bluuebunny/crossref_metadata_2025 huggingface dataset:
Defined and refined: criteria for identifying wound infection revisited
Authors: Cutting Keith F , White Richard
Published: May 2014

Clinical criteria for the identification of wound infection are regularly based on a list created by Cutting and Harding (1994). This list was established from empirical data generated in a large, multidisciplinary clinical practice, and is now widely accepted as a seminal article in wound care. Both Cutting (1998) and Gardner et al (2001) have conducted validation exercises on these wound infection criteria, based on the assumption that the criteria broadly apply to most wound types. Although many of the original criteria do apply across the spectrum of wound types, the major categories of wounds should be considered separately to avoid the possibility of overlooking the presence of infection. The focus of this article is a review of the published literature on wound infection criteria for acute and surgical wounds, diabetic foot ulcers, venous and arterial leg ulcers, pressure ulcers and burns. All known criteria for each wound type are presented, as well as an outline of the ongoing research project to refine the criteria by wound type using a Delphi panel technique. No attempt has been made to correlate visual signs and symptoms with microbiological sampling techniques. It is clear that there are subtle variations between infection criteria for wound types and that these should be recognized if treatment is to be given appropriately and promptly, and morbidity avoided.
Exploring district nurses’ experience of a hospice at home service
Authors: Sullivan Kate A , McLaughlin Dorry , Hasson Felicity
Published: May 2014

Hospice at home (HAH) services complement the role of the district nursing team, providing 24-hour palliative home care. However, little is known about district nurses’ experience or perceptions of working alongside the HAH service. This study surveyed a representative sample of district nurses (DNs) to ascertain their experience of working alongside an HAH service. A self-completed postal questionnaire comprised of 14 items was distributed to 128 DNs. The evaluation found significant levels of satisfaction. All respondents indicated that they would refer a patient to the service again. However, the need for improved communication and increased awareness among DNs about the HAH service were also identified. The findings support the idea that an HAH service can enable patients with advanced progressive disease to be cared for at home. While the findings of this study cannot be generalized, they add to the growing body of research about HAH services in palliative care.
Leading an empowered organization (LEO): does the course work?
Authors: Jones Kathryn
Published: May 2014

Leading an empowered organisation (LEO) is a 3-day course that has been delivered to over 40000 front-line managers in the NHS, among them many district nurses. The aim of this review was to identify and assess all published literature about LEO; to critically appraise such evidence relating to the impact of LEO on participants’ leadership behaviour and to critically appraise any evidence of the need for follow-up activities to sustain participants learning. Because of the limited quantity and quality of research literature (n=6) it was considered legitimate to also include discussion papers (n=2) and descriptive papers (n=4) in the review. All papers were reviewed using a framework devised by the author broadly based on the critical appraisal checklist for qualitative research (Greenhalgh and Donald, 2000). From the available evidence it can be concluded that the LEO programme does have a positive impact on the leadership behaviour of participants, and that follow-up activities are valuable to consolidate and sustain participants’ learning.
Is tea tree oil effective at eradicating MRSA colonization? A review
Authors: Flaxman Deborah , Griffiths Peter
Published: May 2014

In vitro studies show that tea tree oil is capable of killing methicillin-resistant Staphylococcus aureus (MRSA) in a laboratory setting. This review of randomized controlled trials (RCTs) was undertaken to find out whether it is effective at eradicating MRSA colonization compared to standard mupirocin-based regimens in colonized patients. A wide range of databases and internet sources were searched to identify published and unpublished studies. Two RCTs were found that researched the effectiveness of tea tree oil preparations against MRSA. One small RCT (n=30) showed a large but non-significant improvement at eradicating MRSA compared to traditional treatment, whereas a larger study (n=224) demonstrated little difference in rates of eradication overall (41% for tea tree and 49% for mupirocin, p=0.286). However, the larger study found that those with nasal colonzation receiving a tea tree regimen were more likely to remain colonized with MRSA in the nose (absolute risk increase 31%, p<0.001). Currently there is insufficient evidence to support the routine use of tea tree oil in clinical practice for eradication of MRSA colonization.
Encouraging best practice in infection control
Authors: Lawrence Jean
Published: May 2014

Infection control has had a high profile within nursing since the publication of the National Audit Office (NAO) report in July 2004, and before that the Department of Health’s (2003) white paper, Winning Ways, which set out the action that had to be taken to reduce health care-associated infection and tackle antibiotic resistance.
Community nursing in the 21st century: who, where, what, how?
Authors: Cook Rosemary
Published: May 2014

Change is a given in the health service, but the changes currently under way are particularly important in the opportunities they offer district nurses to expand and develop their roles. In this article, the director of the Queen’s Nursing Institute, which pioneered the training and development of district nurses, examines what can be learned from the past and present, in an attempt to inform the future direction of district nursing.
Complex wound or complex patient? Strategies for treatment
Authors: Vowden Kathryn
Published: May 2014

There is no simple definition of what constitutes a complex wound, but in practice the term tends to refer wounds with one or more complicating factors, e.g. exudate, infection, comorbidity, polypharmacy. Management of complex wounds is based on the same principles as non-complex wounds, i.e. holistic assessment and addressing the issues identified. This article presents three case studies in which these principles are applied.
Developing a strategic approach for IV therapy in the community
Authors: Depledge Jane , Gracie Fiona
Published: May 2014

The development of home intravenous therapy (IVT) services is of benefit to patients and organizations, particularly as it can facilitate early discharge from hospital or avoid hospital admission. However in providing an IVT education/refresher programme to local primary care trusts, we have found that not all of them, by their own admission, could engage in the expansion of IVT services as they did not have measures in place to support robust service delivery. Building on the authors’ recent experience of assisting staff, via an education/refresher programme, to update their services, this article offers direction to other PCTs who may be struggling to update their services in times of reform and unprecedented change within the health service.
Advancing practice by developing a primary care nursing programme
Authors: Thurtle Val , Saunders Mary , Clarridge Ann
Published: May 2014

The discussion of advanced practice in nursing is ongoing, yet the need for practice to advance and develop across the health economy is called for in much of the current literature and government policy. This article considers an educational intervention that set out to advance primary care nursing. The programme aimed to facilitated nurses to understand clients, families and carers in the community setting, to offer a high standard of care, to support specialist practitioner team leaders to work across community nursing disciplines and to make their own career development choices. Advancing practice in this novel primary care nursing programme required change management, collaboration, partnership, leadership and involvement of the staff nurses themselves.
Tackling malnutrition among older people in the community
Authors: Denny Anna
Published: May 2014

Undernutrition—of both macronutrients and micronutrients—is still a surprisingly common problem among older people in the UK. There is a variety of nutritional supplements that community nurses need to to be aware of in managing their patients’ nutritional requirements. Different supplements are taken for different disease states. This article looks at the various nutrient and energy requirements that relate directly to clients on the district nurse’s caseload. Some of the negative consequences of malnutrition of the older adult are discussed, as are the NICE guidelines for nutrition. Factors affecting dietary intake in older people are considered.
Innovation in practice: mobile phone technology in patient care
Authors: Blake Holly
Published: May 2014

Mobile phones are becoming increasingly important in everyday life and now in healthcare. There has been a steady growth of information and communication technologies in health communication and technology is used progressively in telemedicine, wireless monitoring of health outcomes in disease and in the delivery of health interventions. Mobile phones are becoming an important method of encouraging better nurse-patient communication and will undoubtedly increase in application over coming years. This article presents recent developments and applications of mobile technology for health promotion and patient-monitoring in chronic disease.
The cost of needlestick injuries associated with insulin administration
Authors: Trueman Paul , Taylor Matthew , Twena Nicole , Chubb Barrie
Published: May 2014

The administration of insulin by a carer or healthcare professional is associated with a risk of needlestick injury. Such injuries create a burden for carers and professionals in terms of anxiety, stress and morbidity as well as the NHS in terms of lost productivity, treatment costs and litigation. This study estimates the economic burden of these injuries to the NHS in the UK based on published estimates of the incidence and cost of needlestick injuries. The findings suggest that such injuries cost the NHS approximately £600 000 per annum. Many of these injuries and their associated costs could be avoided through increased adoption of safety devices. Indeed, evidence suggests that the increased acquisition cost of safety devices could be more than offset by savings resulting from the reduced incidence of needlestick injuries. Trusts are encouraged to implement improved monitoring and surveillance procedures to inform the debate on the appropriate use of safety devices.
Nutritional approaches in tackling hypertension
Authors: Lazarou Chrystalleni , Kouta Christiana
Published: May 2014

There is sufficient evidence to suggest that dietary approaches may help to prevent and control high blood pressure. This review focuses on the main dietary approaches for which there is ample scientific data regarding the prevention and management of hypertension: i.e. moderate use of sodium, alcohol, an increased potassium intake, plant fibers, calcium (and dairy products) and adherence to healthy dietary patterns such as Dietary Approaches to Stop Hypertension and the Mediterranean diet; in addition, the study also presents evidence regarding other nutritional factors which may possibly be associated with levels of blood pressure, but for which there is as yet insufficient current scientific evidence to support the issue of specific dietary recommendations. Finally, further implications for community nursing practice are discussed.
NHS procurement poses challenges
Authors: Stephen-Haynes Jackie
Published: May 2014

Procurement can pose a challenge to nurses accessing dressing supplies. Dressings are available via the logistics catalogue or prescription (FP10). The ease of access to dressings has been greatly improved since nurse prescribing was introduced. However, some PCTs have opted to purchase dressings themselves and increase the availability to practitioners and patients.
Could leg ulcer service provision in the community be improved?
Authors: Knight Susan
Published: May 2014

There has long been informal debate among tissue viability nurses concerning the care mobile patients with venous leg ulcers recieve by GP practice nurses. There is anecdotal concern that evidence based care is not being given in some GP practices. This article considers the management of a patient with chronic venous leg ulceration. It highlights the importance of correct assessment, management and the application of evidence based practice. Suggestions are made for changing current leg ulcer service provision. It is hoped this article will stimulate debate on the national picture of leg ulcer service delivery.
Developing a multidisciplinary leg ulcer clinic across two trusts
Authors: Speding Irene
Published: May 2014

This article takes a retrospective look at modernizing treatment of patients with leg ulceration, moving them out of busy treatment rooms and into designated leg ulcer clinics offering holistic care from nurses who are trained in the core areas of: care plan assessment, Doppler assessment, compression bandaging and evaluation. These clinics led to the formation of a multi-disciplinary clinic shared between primary and secondary care working together to benefit more complex leg ulcer patients.
Rheumatoid arthritis: the role of early intervention and self-management
Authors: Home Diane , Carr Maggie
Published: May 2014

2009 has seen the publication of a number of key documents relating to the care of people with rheumatoid arthritis (RA). The National Institute of Health and Clinical Excellence issued guidance on the management of RA in adults while the King’s Fund and National Audit Office have reported on the services that are available for people with RA. This paper will provide an overview of these reports and their implications for primary care. The role of early identification, referral and diagnosis will be explained as well as the treatment options available. The role of self-management and how community nurses can facilitate self-management will be discussed.
Biofilm and other causes of pain in catheterization
Authors: Wilson Mary CR
Published: May 2014

This article looks at the anatomy of the bladder and how sensations, including pain, are transmitted to the brain. The use of urinary catheters is discussed and initially, the development of biofilm is addressed, from its cause, structure and effect, to how it can be treated. Many of the problems arising from biofilm and the resulting encrustation, can lead to pain, and the causes of this are discussed. Other problems which can cause patients to experience pain are also considered, and where there are possible solutions, these have been put forward. However, even when good practice is carried out, there will still be problems encountered, and further research is needed.
The first national clinical audit of NHS occupational health services
Authors: Williams Siân , Rogers Caroline
Published: May 2014

Two national clinical audits of occupational health care for NHS staff in England looked at: management of back pain, and depression screening in staff on long-term sickness absence, 71% of trusts participated. Key findings were: less than half of back pain cases were screened for red and yellow flags; only 15% of staff on long-term sick with physical problems were screened for depression. The high participation rate is encouraging. The OHCEU will now work with NHS OH units to develop tools that support improved clinical care of staff with back pain and long-term sickness.
Employment references and the Law: an overview for district nurses
Authors: Griffith Richard , Tengnah Cassam
Published: May 2014

Job references are a crucial component of the process of employing competent, trustworthy staff and district nurses will be required to write and take up references for staff that leave and join their teams. Writing a job reference is not always a simple matter, and care must be taken to ensure reliability and truthfulness. In this article Richard Griffith and Cassam Tengnah look at the legal requirements for a job reference.
A mapping of the evidence on integrated long term condition services
Authors: Wilson Patricia , Bunn Frances , Morgan Janice
Published: May 2014

Policies in long term conditions care continue to develop rapidly in England. Currently there is a focus on the integration of services and enabling patient and carer choice. Integration of care across disciplines and services is complex and community nursing services are commonly central to reorganization processes in long term condition care. This paper presents the findings of a mapping of the evidence on integration in long term condition services. Literature on horizontal integration including integrated teams will first be discussed, followed by an exploration of the evidence on vertical integration exemplified by integrated care pathways and disease management programmes. As a relatively recent service innovation, the mapping found a lack of evidence of the effectiveness of integration in long term conditions. Furthermore, the paper highlights the potential tension between vertical integration structures such as care pathways and the patient choice and empowerment agenda in long term conditions.
The controversy surrounding religion
Authors: While Alison
Published: May 2014

It seems that religion is both the source of much comfort and upset across many aspects of social life with the secular movement challenging the presence of religion within state funded institutions such as schools and hospitals. Indeed, the issue of religion within healthcare and nursing practice was thrown into public view by the reporting of Caroline Petrie to the NMC (Dawes, 2009).
Case management in long term conditions: an inconsistent journey?
Authors: Offredy Maxine , Bunn Frances , Morgan Janice
Published: May 2014

This paper sets out to assess the evidence of the use of a case management approach when dealing with long term conditions in the UK. It draws on published papers, some of which emulated or adapted strategies that were used in the USA. The review found that despite there being a unified definition of case management, patients and carers reported benefits of being case managed. However, the wide differences in the factors relating to outcome measures resulted in inconclusive evidence about the effectiveness of case management.
Swine flu: some good lessons learnt
Authors: While Alison
Published: May 2014

Swine influenza is caused by the type A flu (H1N1) virus and is normally found in pigs. It is believed that changes have taken place in the virus circulating in the Americas (creating a new strain) that have enabled the virus to infect humans and spread from person to person, leading to outbreaks in countries around the world. The Health Protection Agency has announced that good progress has been made in understanding the virus’ genomic sequence so that we will understand how the virus behaves as it infects humans-although as viruses are transmitted they often evolve and change their behaviour. Nonetheless, knowing the virus’ genomic sequence is the necessary first step for the production of a vaccine.
Managing type 2 diabetes: new policy and interventions
Authors: Gillibrand W , Holdich P , Covill C
Published: May 2014

This paper presents a critical discussion of the recent developments in diabetes services and concurrent patient care, which have a significant impact on the way that community nurses provide care to people with diabetes. The current prevalence and rising incidence of type 2 diabetes is discussed, mentioning how this trend will impact on community nursing practice. New interventions and management guidelines are presented and discussed, with a focus on patient-centred care as the main driver for these changes. New pharmacological interventions (Byetta®) and biochemical outcome measures are discussed which will have an impact on patient care, delivered by nurses working in the community.
The role of the community nurse in hepatitis C diagnosis and treatment
Authors: Poll Ray
Published: May 2014

Hepatitis C is a common cause of liver disease and many infected individuals remain undiagnosed. Patients may be asymptomatic or have non-specific symptoms, and community nurses can help to identify those at risk and arrange testing. Community nurses can also encourage and support infected individuals to attend specialist hospital clinics for assessment and treatment by giving clear and accurate information about infection and therapy, including common side-effects. Treatment lasts for 6-12 months and patients require regular monitoring with good support. This paper provides an overview of the diagnosis and management of hepatitis C and aims to educate community nurses about this viral infection.
Continuity of care for the stoma patient: psychological considerations
Authors: Borwell Barbara
Published: May 2014

The transition from hospital to home is an important milestone for any patient: having progressed through surgery and early postoperative care, they have now achieved discharge status. Stoma surgery can adversely affect patients’ body image, and community nurses need to help such patients adjust to these changes. While most patients welcome returning home they often have mixed feelings concerning how they will cope with their stoma, both physically and psychologically, as do their families. Within a multicultural society, addressing the individual psychological effects of surgery due to acute/chronic illness can be particularly challenging. Continuity of care for these patients is therefore crucial. Effective communication and collaboration between health professionals is key to psychological adaptation and successful rehabilitation. This article seeks to outline the various psychological factors that need to be considered when caring for an ostomate.
More education is needed to meet demand
Authors: Toner Louise
Published: May 2014

Education continues to feature largely in the field of tissue viability with a range of opportunities for practitioners to access programmes to meet individual and employer needs. However, in respect of individuals with chronic oedema or lymphoedema, the availability of appropriate education and training is questionable. This is particularly relevant given the increased range of commissions for non-cancer related lymphoedema services.
Right Nurse, Right Skills: quality before quantity
Authors: Cook Rosemary
Published: May 2014

There is an old story about frogs that may or may not be true. It is said that, if you put a frog in a pan of cold water and slowly heat it, the frog will allow itself to be boiled to death rather than jump out. The analogy has been used many times before about different sections of the NHS workforce. It recognizes their capacity to continue to absorb pressure long past the point where others might, and should, bail out.
Health visiting registration: wrong battle, wrong reasons
Authors: Unsworth John
Published: May 2014

The Community Practitioner and Health Visitors Association’s (CPHVA) campaign to have health visiting recognized as a legal entity is based on some interesting but fundamentally flawed arguments.
NHS staff: nurture is key
Authors: While Alison
Published: May 2014

The new Government has declared its priority as addressing the public finance deficit and a determination to reduce management costs across all fields of public service (HM Government, 2010). Within the health services the new Government promises to transfer resources from management to support nurses and doctors delivering patient care. However, the imperative will clearly be to look after health-care staff so that they can function to maximum effect thereby saving NHS resources.
A nurse-led rapid response service for frail older people: an assessment
Authors: Oh Kyeung Mi , Warnes Anthony M
Published: May 2014

This paper draws on data collected as part of a comprehensive evaluation of a nurse-led rapid response service (RRS) in South Yorkshire. It reviews the assessments of the service by the RRS team themselves and by other care professionals, drawing on their views about which older people (as differentiated by their health problems) it was appropriate to refer to the RRS, and more generally about the strengths and limitations of the service. The views were collected by administering a postal semi-structured questionnaire to 120 care professionals involved in and with the RRS. The findings indicate that the service’s rapid response to the patient’s needs and its follow-up care were seen by all groups as positive achievements. However, referrers and service providers had contrasting interpretations about the patient eligibility criteria and disagreed strongly about the problems to which the RRS could effectively respond. These differences were a major factor in the conflicts that developed around referrals and service delivery. The findings strongly suggest that it is essential for innovative services to develop clear and consensual patient eligibility criteria and for these to be widely understood by all the professionals that are involved.
Occupational health-related experiences in rural Tasmania
Authors: Newman Barbara , Berens Heidi
Published: May 2014

This descriptive, explorative study sought to identify the occupational-related health experiences of community nurses in their workday within rural North West Tasmania. Tasmania is one of eight states and territories that form Australia. The findings indicate the majority of community nurses consider their health average or better, although 30% reported being overweight; 5% reported smoking; 60% reported feeling tense, anxious or depressed sometimes during the week. In the 12 months prior to survey 48% of participants had experienced a work-related injury or illness. At least two thirds of participants spent an average of 1.5 hours teaching nursing students and 2 hours teaching medical students, per week. Hazards (needlestick injury, items obstructing passageways, debris within homes), dogs and use of mobile telephones were regularly associated with weekly work incidents. Interestingly, more time was spent in a day on documentation than with clients or professional development.
Poetry in practice
Authors: While Alison
Published: May 2014

In the lull before the storm of challenging public service reconfigurations and rethinks, it is worth considering where both health professionals and patients can gain solace at no cost to the services. The election of the new Oxford Professor of Poetry is therefore a timely reminder that the written word does not have to be prose but can take a variety of forms. Indeed, some may argue that poetry provides more expressive language to encapsulate the meaning of illness and experiences of treatments. Not all poetry is serious and humorous poems can cause many a chuckle. That said, Geoffrey Hill, the new Oxford Professor of Poetry has a reputation for erudition, challenging readers to unravel meaning from his poems – perhaps not ideal for either the worried ill or the worried well!
Preparing for future incapacity
Authors: Griffith Richard , Tengnah Cassam
Published: May 2014

A recent inquest in South Wales heard of the tragic case of a husband who killed himself and his wife through carbon monoxide poisoning because he could not bear to see her continued suffering. His wife had spent two years in a persistent vegetative state and attempts to obtain a court order allowing the withholding of her artificial nutrition and hydration had been subject to lengthy delays.

This article discusses how this case highlights the importance of making preparations for possible future incapacity by creating an advance decision refusing treatment and a health and welfare power of attorney under the Mental Capacity Act 2005. These provisions will ensure that the wishes of the patient are respected without the need to go to court and so avoid delay.
General practitioner commissioning: dialogue is key
Authors: Cook Rosemary
Published: May 2014

The health policies of the Coalition Government are becoming clearer, and it appears that a significant part of the future belongs to general practitioners (GPs). Many district nurses will remember GP fundholding, which had mixed effects. In some cases, GPs wanted to use their buying power to secure ‘their’ community nurses and health visitors; in others, they experimented with a developing provider market to buy in community services from organizations some distance away.
Public services: a new era?
Authors: While Alison
Published: May 2014

The Government has declared that its priority is managing the budget deficit and that in consequence difficult decisions will be taken to achieve the intended financial savings across public services and the NHS will not be immune from those challenges. Indeed, the promise of increased health spending in real terms in each year comes with the caveat that health outcomes are expected to improve with a fundamental change in the way that services are commissioned with the dissolution of existing strategic health authorities and primary care trusts (PCTs) (Department of Health, 2010).
Massage: a helping hand for people with chronic oedema and lymphoedema
Authors: Pyke Cheryl
Published: May 2014

Skin care is fundamental in maintaining the integrity of one’s skin and it has become modern practice to wash and dry ourselves on a daily basis to eliminate odour and rejuvenate the skin. What is becoming more apparent is that as health professionals we are not transferring this basic act to our patient’s care and this simple form of neglect can be detrimental to your patient’s recovery. Moreover, when washing with the soapy products that are available to us, and then drying ourselves rigorously, we remove our skin’s natural oils thus the skin appears drier and is more susceptible to damage. This is where the simple application of a moisturising agent will not only replace the lost oils, but it will in fact stimulate the initial lymphatics lying under your skin.

The action of rubbing a cream or emollient into the skin is a form of massage, and this simple action will go a very long way towards the recovery of skin integrity and in the prevention of harm and infection. Make this part of your practice when looking after your patient’s wounds and swollen limbs.
The assessment and management of pain and stress in wound care
Authors: Solowiej K , Upton Dominic
Published: May 2014

Wound pain can cause considerable suffering and distress to patients. Evidence suggests that there is a link between stress and delayed wound healing, and that pain itself is implicated in this relationship. It is essential that stress and pain are assessed and managed effectively during wound management, to promote the rapid healing of chronic wounds
An interview with Leanne Cook
Authors: Cook Leanne
Published: May 2014

Right from the start of my nursing career, even as a student nurse, I was mystified by the question ‘what dressing should I put on that wound?’ and even more mystified by my qualified colleagues’ decision-making processes and the inconsistency that often came with this. This fuelled the desire to be able to answer the question for myself. Once qualified, I worked on a general surgery ward, which included patients undergoing vascular surgery. This is where I was exposed to extensive ulceration and looking back quite disfiguring forms of foot debridement which would be unacceptable in today’s world. This gave me the opportunity to put the little theory of wound healing and the limited knowledge of dressing actions I had into practice. Looking back I now realise I knew very little but worryingly was seen as one of the more knowledgeable in terms of wound care on the ward. In the 1990s vascular surgery started to separate into its own speciality and with it came huge advances in the options for re-vascularization. This came around the same time that the choices of wound care products were expanding; compression therapy became standard treatment for venous ulceration and my desire for knowledge grew and grew. I then had the unique opportunity to set up an out-patient vascular wound clinic while still being a ward sister, this slowly grew into a full time job and I was appointed as vascular nurse specialist in 2005. The learning curve continues to this day and I have just completed a Masters in Advancing Practice and I have recently been appointed as a part-time lecturer practitioner at Huddersfield University focusing on wound healing and peripheral vascular disease.
Negative pressure wound therapy: suggested solutions to barriers
Authors: Ousey Karen , Milne Jeanette
Published: May 2014

Effective communication to ensure maintenance of a seamless quality service for patients being transferred to the community from the acute sector with negative pressure wound therapy (NPWT) is essential. This paper reports the findings of a focus group convened to explore the decision making process; controversy or conflict surrounding the decisionmaking process; perceived barriers to seamless discharge and potential benefits of developing a UK standardized NPWT discharge documentation. A proposed algorithm is presented as a template for practitioners to use when discharging patients to the community to enhance timely and effective transfer.
The district nursing clinical error reduction programme
Authors: McGraw Caroline , Topping Claire
Published: May 2014

The District Nursing Clinical Error Reduction (DANCER) Programme was initiated in NHS Islington following an increase in the number of reported medication errors. The objectives were to reduce the actual degree of harm and the potential risk of harm associated with medication errors and to maintain the existing positive reporting culture, while robustly addressing performance issues. One hundred medication errors reported in 2007/08 were analysed using a framework that specifies the factors that predispose to adverse medication events in domiciliary care. Various contributory factors were identified and interventions were subsequently developed to address poor drug calculation and medication problem-solving skills and incorrectly transcribed medication administration record charts. Follow up data were obtained at 12 months and two years. The evaluation has shown that although medication errors do still occur, the programme has resulted in a marked shift towards a reduction in the associated actual degree of harm and the potential risk of harm.
Looking at the extent of fraud within the NHS
Authors: Griffith Richard , Tengnah Cassam
Published: May 2014

Fraud costs the NHS billions of pounds each year, and takes money away from frontline services. The Fraud Act 2006 has made the offence clearer and therefore easier to bring prosecutions. Offences can range from false representation about qualifications and experience to fraudulent consent forms, and through to bogus invoices and charging ghost patients. In this article, Richard Griffith and Cassam Tengnah outline what constitutes fraud and the measures taken by the NHS to counter fraudulent activity.
High support needs for older people: equality and diversity
Authors: Bliss Julie
Published: May 2014

This paper reviews the recent Joseph Rowntree publication Equality and diversity and older people with high support needs ( Blood and Bamford, 2010 ) and considers the implications for community nurses. It is important to acknowledge that not only is the aging population increasing in size, but also in diversity reflecting the diversity of the general population. Blood and Bamford (2010 ) remind those involved in care of older people of the importance of avoiding stereotyping and making assumptions regarding a range of issues such as; sexuality, poverty and ethnicity. Community nurses work with individuals, families and carers to provide individual holistic care, they should also play an active role in ensuring that services within the community reflect the diverse needs to the aging population. Furthermore, community nurses must access appropriate professional development to ensure that they have the knowledge and skills to provide care based on personal and social identity of individuals.
Interprofessionalism, personalization and care provision
Authors: Laurenson Mary , Brocklehurst Hilary
Published: May 2014

This UK-based empirical research investigates interprofessionalism and personalization to assess their potential to achieve quality care provision for people with long-term conditions. Governmental policies extol the virtues of interprofessionalism and personalization to drive modernization forward, however, change requires the commitment of health and social care professionals. Therefore the complexity of turning policy into practice requires continual review to ensure policy ideals become practice realities rather than speculative rhetoric. This paper examines interprofessional working (IPW) and interprofessional education (IPE) by analysing the experiences and working relationships of professionals from different professions and their potential impact upon personalization initiatives. The conclusion argues that educational providers and professional awarding bodies need to enshrine interprofessionalism into curricula and qualification accreditation thereby instilling collaboration intrinsically into care provision.
Developing a structured education programme for clients with COPD
Authors: Casey Dympna , Murphy Kathy , Cooney Adeline , Mee Lorraine , Dowling Maura
Published: May 2014

This article describes the development of a Structured Education Pulmonary Rehabilitation Programme (SEPRP), for the PRINCE (Pulmonary Rehabilitation In Nurse-led Community Environments) study. This process involved a literature review of existing PR programmes, a content analysis of national and international PR programmes and a concept analysis of empowerment. Secondly, two small descriptive qualitative studies were undertaken to further inform programme content exploring the views of health professionals and clients on programme content, as well as their perceptions of living with COPD. The findings of these two stages led to the development of the eight-week PRINCE SEPRP, based on a philosophy of empowerment and the SEPRP was underpinned by the Transtheoretical model (TTM) of behaviour change. Programme content included managing medications and managing breathlessness, knowing and managing symptoms, recognizing and managing acute exacerbations as well as an individualized exercise programme. Participants' experiences of self management following participation in the SEPRP were also examined. The findings indicate that nurses working in primary care have an important role in informing the development of SEPRP as well as having a key role in their delivery. They have the potential to work in empowering ways with COPD clients and the PRINCE SEPRP is just one example of how this can be put into practice.
Eczema diagnosis and management in the community
Authors: Watkins Jean
Published: May 2014

The old saying, ‘a stitch in time saves nine’ is particularly true in the management of eczema. Early diagnosis and the recognition of an underlying cause can mean that more simple measures, such as moisturizers, may be sufficient to keep eczema under control, while the identification of an allergic stimulus can forestall further problems. Equally, being aware of what action to take when a course of treatment is ineffective, and having the ability to teach parents and families to realize when they need extra help, may allow changes to be made that will restore control of the condition more quickly. An understanding and empathetic ear may make all the difference when a patient is having to come to terms with eczema. This article discusses the aetiology and symptoms of different types of eczema, and summarises the range of available options for the management of this often disruptive condition.
Effect of super-absorbent dressings on compression sub-bandage pressure
Authors: Cook Leanne
Published: May 2014

Venous leg ulcers can be highly exuding and moisture management is often challenging. The emergence of super-absorbent dressings have been marketed as a tool to manage high levels of exudate, in combination with compression therapy, for the management of venous leg ulcers. Compression bandages are designed to give precise amounts of compression which is calculated by considering the circumference of the limb. Super-absorbent dressings contain a form of polymer that swells as it locks in moisture. This study was designed to evaluate the effects of super-absorbent dressings on sub-bandage pressure. A series of controlled tests were performed using four different super-absorbent dressings which were applied to a volunteer's limb beneath compression bandaging. Sub-bandage pressures were recorded as fluid was introduced to the super-absorbent dressing. The results identified that sub-bandage pressure increases and the pressure profile changes following the expansion of the super-absorbent dressing. Further research needs to be performed to assess whether the use of these super-absorbent dressings under compression could be detrimental to venous ulcer healing.
When is an MLD therapist ready to deal with lymphoedema?
Authors: Jones Dee
Published: May 2014

The treatment of lymphoedema is extremely patchy in the UK with some areas having very good and experienced teams and some areas having no one at all. Community nurses will come across an assortment of lymphoedema cases, often not being dealt with properly due to a lack of knowledge or expertise in their area. With access to the Internet, nurses can go to the British Lymphology Society (BLS) or the MLDUK websites and have a look at their list of qualified therapists. This article sets out to explain some of the differences and the similarities between training and to provides some tools for choosing the most appropriate manual lymphatic drainage/lymphoedema therapist.
Preparing nursing students to be community health practitioners
Authors: Marshall Paul , Shelton Rosemary
Published: May 2014

There is currently a greater emphasis on community-based health care and, with that, a shift in focus for pre-registration nursing education within policy documents and standards ( Nursing and Midwifery Council (NMC), 2010 ). This paper reports a mixed methods study that examined the implementation of an initiative that enabled third year adult field student nurses the opportunity to spend the final year of their education within the community setting. Using a questionnaire and focus groups, the views of students at the end of the 12-month period were captured. The diverse approach to the placement provision enabled undergraduate nurses to be fit for purpose and ensured that practice at the point of registration would meet the challenges of working in the community setting. Students developed confidence through the diverse placement provision, opportunities for lone working and the support provided by mentors. This model of placement provision is worthy of consideration by service leads and curriculum planners, particularly in view of the present focus of the NMC's (2010) standards for pre-registration nursing programmes.
Moving and handling in the community: update on legislation and best practice
Authors: Tofts Diane , Arnold Mark
Published: May 2014

Over £400 million per year is spent on back injuries to NHS staff, and back injuries are the largest single cause of work-related sickness in the UK health sector. Moving and handling is an integral part of practice in a community setting, and community nurses face unique challenges to ensure the safety of and minimize risk to both patients and themselves. As with any care activity, moving and handling needs have to be assessed, planned for, implemented and evaluated. This article explains the legislation related to moving and handling, with particular application to community nurses. It focuses on the Health and Safety Executive's (2009) advice Working Alone: Health and Safety Guidance on the Risks of Lone Working, which reinforced that employers have responsibility for the health, safety and welfare of all their employees while they are at work. Employers have a duty to assess risks to lone workers and take steps to avoid or control these risks. Employees have the responsibility to take reasonable care of themselves and others. This article also explores the assessment of the specific risks nurses in the community are confronted with and provides advice on addressing and minimizing these risks at work, both in the client's home and in health-care facilities.
Energise for Excellence in Care: a call to action for nurses and midwives
Authors: Mello Michelle
Published: May 2014

Energise for Excellence in Care (E4E) is a nurse-led quality framework for nursing and midwifery advocated by the Chief Nursing Officer. It aims to support safe and effective care delivery, creating positive patient and staff experiences. Many nurses have the desire to make change but do not feel equipped to do so. Recognition of this is what inspired the development of this programme, which aims to provide easy access to tools, techniques and stories that will enable nurses and midwives to make the improvements to care they feel are necessary. E4E's vision is for at least 200 000 nurses, midwives and health visitors to sign up and share their stories of best practice and cost savings. Through this programme, nurses can demonstrate their personal commitment to improving nursing care for their patients and reinforce their position as role models within the multidisciplinary team. This article provides an overview of E4E with examples of how it can be effectively put to use in practice.
Developing and implementing the Community Nursing Research Strategy for Wales
Authors: Kenkre Joyce , Wallace Carolyn , Davies Robyn , Bale Sue , Thomas Sue
Published: May 2014

In order to obtain the best patient outcomes in community nursing, practice needs to be underpinned by robust research-based evidence. This article describes a Community Nursing Research Strategy developed and implemented in Wales to provide the nursing profession with the evidence to support future organisational and professional change in achieving excellence in the community. This was developed in partnership with education, research, health services, workforce planning and Government using consensus methodology (specifically, a nominal group technique). Consequently, the process was inclusive and included three steps: escalating presentation of ideas, topic debate and topic rating. The result was a strategy with four implementation strands, including a virtual network, research portfolio, application to practice and leadership.