bluuebunny/crossref_metadata_2025 huggingface dataset:
Preventing falls in older people: risk factors and primary prevention through physical activity
Authors: Unsworth John , Mode Anthony
Published: May 2014

Falls among older people represent a major public health issue, which can in part be tackled through an integrated falls service combining both primary and secondary prevention. Many falls can be prevented following comprehensive assessment to identify risk factors and to plan interventions to eliminate them or ameliorate their effect. Community nursing staff are well placed to undertake such risk assessments and can instigate programmes of primary prevention designed to reduce the likelihood of a person falling. Increased physical activity among older people represents one element of a prevention programme. While this is beneficial for the older person’s general health and well-being, certain types of exercise can also be used to reduce falls in individuals with muscle weakness, reduced mobility and balance problems. With the exception of balance training the evidence base related to exercise and falls prevention is patchy; Carter et al (2001) suggest that as yet there is insufficient evidence to suggest an optimum exercise programme for falls prevention. Each person should therefore be individually assessed and the results used to identify what type of exercise they might benefit from in order to address a specific risk factor. Once an appropriate form of exercise has been identified, practitioners should put the older person in contact with a physical activity coordinator to assist them in accessing an exercise programme.
Stoma complications: a case of cooperation
Authors: Lee Janice , Morris Olive
Published: May 2014

Patients who have a stoma formed as the result of an emergency procedure are not only more prone to complications, but also may find it more difficult to adjust to their new status. This article describes the difficulties faced by one patient in such circumstances, and highlights how cooperation between community and specialist nursing services helped the patient not only adjust but become self-caring.
Cohesive short stretch bandages in the treatment of venous leg ulceration
Authors: Charles Hildegard , Moore Christina , Varrow Sarah
Published: May 2014

These two case studies report how a cohesive short-stretch bandage was employed to promote venous leg ulcer healing. The two patients were obese and in addition had champagne bottle shaped legs. The cohesive short-stretch bandage was applied following the shape of the leg. By using a cohesive short-stretch bandage this provided bandage stability. This sustained compression resulted in oedema and pain reduction and promoted wound healing.
Debridement: ethical, legal and practical considerations
Authors: O’Brien Mark
Published: May 2014

ß Deciding which product or technique to use in order to effect debridement involves more than a simple dressing choice. Patient preference, degree of risk, environmental factors, resources and possible contra indications / cautions must be taken into account before proceeding. The option of conservative sharp debridement is a valuable tool and is potentially of great benefit to many patients. Despite this it may be underused in primary in care due to the perception that is a high risk procedure.
Skin grafts 1: theory, procedure and management of graft sites in the community
Authors: Beldon Pauline
Published: May 2014

The skin may not have the same the dramatic appeal as many of the other organs, such as the heart, however it plays a vital part in identifying each of us as a unique individual. When this protective outer barrier is damaged the consequences may be far reaching in both psychological and physical terms. Not all wounds require skin grafting – small, superficial wounds will heal by secondary intention and dressings. However, use of skin grafting to restore skin integrity for large surface wounds such as burns, reduces the risk of infection and enables the individual to resume normal daily activities more rapidly. This article explores the process of skin grafting and subsequent care of skin graft wound sites.
Hydropolymer dressings in the management of wound exudate
Authors: Carter Kate
Published: May 2014

In the UK the so-called ‘foam’ dressings are currently the most widely used absorbent dressings. They can, in certain cases, be particularly useful for the management of exuding wounds. One type of foam dressing – the Tielle hydropolymer adhesive dressing family (by Johnson & Johnson Wound Management) – is a range of five types of hydropolymer dressings: Tielle Original dressing, Tielle Lite dressing, Tielle Plus dressing, Tielle Borderless dressing and Tielle Packing dressing. The Tielle range shares a common basic composition that gives each dressing bacterial barrier properties and the capability of managing exudate by the combined process of absorption and moisture vapour transmission. Each type except Packing can be used as either a primary or as a secondary dressing. The choice should be based on the characteristics of the primary dressing, if any, on the degree of exudate that the wound is producing and on the condition of the surrounding skin. This article aims to give an overview of the Tielle range and a review of research-based clinical and scientific evidence to support the management of differing levels of exuding wounds in everyday clinical practice.
The use of honey for the treatment of two patients with pressure ulcers
Authors: A van der Weyden Elizabeth
Published: May 2014

Chronic wounds such as pressure ulcers, leg ulcers and diabetic wounds are a common problem among older people and alternative methods to the current time-consuming and costly practices of wound management in the nursing home need to be identified. To this end, we trialed the use of a honey alginate on two elderly males in our nursing home who were suffering from pressure ulcers (one on the ankle and one on the sacral region), to evaluate its effectiveness as a viable alternative to the current wound management practices in nursing homes. The use of honey resulted in a rapid and complete healing of both wounds. In addition, the antibacterial activity of honey had a deodorizing effect on the wounds and its anti-inflammatory actions helped reduce the level of pain. Similar healing results are also being observed in other patients with pressure-induced ulcers and as a result honey alginates are now being used as the ‘standard’ treatment for chronic wounds in our nursing home.
Are nurses expected to be role models too?
Authors: Pollard Tom
Published: May 2014

Should nurses be expected to set an example to their patients, or is it enough for them to encourage people to make healthy lifestyle choices? This is the question raised by the new Chief Nursing Officer, Chris Beasley’s announcement that nurses who smoke would be given help to quit, so that they can ‘coincidentally become role models’.
Keeping carers healthy: the role of community nurses and colleagues
Authors: Hare Philippa
Published: May 2014

Carers form a substantial proportion of the patients seen by primary care professionals, but their health needs are often overlooked. By recognizing and addressing the needs of the carer as well as the patient, primary care staff (including practice, community and district nurses) can protect the physical and mental health of both. Staff can start by developing simple systems for identifying and recording both patients who are carers, and patients who have carers. Primary health professionals may be able to identify specific opportunities for checking on carers’ health, e.g. at general health checks or clinics for older people or those with chronic diseases. Community nurses should ensure that they use their home visits to keep an eye on the health of the carer as well as the patient. Much of this input can be integrated into the everyday activities and priorities of the primary care team.
Older community nurses: perspectives and prospects
Authors: Watson Roger , Andrews JoyAnn , Manthorpe Jill
Published: May 2014

In common with the nursing workforces of the developed world, the NHS nursing workforce is ageing. Community nurses, in particular, tend to be older than their acute counterparts and this ageing could have a greater impact on this section of the workforce than on nurses in other sectors. This article reports on a study into the options, decisions and outcomes for nurses over the age of 50years in the NHS. The study was funded by the Joseph Rowntree Foundation as part of a larger programme of work. Older nurses are a valuable part of the NHS workforce, being a repository of skill and wisdom. While this is generally recognized, and there are polices to support this, there is little recognition or action within the NHS. This study found that older nurses would like to see greater flexibility being shown towards them in terms of their working hours and conditions of work, without harming their pension prospects. They would like to see return to practice courses and continuing professional development more geared towards their needs. Furthermore, they would like more information about their options. The article includes the experiences of some older nurses working in the community who remain, have left or have returned to the NHS.
Evaluation of a honey-impregnated tulle dressing in primary care
Authors: Stephen-Haynes Jackie
Published: May 2014

Honey has been used for its healing properties for centuries and has been used to dress wounds with favourable results. The emergence of antibiotic resistance and growing interest in ‘natural’ or ‘complementary’ therapies has led to an interest in honey dressings. Much of the research to date has been related to honey’s antibacterial properties. However, the healing properties claimed for honey also include stimulating new tissue growth, moist wound healing, fluid handling and promoting epithelialization. Until recently, honey had not been developed as a wound management product and was not a certified pharmaceutical devices. Activon Tulle is a sterile, non-adherent dressing impregnated with Leptospermum scoparium honey. The claimed properties of honey dressings would make this a valuable addition to the dressings currently available in the primary care setting. An evaluation was undertaken involving 20 patients with a variety of wounds. A conclusion is drawn that while further research is needed, medical grade honey does appear to be a valuable addition to the wound management formulary.
New opportunities for district nursing: chronic disease and matrons
Authors: Morgan Maureen
Published: May 2014

District nurses have been the backbone of nursing care in the home since the early part of the last century. They have seen and responded to many changes. Today developments in technology, changes in public expectations, changing patterns of disease and reduced length of stay put this group of nurses at the heart of government policy.
Stoma care accessories: an overview of a crowded market
Authors: Burch Jennie , Sica Jo
Published: May 2014

While many stomas do not develop any problems, up to 55% of them do. Stoma accessories are often used to either prevent stoma problems or resolve them, but there is a potentially baffling array of products available. This article provides an overview of the accessories currently available, to assist the community nurse in the care of patients with stomas.
Does compliance therapy improve use of antipsychotic medication?
Authors: Ilott Rebecca
Published: May 2014

Non-compliance with prescribed antipsychotic medication is common among people diagnosed with schizophrenia and is associated with high relapse rates. Compliance therapy is an intervention to promote compliance, developed from motivational interviewing and cognitive behavioural therapy. This mini-review aims to examine the evidence for the effect of compliance therapy on promoting compliance with antipsychotic medication, compared to usual advice. Online medical databases were searched for randomized controlled trials (RCTs) which compared a group of participants who received compliance therapy with a group who did not. Articles were only considered if the participants were on antipsychotic medication; received 4–6 sessions of compliance therapy (as defined by Kemp et al (1998)), which lasted 20–60 minutes; and an outcome measure of compliance and psychotic symptoms was given. Two RCTs met the inclusion criteria. One reported compliance therapy had a significant effect on compliance but not on symptoms. The other RCT reported no significant effects from compliance therapy. However, methodological flaws effected the validity of both findings. Further quality research is required in this important area.
Patient empowerment in primary care: evaluating the expert patient
Authors: Wilson Patricia
Published: May 2014

Preliminary results are now available from a study that explored the relationship between the Expert Patient programme (EPP) and patient empowerment in primary care, and how active and informed patients (expert patients) are facilitated and responded to by health professionals.
Making information technology work
Authors: While Alison
Published: May 2014

Information technology (IT) offers huge potential for improvements in information flow for health service users and employees. For practitioners it offers the possibility of ready access to up-to-date knowledge for the delivery of high-quality care and improved access to patient data and care records. With this in mind there is a major NHS IT investment programme currently in progress, but investment in IT hardware and software will yield limited benefits if practitioners cannot make use of the investment.
Assertiveness: making yourself heard in district nursing
Authors: Lawton Sally , Stewart Fiona
Published: May 2014

Being assertive is not the same as being aggressive. Assertiveness is a tool for expressing ourselves confidently, and a way of saying ‘yes’ and ‘no’ in an appropriate way. This article explores issues concerned with assertiveness in district nurse settings. It outlines helpful techniques to develop assertiveness, such as the broken record, fogging, negative assertion and negative inquiry.
Welfare advice in general practice: a resource for community nurses
Authors: Greasley Peter
Published: May 2014

Recent policy guidance has recommended that community nurses address public health issues, suggesting that they play a role in assessing and addressing poverty, and ensuring patients claim the welfare benefits to which they are entitled. This article reports an evaluation of a welfare advice service catering for 30 general practices in inner-city Bradford. Community nurses, along with other members of the primary care team, were able to refer patients for advice about welfare issues, including benefits, housing, debt etc. A retrospective study was conducted of all patients referred for advice during 24months of the project. The advice workers saw 2484 patients, dealt with over 4000 welfare advice issues, and raised over £2 million in welfare benefit claims for patients, primarily through disability-related benefits. The contribution of community nurses is examined in terms of referrals and outcomes for patients.
A practice-based survey of mortality patterns and terminal care provision
Authors: Lakasing Edin , Mahaffey Wendy
Published: May 2014

Mortality within a general practice population can be used as an indicator of the morbidity, and consequently the health care needs of the population. This article reports on a review of mortality and nursing involvement in terminal care within one general practice, and considers the implications for nursing and medical services.
Learning to support children with complex needs in their homes
Authors: Hewitt-Taylor Jaqui , Farasat Helen
Published: May 2014

There are an increasing number of children with complex and continuing health needs. The aim is that wherever possible they and their families should be supported in a way which enables them to remain at home. A part of achieving this aim is increasing the competence and confidence which nursing staff have to provide such support.

This paper reports on a pilot placement for preregistration nursing students focused on supporting children with complex needs in their homes. The major findings were that such a placement can be extremely beneficial in enabling students to develop practical skills and attitudes and values which will assist them to provide appropriate support. It also clarified some of the major organisational and practical issues which must be considered in facilitating such placements.
Long-term conditions 5: meeting the needs of highly complex patients
Authors: Pratt Laura R
Published: May 2014

This article is the last in the series focusing on long-term conditions. It explores the educational needs and preparation of district nurses in order to meet the drive to efficiently and effectively care for people with long-term conditions in the home setting. It encompasses the findings of a small scale exploratory study conducted with district nurses from one PCT. The findings reveal a well informed and flexible workforce who value their core skills, some of whom are already adopting case management principles in their daily activities. However, the district nurses also expressed feelings of immense insecurity and change associated with their role. Educational deficits relating to long-term conditions and district nurses were discovered, indicating that educational and clinical leadership is paramount in order to meet the needs of this group of patients.
Promoting quality of life for patients with moderate to severe COPD
Authors: Tinker Ros , While Alison
Published: May 2014

Understanding key components of good practice in the management of moderate and severe COPD is important for nurses working in the community. This article reviews the available evidence, which highlights the importance of smoking cessation, allowing breathless patients time to express themselves, encouraging exercise and timely palliative care. Additionally, evidence suggests that hospital-at-home can provide a safe alternative to hospital care and is the preference of some. However, more research is needed to provide evidence regarding the most effective smoking cessation programmes.
Does alcohol stimulate appetite and energy intake?
Authors: Gee Caroline
Published: May 2014

It has been anecdotally suggested that alcohol stimulates appetite and so increases energy intake in people who have poor appetite. This review sought to systematically review the evidence for this practice, using the mini-review approach (Griffiths, 2002). Among the eight studies reviewed, only one showed a significant differences in appetite ratings between the alcohol and no alcohol preload. However, significant differences were found in energy intake following a high-dose alcohol preload as opposed to a no-alcohol preload, in three out of the eight studies reviewed. One further study reported an increase in energy intake after the alcohol preload but this failed to reach statistical significance. In conclusion, the effect of alcohol on appetite appears largely unsubstantiated. Alcohol's effect on energy intake does appear significant, but further research is necessary owing to small sample sizes.
Introducing clinical supervision for community-based nurses
Authors: Abbott Stephen , Johnson Barbara , Dawson Luise , Hutt Jane , Sealy Angela
Published: May 2014

City and Hackney Teaching Primary Care Trust has introduced mandatory clinical supervision for all front-line nursing staff (district nurses, health visitors, school nurses, staff nurses, health care assistants). A group model is used, with sessions occurring monthly and lasting 90 minutes. Groups include a mixture of qualified and unqualified staff. The project was introduced in two phases. First, external facilitators were used to run sessions for 18 months. An evaluation toward the end of this period found very strong staff support for the innovation. Internal facilitators were then trained to implement the second phase. A second evaluation found continuing support for clinical supervision, and a preference for multidisciplinary groups. Clinical supervision is now firmly embedded in the organization. It is primarily ‘restorative’, offering staff relief from the stresses of working in a very deprived and ethnically diverse area where the recruitment and retention of staff is an enduring challenge.
The Warrington workload tool: determining its use in one trust
Authors: Baldwin Melissa
Published: May 2014

With recent advances in chronic disease management and with earlier discharge from the acute sector, it has become increasingly important for district nurses to monitor and evidence their increasing workload, to monitor demand and capacity.

The district nursing service in the author's trust has employed an adaptation of the Warrington workload tool, over several years, to demonstrate and evidence their workload. However, many dispute the accuracy of such tools. This audit set out to discover how accurately the tool was being calculated. The findings have cast doubt on the tool's accurate completion and highlighted an ongoing training need to ensure improvement in its use. The tool is to be further supported with the inclusion of a caseload profiling tool to provide qualitative evidence of the service that the nurses now provide. It was also identified that the service needs evidence that their resource needs are met in response to workload tool data to ensure the tool continues to be used in a proactive manner.
NICE pressure ulcer guideline: summary and implications for practice
Authors: Stephen-Haynes Jackie
Published: May 2014

This article outlines the principle areas for consideration form the NICE (2005) guideline for pressure ulcer prevention and treatment. All key areas are included and recommendations made for their implementation into clinical practice. A conclusion is made that pressure ulcer prevention is a key indicator of quality care and that all professionals have a responsibility for its implementation.
PCT Commissioning: how community nurse involvement can be encouraged
Authors: Norman Kay , Old Claire
Published: May 2014

Commissioning is the process by which PCTs identify the health needs of their population and make prioritized decisions to secure care to meet those needs within available resources. It includes longer term strategic planning, medium term planning (three year Local delivery Plans) and the shorter term agreement and performance management of service level agreements. The process should involve the public, engage clinicians, and be conducted on a whole system basis, informed by health equity audits, and carried through with the full participation of other stakeholders including NHS Trusts, local authority(s) and the voluntary sector (NHS Modernization Agency, 2004).
Piloting the community matron model with alcoholic homeless clients
Authors: Dorney-Smith Samantha
Published: May 2014

This article describes a 13 week trial of the community matron model undertaken with homeless persons in Lambeth in early 2007. Six patients were selected for ‘demand management’ at a ‘wet’ hostel in South London. A reduction in acute service demand (A&E attendances and inpatient admissions), and an increase in Euroqol EQ-5D ‘quality of life’ scores were the outcome targets of the community matron intervention. The article describes what was achieved for the six patients during the 13 week pilot, and the lessons that were learned as a result of undertaking the pilot project. Recommendations for future practice are made.
Part 3: Defining the unique role of the specialist district nurse practitioner
Authors: Barrett Anne , Latham Dinah , Levermore Joy
Published: May 2014

The third of a series of articles concludes the unique role of the District Nurse. District Nurses are proud of their profession and seek to demonstrate their advanced skills through further case scenarios. As Government policy continues to expect health care providers to keep patients in the community who have complex health and social care needs, District nursing is the obvious profession that remainss constant in ever changing times.
Timely recognition of dementia: community nurses’ crucial roles
Authors: Manthorpe Jill , Iliffe Steve
Published: May 2014

This article aims to show that community nurses are well placed to recognize the early symptoms of dementia. It identifies the three main ways in which community nurses can assess changes in cognition, and how the community nurse can work with the GP and other family members to provide a seamless service to this vulnerable group. Special focus is given to the sensitivity with which nurses can guide the older person through the stages of recognition and diagnosis of the condition and subsequent after-care.
Accessible and integrated care: Scotland’s community nursing review
Authors: Jarvis Alison
Published: May 2014

Nurses in the community in Scotland, as in the rest of the UK and across many other parts of the world, face challenges as the focus of care is shifted from hospital to community and towards a health-improvement orientation (Scottish Executive, 2005a; Department of Health, (DH) 2006).
COPD and coping with breathlessness at home: a review of the literature
Authors: Harris Sue
Published: May 2014

Patients with COPD and their partners often feel isolated while trying to cope with the psychological and physical effects of their condition and the change in their quality of life. Research studies support the fact that some patients with COPD cope better with their breathlessness at home with appropriate community support. This support may be provided by nurses and other health professionals. However, there appears to be an imbalance in the provision of community support/palliative care for COPD patients who have a life limiting illness compared to other patients with a life limiting illness and a cancer diagnosis. Where ‘hospital at home’ and support in the community for COPD patients occurs it is provided in many different ways and has been shown to reduce the necessity for acute hospital admissions.
Meeting the needs of people with intellectual impairment in primary care
Authors: Clark Louise L , While Alison
Published: May 2014

People with intellectual impairments are treated within the mainstream NHS including primary care with little support from specialist services. There are communication issues for primary care staff in relation to access of services and the assessment of health needs for this vulnerable group of individuals. Primary care staff do not always feel equipped to support people with intellectual impairment and need training in order to do so.
A hermeneutic phenomenological study of community nurses’ CPD
Authors: Banning Maggi , Stafford Mariline
Published: May 2014

Continuing professional development (CPD) is a mandatory aspect of nurse registration. In the NHS, more demanding professional roles compel nurses to develop and update their knowledge and skills through CPD. Even though CPD is an essential component of nurse education, research investigating community practitioners’ views, experiences and perceptions of the link between reflection and CPD is limited. This phenomenological study explored community health practitioners’ experiences of CPD and perceptions of the link between CPD and reflection. Ten community practitioners who specialized in district or school nursing and health visiting were interviewed using an in-depth approach. Data was analysed using thematic networks as a tool (Attride-Stirling, 2001). Findings revealed that community practitioners viewed CPD positively, perceived the benefits as both professional and personal development. Development needs were identified through reflective practice and appraisal. Even though significant barriers were apparent, the organization provided opportunities to access formal and self-directed learning events. There is a need for organizations to invest in CPD of the workforce, consider cheaper alternatives for meeting CPD needs and for further research to assess the impact of CPD on clinical practice.
Introduction of the primary care cancer nursing role in a GP practice
Authors: Perry Catherine , Thurston Miranda
Published: May 2014

Nurses have always had an important role in the care of cancer patients and many specific nursing roles in cancer services have been developed. A qualitative research strategy using semi-structured interviews was adopted in this case-study of the implementation of a primary care cancer nurse (PCCN) role in a general practice. The implementation of the PCCN role is reported in order to shed light on the extent to which integration of the role into existing systems of care had taken place; and to explore facilitating factors and barriers to the implementation of a new primary care role. Three major themes emerged from the data: the management of change; systems of care; and the complexity of professional interfaces. It is evident that the effective implementation of innovative nursing roles in primary care can present many challenges to the role holder and to the health and social care professionals with whom they come into contact. The importance of communication and consultation in the role implementation are emphasized.
The delivery of dignity when caring for older people
Authors: Potter Charlotte
Published: May 2014

Everyone has a different understanding of what it means to have dignity, however, it is commonly associated with being in control and valued. The dignity of older people is therefore vulnerable as they are likely to be in positions of reduced control over their wellbeing. The six senses framework describes the characteristics of a health and social care environment which can promote dignity. The dignity of older people with dementia or near the end of life can be particularly at risk, however there are practical steps which can make a difference. Help the Aged has produced a series of guides to help medical practitioners and hospital staff care for vulnerable older people in the right way.
Managing chronic oedema: a collaborative community approach
Authors: Lewis Melanie , Morgan Karen
Published: May 2014

Chronic oedema affects over 100?000 people in the UK and is regularly treated by different health care professionals, most commonly community nurses. The effect of chronic oedema on patients can be both physical and emotional and is a huge financial burden on the NHS. Collaborative working between lymphoedema services and community nurses is outlined in this article, highlighting potential benefits to patient care and substantial cost savings. Modified lymphoedema management strategies to treat chronic oedema effectively are identified with the emphasis on joint packages of care and patient goal setting. The role of health care professionals working collaboratively and empowering patients are also discussed in a case study.
Evaluation of study days for community nurses treating chronic oedema
Authors: Todd Marie , Key Margaret , Rice Margaret , Walker Michelle
Published: May 2014

Effective management of chronic oedema patients in the community requires a collaborative approach between lymphoedema specialists and community nurses. This collaboration improves the outcomes of care, reduces community nurses input, creates better understanding of the roles and allows patients to be treated more locally. Lymphoedema specialists in Glasgow developed study days to complement the skills of community nurses and foster a more collaborative and supportive approach to treating patients with chronic oedema. A total of 25 nurses have attended so far and the sessions were well evaluated. The need for further education sessions on the management of chronic oedema was highlighted.
A Welsh pilot study on a distance learning module for end of life care
Authors: Lewis Melanie , Jeynes Kay , Anstey Sally , Way Helen
Published: May 2014

In order to build on and improve the palliative care knowledge and skills of the district nurses in Cardiff, and the Vale of Glamorgan, the South East Wales Cancer Network in partnership with the local NHS Trust, commissioned Cardiff University to develop, implement and audit a bespoke distance learning style module in the foundations of end of life and palliative care. This will be utilised as an internal requirement for all band 5 and 6 nurses. The outcomes will determine whether the module is suitable as an All-Wales programme and whether it has potential for use with other disciplines.
Nutrition in palliative care
Authors: Acreman Sue
Published: May 2014

Nutrition in palliative care and at the end of life should be one of the goals for improving quality of life. It is important to address issues of food and feeding at this time to assist in the management of troublesome symptoms as well as to enhance the remaining life. While this paper focuses upon the nutritional aspects of cancer in palliative care, the sentiments are applicable to other serious chronic illnesses such as advanced cardiac failure, chronic obstructive pulmonary disease and dementia.

Cancer and its treatments exert a major impact upon physical and psychological reserves and at the end of life problems with appetite and the ability to eat and drink compound such impact. The aims of nutritional care minimize food-related discomfort and maximize food enjoyment. Identification of any nutritional problems can facilitate the employment of strategies which need to be discussed with the patient and their families and reviewed regularly as conditions change. Ethical questions will be raised concerning the provision of food and fluids to a person nearing the end of their life. Nurses need to acknowledge that food has greater significance than the provision of nutrients.
Lower urinary tract dysfunction in MS: management in the community
Authors: Panicker Jalesh , Haslam Collette
Published: May 2014

Lower urinary tract dysfunction in multiple sclerosis is common and is highly amenable to treatment. Individuals may have bladder storage and/or voiding dysfunction. The risk of progression to renal failure is low and hence lower urinary tract dysfunction should be considered medically manageable in most individuals. Evaluation begins with history taking and is supplemented by using a bladder diary. Ultrasonography is used to assess the degree of incomplete bladder emptying, and for assessing upper urinary tract damage. Incomplete bladder emptying is most often managed by clean intermittent self-catheterization and should be initiated if post-void residual urine is greater than 100mls. Storage symptoms are most often managed using antimuscarinic medications. Other options include desmopressin or detrusor muscle injection of botulinum toxin type A. There are specific situations where specialist urology services should be involved.
The future of district nursing: the Queen’s Nursing Institute debate
Authors: Sweeney Kieran , Perkins Liz , Goulden Annette , Walsh Nicola , Cook Rosemary
Published: May 2014

The Trustees of the Queen’s Nursing Institute (QNI) spent part of this district nursing anniversary year debating the current state of nursing in the home, and how the Institute could best use its resources and influence to support this essential element of the health-care system. This article distills that debate, and sets the direction for the QNI in 2010.
The protection of vulnerable adults
Authors: Griffith Richard , Tengnah Cassam
Published: May 2014

Abuse of vulnerable adults is a growing yet under-reported problem. Episodes of abuse are often considered to be rare dramatic incidents of physical or sexual abuse. However, most incidents of abuse relate to poor practice, neglect and poor management. The great majority of abuse, 67%, occurs in the person’s own home with 22% occurring in care homes and 5% in hospital. Therefore, district nurses are well placed to identify those suffering or at risk of abuse. As well as criminal sanctions for abuse against the vulnerable, the government has attempted to prevent those who might abuse the vulnerable from working in health and social care through the Protection of Vulnerable Adult scheme. This scheme is to be replaced in the autumn of 2009 by the Safeguarding Vulnerable Groups Act 2006, that will see the remit of the Vetting and Barring system extended to the NHS and will include district nurses. In this article Richard Griffith and Cassam Tengnah discuss the incidence and forms of abuse against the vulnerable and go on to consider the case put forward for replacing the current Protection of Vulnerable Adult scheme.
Transition for adolescents with long-term conditions: event to process
Authors: Brooks Fiona , Bunn Frances , Morgan Janice
Published: May 2014

This paper maps out the evidence relating to quality and user experience of transition services for young people with long-term conditions. The review identified that good quality transition was universally seen as a process as opposed to a single event, supported by effective interagency communication and coordination, with the young person occupying a central place in the decision-making process. Conversely, poor communication and an absence of a designated professional to support the transition were barriers to an effective process. Gaps in the evidence base were most notable when concerned with the relationship between general practice, secondary care and social care. Overall, greater shared learning of the generic components of an effective transition process needs to occur across long-term conditions.
Raising awareness of elder abuse in the community practice setting
Authors: McGarry Julie , Simpson Christine
Published: May 2014

In 2000 the Department of Health published No Secrets: Guidance on developing and implementing multi-agency policies and procedures to protect vulnerable adults from abuse. This has laid the foundation for multi-agency policy development for the prevention of abuse of vulnerable adults at the national and local level. Recognition and appropriate action by community practitioners is essential to safeguard the welfare of older people. This paper aims to provide an overview of the key policy and research initiatives surrounding elder abuse, and to provide clear guidance in terms of identifying and reporting possible cases of abuse.
Understanding the Safeguarding Vulnerable Groups Act 2006
Authors: Griffith Richard , Tengnah Cassam
Published: May 2014

The Safeguarding Vulnerable Groups Act 2006 was enacted as a result of the Government adopting the recommendations of the Bichard Inquiry (2004), that looked into the circumstances surrounding the death of two children in Soham in 2002. The 2006 Act provides a new vetting and barring scheme to replace the existing arrangements for safeguarding children and vulnerable adults from harm, or the risk of harm, by employees and volunteers whose work gives them significant access to these vulnerable groups. The Act extends statutory vetting and barring schemes to the health service as well as the social care sector. It is therefore important that district nurses are aware of the provisions of the Act and the timetable for implementation. This will enable them to better understand their legal duties, in order to protect themselves from liability and to protect their patients from abuse
An update on stoma appliance flanges and base-plates
Authors: Burch Jennie
Published: May 2014

Coping with a stoma can be difficult for many reasons; leakage and skin breakdown are two common problems faced by ostomates (people with a stoma). A flange or base-plate adheres to the patient’s abdomen. A secure and well designed flange is essential to the ostomate when adjusting to their newly formed stoma. Selecting the correct type of appliance and flange is an important part of holistic assessment. This article is the second in a series of three and focuses on the newer flanges that are available. It can be difficult for community nurses to keep abreast of all the new developments within the stoma appliance field; therefore, this article aims to highlight some of the key aspects concerning the functionality of available flanges.
Assisted suicide: increased support for a change in the law
Authors: Griffith Richard , Tengnah Cassam
Published: May 2014

Calls for a change in the law to allow strictly controlled forms of assisted dying in the UK continue following a recent attempt to change the law and an announcement by the Royal College of Nursing that it was shifting its position on the issue from opposition to a neutral stance. In this article Richard Griffith and Cassam Tengnah review the current stance of the law on assisted dying and discuss laws that allow assisted dying in Australia, Europe and the USA.
The swine flu, advice giving and the reporting of adverse drug reactions
Authors: Griffith Richard , Tengnah Cassam
Published: May 2014

The swine flu pandemic has gripped the headlines over the summer and its management in the UK is proving to be controversial. The government’s advice to issue anti-virals to people of all ages with flu-like symptoms runs contrary to World Health Organisation advice. The benefits of anti-virals for children has been called into doubt because of the risk of severe side effects. Concern over adverse drug reactions has prompted the Medicines and Healthcare products regulatory agency to urge health professionals and the public to assist its monitoring of the drug by reporting adverse drug reactions. It is essential that district nurses have up-to-date knowledge of the adverse reactions of the commonly used anti-virals in order to exercise a duty of care to their patients by giving appropriate advice and ensuring adequate monitoring and early detection of unwanted side effects. This article makes recommendations to district nurses for improving patient concordance with prescribed medicines, reporting adverse drug reactions via the swine flu ADR portal and how to obtain up-to-date information on unwanted side effects.
Pendleton’s consultation model: assessing a patient
Authors: Harper Cecily , Ajao Alex
Published: May 2014

The notion of nurses undertaking consultations is a relatively new dimension. Consultation models have historically been researched from a GP’s perspective (Baird, 2004). Sprague (2005) identifies that consultation models should be straightforward, practical and provide guidance that enables advanced nurses to adapt to their new medicalised role.
Implications of the 2010 rheumatoid arthritis classification criteria
Authors: Carlone Joyce P
Published: May 2014

Since their last revision in 1987, nurses and other health professionals have looked to the American College of Rheumatology Classification Criteria for Rheumatoid Arthritis in working with arthritis patients. At the time of their development, these criteria reflected our current understanding and definition of established disease and allowed us to stratify patients into those with and without rheumatoid arthritis (RA) (Arnett et al, 1987). Unfortunately, the 1987 criteria have been limited in their ability to recognize those with early RA among patients who present with undifferentiated inflammatory arthritis. This limitation has been more fully appreciated over the past several years since the discovery of new disease modifying anti-rheumatic drugs (DMARDs), such as biologics, and more sensitive laboratory testing, such as anti-cyclic citrullinated peptide, which can precede the development of clinical disease by years. (Rantapaa-Dahlqvis et al, 2003). Early implementation of modern DMARD treatment regimens have also shown us that RA patients can often be prevented from reaching a chronic, erosive disease state as defined by the 1987 criteria. With this in mind, the American College of Rheumatology (ACR) and the European League Against Rheumatism (EULAR) collaborated to publish the 2010 RA Classification Criteria in September (Aletaha et a, 2010).
Issues for people living with long-term urinary catheters in the community
Authors: O’Donohue Diane , Winsor Georgie , Gallagher Robyn , Maughan Judy , Dooley Katherine , Walsh Joan
Published: May 2014

People with a long-term urinary catheter living in the community often experience catheter-related issues, however, the frequency and extent of these issues has not been well described in the literature. A survey on issues clients (n = 62) experience with their long-term urinary catheter was conducted in one community health service. The majority (79%) had experienced at least one issue in the last two years, 62% had urinary tract infections, 33% had an emergency department visit and 29% had leakage. Discomfort at catheter change was at least moderate in 32% and predictive of more interference from the catheter in clients’ daily lives and 55% reported at least moderate interference from the catheter in their daily lives. In conclusion, most clients with long-term urinary catheters experience issues and interventions need to be assessed for effectiveness in decreasing these problems.
Improving end of life care in the community: national strategy
Authors: Henry Claire , Hayes Anita
Published: May 2014

The National End of Life Care Strategy published last year by the Department of Health called for a ‘cultural shift’ among the 2.5m strong health and social care workforce. This article explores the competence and principles which those staff should have to provide improved care for those at the end of their lives. It links these to Transforming End of Life Care, one of six guides in the ‘Transforming Community Services’ series which emerged from the ‘NHS Next Stage Review’ led by Lord Darzi. Together the three documents explored in this article call for a new emphasis on partnership working and teamwork to provide care that is responsive to the wishes of the person nearing the end of his or her life and their loved ones.
Day case gastrostomy placement for patients in the community
Authors: Best Carolyn , Hitchings Helen
Published: May 2014

The numbers of patients receiving home enteral feeding via a gastrostomy is increasing, with placement of the gastrostomy often being undertaken as a hospital day case. There are a number of benefits to the patient having the procedure in this way, however, problems may arise if a comprehensive assessment is not undertaken prior to the procedure, there is a lack of communication between hospital and community services, or inappropriate or inadequate training. It is essential to ensure that the transfer of care from acute hospital to community services is thorough to minimize these potential problems. This article aims to address some of the pitfalls that may occur when patients who require home enteral feeding are admitted to hospital for the placement of a gastrostomy and discharged from hospital into their own homes or into a care home the same day. Discussion will centre around the timing and assessment for gastrostomy placement, managing the risk of refeeding syndrome, devising a suitable feed regime, obtaining prescriptions, setting up community services and monitoring the patient’s progress.
Managing wound exudate and promoting healing
Authors: Adderley Una J
Published: May 2014

Exudate is a product of the normal wound healing process. It is usually clear or amber coloured but variations in the colour, consistency, odour and amount can indicate disruption to the normal healing process. Certain types of chronic wound commonly seen in the community can be associated with the production of excessive exudate. Copious exudate can be distressing for patients and expensive for community health-care providers. Effective management depends on the accurate diagnosis and treatment of the underlying condition and skill in selecting the most appropriate dressing regime.