bluuebunny/crossref_metadata_2025 huggingface dataset:
Research Roundup
Authors: Linden Belinda
Published: May 2014

Recent research has found sleep duration to be associated with glucose regulation, blood pressure, sex, age, education, and body mass index. Th is fi ve-year observational study by researchers in Illinois aimed to fi nd out whether the quality and duration of sleep were linked with the incidence of coronary artery calcifi cation. Calcium is deposited early in the formation of atherosclerotic plaque, and therefore calcifi cation can be a useful marker of the atherosclerotic process.
Atrial septal defects: Not always so simple
Authors: Francis Marie L
Published: May 2014

There are an estimated 250 000 adults with congenital heart disease in the UK. Atrial septal defect is the most common congenital heart condition diagnosed in adulthood. Management of this defect has been much debated but within the last decade a number of studies have shown that there are clear benefits to closing ASDs, even at a late stage. Untreated atrial septal defects can be a cause of significant morbidity including arrhythmia, right-sided heart failure, thromboembolism, pulmonary hypertension and potentially pulmonary vascular disease.

The increasingly prevalent use of percutanous devices to close secundum defects has enhanced the attractiveness of the closure option for patients and clinicians alike. While to date, short-term outcomes have been encouraging, greater follow up is needed if the long-term effects of device closure are to be properly understood. This article addresses the presentation and management of atrial septal defects and late complications in defects that go untreated. It argues that while atrial septal defects may be regarded as ‘simple’ management is not always straight forward, and they can, if left untreated, significantly influence morbidity and mortality.
Recording a standard 12-lead ECG: Filling in gaps in quality
Authors: Crawford Jacqui , Doherty Linda
Published: May 2014

Jacqui Crawford and Linda Doherty discuss ways to improve the quality of electrocardiograms by ensuring appropriate preparation and understanding calibration and other settings
Auditing the management of familial hypercholesterolaemia
Authors: Humphries Steve , Young Katharine
Published: May 2014

Steve Humphries and Katharine Young argue that the greatest opportunity for preventing the damage caused by coronary heart disease lies in diagnosing and treating people with familial hypercholesterolaemia and ‘cascade’ screening their families
Hypertrophic cardiomyopathy: An inherited cardiac condition
Authors: Elliot Kay
Published: May 2014

Hypertrophic cardiomyopathy (HCM) is an inherited cardiac condition affecting the cardiac muscle and a major cause of sudden cardiac death (SCD) in young people and adults (Michels et al, 2007). Patients are often unaware of their condition until presenting with serious and often fatal arrhythmias or heart failure. Clinical guidelines have assisted the diagnostic process but the genetic origin of HCM raises important ethical and counselling issues. This article highlights the molecular, counselling and ethical issues related to managing patients with HCM. A case example of a woman who presented with HCM aged 39 years is used to help the reader understand how some of the broad issues relate to practice. The HCM diagnosis in this case indicated that members of her family could be carrying a genetic mutation responsible for HCM.
The radial approach for percutaneous coronary intervention
Authors: Metcalf Bridgette
Published: May 2014

Current statistics and national guidelines forecast that the number of patients undergoing invasive diagnostic and interventional percutaneous procedures is increasing. The femoral artery has traditionally been the most commonly used access site for invasive coronary procedures but femoral vascular complications and bleeding risks are widely documented. The transradial approach is a well established technique associated with lower rates of vascular and bleeding complications, early patient ambulation, enhanced patient satisfaction, a decrease in nurse workload and a reduction in hospital costs. National audit results confirm that the radial approach is becoming increasingly popular and cardiac nurses are therefore required to frequently care for patients with radial artery puncture sites. This article provides an overview of the rationale and technique behind radial arterial access, haemostasis, use of a compression device and the associated nursing considerations. The evidence base in relation to patient outcomes and nursing care will also be explored.
The clinical effectiveness of exercise training for patients with chronic heart failure
Authors: Leslie Rosalind , Buckley John P
Published: May 2014

Aims: The efficacy of a supervised exercise-training programme, for patients with chronic heart failure, was assessed by comparing programme results with recommendations from current national ser vice frameworks and key systematic reviews.

Methods: Retrospective data, on 22 Caucasian patients (18 male) aged 47 to 81 years were collected before and following a 12-week course of supervised exercise training, including: step test performance, New York Heart Association (NYHA) functional classification and brain natriuretic peptide (BNP).

Results: For the same heart rate (~60% heart rate reserve), mean (SD) step test levels increased from 4.5 (0.2) to 5.1 (0.3) metabolic equivalents (P=0.0001) and NYHA scores improved from 2.1 (0.4) to 1.8 (0.5) (P=0.004). Mean BNP levels were 1563 (664) nanograms/ litre before the exercise programe and 1351 (536) nanograms/litre, after it (P=00.075).

Conclusions: This audit clearly reflects the recommendations of national guidelines and systematic reviews, that exercise is not detrimental to the health and wellbeing of CHF patients and enhances physical functioning. The trend of improved BNP levels appears favourable and demonstrated to be of clinical significance in spite of not reaching statistical significance. This area requires further study on a greater number and wider variety of patients, where it is hypothesized that exercise will be both clinically and statistically significant.
A guide to lipid modification
Authors: Waterall Jamie , Jewkes Christina
Published: May 2014

Cardiovascular disease remains the leading cause of premature morbidity and mortality in the UK, therefore effective prevention and treatment remains a fundamental priority for NHS managers and clinicians. This article will explore the relationship between blood lipids and cardiovascular risk and discuss the current guidance in England for modification of lipids for the primary and secondary prevention of cardiovascular disease.
Percutaneous left atrial appendage occlusion in atrial fibrillation: Who, how and why?
Authors: Meredith Tara , Betts Tim
Published: May 2014

Atrial fibrillation (AF) is the most common sustained common cardiac arrthyrthmia which has been estimated to effect 1% of the total the NHS budget and is responsible for 12,500 ischaemic strokes in AF occur as a result of embolisation of thrombus that has formed in the left atrium more specifically, in the left atrial appendage (LAA). Strategies employed to isolate the LAA from the systemic circulation could avert the need for oral anticoagulation in high risk patients with AF. LAA occlusion devices, although still novel, have been shown to be non-inferior to warfarin in recent clinical trials and may increasingly become an option for those with a high stroke risk where oral anticoagulation is contraindicated. This article reviews the indications for implantation of a LAA occlusion device, describes the procedure and discusses the relevant considerations for nursing care.
ESC guidelines for acute coronary syndromes without ST elevation
Authors: Linden Belinda
Published: May 2014

presents an overview of the key points from the recently published guideline from the European Society of Cardiology on management of NSTEMI and unstable angina.
Raising awareness of the need for cardiac pre-participation screening in young athletes
Authors: Spiers Christine , Durrant Jill
Published: May 2014

Regular physical exercise confers many health benefits which are well known. However a small proportion of athletes are at risk due to undiagnosed cardiac conditions which increase their risk of exercise-related sudden cardiac death. Many authors now recommend pre-participation screening of all athletes undergoing regular athletic activity. This article describes the experience of working with a professional football club and the charity Cardiac Risk in the Young (CRY) to perform cardiac screening for their 14–16 year-old squad. The authors do not discuss the full complexity of issues surrounding screening, but do acknowledge the importance of adherence to national criteria recommendations.
Cardiac tamponade following heart surgery
Authors: Laidler Sandra
Published: May 2014

This article explores cardiac tamponade in postoperative cardiac patients and highlights the role and responsibilities bestowed upon the cardiac nurse in assessing, preventing, recognising and managing this situation. Cardiac tamponade is the compression of the heart that occurs when blood builds up in the space between the myocardium and the pericardium. In this condition, blood collects in the pericardium and mediastinum; this can prevent the ventricles from expanding fully. Excess pressure from the fluid prevents the heart from functioning normally. The signs of cardiac tamponade and cardiogenic shock are discussed, as are the urgent treatments they require. The cardiac nurse requires specialist skills and knowledge in managing surgical patients postoperatively. A thorough assessment, observation, early detection and quick intervention can mean the difference between life and death for patients who suffer cardiac tamponade following cardiac surgery.

The standards of care suggested throughout this article are based on local practice in association with national and European guidelines.
Treatments to achieve fluid balance in heart failure
Authors: Hughes Rebecca
Published: May 2014

Chronic heart failure is a progressive disease with persistent symptoms that limit day-to-day activities. Fluid retention and congestion contribute to the debilitating symptoms experienced by heart failure patients, impacting on their quality of life. Assessment and management of fluid intake and output are key nursing issues, and this article discusses the importance of fluid balance interventions that can aid symptom control, thus enhancing patient comfort. The underlying physiology of fluid balance in chronic congestive heart failure patients will be explored, as will the psychological factors that may enhance or impede treatment.
Treatment of chronic sternal fistulae after cardiac surgery
Authors: Lamas M.J. , Centella T.
Published: May 2014

Chronic sternal infection is a relatively rare complication following cardiac surgery that can cause high morbidity and mortality and can require repeated surgical procedures, including sternal resection, to resolve. However, preserving sternal integrity is essential, particularly in children. A variety of conservative treatments for this complication of cardiac surgery have been reported. Here, we report three cases of children in whom a bone substitute containing tricalcium phosphate and hydroxyapatite was used to fill sternal defects. After extensive surgical debridement, this method yielded primary wound closure with good resolution, preventing the recurrence of sternal infection.
Research Roundup
Authors: Linden Belinda
Published: May 2014

This section presents a synopsis of a selection of recently published articles of interest to those nurses working in the field of cardiovascular nursing. The aim of this roundup is to provide a brief overview, rather than a detailed critique, of the research papers selected. A full reference is provided for those who wish to look at the research in further detail.
The role of the Scottish Heart Failure Nurse Forum
Authors: Reid Janet
Published: May 2014

Here, Janet Reid, provides a précis on behalf of the Scottish Heart Failure Nurse Forum of a recent review of specialist heart failure nursing services in Scotland and outlines the role of the forum
Pharmacological treatments for stroke prevention in AF
Authors: Wilson Anne
Published: May 2014

Atrial fibrillation currently effects over 6 million Europeans, causing 22 500 non-valvular strokes each year, and its prevalence is due to double in the next 50 years. As the burden of atrial fibrillation increases, early detection and stroke prevention with timely thromboprophylaxis is imperative. For six decades, warfarin has been the ‘gold standard’ prophylaxis against stroke in patients with atrial fibrillation, but the advent of novel oral anticoagulants means that warfarin is no longer the only option. Novel oral anticoagulants, such as dabigatran, rivaroxaban and apixaban, are redefining the thromboprophylaxis of atrial fibrillation and are at least as effective as warfarin in stroke risk prevention, with better safety, consistently limiting the number of cases of intracranial haemorrhage. This article reviews the treatment options available for stroke prevention in atrial fibrillation and the implications for patients and those who care for them.
We made sure twins were free from cardiomyopathy
Authors: Davies Aurelia
Published: May 2014

Cardiomyopathy can be life-threatening and can be inherited by the offspring of people diagnosed with the condition. Some individuals may therefore want to ensure that their children will not have the disease. Preimplantation genetic diagnosis involves genetic testing of the couple, in vitro fertilisation, testing of embryos, and finally the implantation of unaffected embryos. This process offers couples the chance to give their children a healthy and secure future.
Mental Capacity Act 2005: applying statutory principles
Authors: Griffifth Richard
Published: May 2014

The Mental Capacity Act 2005 seeks to promote the autonomy of individuals by enabling as many people as possible to be supported to make decisions about their care, while providing a framework for acting in the best interests of those who truly cannot make a decision due to an impairment or disturbance to the functioning of the mind or brain. The Court of Protection has been critical of the approach of health professionals to the implementation of the 2005 Act, resulting in a more paternalistic approach to decision-making at the expense of the autonomy of frail and vulnerable patients. In this article, Richard Griffith argues that cardiac nurses can learn valuable lessons from the Court of Protection when applying the statutory principles that underpin the application of the Mental Capacity Act 2005.
‘Do not attempt resuscitation’ orders: a review of the law
Authors: Griffith Richard
Published: May 2014

Controversy surrounding the use of do not resuscitate orders on patients often without their knowledge and without apparent good reason have led some to question the lawfulness of such orders ( An NHS Trust v Mr and Mrs H [2012] ).

In this article Richard Griffith considers the legal basis for do not resuscitate orders and outlines decisions from the courts that will assist nurses in deciding whether making such an order is lawful.
Practical issues in acute heart failure management
Authors: Riley Jillian
Published: May 2014

Heart failure is common in the United Kingdom and largely affects the more elderly. Disease management programmes that support the patient on discharge from hospital are now well established. There is a more varied approach to inpatient services, however, and many do not receive optimal care on a heart failure pathway. This article discusses how the nurse can identify the patient with suspected heart failure. It also discusses key issues in the delivery of safe care during the inpatient hospital admission.
Nurse-led community diuretics for heart failure patients
Authors: Quinn Miriam , Read Haley
Published: May 2014

Heart failure is a chronic condition that results in a high incidence of hospital admissions, often due to decompensation and fluid retention. Patients often require intravenous (IV) diuretics, and until recently these were routinely delivered in secondary care settings. The British Heart Foundation is currently evaluating the delivery of IV diuretics within patients' homes.

As IV diuretics have traditionally been delivered in secondary care, there are challenges in implementing such a service in the community. New ways of working and delivering care need to be considered, along with the development of clinical skills. This article explores the development of a community IV diuretics service and how challenges were embraced and overcome in order to deliver a robust and effective service. A case study highlights how the IV diuretics service was implemented in practice and how patients can benefit from such a service. Recommendations are made for future service delivery.
Heart failure in the South Asian patient population
Authors: Gammon Brian
Published: May 2014

Heart failure (HF) is increasing throughout the developed world as a consequence of better survival rates following acute myocardial infarction (MI). South Asian (SA) patients with HF risk poorer outcomes through differing pathophysiological genesis, and a number of cultural and healthcare organisational factors. Nurses have a key role to play in attempting to reduce this potential disease burden among SA HF patients. This article discusses specific nursing care of the SA patient from the perspectives of diagnosis, aftercare, cultural and organisational barriers and tenders suggestions for improving service uptake among members of this marginalised group.
Adjustment to the need for an ICD
Authors: McCaig Marie , Orr Julie , Snowden Austyn , Collins Garry , Thomson Annette , Marland Glenn
Published: May 2014

The implantable cardioverter defibrillator (ICD) is an electrical medical device designed to monitor the electrical activity of the heart and is set to deliver a programmed, corrective defibrillatory discharge, or shock, on encountering abnormal cardiac rhythms. Adjustment factors: Individual characteristics, including age, gender, support and personality, impact on how an individual adjusts to the device. It is clear that adjustment to the device is a personal and individual process. Coping strategies, attitude towards and perception of the ICD also influence acceptance. Vulnerability factors: Chronic stress has a negative impact on the heart and the vascular system. Stress is a natural bodily response to danger and is mediated by the sympathetic and parasympathetic system. In relation to the cardiovascular system, constant stress, mediated by catecholamines such as adrenaline, elevate heart rate and blood pressure causing increased oxygen demand, electrical instability of the heart muscle and spasm of coronary blood vessels. Role of the nurse: The nurse needs to recognise the signs and symptoms of stress and distress, and use their knowledge and skills to provide both values and evidence based practice. Referral for psychosocial support should be considered, particularly where risk factors are identified. Reflection and collaborative working can support the adjustment process.
Accident prevention and older people
Authors: Morgan Pauline , Carter Yvonne
Published: May 2014

During 1993, the European Year of Older People and Solidarity between Generations, a national study to examine the accident situation amongst people aged 70 years and over was commissioned by The Royal Society for the Prevention of Accidents (RoSPA) and funded by the Department of Health (DoH).

This study consists of two parts: a national postal survey and an interview survey. This paper will concentrate on the second part of the study to examine the accident experience of older people living in the community. The database that was used for the postal survey consisted mainly of people from social classes I, II and III. The authors felt that it would be worthwhile to conduct a further study consisting of structured interviews with 104 older people, residing in the West Midlands and belonging to social classes III, IV and V.

This paper describes the retrospective accident experience of these people during a 12 month period. The aim of the study was to determine whether people aged 70 and over were receiving sufficient accident prevention advice to meet their needs.
Stoma appliances: a product update
Authors: Pullen Mandy
Published: May 2014

The range of appliances for stoma care patients is continually changing and expanding. Although stoma care nurse specialists are kept informed of developments, it is often difficult for community nurses to keep abreast of the changes, as they may not receive stoma care information on a regular basis. The following appliance update has been devised to present and discuss a range of products frequently used in stoma care.
Impotence: a complication of diabetes
Authors: Hill Caron E
Published: May 2014

Erectile dysfunction in diabetic men is a problem that needs to be addressed by the primary health team. Defined as erectile failure for more than 75 percent of the time, it prevents satisfactory sexual intercourse. However, another difficulty experienced is the inability for the patient to approach the primary care team. Should the patient be asked directly, as part of their diabetes care, or should they volunteer this information themselves? Time constraints within the clinic usually do not allow discussions of potentially difficult issues. In addition to this, many men, while experiencing erectile dysfunction, do not wish to opt for treatment. It is therefore left to the patient to volunteer this information. Treatment options include intracavenosal injections, vacuum devices and oral agents such as yohimbine. The primary care team can offer an environment which enables a patient to discuss this sensitive issue.
Diagnosing leg ulcers
Authors: Williams Clare
Published: May 2014

Leg ulcer is not a diagnosis. The ulcer is not the disease but a manifestation of the underlying process (Young, 1994). Leg ulceration affects approximately 1% of the population at any point in time and is most commonly associated with venous and arterial disease. Between 60 and 90% of leg ulcer patients are managed entirely in the community, mainly by district nurses during frequent home visits. Leg ulcer assessment and subsequent diagnosis is the most important aspect of leg ulcer management to ensure successful subsequent treatment and prevention of recurrence. Accurate assessment and successful management includes the use of Doppler ultrasound and bandaging techniques which has educational and training implications. The best way to influence healing is to adopt a community based approach with the focus of diagnosis through accurate holistic assessment.
Clinical governance
Authors: Thurtle Val
Published: May 2014

Clinical governance, a relatively new term which emerged from last Autumn’s White Paper (DoH, 1997), has the potential to make a lasting impact on health care at every level. Academics, managers, and clinicians are still exploring what clinical governance may mean and await further guidance which is expected by November 1998; some guidance has already been incorporated in the recent Green Paper A First Class Service: Quality in the New NHS (DoH, 1998).
The challenge for qualitative research in nursing
Authors: Whitehead Dean
Published: May 2014

A common consensus regarding the way in which qualitative and quantitative approaches to research are viewed within nursing has existed unchanged for many years, i.e. the quantitive or positivistic research paradigm has traditionally been viewed as being more scientific, logical, rigorous and superior to the naturalistic/qualitative approach. Indeed, there is little evidence to refute the suggestion that these two approaches are perceived as being separate to, and independent of, each other. This article suggests that this long-standing division has served to create many of the problems and barriers surrounding qualitative research in nursing. One of the main reasons for this division results from the inherent interpretation of each approach and also the perceptions of nurse researchers. Qualitative research is traditionally viewed as the weaker of the two approaches and therefore qualitative researchers are often left to actively promote the standing and credibility of this research paradigm. This article aims to identify how nurse researchers can strive to resolve the imbalance that frequently exists between these two paradigms and, consequently, redress any related misconceptions within the nursing profession.
Palliative care: the situation of people with chronic respiratory disease
Authors: Rhodes Penny
Published: May 2014

This article reports on a study of the care and services received by people in the year before death in one Yorkshire health authority. It describes the circumstances of people with end-stage chronic obstructive pulmonary disease (COPD) or emphysema, who made up over a third of the deaths in the sample. People dying from chronic respiratory conditions often seemed to fall through the net of service provision, with their visibility to service providers limited to the need for symptom management in acute phases of their illness. Despite their terminal prognosis and often high levels of dependency and need, people had little or no access to palliative and terminal care. Some of the reasons for this are explored and ways in which services might be improved are suggested.
Parent-held child health records: an evaluation of parental attitudes
Authors: Davies Alyson
Published: May 2014

A survey was carried out in Pembrokeshire to assess the attitudes of parents and professionals to parent-held child health records. This article addresses the quantitative component of the research. A cross-sectional study was carried out in two general practices. One hundred children were randomly selected from the two practices. Parents were given the parent-held child health record by their health visitor and instructed to use it over a period of 3 months during contact with any health professional, or if their child was ill but did not see a doctor. Attitudes were assessed using a structured questionnaire. Results showed that parents felt positive about using the record. They enjoyed holding their child’s health notes and having increased access to information about their child’s health care. They welcomed having greater involvement in, and responsibility for, their child’s care.
Emollients: treatment for dry skin disorders in older people
Authors: Crawford Moira
Published: May 2014

Older people are particularly prone to a range of dry skin complaints. Management of these conditions with daily use of emollients is now considered first-line therapy (Cork, 1997b), and the nurse has a crucial role to play in educating patients about their condition and the appropriate and adequate use of emollients. Crookes Healthcare offers a range of extensively researched emollients in various formulations for direct application, bath and wash use. This article examines the use and research behind some of those products.
Joint training in learning disability nursing and social work
Authors: Sims Dave
Published: May 2014

The changing nature of learning disability services over the past 25 years has led to progressive collaboration between the English National Board and the Central Council for Education and Training in Social Work regarding the education and training of professional practitioners. As a result a number of training programmes have developed from which practitioners jointly qualify in both nursing and social work disciplines. The BSc Nursing and Social Work Studies programme at the South Bank University is one example of how interprofessional collaboration has been developed and operationalized. The background to and structure of the training is discussed as well as the partnership arrangements which underpin it. Issues around the professionalidentity of course participants and the challenge of achieving an interprofessional ‘balance’ are explored. Research undertaken with qualified practitioners and their employers suggests positive outcomes in terms of breadth of knowledge, interprofessional understanding and the ability to work in a holistic way with people who have learning disabilities.
Selecting leg bags for sheath users: evaluation results
Authors: Fader M , Pettersson L , Dean G , Brooks R , Cottenden A
Published: May 2014

Selecting appropriate leg bags for people who use sheaths may be a difficult task for community nurses given the large number of leg bags available. Guidance on product selection is available through the Continence Products Evaluation (CPE) Network. The CPE Network carries out multicentre evaluations for the Medical Devices Agency (MDA), and produces reports on product performance for users and prescribers of products. The five non-sterile 500–700ml leg bags for urine drainage available in the UK were evaluated between May and October 1997. This supplemented a previous evaluation of 14 sterile leg bags which was completed in 1996 (MDA, 1996). Each leg bag was evaluated by 29–31 male sheath users based in the community. Each leg bag was tested for 1 week and each user kept a diary to record urine leakage. At the end of the week a product evaluation form was filled in to record product performance. The leg bags tested had different strengths and limitations. This evaluation provides a basis for making appropriate product selections for users and prescribers.
Community care for children
Authors: Jackson Karen
Published: May 2014

Children's health care is at the forefront of government policy and development with many innovations occurring in practice. In 1976, the Court Report (Department of Health and Social Security, 1976) produced a comprehensive review of children's health services. Since then there have been many changes in legislation and major reorganizations in the NHS and the provision of health care. Although some of the recommendations have been implemented over the 23 years since the report was published, many that have direct relevance to the health and wellbeing of children have not. A good example is the proposal that a comprehensive community nursing service should be provided. Community services for children have increased but there is still a dearth of such facilities.
Schizophrenia: management and care in the community
Authors: Toner Jane
Published: May 2014

The move to community care has resulted in many more individuals with severe mental health needs relying on community services. Community facilities did not receive the proceeds from hospital closures and this had led to inadequate provision and facilities for individuals with severe mental health needs. There also appears to have been a lack of effective interventions and skills for dealing with this specific client group. The National Framework Strategy (Department of Health, 1999) for mental health outlines ways to modernize mental health services and aims to ensure that they will be more accessible, more effective and coordinated across health and social care. Over the past decade, there has been a great deal of research examining the effectiveness of psychosocial and family interventions for individuals with psychosis. This article discusses how such interventions could address some of the shortcomings of community care for the severely mentally ill.
Putting fever in perspective
Authors: While Alison
Published: May 2014

Within a few months all specialist community nurses will be registered nurse prescribers, from whom their clients may reasonably expect wise counsel and appropriate prescriptions to manage pyrexia. However, the evidence regarding what constitutes pyrexia or fever is not incontrovertible (Purssell, 2000a). Indeed, it seems that the adoption of 37°C as the normal human temperature is derived from work carried out by Carl Reinhold August Wunderlich in 1868, with little subsequent scientific study to add to our understanding. Even Wunderlich noted that ‘normal temperatures exist within a range’ (Purssell, 2000a), with the only subsequent work finding that just 8% of subjects actually have a temperature of 37°C. Additionally, studies of circadian rhythms have demonstrated significant temperature variation during a 24-hour period.
Distinguishing chronic obstructive pulmonary disease from asthma
Authors: Crockett Antony
Published: May 2014

Asthma and chronic obstructive pulmonary disease (COPD) are the most common chronic respiratory diseases in the UK. Good management of both diseases results in better symptom control and improved quality of life for the patient, but will rely on all members of the primary healthcare team sharing the aims of management as well as helping to implement those goals. The two diseases share many clinical features and similar drugs can be used to treat them both. However there are important clinical differences which help to distinguish them from each other. The management of the two diseases differs in drug regimens and in the long-term aims of management. This article clarifies the important features that distinguish asthma from COPD and which allow patients to receive the best specific management.
Keeping kids healthy: a school nursing strategy
Authors: Thurtle Val
Published: May 2014

School nurses have welcomed the document, School Nursing within the Public Health Agenda: A Strategy for Practice (DeBell and Jackson 2000) as a forward-thinking and relevant piece of work. The result of a stock-taking of school nursing across the country, it aimed to explore current issues of delivering a service to meet the needs of the school-aged population, reach a consensus on a strategy for the delivery of school health services and formulate a work plan in line with current government policy.
Who deserves publicly funded nursing care?
Authors: While Alison
Published: May 2014

The current nurse staffing crisis is highlighting the contribution of nurses as part of healthcare manpower, and nursing care to the wellbeing of patients. While those with long-term disabilities and chronic illness living in the community have become accustomed to a lack of skilled nursing in their care, it is now apparent that acute healthcare services are also feeling the pinch. In the current climate it will be easy for those with ongoing needs to be forgotten as politicians seek rapid solutions to lengthening waiting lists and media reports of cancelled life-saving surgery.
Primary care research needs community nurses
Authors: While Alison
Published: May 2014

Primary care services manage most health problems and yet much primary care activity is unsupported by evidence. Clinical governance and other health service initiatives require careful consideration of available evidence to ensure the provision of the highest quality care. This significant evidence gap in part reflects the lack of research capacity within primary care.
Community nursing and stroke: a reassessment of the issues
Authors: Gibbon Bernard , Burton Christopher R
Published: May 2014

Recent research has highlighted the difficulties that stroke patients and carers experience in navigating a recovery path through a complex array of service providers. Many of these difficulties relate to continuing recovery from stroke at home, often when professional help is decreasing. A study by Gibbon (1994) demonstrated a potential role for community nurses in helping patients and carers to cope with the aftermath of stroke. This article reassesses the issues that affect the capacity of community nurses to develop this role. A focus group conducted with community nursing students identified a number of barriers to the expansion of service provision for this patient group, including workload pressures, training and management support. Understanding of the problems faced by stroke patients and their carers in the current organization of continuing care and rehabilitation is required to support expansion of nursing practice in this area.
Legal issues arising in community nursing 5: nurse prescribing
Authors: Dimond Bridgit
Published: May 2014

Major changes are recommended in prescribing which will extend prescribing powers to many other professional groups on a restricted basis. Nurse prescribing in the community was made possible following the recommendations of the first Crown report (Department of Health (DoH), 1989) by the Medicinal Products (Prescription by Nurses etc) Act 1992 and by changes to Section 41 of the National Health Service Act 1977. However, prescribing by nurses on the basis of group protocols has taken place in hospitals and in primary care with no clear basis in law. A further inquiry to review prescribing, supply and administration of medicines reported in March 1998 on group protocols and published its final report in March 1999 (DoH, 1999). A recent press release announced that the Government will implement the Crown proposals by July 2000 (DoH, 2000). This article examines these proposals and their potential impact on community nursing.
e-healthcare cannot be ignored
Authors: While Alison
Published: May 2014

Information technology is rapidly changing the world in which we live and ever-cheaper technology will ensure that this change continues at a rapid pace; this Government plans to have Internet access in every home within 5 years. Additionally, preregistration curricula are including technological training — and therefore IT competence — among learning outcomes in preparation for the inevitable changes in healthcare delivery.
Advocating provision for people with disabilities
Authors: While Alison
Published: May 2014

An important dimension of quality of life is the ability to be independent in thought and action. Enabling people with a disability to access aids, equipment and therapies so that they may live as independently as possible has a heavy emphasis in all rehabilitative work. However, a recent Audit Commission (2000) report challenged the effectiveness of current provision and highlighted how all too frequently needs are not met, leaving those with a disability isolated and ‘unproductive’.
Community management of peripherally inserted central catheters
Authors: Aston Val
Published: May 2014

Peripherally inserted central catheters (PICCs) are increasingly being used in the UK to allow patients requiring medium-to-long term venous access for a range of therapies, including ambulatory chemotherapy, to receive their treatment at home, away from the hospital setting. This article provides information for community nurses on the background of PICC lines in the UK, and practical advice on how to clinically maintain and manage these lines. Complications relating to PICCs are discussed, including how to recognize and deal with these complications in the community, and when to refer back to the specialist centre. The author leads at a nurse-managed PICC insertion service at a major cancer centre in Wales. The ongoing success of this service relies heavily on the skill and expertise of the community nurses who support the service.
National plan: strategic development for the NHS
Authors: Clarke Gwen
Published: May 2014

The Government appears to be committed to the long-term development of the NHS and, without instigating radical change, has outlined a 10-year plan for reform and investment, building on what has already been achieved and endorsing the patients perspective (Department of Health (DoH), 2000a). The Government has pledged more nurses and doctors, plus reduced waiting lists for patients. While the Government is to be congratulated on many aspects of The NHS Plan, some crucial areas, such as the care of older people, have not received as much attention as they deserve.
The principles of pain management in advanced cancer
Authors: Regaard Anna
Published: May 2014

Pain is the most feared symptom for patients with advanced cancer. Although effective pain relief is critical to preserving quality of life for these patients, the incidence of uncontrolled pain is high. A variety of physiological mechanisms contribute to cancer pain, and psychological, social and spiritual factors all contribute to the overall pain experience. Therefore the rationale for treatment must be appropriate. Regular assessment of both pain and treatment is indicated, as is the management of adverse reactions of treatment. In most cases, pain may be managed by conventional means (e.g. oral analgesia) but sometimes other modes of administration (e.g. transdermal/subcutaneous routes) may be more appropriate. In addition, some patients will require interventional treatment such as nerve blocks or radiotherapy, while in other patients non-drug therapies may be more appropriate. Improved assessment, education and communication can do much to alleviate pain in the patient with advanced cancer.
Palliative care in the community: the challenge for district nurses
Authors: Bliss Julie
Published: May 2014

Palliative care is expanding out of the hospice, and out of the narrow confines of its association with cancer. It should be a part of all care. District nurses are ideally placed to implement and coordinate palliative care in the community, making use of the talents of many other agencies and professionals. However, because of a lack of communication between these agencies, there is confusion about their roles, and many patients may not be receiving optimal care. This article argues that by promoting interagency and interprofessional communication and cooperation, district nurses can strengthen their role at the heart of palliative care provision in the community.
The information technology challenge for the NHS
Authors: Pollard Tom
Published: May 2014

One cannot turn a corner these days without seeing a poster for a new website. Television is awash with dot.com advertisements. One-quarter of UK homes have access to the internet (Office of National Statistics, 2000). We have entered the information technology age. How is the NHS coping with it?
Recent developments in the management of type 2 diabetes
Authors: Hicks Debbie
Published: May 2014

Type 2 diabetes is a common, chronic disease, with a high risk of macrovascular and microvascular complications that lead to premature death and disability. The disease is managed largely in primary care and its rising prevalence will increase the workload of community nurses. The forthcoming Diabetes National Service Framework will aim to improve the standards of diabetic care, while scientific and technological developments offer new treatments that may also improve the outlook for patients. There is as yet no case for population screening for type 2 diabetes, but community nurses are ideally placed to carry out local screening initiatives based on consensus guidelines.
Needs of older people in the community: issues for PCGs and PCTs
Authors: Ryder Elaine
Published: May 2014

National policy (Department of Health, 1997, 2000) is directing care provision to being appropriate to meet people’s needs; to be effective; evidence-based; efficient and economic. Primary care groups (PCGs) and trusts (PCTs) have been identified as being the organizations to deliver such care. Since the introduction of the NHS and Community Care Act 1990, certain issues have been highlighted as having implications for the provision of an ’ideal’ service for older people on the community. These issues focus around three main areas: assessment of need; working in partnership and quality of service provision. This article discusses these issues and their implications for PCGs/PCTs in relation to supporting older people in the community.
The practice nurse’s role in the management of epilepsy
Authors: Welsh Marion
Published: May 2014

Epilepsy is a serious and common neurological condition of which the medical, psychological and social implications are far-reaching. This article aims to discuss the practice nurse’s role in responding to the needs of clients with epilepsy. This is explored from a primary health care perspective, focusing upon nursing interventions and implications for practice. The potential exists for community nursing intervention to improve quality of life for clients through responsive service provision and by challenging the inequality that appears to exist with regard to it. The available research is overtly pharmacological in origin and nursing research in this field is extremely sparse.
The pathophysiology of different types of leg ulcers
Authors: Watson Steve
Published: May 2014

Leg ulcers are wounds on the leg of 6weeks or more duration, and may range in size from very small to very large. They are caused primarily by deterioration in the peripheral circulation of the affected individual, although this may arise from a number of conditions. This article discusses the major conditions leading to the formation of a leg ulcer, in order to improve understanding of the rationale for leg ulcer management techniques.
Implementing the NHS Plan
Authors: While Alison
Published: May 2014

The NHS Plan Implementation Programme (Department of Health (DoH), 2000a) reiterates the key messages of The NHS Plan (DoH, 2000b). It emphasizes the Governments support for the provision of preventive services; social, primary, intermediate and hospital care with improved pathways between the different types of care. There is also an emphasis on the promotion of self-care and the judicious use of different sources of care with, for example, the greater use of pharmacies as referral points for users of NHS Direct.
Is a blueprint for care of older people enough?
Authors: While Alison
Published: May 2014

It is proper that the care of older people, who represent approximately a fifth of the population, has at last received the recognition it deserves through the release of the National Service Framework for Older People (Department of Health (DoH), 2001). Older people, like others, want to enjoy good health and have access to high quality services to support them in times of need. It is perhaps remarkable that the issue of equity has for so long been overlooked with discriminatory practices being tolerated within publicly funded provision.
A challenge for the new government: be radical
Authors: Pollard Tom
Published: May 2014

By the time this journal hits your doorstep, the election will be old news, and the new government will have started enacting whatever transformations in policy they have promised during the election campaign. If, as current predictions indicate, Labour is swept to power with another significant majority, it seems likely that they will have at least another two terms in which to effect their policies. After 18 years of Conservative government, many would once have relished the prospect of a longlived centre-left government. This is no longer the case – despite a commanding lead in the opinion polls, it is hard to find people who do not have a word to say against New Labour.
Use of the Polaroid Macro 3 SLR camera in wound assessment
Authors: Ballard Kate
Published: May 2014

Patient assessment is essential to effective care and facilitates systematic care planning. Assessment must be performed in combination with good documentation and accurate record keeping. Clinical governance, risk management and accountable practice are continuously emphasized by the UKCC (1992, 1998) and Department of Health (1998), and in the light of increasing litigation, it is imperative that planned and given care is accurately documented.
Awful things can happen inside the home
Authors: While Alison
Published: May 2014

The extent of violence and abuse within the home is unknown because much of it is likely to go unreported to the police and therefore unrecorded. It may take various forms, including domestic violence which occurs between those who have been in an intimate relationship, child abuse and abuse of older people and other vulnerable adults.
Use of gloves in the community: why, when, which and how?
Authors: Carroll Anne K
Published: May 2014

The use of gloves has become routine since the early 1980s. It is recognized that they have an important part to play in the protection of both staff and patients/clients in the prevention of cross-infection. However, as choices relating to glove usage have increased over the years, health-care staff need to adopt a risk assessment approach, considering why, when, which and how gloves should be used. This article outlines the different types of gloves available and when they should be used.