bluuebunny/crossref_metadata_2025 huggingface dataset:
School and practice nurses: an under-utilized resource
Authors: Kari Jameela , Donovan Chris , Li Jun , Taylor Brent
Published: May 2014

A survey carried out on 347 pupils aged between 13 and 18 years in three state secondary schools in North London showed that teenagers did not view school and practice nurses as being an important source of support or advice on psychosocial or medical issues. Friends were the main source of support for teenagers feeling in need of psychosocial help, although parents were also an important source of advice. More than half of the respondents in this study group sought professional help from GPs or the Brook Advisory Clinic regarding information/advice on sexually transmitted diseases or when seeking abortion. The health concerns of these teenagers were dominated by skin and weight problems with anxiety/nerves ranking third, physical problems fourth and sex-related concerns ranking fifth. The findings indicate that practice and school nurses appear to be an under-utilized resource in the provision of information and support for teenagers.
Developing the research base in primary and community care
Authors: Fagan Rose , Szczepura Ala , Jardine Jonathan
Published: May 2014

The Centre for Health Services Studies (CHESS) at Warwick University has undertaken a range of activities to further develop nursing as an academic discipline in the primary and community care field. This article summarizes this work. In order to strengthen the research base of primary and community care, intervention measures must occur at both individual and strategic levels. This article describes interventions which have been made at each of these levels and discusses developments in research skills training, networking and strategy development, and information and resource provision.
The jury is out on PCGs
Authors: While Alison
Published: May 2014

The government claims that the introduction of primary care groups (PCGs) like previous NHS reforms will provide a more effective basis for organizing sound care delivery. A cynical view might perceive them as representing the roll-out of multi-funds nationwide, the only difference being that while previously general practices worked with their ‘friends’ they are now obliged to work with whoever serves the designated community, ‘friends’ and ‘enemies’ alike. Furthermore, although other stakeholders including community nurses are represented on PCGs, GPs continue to hold the power through majority representation and guaranteed chairmanship.
The new Council: will it provide the basis for a sound profession?
Authors: While Alison
Published: May 2014

The proposals put forward by JM Consulting Ltd (1999), following their independent year-long review of the Nurses Midwives and Health Visitors Act 1997, recommend that the UKCC and the four National Boards are replaced by a single, UK-wide regulatory body. The Government has accepted most of the proposals; however, the response (NHS Executive, 1999) has indicated that there is much competition for parliamentary time therefore changes in legislation governing the regulation of the profession will be enacted through an amendment to the current Health Bill.
The Crown Report: a new prescribing framework
Authors: Edwards Margaret
Published: May 2014

The eagerly awaited final report of the Review of Prescribing, Supply and Administration of Medicines has been published (Crown, 1999) and now lies with the Secretary of State for a period of consultation. The message from the chair, Dr June Crown, and her review team is unequivocal: patient need should govern any extension to prescribing authority and new prescribers must be able to demonstrate clear cost benefit.
Prison nursing: improving the quality and range of service
Authors: Norman Ann , Parrish Alan
Published: May 2014

This article examines some of the issues regularly encountered by nurses working in prison health care and stresses the need for positive and progressive managers to support them in their work. The authors suggest that prisoners have the right to the same standard of health care as other members of the public. Prison nurses are currently introducing many innovations into the prison setting and despite the fact that this environment is not conducive to change they are striving to enhance the quality and range of services provided. Many of the issues arising in the prison environment, if not unique, are certainly different to those encountered by most nurses during their work. Some of these differences may make developing practice more difficult for nurses working in these areas. The value of teamwork and the need to use existing resources, in particular, the important role of healthcare officers in taking the service forward, are discussed.
Nutritional management of patients with dysphagia
Authors: Shaw Clare , Power Jane
Published: May 2014

Nutritional management of patients with dysphagia is essential to avoid weight loss and malnutrition associated with a poor food and fluid intake. Whatever the cause, the consequent effect on the ability to eat and drink often requires a change in the consistency of food to a soft or liquidized diet. For some the safest option may be to rely solely on enteral feeding. Eating and drinking is an important part of life; food not only sustains life but also has cultural, emotional and social meaning in all societies. Therefore, any interferance with this essential part of day-to-day living can be socially isolating, affecting many aspects of daily life. The impact of dysphagia on the individual and concerned carers should not be underestimated. A multidisciplinary approach to care provides an opportunity to address patient and carer needs. Good communication between acute and community teams helps to ensure continuity and a high standard of care for such patients.
Adapting eating patterns to address problems of malnutrition
Authors: White Gillian
Published: May 2014

Malnutrition can be a significant problem for adults with chronic diseases in the community. Early recognition of those individuals at risk of malnutrition helps to prevent further decline in nutritional status. Treatment needs to consider all aspects of nutritional intake, including ordinary food and nutritional supplements as well as artificial means of nutritional support. A brief review of malnutrition is outlined and the practical changes that can be made in food intake to boost nutritional intake are suggested. Small changes in eating patterns and food intake have the potential to play an important role in nutritional care alongside the use of prescribable supplement drinks.
Healthy living is not an alternative medicine
Authors: While Alison
Published: May 2014

Confusion is creeping into our language and the concept of a healthy living is being increasingly confused with that of alternative medicine. The practice of prescribing medicines is governed by the Medicines Act 1968, which was amended recently to permit appropriately trained nurses to prescribe; such prescription is concerned with Western medical practice.
Reviewing professional boundaries in the NHS
Authors: Clarke Gwen
Published: May 2014

It would appear that community nurses have much to celebrate in the new Millennium with many new and exciting initiatives increasing the focus on care in the community. Recent Government policy highlights the scope for developing health care in the community and emphasizes the important role of community nurses in providing a high quality service for patients (Department of Health (DoH), 1998, 1999).
The changing focus of mental health nursing in east London
Authors: Mathers Billy , Howard Caroline
Published: May 2014

The focus of care for Community Mental Health Nurses (CMHNs) has been moving towards the Severely Mental Ill (SMI) client group over the past ten years. Government guidelines and nursing literature indicate that SMI clients have been neglected in the past and that CMHNs should now prioritise this client group. This paper attempts to define the term SMI and to ascertain whether or not CMHNs in three east-London boroughs are prioritising this client group. The opinions of these CMHNs are also given in relation to the specific new education and training required to work with this client group. We found that CMHNs were conscious of a distinct shift in focus towards SMI clients, but that they often felt inadequately trained for this change in focus. Recommendations are made for the future training and education of CMHNs to enable them to work with SMI clients more effectively.
Public involvement in primary care groups
Authors: Anderson Will
Published: May 2014

Public involvement has become an ever more prominent feature of health policy and the current Government has made clear that it wants public involvement to be integrated into all aspects of NHS organization (Department of Health (DoH), 1999). These developments have a variety of sources: the increasing pressure for greater accountability in the NHS; the shift to needs-led service provision; the challenges made to the traditional clinician-patient relationship; the increased value of partnership in public life; and the promotion of the patient as consumer.
Contributing to a healthier nation
Authors: While Alison
Published: May 2014

The Government outlined its ambitions for health improvement in the document Saving Lives: Our Healthier Nation (DoH, 1999), setting out a ‘Third Way’ of combining governmental, non-governmental and individual action to achieve reductions in mortality and morbidity. The UK has one of the worst rates of coronary heart disease (CHD) in Europe for both men and women, reflecting the high incidence of smoking, poor nutrition, obesity and low levels of physical activity in the population (DoH, 1999). Therefore, effort to achieve reduction in mortality due to CHD and stroke by at least two-fifths was identified as a priority. Importantly, the incidence of CHD is unequal, with those in poor socioeconomic circumstances and those of Asian ethnic origin experiencing ignificantly greater risk (Balarajan, 1996).
A pilot scheme for the development of evidence-based practice
Authors: McGee P , Ross B , Hodgson A , Fice M , Thompson E , Uhrmacher L
Published: May 2014

This article presents an evaluative account of a pilot scheme that aimed to introduce evidence-based practice in one NHS trust. The scheme was based on collaboration between staff in the quality assurance department and a nurse researcher based in a university. This collaboration enabled three designated staff to develop skills required for evidence-based practice and guide the production of information that could be disseminated to nurses throughout the trust. Evaluation demonstrated that participants had examined eight practice-based topics and devised protocols that could be applied to practice in a range of hospital and community settings throughout the trust. Evaluation also highlighted the importance of ensuring that members of other disciplines are aware of, and feel involved in, new developments even if they are not directly concerned with them.
Good health care improves outcomes in diabetes
Authors: While Alison
Published: May 2014

Diabetes mellitus (DM) is one of the more common chronic disorders and, for reasons which are not entirely clear, is becoming more prevalent both in childhood (Gardner et al, 1997) and adulthood (Audit Commission, 2000). A worrying and relatively new trend has been the presentation of non-insulin dependent (type 2) DM among adolescent Asians. While the aetiologies of insulin-dependent (type 1) DM and type 2 diabetes are very different, good health outcomes for both conditions are dependent on adherence to high standards of self-management.
NHS Plan: does it meet older people's needs?
Authors: Lishman Gordon
Published: May 2014

The Government’s recent NHS Plan has been welcomed by many as a significant step in the right direction. But will it result in a better NHS and better health care for older people? Age Concern argues that there are six priority areas where the Plan needs to deliver. Older people are looking for: help when it is needed; clarity about where to go for information and advice; services that respond to their needs and are provided in a coordinated way; to be treated with dignity and respect and to be partners in their own care; clarity about what services they are entitled to, what is free and what is not; and services that support them to live independently and to stay in control of their own lives.
Management of the older person with diabetes in the community
Authors: Mayes Mary
Published: May 2014

As the incidence of diabetes increases in the UK, community nurses will have increasingly larger caseloads of elderly patients with diabetes. It is important that nurses assess the patient’s understanding of the disease and its treatment. The aim of good diabetic control is to reduce morbidity from the complications of the disease. Factors that affect the patient’s quality of life; the patient’s ability to manage their condition; and the importance of providing education and support for both the patients and their carers are discussed. The importance of diet, blood glucose monitoring and taking diabetic medication appropriately are explained.
Nurse prescribing empowers the new NHS
Authors: Clegg Anthea
Published: May 2014

As the real new millennium dawns, the outcome of the Government’s consultations to extend nurse prescribing to a wider range of nurses, with an expanded formulary, is eagerly awaited.
Caring for dry and damaged skin in the community
Authors: Peters Jill
Published: May 2014

Community nurses are ideally placed to fully utilize nurse prescribing to improve the accessibility to emollient therapy for any patient with dry skin, regardless of cause. Skin diseases affect 23% of the general population and patients accessing care in the primary setting contribute to 15–20% of general practice appointments.
Early detection of type 2 diabetes: the role of the community nurse
Authors: Perry Margaret
Published: May 2014

Recent changes to the diagnostic criteria for type 2 diabetes have raised concerns that if steps are not taken to address relevant issues, the number of diagnosed sufferers will escalate in future years, with a similar increase in the prevalence of associated complications. Research suggests that for many patients, complications are evident at the time of diagnosis, and may have been present for several years before a diagnosis was made. Late presentation is the cause of considerable morbidity and mortality among these patients, largely because undiagnosed complications are often irreversible by the time the underlying diabetes is discovered. The current emphasis on public health augments the need for community nurses to recognize warning signs, particularly in patients who are at an increased risk of developing diabetes. This article aims to raise awareness of early signs and symptoms, and gives a brief insight into some of the associated health problems. If community nurses are to play a significant role in reducing the potentially devastating effects of this disease, they will need to be involved in educating patients and implementing screening and intervention programmes.
Nursing management of constipation in housebound older people
Authors: Edwards Margaret , Bentley Alison
Published: May 2014

In this article two algorithms are suggested for use by district nurses in the management of constipation in dependent older people at home. Prescribing for this group of patients requires a complex assessment of medical and social factors as 24-hour supervision is not always available and local health and social service resources may impact on the level of care that is available in terms of the provision of food and drink and the taking of medicines.
The benefits of integrated nursing teams in primary care
Authors: Adams Cheryll , Thomas Eileen
Published: May 2014

This article reports a study in which a literature search, questionnaire study and interviews were used to measure the costs and benefits to patients and professionals when nurses work in integrated nursing teams in primary care. Our study showed that there are significant benefits for the nurses’ employers, the primary health-care team, the nurses and the patients. Compared with traditional models, delivery by integrated nursing teams can offer a much higher quality service. Patients can expect to be cared for by a team in which morale is high, communication is good and care is efficient and effective. The team can also offer many specialist services that were not previously available. Integrated nursing teams are most effective when the management savings are used by the teams to meet their professional and client needs. Financial savings, therefore, cannot be expected. The difficulties that arise when such teams are set up should be short-term and surmountable, but will be influenced by the motivation of the team members and the efficiency of the human resource management.
Bringing the outsiders in: tackling social exclusion
Authors: Whitehead Elizabeth
Published: May 2014

As community nurses we are ideally placed and have the professional skills to confront the profound challenges of the socio-economic inequalities of health. These inequalities lead to personal and community stigmatization and social exclusion. Our working environment is in inner-city areas of urban deprivation, where there are high rates of crime and unemployment, and rural communities, where there is social isolation, poor amenities and covert poverty. It is here, in the flats, bedsits and tenanted farms and cottages, where community nurses visit their patients and clients, and it is also the natural breeding ground for every experience of social exclusion. Community nurses have first-hand knowledge and understanding of the pain and anguish of the poorest in society and we work individually and collectively to raise their expectations and widen their choices of housing, educational and employment needs. These are often limited or even non-existent.
An assessment of dual-role primary care nurses in the inner city
Authors: Drennan Vari , Williams Glenn
Published: May 2014

The integration of primary care nursing roles into single posts, closely associated with GPs, has been advocated in the UK and in Europe. However, there has been little exploration of the benefits and difficulties of integrating roles in the UK. In this article, we assess three posts in inner London that combine health visiting and district nursing. Our findings indicate potential benefits in collaborative working with small general practices, as well as high job satisfaction in post-holders. However, these benefits, when weighed against consequences such as increased stress for the post-holders in managing two separate caseloads and increased costs for the nursing services, would need to be assessed in a larger-scale study. Our study suggests that other combinations of current, defined specialties in community nursing might capitalize on the benefits and diminish the negative consequences.
Walk-in centres: not yet on a firm footing
Authors: Pollard Tom
Published: May 2014

The Kings Fund has recently completed an evaluation of the nine trial NHS walk-in centres in London (Mountford and Rosen, 2001). Although the report highlights a number of problems which will need to be overcome if the scheme is to be rolled out nationally, it seems to provide support for the extension of the nursing role in primary care.
Sexual health is no laughing matter
Authors: Pollard Tom
Published: May 2014

Twenty years after HIV was first identified as the cause of the syndrome now known as AIDS, and despite millions of pounds spent on awareness campaigns and a decade of stability, the UK’s rate of HIV infection has seen a sharp rise. This must be depressing news for people engaged in sexual health education, but it has spurred the government into action. In July the Department of Health published the first National Strategy on Sexual Health and HIV for England. Hopefully the rest of the UK will soon follow suit.
Focusing on local health needs and promoting new partnerships
Authors: Rowley Claire , Dixon Libby , Sheldon Jane
Published: May 2014

Government reports have stressed the importance of community based interventions in addressing health inequalities. This article discusses the pivotal role played by a health visitor and school nurse team in identifying the health needs of a local community and working in partnership with local people, key community groups, health and youth workers to address these specific needs. A health needs assessment highlighted the need for a parenting programme to support parents in managing young children’s behaviour, a forum for teenagers to socialise and access pertinent health information and health days to raise public awareness of key community health issues. To date the parenting programme and the youth club have been implemented. Evaluation has considered how accessible, appropriate, efficient and effective they have been and the knowledge and skills gained by participants. This community development demonstrates how health promotion works through effective community action.
Cultural change a necessity for new NHS
Authors: Pollard Tom
Published: May 2014

According to a survey carried out by the BBC, up to one in 10 NHS managers admits to manipulating or falsifying figures to show that national targets for areas such as waiting times and accident and emergency waiting times are being met in their trust. In addition, up to one-third of managers are aware of money intended for tackling these key areas being spent elsewhere.
Real users’ experiences fall short of the mark
Authors: While Alison
Published: May 2014

User involvement in health service planning and delivery is central to Government plans, but in reality much of it is becoming tokenism of the worst sort. For example, the ‘troublesome’ community health councils are being replaced by limited implementation of other organizations such as patient advisory and liaison services about which there is limited information. More worrying is the confusion between public participation and patient-centred care, and the mistaken view that the ‘professional’ user will represent the best interests of the ordinary user in public debates. It has long been recognized in research that sample panel participants in longitudinal studies rapidly develop characteristics that distinguish them from those whom they purportedly represent. Tell someone to record their health deviations in a diary and they will soon become overly conscious of any signs and symptoms; similarly ask someone to represent the critical consumer of health services and they may become troubled by issues of marginal concern to the ordinary user. For example, walk-in centres may be a popular choice of the busy employed person who requires rapid acute episodic care but may be of no interest to the housebound older person in frail health who values domicillary support and continuity. The danger is that the vociferous working person distorts health-care provision to the detriment of those in most need but of limited interest to politicians.
Improving access to continence services: action in Walsall
Authors: Neal Rachel , Linnane John
Published: May 2014

New government guidelines state that primary care trusts should be moving towards an integrated continence service. In Walsall a study was undertaken to inform the development of care pathways and to support a move to a single specialist continence service. The study looked at accessibility to services, and the opinions of patients (suffering from urinary incontinence), and professionals about the two existing specialist continence services. Over a period of approximately 3 months primary care staff, particularly GPs and practice nurses, and patients filled in questionnaires. Overall the primary care team and patients were satisfied with the help they had received from the current services. The study identified a need to raise awareness and provide more information about incontinence and the services available. There is also an opportunity to get practice nurses more involved in the management of incontinence. The recommendations of this study have been incorporated into the changes being made to the local service.
Placing the right value on public servants
Authors: Briggs David
Published: May 2014

As I sit and listen to the reports on the firefighters’ strike this week, I cannot help but reflect on the situation generally affecting public service. The firefighters undertake what must be described as a dangerous job and there seems to be little disagreement about that. However, when it comes to remuneration, no-one can easily put a monetary value on the firefighters’ work. I can relate this to the position of my own profession, nursing. Just how do we decide what a firefighter or a nurse is worth in monetary terms and consequently what is their financial value to society?
Flexible cystoscopy: outpatients or domiciliary?
Authors: Fraczyk Linda , Godfrey Helen , Feneley Roger
Published: May 2014

The cost of caring for people in the community with long-term indwelling catheters varies widely but represents a significant amount of NHS spending. A rapid access catheter clinic was established at a Bristol hospital, for people experiencing difficulties with their long-term catheters, to facilitate prompt assessment and treatment. Many patients were found to be severely disabled with mobility problems and relied on hospital transport to attend the clinic for flexible cystoscopy. As a consequence the concept of undertaking this procedure on a domiciliary basis was introduced with a view to cutting costs, improving time management and offering a more reliable service to patients. A prototype battery-powered flexible cystoscope was developed to facilitate this service and five visits were undertaken. Feedback from patients indicated a preference for the domiciliary service and cost benefits were identified. As a result of these initial experiences, we are now planning a pilot study to establish the feasibility and costs of providing a domiciliary service on a permanent basis and gather qualitative data from patients on quality-of-life issues.
Stroke patients’ carers’ views of formal community support
Authors: Simon Chantal , Kumar Satinder
Published: May 2014

Stroke is a common, disabling condition. Those who look after stroke patients in the community are placed under a lot of strain. In this study a purposive sample of eight carers, chosen to obtain as wide a spread of opinion as possible, were interviewed in depth on their views about the formal support services they receive in the community. A detailed content analysis of the transcripts of the interviews revealed four areas important to carers: information and education; provision of practical help; convenience, coordination and adaptability of services; and consultation with and consideration of the carer. In all areas there was considerable room for improvement. Carers particularly valued community care professionals who listened to them, seemed to understand them and were prepared to put in some effort for them. The importance of ongoing information provision was stressed.
Tuberculosis:the silent epidemic
Authors: While Alison
Published: May 2014

Tuberculosis (TB) used to be a common cause of death in the UK, accounting for a quarter of all annual deaths in the 19th century. While the poor were most vulnerable to the disease, every stratum of society was affected, as witnessed by the suffering of the Brontë sisters and Keats among others. Improved social conditions and better nutrition helped to reduce the prevalence of TB, and the introduction of the BCG vaccine and successful antibiotic therapy reduced the incidence further. Indeed, in the 1970s some thought that there would be no TB at the millennium. However, following a steady decline in recent decades, there are now an increasing number of TB notifications in England and Wales. While most of the rise is accounted for by notifications in the London area, there has also been a significant rise in notifications in the South East and Trent. Three quarters of notifications relate to males, of whom the vast majority are aged 25–64 years. It is perhaps not surprising, therefore, that TB is ranked the fifth most important communicable disease by professionals and the fifth most important disease requiring further work (Horby et al, 2001).
The scope of guidelines to prevent health-care-associated infections
Authors: Pellowe CM , MacRae ED , Loveday HL , Reid P , Harper P , Robinson N , Pratt R
Published: May 2014

As care is increasingly delivered in the community rather than acute settings, there has been concern that this might be accompanied by a rise in healthcare-associated infections. Consequently, the National Institute for Clinical Excellence (NICE) has commissioned a set of infection prevention guidelines for health-care workers in community and primary care. The guideline developers were anxious to concentrate this guidance on the areas of most concern to practitioners, particularly in relation to devices. This article describes how a survey and focus groups were employed to identify the areas for guideline development, namely standard principles, long-term indwelling urinary catheters, enteral feeds and central intravascular devices.
Nurses can be good substitutes
Authors: While Alison
Published: May 2014

The Government is determined to deliver the expectations of the electorate regarding improved access to effective first-point-of-contact health care. Rising expectations together with doctor shortages are forcing the reshaping of healthcare manpower, and previous ‘sacred cows’ of the roles of professional groups are being challenged. Against this background, nurses are increasingly delivering aspects of care management previously within the domain of doctors. At the heart of this lies the extension of prescribing rights.
Domestic violence and anger: what can primary care nurses do?
Authors: Siddle Ronald , Jones Freda
Published: May 2014

Patients with anger problems can cause difficulties for themselves, their families and society. Though psychological treatments are available, they are not always accessible. In order to help the victims of domestic violence, we focus here on working with perpetrators of violence. This article offers some statistics about the extent of the problem. It discusses difficulties in motivating patients for therapy and describes the cognitive model of anger. A number of intervention strategies based on this model are then discussed. The purpose is to assist clinicians with less experience of this patient group to help their patients minimize the frequency and severity of the anger incidents. Pointers for good practice are outlined.
Pharmacists must be brought into the fold
Authors: While Alison
Published: May 2014

There is increasing concern that the current structure and organization of primary care delivery based around the general practitioner is unable to cope, with recent reports suggesting that some GPs are refusing to accept any more patients on their lists. More effective use of all qualified health practitioners will become increasingly important if care delivery targets are to be met.
Nutrition for healing: everyone’s responsibility
Authors: Vernon Tracy
Published: May 2014

Welcome to the second edition of WoundCare. This edition builds on the success of our first journal, which we launched in June of this year. I would like to take this opportunity to thank all of you who have contacted us with positive feedback; this gives us the clear message that we are providing practitioners with an informative journal which allows them to develop and enhance their professional practice. This is ultimately what we set out to achieve when the Wound Care Society joined partnership with Mark Allen Publishing.
Changing wound-care practice: management of percutaneous endoscopic gastrostomy sites
Authors: Leak Kathy
Published: May 2014

Following the involvement of the wound-care service in the management of problem percutaneous endoscopic gastrostomy (PEG) sites in the Doncaster Trust, the scope of the service has been extended. In light of experience obtained from managing PEG sites and associated skin problems, and the evidence of clinical outcomes after treatment, educational and treatment policies have been implemented. These policies have raised the profile of the service and improved patient outcomes in the Trust and in areas of the community that have adopted our practices.
Evaluation of a child development centre in a rural area
Authors: Thurtle Val , Cordle Dot , Phillips Nansi
Published: May 2014

In this article we discuss the setting up of a child development centre for children with a developmental delay in a rural market town away from a tertiary centre. The process was evaluated by a variety of methods including analysis of centre activity, preliminary questionnaires to parents at the end of their child’s assessment, reflections by the centre team and in the final year of the project, a survey of all parents who had used the service, professionals who worked in it and other agencies in the centre town and a comparison town. Parents and staff reported high levels of satisfaction in relation to multidisciplinary working, venue, communication, and a child/family friendly approach. Further work is needed in developing links with social services and the voluntary sector.
The right to refuse life-saving treatment: Who decides?
Authors: Griffith Richard
Published: May 2014

District nurse Alison has a patient, Nigel, who has type 1 diabetes that remains unstable. Nigel’s eyesight has deteriorated, his sexual function has dramatically reduced and he has now developed an infection in his right foot which requires immediate treatment. Nigel refuses the treatment and any further insulin declaring he would rather die than live the rest of his life like this. The GP says he will have Nigel detained under the Mental Health Act for assessment and enforced treatment, as his decision to refuse treatment amounts to suicide. Alison is concerned that Nigel will die without treatment, but also worries that to force treatment would be unlawful.
Generosity or stealing? When accepting a gift can be theft
Authors: Griffith Richard
Published: May 2014

Patients often give gifts as a way of showing their gratitude for the care and support they have received from others. It is not unusual for a nurse or doctor to receive small gifts as a thank you or to commemorate a traditional anniversary such as a birthday or Christmas.
Hospital secondments of community nurses to improve stoma care
Authors: Adams Tracey , Dufton Rachel , Lamb Caroline , Taylor Margaret
Published: May 2014

As clinical nurse specialists working in a busy and proactive colorectal team we are continually looking for different ways of working to enhance patient care. The opportunity to review the range of skills in the team, highlighted the need for a staff nurse. It was decided that this role should be an educational secondment (on a rolling programme) to give staff nurses the opportunity to develop skills in colorectal nursing. The post was piloted with a community staff nurse for it was felt that this would improve the primary/secondary interface, communication and collaborative working between the teams. The aim was to empower generalist and community nurses in the care of patients with colorectal diseases. This was delivered through a work-based programme to help develop the knowledge and skills of the nurses, in addition to enhancing multidisciplinary teamworking, in an environment of mutual regard and shared understanding.
Court appearance 1: The English and Welsh court system
Authors: Griffith Richard , Channon Ceri
Published: May 2014

It is not surprising that Mary finds the prospect of appearing in court daunting. The process is very formal and steeped in tradition. The language, rules and etiquette are unfamiliar. However, courts and tribunals are a key part of the legal system. In child protection proceedings the court ensures fairness and is required to consider the child’s welfare as paramount (Children Act 1989, s1). With knowledge of what to expect and some simple planning Mary will be able to make a valuable contribution to this process to the benefit of the court.
Learning ought to follow mistakes
Authors: While Alison
Published: May 2014

Health care is delivered by people, who inevitably make mistakes. The Nursing and Midwifery Council (2002) emphasizes that nurses are accountable for their practice, which includes recognizing errors and taking appropriate action afterwards. Nurses also have a duty of care which includes a responsibility to act in a client’s best interests when the actions of others may compromise a client’s wellbeing. The Bristol Children’s Hospital and Dr Shipman inquiries both illustrated that every practitioner has a part to play, even if it is only to draw attention to deviations from the expected norms of health-care contact.
Teenage pregnancy still a challenge for all
Authors: Pollard Tom
Published: May 2014

The latest figures for teenage pregnancy rates in England and Wales appear to indicate some success for the Government’s strategy for tackling the issue. However, even the reduced rates represent an unacceptably high level of pregnancy in an age group that is likely to suffer the social consequences of early pregnancy most.
Does research reach practice?
Authors: While Alison
Published: May 2014

National service frameworks, the Commission for Health Improvement and the National Institute of Clinical Excellence all form part of the government initiative to embed evidence-based practice into health-care delivery. Nurses perform a crucial role in the delivery of evidence-based practice, not only because they have significant contact with patients but also because they are important care managers, often coordinating packages of care involving other practitioners and agencies. Nurse education moved into higher education to ensure the centrality of education within the professional socialization process and to provide a foundation in research utilization in practice. The move was supposed to steer the practice of nursing away from routine and ritual learned through an apprenticeship training to decision-making based on knowledge informed by research.
Don’ believe the hype: get SARS in proportion
Authors: Pollard Tom
Published: May 2014

First war, then pestilence. The global relief that followed the collapse of the regime in Baghdad was short lived. In a matter of days a new public enemy had appeared on the horizon, as ruthless as Saddam Hussein, as invisible as Al-Qaeda, far less comical than Kim Jong-il. Sudden acute respiratory syndrome (SARS) was upon us.
Microalbuminuria testing in diabetes: is a dipstick as effective as laboratory tests?
Authors: Berry Jakki
Published: May 2014

The National Service Framework (NSF) for Diabetes (Department of Health, 2002) aims to improve care for people with diabetes. Primary care trusts need to demonstrate the provision of cost-effective and evidence-based care. The National Institute for Clinical Excellence guidelines (NICE, 2002) recommend that microalbuminuria is tested annually in people with diabetes, either by a dipstick method or by a laboratory method. A mini systematic review was undertaken to establish whether a dipstick method of detecting microalbuminuria is as effective as a laboratory method. Four databases were searched and studies comparing dipstick and laboratory methods were included. A hand search was also included. The review was further limited to the Micral test II compared to a reference laboratory standard. Four studies met the inclusion criteria and it was concluded that the Micral test II has a high sensitivity but not very high specificity with low positive predictive value; it was therefore found to be adequate as a screening tool but not as a diagnostic tool. Therefore the Micral II test is not as effective as a laboratory comparator.
Gastro-oesophageal reflux in infants: an evidence-based approach
Authors: Lawson Dr Margaret
Published: May 2014

Gastro-oesophageal reflux (GOR) is present in most infants, but is usually a benign condition that resolves by the age of 6 to 12months as the gastrointestinal tract develops. While it lasts, however, reflux symptoms can be very worrying for parents, and community nurses are well placed to provide them with reassurance, support and advice on practical measures that will improve symptoms in most cases. Nurses also have an essential role in monitoring infants for possible progression of symptoms to complicated GOR or gastro-oesophageal reflux disease (GORD), and in ensuring that such babies, and those with a possible underlying abnormality, receive appropriate referral for further investigation and medical or surgical treatment.
Tackling undernutrition through appropriate supplement prescribing
Authors: Jones Jacklyn
Published: May 2014

Undernutrition has significant implications for patients’ clinical condition and economical consequences for the NHS. However, due to continually increasing prescribing costs for sip feeds, treating undernutrition is often seen as very costly. An audit project in Lothian was undertaken to look at the appropriateness of sip feeds being prescribed. The project found there was a significant level of inappropriate prescribing with 30% of patients having their prescriptions for supplements stopped as they were deemed unnecessary. In view of this, the community dietitians involved developed and introduced a nutritional care pathway to allow a systematic and evidence-based approach to the identification and treatment of undernutrition.
Identifying nurse and health visitor priorities in a PCT using the Delphi technique
Authors: Brooks Nicky , Barrett Anna
Published: May 2014

A three-stage Delphi investigation was undertaken over a 4-month period in a primary care trust to identify the perceived clinical needs of nurses. Practice nurses, district nurses, health visitors and community hospital nurses all participated. In round 1, there were 28 replies from these groups of nurses, in round 2 there were 31, and in round 3 there were 25 replies. In round 1, 77 issues (excluding duplications) were identified. These were separated into three themes according to the most appropriate method for addressing the issue: education (29 issues), research (16 issues) and management (32). In round 2, the issues were redistributed in the three areas and staff were asked to choose the ten most important issues from education, research and management. Finally, in round 3 the ten issues in education, research and management were prioritized in terms of the ‘most pressing’. The most pressing education need was recognizing accountability; the most pressing research need was caseload/dependency scoring – matching staff levels to workload, and the most pressing management need was risk management, e.g. staff safety. The results have identified locally that there is a gap between the modernization agenda and what nursing staff consider to be the issues that need addressing locally. If measures are not put in place to address these local issues, there is a danger that nurses will not take a full and active role in the modernization of the NHS.
Skin grafts 2: management of donor site wounds in the community
Authors: Beldon Pauline
Published: May 2014

Skin grafting is a surgical procedure used to quickly restore skin integrity in large wounds or those wounds which cannot be directly closed by suturing. The procedure of skin grafting necessitates the creation of a second wound; the donor site. Although often viewed as secondary importance by surgeons once skin has been harvested from the area, it is the donor site which frequently causes complications such as pain/discomfort and slow healing (Wilkinson, 1997). Because skin graft sites and donor sites are viewed as part of a specialist practice, their wound management is regarded as being ‘something different’. However, the donor site is a partial-dermal thickness wound and should be seen as such, rather than a ‘special’ wound. This may help to lessen the anxiety felt by both patient and nurse in dealing with donor site wounds.
Understanding exudate management and the role of exudate in the healing process
Authors: Vowden Kathryn , Vowden Peter
Published: May 2014

Studies suggest that wound fluid from acute wounds may have a beneficial effect on wound healing, whereas that of chronic wounds may inhibit healing. Changes in the volume and nature of exudate provide information on the underlying state of the wound and may give an indication of an increasing bacterial load and the presence of infection, and if a wound is likely to proceed to healing. Careful monitoring of the exudate can provide information for the application of systemic and local therapies. Individual wound care products have specific functions which relate to the volume, viscosity and nature of the exudate and these should guide skin care and dressing selection.
New Year resolutions for the NHS
Authors: Pollard Tom
Published: May 2014

The start of a new year is traditionally the time for making resolutions – targets or promises to ourselves that almost inevitably come to nothing by the end of the year (or sooner). Lose weight, drink less, exercise more – these are my annual resolutions, which rarely last past my birthday on 2nd January.
The nation needs to change its habits
Authors: While Alison
Published: May 2014

The Wanless report on NHS funding (Wanless, 2002) rejected alternative funding arrangements for health services in favour of general taxation. However, it outlined a gloomy picture of unfulfillable demand for health care generated by increasing public expectations, minimum standards set out in the national service frameworks and an increasingly ageing population. Capacity problems of the NHS are well known by all those who work in it and include poor information technology and workforce issues. Even if recruitment targets are met, much depends on GPs offloading some of their responsibilities to nurses, and nurses likewise cascading some of their work to health care assistants with no detriment to care delivery targets. This is all the more challenging with the current emphasis on evidence-based care, which requires a highly skilled workforce constantly updated as the research becomes available to change practice.
Screening for dementia in older people
Authors: Ouldred Emma
Published: May 2014

Dementia is a growing challenge for health and social care services. Over 750000 people are currently living with dementia, a figure predicted to rise to approximately 840000 by 2026. Of these, over 150000 live alone in the community. Early diagnosis of dementia is essential to enable patients and carers to make informed choices about their future, and to enable health and care services to plan provision. This article discusses the clinical signs of dementia, and the screening tests that can be used to diagnose it. It also considers depression, which is often mistaken for dementia, and often occurs alongside it. Community nurses are ideally placed to identify the early signs and symptoms of dementia, and need to make the most of their position to improve support of patients and carers.
Living wills, duty of care and the right to treatment
Authors: Griffith Richard
Published: May 2014

Artificial hydration and nutrition (ANH) is a common therapeutic tool used by district nurses to sustain patients who have swallowing difficulties or are otherwise unable to eat or drink. District nurses ensure that patients continue to be fed through percutaneous endoscopic gastrostomy tubes, nasogastric tubes, subcutaneous and intravenous fluids (Wright, 2004).
What’s on the Agenda for Change?
Authors: Savage Yvonne
Published: May 2014

With the imminent roll-out of Agenda for Change, most nurses will be busy checking their job profiles and ensuring they get the most out of the process. In this article, Yvonne Savage provides a timely overview of what all this effort will mean in the longer term.