bluuebunny/crossref_metadata_2025 huggingface dataset:
What type of eye drops should be given to a toddler with conjunctivitis?
Authors: Griffiths Dr Peter
Published: May 2014

This mini-review describes a parent’s search for evidence on the relative merits of two commonly-used treatments for conjunctivitis. It was conducted in a very limited period of time with access to free databases (Pub Med, Cochrane Library) and only the abstracts of papers. Five relevant studies were identified that compared fusidic acid eye drops to chloramphenicol. Three of the five studies reported no difference in effectiveness between the two preparations with both drugs performing equally well. Two studies undertaken in less-developed countries showed fusidic acid to be far more effective but the cure rate with chloramphenicol was low, suggesting resistance or different causal agents. However, there was some evidence that chloramphenicol was less well tolerated and so fusidic acid may be the drug of choice. The review illustrates that evidence for practice can be found rapidly with access to limited facilities by an appropriately skilled practitioner.
Nutritional screening in the community: developing strategies
Authors: Todorovic Vera
Published: May 2014

Malnutrition is a significant clinical and public health problem in the community with the wider determinants of health including poverty, social isolation and deprivation all exacerbating its incidence. It is frequently undetected and untreated. Effective nutritional screening is needed to reduce the prevalence of malnutrition but barriers to implementation do exist. Working with staff to identify barriers that prevent the effective adoption of nutritional screening is key to ensuring that appropriate nutritional action always occurs in a timely manner. Profiling the local community helps to give a clearer overview of the high risk population groups and provides robust evidence which helps the process of identifying priorities for action.
Use of strong opioids for non-cancer pain in the community: a case study
Authors: T Cowan David , While Alison , Griffiths Peter
Published: May 2014

The continued extension of prescribing rights among nurses may necessitate that effective pain management will require more involvement of nurses in the prescription of controlled drugs. The prescription of strong opioid analgesic drugs for chronic non-cancer pain (CNCP) is viewed as controversial. Misconceptions about opioid drugs fuel this controversy. This case study highlights the knowledge gap that exists between pain and addiction medicine and highlights the problems that CNCP patients treated in the community with opioid therapy may encounter. Community nurses are in an ideal position to be instrumental in identifying such vulnerable patients and ensuring that appropriate interventions are available.
Uncommon causes of leg ulceration and lesions not to be missed
Authors: Tillman David
Published: May 2014

While the vast majority of cases of leg ulceration are the result of venous and/or arterial disease, and occur in older people, there are several other, less common conditions that can lead to leg ulceration, often in younger people. This article examines the diagnosis and management of some of these conditions, almost all of which will require referral for specialist assessment and treatment.
Improving chronic disease management
Authors: While Alison
Published: May 2014

Chronic disease accounts for nearly 80% of spending on health care, so it is not surprising that a different approach to care delivery is a priority for the NHS. By 2008 all primary care trusts will be expected to have implemented case management approaches alongside existing initiatives such as the expert patient programme (Department of Health, 2004) and so contribute to a reduction in costly unplanned admissions.
Managing student transitions into primary care
Authors: Doley Bridget , Roberts Sally
Published: May 2014

In response to its specific recruitment needs, Walsall teaching primary care trust has implemented a new final placement programme for community nursing students that focuses on providing students with hands-on experience in the community setting. This article presents the results of an evaluation of the programme. Outcomes of the programme are discussed and analysis is drawn from all key participants. This has been the first stage of a career pathway for 80% of these students, who are now successfully employed as community staff nurses within the PCT.
Chilling lessons from the Shipman Inquiry
Authors: Pollard Tom
Published: May 2014

If you thought the spectre of Harold Shipman was behind us, you are very much mistaken. The impact of his unspeakable betrayal of his patients’ trust and friendship, and the ease with which he was able to subvert the controls that were supposed to stop exactly the kind of things he did happening, will roll on for many years to come. As the Shipman Inquiry Chairman, Dame Janet Smith, put it at a recent lecture, in his 25-year killing career, ‘Shipman rode a cart and horses through our systems of regulating the use of controlled drugs by GPs and our systems of death certification, made a detour round the coroner’s system of death investigation, and undermined public confidence in the medical profession.’
Community matrons: what’s in a name?
Authors: Pateman Brian
Published: May 2014

What is a community matron? The matron was historically a feared and respected, formidable figure, who reigned supreme in hospitals, until the post was removed under previous modernization plans. Modern matrons have been reintroduced into hospitals as part of the NHS Plan (DH, 2000). When the government asked how the NHS could be improved there was an overwhelming call to ‘bring back Matron’. Matrons provide professional leadership to nurses and ensure that the patient’s hospital experience is comfortable and safe. Both major parties support the role. The Conservative party announced recently that if elected in the forthcoming general election they would give matrons power above all others to close unhygienic wards in the fight against MRSA. So a hospital modern matron role could be summarized as improving quality by being a manager, leader and patients’ interest promoter.
A survey of psychological wellbeing in an adult population
Authors: Barr Wally , Kirkcaldy Andrew , Robinson Jude , Poustie Vanessa J , Capewell Simon
Published: May 2014

The British government has called on all NHS staff to help promote good psychological wellbeing in the population. This article reports results from a survey conducted in Merseyside, England, into the prevalence of poor psychological wellbeing across a large part of the region. People registered with one of five Merseyside primary care trusts were stratified by age group and deprivation, and a questionnaire was mailed to 28000 who had been randomly selected from those aged 15 or over. A total of 11168 (45%) completed questionnaires were returned. Of these, 2442 (21.9%) respondents rated their psychological wellbeing as fairly poor or very poor. Mean levels of psychological wellbeing were significantly worse in a number of readily identifiable groups within the population, but overall, the lowest wellbeing ratings were concentrated in the most socioeconomically deprived quartile. We make a number of practical suggestions for the role of the community nurse in promoting good psychological wellbeing in patients. We also highlight our finding that socioeconomic deprivation was strongly associated with poor psychological wellbeing, which was in turn associated with a lifestyle high in risk factors for non-communicable diseases.
Referral criteria: making the district nursing service visible
Authors: Jarvis Alison , Mackie Sheila , Arundel Dawn
Published: May 2014

The development of referral criteria has been seen as one of the keys to the proactive enhancement of the district nursing service to ensure equity and efficiency of service provision (Audit Commission, 1999). Referral criteria specify what constitutes an appropriate district nursing referral and who is the best person or service to undertake the care if it is not. With the continued focus of shifting the balance of care away from the hospital and into the community and a historically reactive rather than proactive work force, district nurses in Lothian, Scotland developed referral criteria for the service. This article discusses the drivers for the development of these criteria, how they were developed, and the anticipated difference implementation of the criteria would make to district nursing.
The management of deep vein thrombosis in lymphoedema: a review
Authors: Shrubb Debbie , Mason Wendy
Published: May 2014

The purpose of this article is to investigate current evidence for the management of deep vein thrombosis (DVT) in the lymphoedematous limb in order to develop guidelines for the management of this patient group. Starting with a review of the literature related to current management of DVT in the wider population, it then considers its applicability to lymphoedema care. Outpatient management of ambulant persons who develop DVT has recently gained wide acceptance. Contrary to standard practice of removing compression, bed-rest and anticoagulant therapy, evidence is emerging for the use of graduated compression hosiery in the management of lower limb DVT in the care of ambulant patients. Its relationship to lymphoedema care and current practice by practitioners in order to improve the care and outcomes of people affected by lymphoedema will also be examined.
Nutrition and the ostomate: input, output and absorption
Authors: Burch Jennie
Published: May 2014

This article discusses the function of the gastrointestinal system in relation to diet and fluid absorption and how this will alter after the formation of a stoma. The different types of stoma are discussed to enable the community nurse to understand how this may lead to changes in dietary requirements for the ostomate (a person with a stoma). The function of the nutrients in the diet is discussed and how the ostomate can best obtain these into their diet.
Structure and function of the lymphatic system: an overview
Authors: Ellis Sandy
Published: May 2014

The lymphatic system is often overlooked, but is a vital part both of the circulation and the immune system. This article provides a basic overview of the structure and function of the lymphatic system as a grounding for understanding the development of chronic oedemas, notably lymphoedema.
Developing an education package on diabetic foot disease
Authors: Mackie Sheila
Published: May 2014

This article describes the process of developing an education package on diabetic foot disease (DFD) for district nurses, a component of the author's work for the Warwick certificate in diabetes care. The author undertook an audit of the DFD knowledge and information needs of district and community staff nurses within her local health partnership (LHP). The author then developed and delivered an education package tailored to cover the subjects and gaps identified by staff in the audit. The package comprises a presentation followed by a practical demonstration of foot assessment and screening. Favourable evaluation has led the author to disseminate the package to a wider range of nursing staff and other disciplines.
Choosing and using: patient choice in ‘Choose and Book’
Authors: Bentley Jenny , Fletcher Dave
Published: May 2014

Seventy six percent of people feel that the main healthcare priority should be to involve people in decisions over the treatment of their illness. One group of users in primary care that are likely to have diminished choice are the heaviest users: the elderly. Modernization of the NHS has placed the user as a consumer, thus creating a more user-friendly service that not only takes into account the role of the consumer, but actively engages with them. Increased patient choice provides a context for meeting patient expectations. Patient choice and patient centred care are evident within the NHS Plan, which outlines a vision of health services designed around the patient. This article will review the extent to which elderly patients have real and meaningful choices in the ‘Choose and Book’ system which operates within the primary care setting.
Using cooperative inquiry and clinical supervision to improve practice
Authors: Jenkins Emrys
Published: May 2014

District nurses and a nurse lecturer used the process of co-operative inquiry (Heron, 1996; Reason and Heron, 2001) to research the value of regular, critical reflection in developing their practice. Stories and metaphor were shared and appraised through i) supportive challenge; and ii) talking that critically informed learning (rather than reinforcing opinions or moaning). These methods were informed by clinical supervision and action research literature. The co-inquiry process made overt our tendencies to hide and the merit in sharing and in being ourselves, authentic (Hartrick 1997; McCormack 2003). In place of professional attitudes that present a ‘we know best’ stance, we are improving our nursing and education work through engaging more personally with others. Our relationships and humour help us to seek more holistic appreciations of experience than solitary self-reflection can provide, and we need dedicated time for this social, more critical appreciation.
A case study looking at appropriate catheterization
Authors: Nazarko Linda
Published: May 2014

The use of indwelling urinary catheters in older adults is not without its consequences. Catheters used appropriately are cost effective and very useful in clinical practice. However, what happens when catheters are used as a means of aiding the nurse rather than the patient? What sort of problems can practitioners inadvertently create? In this case study Mrs Seymour is tracked through the process of admission for osteoporosis. The relative advantages and disadvantages of catheterization are discussed.
Assessment and management of wound infection: the role of silver
Authors: Stephen-Haynes Jackie , Toner Louise
Published: May 2014

The appropriate selection of anti-microbial dressings has become an increasing challenge within clinical practice with an increasing array of dressing availability. A major area of growth has been in dressings containing silver. This article will discuss the rationale for use of silver dressings in the context of wound bed preparation, and offers guidance on their selection and appropriate use.
‘Heal not hurt’: piloting an initiative on wound pain assessment
Authors: Barrett Simon
Published: May 2014

As a number of consensus and position documents have made clear, wound pain is an issue that all nurses involved in wound care should take seriously. Based on the ‘Heal not hurt’ initiative supported by Molnlycke, a wound assessment tool has been adopted by East Riding of Yorkshire PCT. This article gives an overview of the documentation and argues that thorough assessment is essential in wound care and proper documentation is the key to successful clinical outcomes.
Apomorphine nodules in Parkinson’s disease: best practice considerations
Authors: Todd Amy , James Cherry-Ann
Published: May 2014

Apomorphine hydrochloride infusion therapy is used by approximately 1000 people with advanced Parkinson’s disease in the UK (Britannia Pharmaceuticals Ltd, 2008). Subcutaneous nodules that develop as a result of these infusions can cause discomfort and may impact on the effectiveness of the drug therapy. Community nursing teams have a key role in supporting patients on apomorphine; they may be responsible for administering the drug, or supporting and empowering the patient or their carer to administer the infusion.

A recent randomized controlled pilot study by a research group at the University of Hertfordshire investigated the use of therapeutic ultrasound for the treatment of apomorphine nodules. A number of observations about apomorphine nodules and the technique used to site infusions were made which may help to promote safe and effective management of apomorphine therapy. This article is a collaboration between one of the researchers and a Parkinson’s disease nurse specialist from the University College of London Hospitals NHS Foundation Trust. It draws on best practice observations from both research and clinical experience and puts them in context of published research. It summarizes best practice considerations for administering infusions, identifies the current treatment and management options that participants from the trial reported using on their nodules, emphasizes the need for standardized documentation and suggests a rating system that may be useful to document nodule severity.
Nurse prescribing, policy, practice and evidence base
Authors: Courtenay Molly
Published: May 2014

There are now over 30000 nurses across the UK who are qualified to prescribe from the Nurse Prescribing Formulary (NPF) for community practitioners. Training to prescribe from this formulary is now available to community staff nurses. Increasing numbers of community nurses are extending their prescribing skills by adopting independent and supplementary prescribing. Over 14000 nurses across the UK are qualified to prescribe using these modes of prescribing.

The benefits of nurse prescribing exceed those anticipated by the Government. However, there is some misunderstanding by doctors about the prescribing role. Doctors have concerns about nurses encroaching on medical territory, nurses’ clinical skill base, and the possibility that nurses will prescribe outside of their area of competence. If doctors have an established relationship with a nurse prior to the adoption of prescribing, and have experienced some of the tangible benefits of this role, this helps to readdress these concerns.

The increasing numbers of community nurses adopting and extending their role in the prescription of medicines is an indication that healthcare reforms, shifting care into the community, means that nurses are frequently the first point of contact from whom patients access their medicines. If the benefits of nurse prescribing are to be maximized and nurses are to feel supported in this role, there is a need to educate doctors about the professional limitations of nurse prescribing.
Age related macular degeneration: visual impairment with advancing age
Authors: Redmond Neill , While Alison
Published: May 2014

This article sets out a comprehensive outline of age related macular degeneration including the underlying disease mechanisms. Current treatment options are described together with recommendations for preventive care and support for those with visual impairment.
Telemedicine seeks to empower patients to manage their care
Authors: Kohler Mervyn
Published: May 2014

The world of telemedicine is expanding the way in which care is being delivered in both the healthcare and the social care arena. This article explores how telemedicine will change the delivery of healthcare and presents recommendations for the future. Telemedicine is already having an impact on district nursing practice.
Exploring the views of nurse prescribing among Macmillan nurses
Authors: Ryan-Woolley Bernadette , McHugh Gretl , Luker Karen
Published: May 2014

Nurse prescribing is a key government initiative which aims to enhance patient care. The aim of this study was to investigate the prescribing practice of specialist nurses working in cancer and palliative care and to explore the benefits of and barriers to uptake of nurse prescribing training. A national postal survey of 2252 Macmillan nurses was undertaken using a structured questionnaire with open-ended questions. Data were analyzed using thematic content analysis for 1575 respondents (70% response rate). Only 13% (203) had undergone prescribing training and of these 105 provided responses to the open questions concerning training and of the 87% (1372) who had not undergone the training, 423 provided details on barriers to nurse prescribing training. The data presented in this paper draw from this data. The findings indicate that those who prescribed gave the prospect of improving care as the main reason for undertaking nurse prescribing training. The main reasons why these specialist nurses did not undertake training were: resource issues particularly with respect to backfill while training, lack of medical support and mentorship, concerns about the relevance of prescribing as a nursing role and prioritizing other courses. If nurse prescribing is to be more widely available for cancer and palliative care patients it is important in both primary and secondary care to address the resource and support issues.
The importance and function of footwear in managing lymphoedema
Authors: Farrelly Ina
Published: May 2014

Lymphoedema is a chronic progressive condition of the lymphatic system. It occurs because of poor lymphatic drainage of an area of the body leading to an increase in interstitial volume secondary to a build up of lymphatic fluid, and chronic oedema (Lymphoedema Framework, 2006; Tiwari A, et al 2003). Lymphoedema may affect any part of the body but the arms and legs are the most common sites. It is estimated that there are at least 100?000 sufferers in the UK alone (Moffat C et al, 2003). This article seeks to look at the importance of appropriate footwear in patients with chronic swelling caused by lymphoedema and takes a look at some of the practical problems encountered with footwear in clinical practice.
Constipation, treatment and biofeedback therapy
Authors: Collins Brigitte , Burch Jennie
Published: May 2014

Constipation is commonly encountered by the community nurse, particularly in older people. A comprehensive assessment is required prior to treatment, to exclude potential pathologies such as a bowel cancer. There are many potential causes of constipation, such as poor diet or use of opioid analgesia. This can guide the nurse to a potential treatment, for example to include more fibre in the diet or to possibly change the analgesia used. However if these and/or other therapies fail, biofeedback therapy offers a non-surgical option. Biofeedback therapy includes patient education, retraining of the bowels and muscles, behavioural therapies and psychological support.
Monitoring long term conditions with Telehealth
Authors: Marshall Matthew
Published: May 2014

Matthew Marshall of Tunstall explains the role that telehealth is playing in supporting health and social care professionals and enabling them to deliver more integrated, flexible and person-centred care. He discusses the approach three PCTs have taken for more preventative, community based care and how their use of telehealth has transformed chronic disease and long term condition management, shifting the balance away from a reliance on hospitals and into the community setting.
Topical dressings to manage pain in venous leg ulceration
Authors: Beldon Pauline
Published: May 2014

The pain experienced by patients with venous leg ulceration can be severe, disabling and have an impact on their quality of life. Pain assessment should be an integral part of leg ulcer assessment, since unless pain is successfully managed, the patient may not be able to comply with compression bandaging or exercise and elevation, all of which are crucial components in the successful management of venous leg ulceration. Neuropathic pain can be difficult to identify for both patient and healthcare professional, if it is unrecognized and untreated the patient’s ulceration may persist due to an inability to tolerate dressings or bandaging.
Negative pressure wound therapy in the community: the debate
Authors: Ousey Karen , Milne Jeanette
Published: May 2014

Recent government documents (Department of Health (DH), 2009) have suggested that as a result of advances in tissue viability, more complex wound care can now be provided in the community setting and that therapies such as negative pressure wound therapy (NPWT) should be commonplace with tissue viability professionals appointed to direct service provision and ensure high standards (DH, 2009). This is a major step forward in current thinking, however, there are still gaps in our understanding of NPWT with regard to both the mechanism of action and which wound types will respond most favourably to the therapy. Managing complex patients in the community setting can be challenging, add to this scenario a device that has to remain attached for around 22 out of 24 hours a day and there is a major challenge. It yet remains to be ascertained if it is appropriate for all patients or if some definitive exclusion criteria should be agreed. This paper will seek to explore the mechanism of action, benefits, and barriers to adoption in community settings.
Self-care in the community: moving away from a culture of dependency
Authors: Wrixon Sarah
Published: May 2014

As ever greater pressure is brought to bear by the current economic climate, one simple step may yield a very significant release of time and money. Leaders from primary care and the non-prescription medicines industry are in agreement that the time has come to break the national culture of dependency on the NHS, estimated to cost every general practice in England an average of £250000 annually, equivalent to an astonishing £2 billion across primary care. It also actively denies people the confidence to take control of their own, and their families’ health and therefore ‘the opportunity to set up good behaviours for the longer term’ according to Dr Laurence Buckman. This paper examines the role community nurses can play in helping to change this culture.
Exploring the role of the community matron
Authors: Dossa Nadia
Published: May 2014

The introduction of the community matron (CM) is important for the management of long-term conditions (Department of Health (DH), 2005b). However, the role is relatively new in the UK and evidence is limited as to how CMs perceive their role. This study has therefore examined CMs’ perceptions of their role.

The objectives of the study are to understand how CMs perceive and practice their roles. Furthermore, to analyse the affect of influencing factors on the CMs role and understand the perception of the role in light of Governmental policy.

Two focus groups were held to which twelve CMs from a range of PCTs attended. Data were manually transcribed and an analytical approach was used to index the data. Six main themes emerged which are explored in the article.

CMs perceived their role to be highly valued by their patients. The perception of their role by other professionals varied and anxieties about role recognition, support and dual roles were raised. Similarly, support from managers and PCTs varied. Training and developmental needs were highlighted to be paramount for their role.

CMs were generally optimistic about their role, especially the positive effects it has had on their patients. However, the concerns raised
Managing quality of life in the older person with a stoma
Authors: C Slater Rebecca
Published: May 2014

Undergoing surgery and having the formation of a stoma may be required for a number of reasons and how a patient accepts their new body image and changes to their lifestyle can be greatly determined by the support and care they receive from their stoma nurse and other health professionals involved in their recovery after stoma formation. Preparing a patient pre-operatively and taking time to listen to their individual needs will enhance their perception of living with a stoma and accepting their stoma, thus not negatively impacting on what they perceive to be their quality of life. Acknowledging the quality of life of an individual and taking measures to maintain a person’s quality of life at an early stage within the surgical pathway will have a positive impact on a patient’s recovery from surgery and ability to cope with the daily routine involved when living with a stoma. Nurses need to understand what their patient perceives as a good quality of life and how to alter any negative factors that may inhibit a patient’s ability to care for and accept their stoma.
Cancer-related fatigue: a review of nursing interventions
Authors: Kirshbaum Marilyn
Published: May 2014

Fatigue is a common and distressing symptom that is a concern for cancer patients, their families, carers and health professionals. Cancer-related fatigue is a multidimensional phenomenon that is self-perceived and includes physical, emotional, cognitive and behavioural components. It can be unrelenting, disrupts daily life, fosters helplessness and may culminate in despair. The many causes of cancer-related fatigue stem from the disease itself, the cancer treatments and their side effects. The conclusion from a recent critical review of research evidence is that physical exercise and the treatment of underlying problems, such as anaemia or clinical depression, are effective interventions. However, a wide range of practical interventions and complementary therapies are likely to be helpful such as: acupressure and acupuncture, stress management and relaxation, energy conservation measures, anticipatory guidance and preparatory information, and attention-restoring activities. This article will provide a comprehensive review of current knowledge surrounding cancer-related fatigue and the nursing interventions that can be implemented in community practice.
Integrated malignant and non-malignant palliative care in Scotland
Authors: Senior Lorna , Hubbard Gill
Published: May 2014

The Scottish Government promotes equity in palliative care delivery in Living and Dying Well (Scottish Government, 2008). Ten nurses, working in the community in the Western Isles, participated in focus groups to discuss how palliative care needs of islanders may best be met. Analysis used Framework (Ritchie et al, 2003) and identified needs of the family unit, teamwork, specialist skills and rural issues as the main themes. Nurses feared burgeoning caseloads and expressed a need for time to share and develop knowledge and skills. They described a collaborative model of care in keeping with that recommended by Scottish Partnership for Palliative Care (2006). Further research could seek the views of island patients and families requiring long-term palliative care.
Stroke awareness among British ethnic minorities
Authors: Ryan Tony
Published: May 2014

Stroke is the third common cause of death in the UK. It is also a leading cause of disability. The recent National Stroke Strategy (Department of Health, 2007) has provided major impetus behind changes in the ways in which stroke is prevented and treated (National Audit Office, 2010). Stroke awareness sits as a significant part of the Strategy, but there are some concerns that the Government’s centrepiece campaign to increase public knowledge is not reaching some of the most vulnerable sections of our population, people from black and minority ethnic communities, despite clear evidence of increased risk among some ethnic communities. This paper describes some of the literature, mainly from the United States, which can help nurses working in community settings consider strategies for raising awareness about both stroke knowledge and risk. The paper points to three important themes: initial and prolonged engagement with local communities; self-management and cultural sensitivity.
Consent and capacity: a guide for district nurses
Authors: Ford Lorna
Published: May 2014

The Mental Capacity Act 2005, which came into force in 2007, sought to provide a statutory framework to facilitate empowerment and provide protection to individuals who lack capacity. District nurses must be aware of the legislation regarding mental capacity (Nursing and Midwifery Council, 2008) and understand how and when they may need to assess decision-making capacity. The article explores the legal and ethical issues surrounding consent, and seeks to inform district nurses as to the guidelines used in assessing a person’s capacity to consent, along with best interests policy.
Managing dysphagia in older people with dementia
Authors: Kyle Gaye
Published: May 2014

In the UK there is an increasing ageing population, bringing with it a host of degenerative conditions such as dementia. Dementia is a common condition among older people. In the UK there are estimated to be over 750 000 people with dementia and numbers are expected to double in the next 30 years ( Comas-Herrera et al, 2007 ). The term ‘dementia’ is used to describe a syndrome which may be caused by a number of illnesses and is associated with ongoing decline of the brain and its abilities. There are many types of dementia, the most common are Alzheimer's disease, vascular dementia and dementia with Lewy bodies. The most common form of dementia is Alzheimer's which accounts for 62% of all cases. Vascular dementia either alone or co-existent with Alzheimer's, is the second most common subtype of dementia ( Knapp et al, 2007 ). Dementia is associated with complex needs especially in the later stages, and can have a devastating effect on the individual, their family and friends. The care needs often challenge the skills and capacity of carers especially when normal every-day activities decline. Food and drink are fundamental to living. Consequently observing individuals struggling with eating and drinking not only poses difficulties for professionals but also raises emotional issues for the individual and their family.
Providing information and advice on diet to stoma patients
Authors: Burch Jennie
Published: May 2014

The community nurse will encounter many queries and requests for advice in the work environment. This article offers information on diet related to the stoma. Specific advice for the three different types of stoma, and for certain situations that might arise after the ostomate (person with a stoma) is discharged home, is provided. Much of the advice is common sense, but it might prevent the use of medication such as laxatives. Nutrition is essential for recovery following surgery and in the long-term. By using the information provided, the community nurse can give better care to this group of patients.
Expert patients: the Service User Mentorship Programme
Authors: Stokes Gill
Published: May 2014

As part of its remit to improve the lives of people with long-term conditions, the Expert Patients Programme Community Interest Company has partnered with South Central Strategic Health Authority and a number of local universities to provide Service User Mentors for students on the Foundation Degree in Health and Social Care Long Term Conditions Pathway. This article discusses how giving students the opportunity to have greater insight into what it means to live with a chronic condition, and an understanding of and improved practice in effective self-management, can support and improve health and social care outcomes for people living with long-term conditions.
Incontinence-associated dermatitis: step-by-step prevention and treatment
Authors: Beeckman Dimitri , Woodward Sue , Gray Mikel
Published: May 2014

Incontinence-associated dermatitis (IAD) is one of the clinical manifestations of moisture-associated skin damage. It is a common problem in community dwelling patients with faecal and/or urinary incontinence, and IAD management is an important challenge for community nurses. The aim of this practice focused article is to provide a brief update about the evidence of: (1) the pathophysiology of IAD, (2) the differentiation between IAD and pressure ulcers, and (3) the prevention/treatment of IAD. Recommendations for patient care in the community is described with reference to a patient case study.
Modernizing public health law: protection and enforcement
Authors: Griffith Richard , Tengnah Cassam
Published: May 2014

Health protection legislation has been updated through amendments to the Public Health (Control of Disease) Act 1984 to take account of emerging diseases and the risk of contamination by adopting an all hazard approach to disease protection. To further strengthen safeguards for protecting health, new health protection powers have been given to local authorities and magistrates. The powers can be used to prevent and control the spread of infectious diseases and contamination. Health professionals, including district nurses, need to be aware of the health protection powers. This will enable them to take appropriate decisions in cases where voluntary measures to protect health are not possible.
Non-pharmacological management of behavioural symptoms of dementia
Authors: Khan Farooq , Curtice Martin
Published: May 2014

This article describes a 6-month pilot project in which a community mental health team provided a dementia inreach service into 4 care homes in Birmingham, UK. The project included analysis of the impact of the service at the end of the project as well as a literature review of dementia care in care homes, and especially the issue of antipsychotic medication use and non-pharmacological approaches in managing behavioural and psychological symptoms of dementia (BPSD). The project included training care home staff in the management of BPSD; 2 questionnaires distributed at the beginning of the project found that 65% of care home staff felt a need for education and awareness, practical problem-solving and counselling in managing BPSD. Self-reported knowledge of common mental health problems and dementia increased in care home staff at the end of the project by a margin of 7% and 11% respectively. Reported confidence in managing behavioural problems increased by 9% among care home staff at the end of the project. The project achieved regular monitoring of psychotropic medications, and enabled the discharge of 14 out of 63 existing patients in the selected homes. The project also provided guidance for non-pharmacological techniques for management of BPSD, which included relaxation techniques, distraction techniques, reality orientation, reminiscence work, needs led therapy, music therapy, person-centred approach and behaviour therapy.
Wound Expo: the challenges of pressure area care
Authors: Stephen-Haynes Jackie
Published: May 2014

This article identifies the importance of pressure ulcers currently within the UK, the challenge of providing care and the impact on patients who develop them. In the Wound Expo 2010 pressure ulcer zone the educators explored the most significant challenge of pressure area care within their clinical environment from 180 delegates. These have been analysed into themes and are presented here. The findings are discussed and the implications are outlined.
Rekha interviews Baroness Sally Greengross
Authors: Elaswarapu Rekha
Published: May 2014

Baroness Sally Greengross

Baroness Sally Greengross is an influential figure in nutritional and ageing policy through her involvement in parliamentary and advisory groups. She has been a crossbench (independent) member of the House of Lords since 2000 and chairs four All-Party Parliamentary Groups: Dementia, Corporate Social Responsibility, Intergenerational Futures and Continence Care. She is the Vice Chair of the All-Party Parliamentary Group on Ageing and Older People, and is Treasurer of the All-Party Parliamentary Group on Equalities. Sally is Chief Executive of the International Longevity Centre—UK, Co-President of the ILC Global Alliance and in December 2006, and she was announced as a Commissioner for the Equality and Human Rights Commission. Baroness Greengross is Chair of the Advisory Groups for the English Longitudinal Study on Ageing (ELSA) and the New Dynamics of Ageing (NDA). She is President of the Pensions Policy Institute and Honorary Vice President of the Royal Society for the Promotion of Health and a Global Ambassador to Help Age International. She holds honorary doctorates from seven UK universities and is an Honorary Fellow of the Institute and Faculty of Actuaries.

In this interview, Baroness Sally Greengross describes how current research is shaping public policy and identifies the areas that we need to think about in practice.
A brief overview of dietetic issues for people with late stage dementia
Authors: Smith Alison
Published: May 2014

Dementia is a disease that can have a profound impact on nutritional status, particularly in late stage. Dysphagia (a swallowing disorder ( Royal College of Speech and Language Therapists, 2009 )) and difficulty self-feeding, among other problems, make achieving an adequate food intake challenging for people with late stage dementia. This is made more difficult by the different care settings that many people with late stage dementia find themselves in, which may have varying abilities to meet their food intake needs. Tube feeding may be considered instead of continued oral intake but current thinking suggests this may not be appropriate for the majority of people with late stage dementia.
Case study: the use of telehealth technology in a community setting
Authors: Watson Dawn
Published: May 2014

Self-care is a great concept and telehealth can give any patient with a long term condition the confidence to understand and manage their health better. Patients are usually surprised at how small the equipment is and how easy it is to use. Giving patients control provides peace of mind and enables nurses to work more efficiently and effectively.
Uncovering the features of negotiation in developing the patient–nurse relationship
Authors: Stoddart Kathleen , Bugge Carol
Published: May 2014

This article describes a study that set out to explore the interaction between patients and nurses in community practice settings, in order to understand the social meanings and understandings brought to the interaction and at play within it.

Method:

The study used a grounded theory methodology with traditional procedures. Driven by constant comparative analysis, data were collected by non-participant observation and informal and semi-structured interviews in four community health centres. Eighteen patients and 18 registered practice nurses participated.

Results:

Negotiation was found to be a fundamental process in patient–nurse interaction. Navigation, socio-cultural characteristics and power and control were found to be key properties of negotiation. The negotiation processes for developing understanding required patients and nurses to draw upon social meanings and understandings generated from within and beyond their current interaction.

Conclusion:

Social meanings and understandings created within and beyond the health-care setting influence negotiation. The developmental nature of negotiation in interaction is an important dimension of the patient– nurse relationship in community practice.
Nursing people at home is a special skill that requires support
Authors: Cook Rosemary
Published: May 2014

The QNI has published the findings of a patient survey, highlighting some areas for improvement in the provision of appropriate community care. Rosemary Cook reports.
Sexually transmitted infections in older people: the community nurse's role
Authors: Peate Ian
Published: May 2014

Sexual health is complex and applies to everyone. Sexual ill health can have negative outcomes for individuals, communities and the country in terms of costs, as well as the impact it can have on a person's health and wellbeing. STIs are an important source of sexual ill health, but can be prevented by education and promotion of safer sex practices. One essential aspect of the role of the community nurse is to promote health; community nurses have an obvious and clearly defined public health role. The challenges faced by the older person with regards to their sexual health need to be acknowledged and actions, devised and implemented, that will engage them. This article discusses some of the issues that older people may face with regards to their sexual health. A resource list is provided.
Community supports used by older people post hospital discharge
Authors: Coffey Alice , McCarthy Geraldine
Published: May 2014

Community support in the post-discharge period is of importance, as difficulties managing at home can lead to readmission to hospital ( Strunin et al. 2007 ; Arbaje et al, 2009). There is evidence that support from family in the community is perceived to be the best option by older people (McCann and Evans 2002; Themessl-Huber et al. 2007 ). However, during the transition from hospital to home gaps may occur in the continuity of support, with the potential for poor outcomes. Knowledge about how older people interact with supports in their communities is therefore important to inform health and social care policy and provision. This article presents the results of a southern Irish study to examine the use of informal and formal supports and services by older people in the post discharge period. Recommendations for practice and further research are included.
Timely symptom management at end of life using ‘just in case’ boxes
Authors: Lawton Sally , Denholm Margaret , Macaulay Lisa , Grant Eileen , Davie Alison
Published: May 2014

This article discusses the successful implementation of anticipatory prescribing using ‘just in case’ boxes (JICB) in primary care across the Grampian region and a subsequent follow up survey one year later. The implementation approach used local educational sessions to primary care clinicians. The survey was distributed to 65 primary care bases to gauge awareness and use of the JICB and thoughts about how the box was used. An estimate of prescription costs was undertaken using stock balance forms. The response rate was 89%. All respondents had heard about the JICB and most had used a JICB. There were 37 positive comments about the benefits to patients, 15 comments about the process and 11 negative comments, often about possible drug wastage. The cost of a prescription was estimated at £22.12. The findings have informed our ongoing educational programme and build on the strong links that exist between primary care and the specialist palliative care service.
Chemotherapy in the community for adult patients with cancer
Authors: Depledge Jane
Published: May 2014

The NHS Operating Framework for the NHS in England 2010/11 proposed more community-based services for people receiving chemotherapy. This is also advocated in the Department of Health publications NHS 2010–15 from good to great: preventative, people centred, productive ( 2009b ) and Chemotherapy services in the Community – A Guide for PCTs Chemotherapy closer to home ( DH, 2010a ). This article reflects on the provision of chemotherapy services closer to home, with the aim of engaging community practitioners in considering this area of service provision. It examines the need for this service, reviews the chemotherapy pathway, and considers what models have been adopted to deliver this in the community. Education and training to ensure patient safety and practitioner competence will be briefly considered in light of new national initiatives. The article also aims to provide information for service commissioners ahead of the transition from PCT to GP commissioning in 2013. Although for several years the trend has been towards delivering services closer to home, there is not a wealth of research-based literature on this subject. While patient experience can be captured and analysed it also needs to be placed in context with that of those delivering the service, as safety and quality is paramount. Until then we should be optimistically cautious in rolling out these services until the meaning of closer to home is defined by local context.
Extension of controlled drug prescribing rights to independent prescribers
Authors: Griffith Richard , Tengnah Cassam
Published: May 2014

After a wait of three years, the Home Office has finally made good on its promise to end the confusion over the range and use of controlled drugs by independent non-medical prescribers (NMPs). Since 23 April 2012, both nurse and pharmacist independent prescribers are able to prescribe a far broader range of controlled drugs as part of their practice. In a follow up to their article from November ( Griffith and Tengnah, 2011 ) setting out the limits on prescribing controlled drugs by NMPs, Richard Griffith and Cassam Tengnah discuss the changes introduced by the Misuse of Drugs (Amendment No. 2) (England, Wales and Scotland) Regulations 2012 and consider the implications of the changes on practice.