278) comparing HbA1c in subjects who performed blood glucose monitoring with those who performed urine monitoring. The reduction in HbA1c when monitoring blood glucose rather than urine glucose was −0.03% (95% CI −0.52−+0.47). This result is not statistically significant. The efficacy of blood and urine glucose monitoring testing, for people with type 2 diabetes, in improving glycaemic control as measured by HbA1c levels is still questionable. A rigorous randomized controlled trial is needed to establish these answers although there is no evidence of harm. Clinical protocols that make recommendations for glucose monitoring strategies for people with type 2 diabetes should acknowledge that the evidence is weak. There is no basis to recommend one method above another.
An evolutionary approach to team working in primary care
Authors: Curry Rose , Hollis Jill
Published: May 2014

Recent government policy emphasizes that interventions to improve health should be shifted as far as possible towards addressing identified needs and that partnership working is a key part of this initiative. The needs of patients are central, and patients want consistency and continuity from nursing. However, their experiences are sometimes fragmented, as professionals often have a degree of protectiveness about roles between nursing disciplines. Our vision for primary care in Sunderland is to achieve collaborative, empowered teamworking with shared philosophies and goals to develop and deliver creative, effective services in primary care. The balance of power will be shifted to front-line teams supported by strong strategic and professional leadership. This article outlines Sunderland’s approach to team development and demonstrates how new models of practice are replacing routine patterns of work; how service developments are now moving towards being based on health needs and user involvement is encouraged. The role of the facilitator and the tools developed to progress with this initiative are described, including a staged approach to team development, a benchmarking tool and achieved outcomes of teamworking through new service developments.
Health and society in Finland: public health nurses’ daily practice
Authors: Jakonen S , Tossavainen K , Tupala M , Turunen H
Published: May 2014

The role of public health nursing in Europe is changing as an ageing population and increasing social exclusion make new demands on health and social services. The purpose of this study was to describe how Finnish public health nurses (PHNs) practise in their daily work in order to meet the needs of this changing society. The knowledge base of the PHNs’ work strongly emphasised experiential knowledge. However, on a theoretical level, medical knowledge dominated their work. The target of the PHNs’ work was most frequently an individual, and perspectives of population or community were less common. The methods used in interactions with clients were participatory and empowered individuals to enhance their own health, and multiprofessional collaboration focused on joint decision-making and working towards the shared health goals of the client. However, PHNs need to employ a more reflective approach to their daily practice and take a more active role as an influential person in community and policy level.
The role of cranberry juice in the treatment of urinary tract infections
Authors: Griffiths Peter
Published: May 2014

There has long been an interest in the use of cranberry, usually as a juice, to prevent and treat urinary tract infections (UTI). This mini-review examined the evidence available using a simple search on an internet-based resource designed to make evidence readily available to practitioners in the South Eastern NHS regions of the UK. The resource, known as KA24, provides access to a range of databases and full text of journal articles. The first stage of the review identified two existing Cochrane Reviews, one examining cranberry as a treatment, the other as prevention. Both concluded that there was insufficient evidence to recommend the use of cranberry in treating UTIs, although some weak research did offer support for cranberry juice in preventing UTIs. A search for further evidence not included in the Cochrane review identified several new reviews and two randomized controlled trials (RCTs) of cranberry as prevention. The reviews were not systematic and came to contradictory conclusions. They were based on a selective reading of the evidence base and gave no criteria for determining the inclusion or validity of studies. One of the RCTs was available for full scrutiny and was appraised as a valid study. Both RCTs found that cranberry (as juice or capsule) significantly reduced the rate of UTI in sexually active women. There is evidence to support the use of cranberry to prevent UTI in some populations but none to support its use as a treatment.
Health visiting at the crossroads: which way to the 21st century?
Authors: Malone Mary , Edwards Margaret , Bliss Julie , Cheung Heidi , Hobden Alison , Quioc Victoria , Watts Suzanne , Dooley John
Published: May 2014

This article presents a response from a group of lecturers at Florence Nightingale School of Nursing and Midwifery, King’s College London and one service user to the perception of a crisis of confidence within health visiting. Changes in registration procedures and shifts in policy have led health visiting to question its place within primary care and the model of preparation for health visiting practice. The group argues that this debate is based on a misunderstanding of the changing health care environment and that health visiting can find a place within the primary care team. Key to this is the continued adherence to a basic nursing training. The authors suggest an incremental model of health visitor training to provide the fullest scope to implement the new health agenda.
Developing a culture-specific tool to assess postnatal depression in the Indian community
Authors: Mantle Fiona
Published: May 2014

Postnatal depression is a serious and debilitating condition which affects, at a conservative estimate, 10% of postnatal mothers. It can be difficult to identify due to the reluctance of some women to acknowledge their feelings. The Edinburgh Postnatal Depression Scale was developed to facilitate the elicitation of negative mood, however, it does not translate adequately into other languages or cultures. To address this problem the dosha assessment tool for postnatal depression was developed. This tool is aimed at women who are more familiar with the concepts of Ayurvedic medicine, one of the key medical systems of the Indian subcontinent. Although not yet evaluated, the tool goes some way towards the development of a culturally-specific screening tool for this condition.
Wound bed preparation: a systematic approach to chronic wounds
Authors: Douglass Jude
Published: May 2014

‘Wound bed preparation’ is a current ‘buzz phrase’ in tissue viability and chronic wound management, but the majority of practitioners are uncertain what it actually means. This article summarizes the content of a series of study days recently given around the UK by a panel of experts in wound management. It discusses the meaning of the phrase ‘wound bed preparation’ and offers an acronym – TIME – that practitioners may find useful in their daily treatment of chronic wounds.
The nursing management of enterocutaneous fistulae: a challenge for all
Authors: Cobb Ann , Knaggs Elaine
Published: May 2014

This article focuses on the principles of managing patients with enterocutaneous fistulae. Successful management involves comprehensive assessment, planning, implementation and evaluation of care and involves all members of the multidisciplinary team in both primary and secondary care. The main challenge for the nursing team is effective containment of the effluent to prevent excoriation of the skin thereby ensuring patient comfort. The article includes suggestions for choice and application of suitable appliances which have been successfully used by the authors. Early involvement in of patient and carer in all aspects of management is recommended for successful discharge of patients into the community.
Influencing exercise and diet to prevent osteoporosis: lessons from three studies
Authors: Wallace Louise , Boxall Matthew , Riddick Nicola
Published: May 2014

Osteoporosis is a major public health problem, causing fractures of wrist, back and hip with high associated morbidity and mortality. Particularly at risk are postmenopausal women. Recent moves away from hormone replacement therapy as a preventative measure have focused attention on exercise and dietary supplementation with calcium for prevention and treatment. This article reports three studies of women screened for osteoporosis – an outpatient sample (n=129), a GP sample (n=25) of women before and after bone mineral density screening, and a sample of women diagnosed with osteoporosis in the past 5 years (n=26). Only 57% in the outpatient sample consume the recommended amount of calcium (1500mg calcium daily); 65% in primary care consume 1200mg five times per week, although 90% intend to do so. For bone-loading exercise, the recommendation is three 20-minute periods per week. Most women thought they were undertaking enough exercise, and diaries showed that 74% of the women undertook 60minutes per week, and 44% undertook 30minutes five times per week. Women were more willing to change diet than exercise. Suggestions are made to help primary care teams to motivate women to make sustained changes in diet and exercise.
Making the most of teams in the mentorship of students
Authors: Leyshon Stephen
Published: May 2014

Community nurses are rightly expected to act as mentors. This role offers students valuable opportunities to gain insight into community care and contributes to the development of future services and the professional growth of individual mentors. There can be tensions, however, between the demands of nurses’ clinical roles and the need to support students. This article identifies ways in which teams can get the most out of mentoring, focusing on the importance of strong clinical leadership and the need for nurses to ‘own’ the mentorship role and to work with other stakeholders. Finally, examples of initiatives from one inner-London trust are offered to demonstrate robust ways of enabling practice-based education.
Identification of skin cancers 2: malignant lesions
Authors: Freak Jane
Published: May 2014

With the incidence of skin cancers doubling in the last 20 years, it is becoming more and more important for health professionals to be able to identify these dangerous malignancies. In this, the second of two articles, the author discusses the three main types of malignant cutaneous lesion, and provides information on prevention that can be passed on to patients of all ages.
Developing a journal club in the community setting
Authors: Dobrzanska Linda , Cromack Debbie
Published: May 2014

Nurses are required to deliver care based on current evidence, best practice and, where it is available, validated research. A senior staff nurse in an 18-bed community hospital in North Bradford primary care trust identified a gap whereby there were no defined processes to address the lack of evidence-based material, look at new evidence or provide a forum to discuss new ideas. Following a meeting with the trust’s research facilitator, the idea of setting up a journal club began to take shape. Funding was obtained via a small grant from the Foundation of Nursing Studies. Various approaches were undertaken to increase attendance, and although the purpose of establishing a journal club within a community setting was clear, the reality was very different. A new approach was eventually found to be successful, and is described here so that it may help other people in similar settings develop and run a journal club.
Palliative care for breathless patients in the community
Authors: Maher David , Hemming Laureen
Published: May 2014

Breathlessness is one of the commonest symptoms experienced by people receiving palliative care. However, misunderstanding of the nature of palliative care may hinder assessment, management and evaluation of care and may contribute to the fear associated with living with breathlessness in the community. Knowledge of related anatomy and physiology of breathlessness is vital in informing nursing care and interventions. Pharmacological interventions have their place, but the focus of nursing care should be on systematic holistic assessment. Using this, nurses should adopt a proactive role in supporting and helping patients to adapt to change by maximizing coping strategies.
Prevention and management of superficial pressure ulcers
Authors: Butcher Martyn
Published: May 2014

Superficial pressure ulcers – those involving the upper layers of skin – are currently the object of academic controversy, in particular regarding the influence of moisture in their formation. This article aims to steer nurses round these debates with a practical approach to preventing pressure damage, placing a strong emphasis on skin care and reduction of friction.
Improving pressure ulcer prevention in a nursing home: action research
Authors: Kennedy Margaret
Published: May 2014

A study conducted in Sunderland investigated how staff in a private sector care home manage pressure ulcer prevention and what staff perceive to be the reasons why residents in their care develop pressure ulcers. It also identified how using a collaborative action research study design (utilizing an action research cycle with collaborative focus groups) can bring about an improvement in practice, by allowing the staff to reflect on and analyse the way they work and develop and implement strategies to provide solutions to the problems they identify.
Falls prevention in practice: guidance and case study
Authors: Nazarko Linda
Published: May 2014

Falls are a major health issue for older people. Each year 1.57 million older people fall more than three times and 70 000 fracture their hips, and injury which freqquently leads to disability and even death. The National Service framework for Older People identified falls prevention as a major health priority. This article explains how a community based falls service led by a nurse and physiotherapist identified falls risk factors affecting a housebound 97-year-old lady. Factors identified and treated were poor balance and strength, osteoarthritis of the knees and thumbs, inadequate pain control, uncorrected poor vision, oedema of the legs and feet, unsuitable footwear and an unsuitable walking aid. As a result of the interventions falls risk was reduced and quality of life improved.
Community matron implementation: meeting the challenge in Leeds
Authors: Bee Alan , Clegg Angie
Published: May 2014

The introduction of the community matron role is an important milestone in the national strategy for the management of long-term conditions (DH, 2005a). Community matrons are seen as key in delivering personalized, managed care to adults with complex long-term needs. The Department of Health requires there to be 3000 community matrons in post across England by March 2007 (Beasley et al, 2005). Leeds North West PCT is required to have seven community matrons in 2005/2006 and 13 by March 2007. This article describes the process of the introduction of the first wave of community matrons in North West Leeds.
Challenges and strategies: weight management in type 2 diabetes
Authors: Holt Paula
Published: May 2014

This article examines the link between obesity and type 2 diabetes and discusses some of the challenges health-care professionals face in helping people with diabetes achieve and maintain a healthy weight. Increasing numbers of people in both developed and developing countries are being classified as overweight or obese, which is resulting in growing numbers of people being diagnosed with type 2 diabetes. Worryingly this includes large numbers of children developing type 2 diabetes as the younger age groups are becoming overweight or obese. The health-care practitioner's role is explored and strategies to promote and achieve a healthy lifestyle for people with type 2 diabetes are offered. Such strategies are linked to obesity management through, diet, exercise and behavioural therapy.
The National Lymphoedema Framework project
Authors: Morgan Phil , Moffatt Christine
Published: May 2014

Lymphoedema is a common but unrecognized problem. The National Lymphoedema Framework (NLF) – a partnership between academics, patients, lymphoedema specialists and industry – is working to implement a new approach to lymphoedema care to tackle this problem. This article discusses the progress of the NLF, and describes the role of community nurses in the new service framework.
Clostridium Difficile: dealing with a silent menace
Authors: Nazarko Linda
Published: May 2014

Clostridium Difficile infection is a growing problem and infection is not confined to acute hospitals. People with C. Difficile may be cared for in community hospitals or at home. Some people with C. Difficile suffer recurrent bouts of infection, others are left with ongoing bowel problems as a result of the infection. Prevention, wherever possible, through prudent antibiotic prescribing and scrupulous infection control procedures can reduce infection risks. Prompt diagnosis and treatment can reduce the risks of life threatening colitis or chronic bowel problems.
‘New partnerships New perspectives’
Authors: Billingham Rebecca
Published: May 2014

Welcome to the fourth edition of the lymphoedema supplement. This issue focuses upon compression and support. Compression hosiery is well researched in the vascular field but the range of styles and fabrics used for lymphoedema management has not historically been widely available.
Participation in community exercise classes: barriers to access
Authors: Vernon Sue , Ross Fiona
Published: May 2014

Falls prevention is an important part of national health policy and while there are many causes of falls, there is increasing evidence that advocates the use of targeted balance and stability exercise training to address the risk factor of postural instability. The introduction of these exercise programmes in primary care raise questions about the most effective implementation methods that are accessible and acceptable to older people and support maximum adherence. An understanding of factors that support adherence of older people to exercise programmes is of value to community nurses to enable them to deliver health promotion advice appropriately. The purpose of this paper is to discuss the findings from interviews with older people to explore their experiences in relation to access and acceptability of local community based postural stability exercise classes.
Effective practice in community iv therapy
Authors: Kayley Jill
Published: May 2014

The government has policies for care in the community, reducing acute admissions and length of hospital stays and greater patient choice (Department of Health (DH) 2002; DH, 2006) but the NHS has no overall strategy for community intravenous (IV) therapy. Despite this, community IV therapy is expanding to cover a wider range of medication and therapies. While this enables community nurses to extend their skills it can also present many challenges. Carrying out this form of treatment in the community requires comprehensive organization and multidisciplinary working. This article aims to cover the key aspects that need to be in place to ensure that community IV therapy is safe, appropriate and manageable and that infection control is maintained.
Survey of Doppler use in lymphoedema practitioners in the UK
Authors: Todd Marie , Welsh John , Key Margaret , Rice Margaret , Adam James
Published: May 2014

Lymphoedema practitioners anecdotally don’t use Doppler in the vascular assessment of their patients prior to the application of compression. The belief is that the results are inaccurate in the presence of oedema. The objective of this article is to gather information about the use of Doppler by lymphoedema specialists in the vascular assessment of lymphoedema patients in the UK. A questionnaire on the use of Doppler in lymphoedema patients was distributed to 250 delegates attending the British Lymphology Society Conference in Glasgow in Ocotber 2005. There appears to be no consensus in the method of vascular assessment of lymphoedema patients. More research is needed to ascertain the accuracy of Doppler in the assessment of lymphoedema patients. Guidelines are also required in the vascular assessment of lymphoedema patients based on scientifically valid evidence.
Cognitive decline: is there a protective role for nutrition and physical activity?
Authors: Miles Lisa
Published: May 2014

In the UK, life expectancy has doubled over the last 200 years. The ageing population means that prevalence of dementia is set to increase in the coming decades. Mental impairment and dementia have a severe impact on a person’s autonomy and independence, so the prospect of postponing or preventing cognitive impairment is therefore of great importance. Current research indicates that adequate intake of vitamins B6, B12 and folate (most likely via their effects on homocysteine), and particularly long chain omega-3 fatty acids could offer protection from cognitive decline. Epidemiological studies indicate that physical activity could improve cognitive function in older people. Further results from randomized controlled trials are eagerly awaited in order to confirm observational findings. In the meantime, supporting individuals in making healthy choices throughout their life course should be a priority for health professionals, in order to reduce the disease burden of cognitive decline and dementia.
An overview of suprapubic catheter care in community practice
Authors: Rigby Deborah
Published: May 2014

This paper gives a broad overview of suprapubic catheterization. Community nurses can often feel they lack experience with suprapubic catheter general care and routine changes. This paper sets out the advantages and disadvantages of suprapubic catheters, the procedure for routine change and the golden rules for general care. The paper contains an introduction on trouble shooting.
Research and tissue viability
Authors: Toner Louise
Published: May 2014

The recent research assessment exercise has proved a huge success for nursing, rated 44th from the 67 subject areas, whose research was identified as being internationally recognized or world leading. This was a far cry from the relatively poor results in the 2001 Research Assessment Exercise where nursing was recognized as one of seven emerging research disciplines. As a result, funding was made available to increase nursing research capability and this, together with other factors, has played a significant part in placing nursing on a par with other academic disciplines. This is an important step forward for the profession in the context of advanced practice, multi-professional and cross boundary working with the emphasis on the provision and delivery of evidence-based patient care.
The use of Silflex in burn wound management
Authors: Edwards Jacky
Published: May 2014

This article presents three case studies looking at the effective use of an atraumatic wound dressing: Silflex® (Advancis Medical). Pain is known to be very debilitating in patients with burns and frequent dressing changes can pose a painful problem. The case studies, presented here, support the view that Silflex, a silicone-based conformable dressing, is a useful adjunct when treating superficial burns.
Diabetes: prevention is better than cure
Authors: Smith Julie
Published: May 2014

Following the festive period, many people make new year’s resolutions, the most common ones being related to health and lifestyle. This presents the community nurse with an opportunity to provide advice to those in their care about how to improve their health. With an estimated 2.35million people with diabetes in England and the prediction that this will rise to 2.5million in 2010 (Department of Health, 2009), tackling weight loss is high on the NHS’ agenda.
Consent to organ donation part 2: alternative modes of consent
Authors: Griffith Richard , Tengnah Cassam
Published: May 2014

In the December 2009 issue of British Journal of Community Nursing Richard Griffith and Cassam Tengnah reviewed the system of consent for non-beating heart organ donation at the centre of the Human Tissue Act 2004. This article considers the benefits and risks of alternative systems of consent being proposed to overcome the United Kingdom’s poor organ donation rate that is the worst in Western Europe.
Cancer: no longer a death sentence
Authors: Hubbard Gill
Published: May 2014

There are more people living with cancer owing to improvements in screening, early diagnosis and treatment programmes compared to a couple of decades ago. However, those diagnosed with lung or pancreatic cancer still have poor prognosis and the UK cancer survival is relatively poor compared to some countries (Coleman et al, 2003)
Stop-smoking support: considerations for community nurses
Authors: Williams Anne
Published: May 2014

Smoking is the most preventable cause of ill health, and is associated with many long-term conditions. Around 24% of all deaths in Scotland in 2004 were attributed to smoking (NHS Health Scotland and ASH Scotland, 2007). This article provides background information on the health effects of smoking, and discusses issues around stop smoking support, highlighting some implications for community nurses who work with clients who want to stop smoking.
Improved productivity and cost cutting through effective evaluation
Authors: Phillips Jim
Published: May 2014

Anyone who works within the NHS will be aware of the recent government commitment to cost-cutting measures. In February 2009, McKinsey were asked to produce a report on how productivity may be improved as well as saving money.
Community nurses working in piloted primary care teams: Irish Republic
Authors: Burke Triona , O’ Neill Catherine
Published: May 2014

Primary care health services in the Irish Republic have undergone fundamental transformation with the establishment of multidisciplinary primary care teams nationwide. Primary care teams provide a community-based health service delivered through a range of health professionals in an integrated way. As part of this initiative ten pilot teams were established in 2003. This research was undertaken in order to gain an understanding of nurse’s experiences of working in a piloted primary care team. The methodology used was a focus group approach. The findings from this study illustrated how community nurse’s roles and responsibilities have expanded within the team. The findings also highlighted the benefits and challenges of working as a team with various other community-based health-care disciplines.
Hydrogel sheet dressings and short-stretch cohesive bandaging: case study
Authors: Powell Gail
Published: May 2014

Hard-to-heal wounds such as leg ulcers are associated with long duration and a high incidence of complications such as pain, often resulting in considerable financial burden (European Wound Management Association (EWMA), 2008). The financial burden is not just one for the NHS but for the patients as well in lost days from work, taxi fares, prescription charges and even having to take early retirement. The prevalence of venous leg ulcers is approximately 1% in the whole population and this increases with age. Where appropriate research-based treatment protocols and guidelines are in place, about 50% of leg ulcers heal within 4months (EWMA, 2008). The following case study demonstrates that using protocols, national and local guidelines can have a positive effect on the patients wound care journey and promote optimal wound care (Wounds UK, 2008).
Innovative solutions to daily challenges
Authors: Derbyshire Adam
Published: May 2014

Today’s clinicians face the daunting task of finding the best cost-effective and clinically appropriate solutions to ever complex wounds.

The right combination of dressings help to maintain a moist environment, successfully manage exudate levels and reduce complications. This article seeks to explore the fundamental issues behind successful dressing choice and the new products that are becoming available for use as tools in the ongoing wound care initiative. In particular, the antimicrobial dressing Cutimed® Sorbact® used in conjunction with the exudate management properties of Cutimed® Siltec® and Cutisorb® Ultra by BSN medical will be examined with the commencement of three clinical evaluations.