bluuebunny/crossref_metadata_2025 huggingface dataset:
The voice of the community nurse will be heard
Authors: Cook Rosemary
Published: May 2014

One of the key themes of the Queen’s Nursing Institute’s (QNI) 2006 report, Vision and Values – a call for action on community nursing (QNI, 2006), was that community nurses often struggle to make their voices heard. The district nurses who attended our focus groups around England, Wales and Northern Ireland agreed that they feel unable to influence policy or strategy, at either local and national levels. They talked of the community nursing voice being absent from policy and planning groups; and no expert community nursing input to strategic decision making (p7).
Overactive bladder syndrome in the older woman: conservative treatment
Authors: Stewart Ellie
Published: May 2014

Over active bladder syndrome (OAB) is the most common cause of urinary incontinence in the older population (Gadgil and Wagg, 2008). Many women do not seek medical help and advice as they consider it to be an inevitable part of ageing. It can have significant impact on sufferers’ lives and can contribute to an increased risk of falls, reduced quality of life, social isolation and depression. It is also known to be hugely under-reported as patients are often too embarrassed to discuss their symptoms with members of their family or health professionals. OAB syndrome can however, be treated effectively in primary care with conservative, nurse-led treatments. This article will discuss the causes, implications, assessment and conservative treatments available to women over 65 years old presenting with OAB syndrome in primary care.
Funding to attract the best
Authors: While Alison
Published: May 2014

A High Quality Workforce (Department of Health (DH), 2008) reiterated the ambitions for the future of the NHS founded upon high-quality care for all patients, ensuring patient safety, effectiveness of care and a positive patient experience. The NHS is a ‘people’ organization with delivery of its services depending upon health professionals and all the support staff. It is therefore imperative that it can attract high calibre people from all sections of the population to train as health professionals.
Simple staff-led change can revolutionize community services
Authors: Manning Sean
Published: May 2014

The new Productive Community Services programme from the NHS Institute for Innovation and Improvement enables nurses and other community staff to improve services and substantially increase the amount of time they spend with their patients.
An update on available stoma appliances in the community
Authors: Burch Jennie
Published: May 2014

It can be difficult for the community nurse to keep up with all the new stoma products; however as prescribers and/or nurses it is important to know what is available. More importantly, the community nurse needs to know when certain products may be beneficial for the individual ostomate, to help them to cope better with their stoma (Cottam and Porrett, 2005). The flanges or base plates and accessories will be discussed in future articles. In this article the merits of the bag will be explored.
Understanding why patients don’t take their medicines
Authors: While Alison
Published: May 2014

The costs of patients not taking their prescribed medications are substantial and occur through wastage of prescribed medications and increased health service usage. The costs to the individual arise from increased disability which may interfere with employment and reduced quality of life. While everyone is entitled to make a choice whether to take a prescribed medication, there is a concern that some patients do not adequately understand the consequences of non-adherence.
One voice: shaping our ageing society
Authors: Mitchell Michelle
Published: May 2014

Michelle Mitchell, the newly appointed Charity Director at merged charity Age Concern and Help the Aged takes a look at the challenges a growing older age demographic will put on health and social care services. She suggests that the sector is facing a crisis and that decision-makers will need to act soon or risk failing older people in the future.
The debate on assisted suicide has begun
Authors: While Alison
Published: May 2014

The deaths of Sir Edward Downes and his wife in early July re-ignited the debate on assisted suicide and the rights of individuals to choose to shorten their lives with the help of others. Until very recently, there has been consistent opposition to any changes in legislation by those representing doctors and nurses, although individual practitioners may have been sympathetic to the plight of those not wishing to wait for a natural death.
Understanding the role of smoking in the aetiology of bladder cancer
Authors: Anderson Beverley
Published: May 2014

Bladder cancer is common in the UK. Of all the aetiological factors associated with the development of the disease, cigarette smoking is the most important, in industrialized countries. It is estimated that 60% of all bladder cancers result from smoking. The management of bladder cancer is governed by specific guidelines. Superficial cancers are managed surgically with transurethral resection, while more aggressive tumours are managed with cystectomy (removal of the bladder). Additional treatment includes cytotoxic therapy with intravesical chemotherapy and immunotherapy agents. However, while treatments may be effective in reducing tumour recurrence, the side effects of treatments on the individual’s quality of life can be devastating. This paper seeks to provide an overview of bladder cancer, namely how the disease presents and is subsequently treated. The role of smoking is discussed in relation to the development of bladder cancer. Also, whether health promotion and education are effective in increasing the individual’s awareness of the dangers of smoking are explored.
Innovations in the management of chronic oedema
Authors: Lawrance Sue
Published: May 2014

Chronic oedema is a common problem faced in primary care and community nurses are ideally placed to identify and manage uncomplicated cases. Lymphoedema and chronic lower limb oedema are conventionally treated with multi-layer bandaging followed by compression hosiery, however new innovations are becoming available to help manage this complex condition. This article outlines the basic management of chronic oedema and discusses treatments that are available in specialist lymphoedema clinics such as FarrowWrap™. A case study of the use of FarrowWrap™ is provided to illustrate how effective intensive treatments can be.
Healthy steps: moving to better health with The Lebed Method
Authors: Williams Julia
Published: May 2014

The Lebed Method is an innovative exercise and movement programme using dance and physiotherapy movements to improve lymphatic function, range of motion and to provide therapeutic movement. The method produces lymphatic opening for both upper and lower body lymphoedema. The sequence of slow smooth exercises done with a slight resistance emulates manual lymphatic drainage, making this a useful tool for all lymphodema specialists to be aware of. The classes provide a positive social atmosphere. This article provides an overview of The Lebed Method and informs community nurses about this novel treatment that is growing in popularity and is currently being used in a number of UK hospices.
Silver ion antimicrobial technology: decontamination in a nursing home
Authors: Phillips Paul , Taylor Lesley , Hastings Richard
Published: May 2014

This study aimed to quantify the reduction of bacterial contamination in a nursing home achieved by the presence of silver ion-treated antimicrobial products (BioCote®). BioCote® products were integrated into a single-occupancy residence and swabs were collected over a five-month period from silver-treated products in this residence and equivalent, untreated products in a control residence. Swabs were cultured for total viable counts of bacteria. A mean difference of 94.8% in bacterial counts was observed on BioCote®-treated surfaces compared to untreated products in the control environment. Bacterial counts from a number of untreated objects in the test residence were also lower than equivalent untreated objects in the control environment suggesting reduced levels of cross-contamination in the test environment. Counts of bacteria present in the test environment before antimicrobial treatment support the explanation that reduction of bacterial numbers in that environment over the study period was primarily due to the efficacy of antimicrobial products used. Further studies are needed to determine the beneficial clinical outcome that consistently cleaner environments might offer their patients.
Scrutiny, tissue viability and the future
Authors: Stephen-Haynes Jackie
Published: May 2014

It has been a challenging year, with the ‘credit-crunch’, plummeting house prices, MPs’ expenses and the loss of pensions dominating the news. 2009 has been a year of increased public scrutiny. The NHS has been subject to drastic changes this year and severe financial constraints are predicted—there may be a review of pensions and the way services are provided. Such a review will include the clinical and financial cost of delivering wound-care services.
ROHO Dry floatation technology: implications for clinical practice
Authors: Stephen-Haynes Jackie
Published: May 2014

This article discusses the aetiology of pressure ulcers, the clinical and financial cost of pressure ulcer prevention and the need for pressure reducing equipment. The role of Dry floatation in pressure ulcer prevention and management is explored. How Dry floatation technology works is discussed and its use within clinical practice is highlighted. The evidence to support Dry floatation is presented.
Chronic oedema in patients with CVI and ulceration of the lower limb
Authors: Williams Anne
Published: May 2014

Patients with chronic venous insufficiency and ulceration can have additional problems with chronic oedema, if a combination of venous and lymphatic insufficiency is present. Standard leg ulcer bandaging systems may not be suitable for reducing chronic oedema. This article provides the opportunity for practitioners to learn more about oedema in patients with CVI and to reflect on their current bandaging practice.
Practice-based commissioning: privatization or saviour?
Authors: Hampton Sylvie
Published: May 2014

Practice-based Commissioning (PBC) has been designed by the Department of Health as a simple toolkit that can be used to determine budgets at practice level and is a fair method of sharing resources throughout the NHS. It means that money can follow the patient, enabling them to obtain the best resources in order to address their individual health needs. These resources must be shown to be clinically-effective and cost-effective and will be selected on the basis of good outcomes and can be privately managed or organized within the NHS system. This means that PBC will offer the potential to redesign services while insisting that these services are evidence-based and regularly audited.
An investigation of the role nurses play in Norwegian home care
Authors: Johansen Edda , Fagerström Lisbeth
Published: May 2014

Registered nurses’ (RNs’) role in Norwegian home care services exists in a state of flux owing to the early discharge of patients from hospitals, more time-consuming and complex care for young patients, and a growing number of older care recipients. The aim of this study was to investigate the RN role through an integrative research review, with a focus on nursing activities and competence. This study found that RNs and assistant nurses often perform the same tasks, providing assistance with personal hygiene, medication and wound management. The change towards more medicalized and complex home care entails that requirements pertaining to RNs’ competence, the allocation of RNs’ time and skills to those in most need of nursing care, and the assignment of assistant nurses to lower care levels activities must be delineated. Norwegian home care must examine how care activities can be better allocated between RNs, social educators, assistant nurses, and informal care-givers.
Liberating the NHS; commissioning, outsourcing and a new politics debate
Authors: Regan Paul , Ball Elaine
Published: May 2014

In the short months following the result of the UK 2010 General election, a new Government White Paper has been released entitled: Equity and Excellence: Liberating the NHS (Department of Health (DH), 2010a). It strives to distance itself from previous health-care proposals (DH, 2009), yet if the initiatives of this latest paper are combined against previous initiatives, also using high impact declarative terms, such as competition and choice, it is clear that little has changed and more important principles than saving money are at risk.
Treating urinary incontinence in older women
Authors: Stewart Ellie
Published: May 2014

Urinary incontinence is a common hidden problem which affects up to 30% of older people (Nazarko, 2008). It is often ignored or not treated effectively and often women suffering with urinary incontinence do not present to primary care practitioners, as they perceive it as an inevitable consequence of ageing. This article aims to discuss the types of urinary incontinence and treatments available to older women presenting with urinary incontinence in primary care.
Community palliative care: role perception
Authors: King Nigel , Melvin Jane , Ashby Joanne , Firth Jan
Published: May 2014

Community nurses play a key part in palliative care for patients and their families, yet there is relatively little research examining how their role is understood by nurses themselves. This paper presents findings from a qualitative study exploring how district nursing teams and community matrons (CMs) understood their own and each other’s roles in palliative care. Twenty-four district nurses (DNs), 15 CMs and seven other key stakeholders were interviewed. DNs saw themselves as having a pivotal role, often coordinating other services as well as providing hands-on care. CMs agreed with the importance of the DN role, but had doubts about whether DNs had the capacity or skills to provide genuine case management. Both sets of nurses varied in their views of the CM role in palliative care, from seeing it as negligible to extensive and valuable. Organizational change contributed to the defensiveness of many DNs about their role, and to CMs’ experiences of suspicion towards theirs.
Improving service provision for patients who are prescribed continence products
Authors: Mangnall Joanne , Midgley Kate , Lakin Stuart , Beckitt Liz , Shepherd Laura
Published: May 2014

It is estimated that 14 million people experience problems with bladder control and 6.5 million people have a bowel control problem (Bladder and Bowel Foundation, 2008). Many will rely on continence products to manage their problem and as such require products which ensure user dignity and discretion is maintained. Locally, an ever-increasing spend on prescribed continence products promoted a review of current service delivery. The combined results of a clinical audit and patient satisfaction survey highlighted areas in which service delivery needed immediate improvement. Significant service re-design has been undertaken with prescribing responsibility for continence-related products being transferred from GP practices to specialist nurses working within the continence service. Improvements in clinical care have been achieved and cost savings have been re-invested in the service.
The Equality Bill – simplifying and strengthening anti-discrimination
Authors: Griffith Richard , Tengnah Cassam
Published: May 2014

Last month Richard Griffith and Cassam Tengnah considered how current discrimination law affects district nurse practice. This month they outline the proposals in the Equality Bill, which is being introduced to simplify and extend discrimination law to include socioeconomic factors, discrimination by association and dual discrimination. Significantly for district nurses and the NHS, it will extend discrimination related to age to include the provision of goods and services, such as health care.
Thinking falls - taking action: a guide to action for falls prevention
Authors: Robertson Kate , Logan Philippa , Conroy Simon , Dods Verity , Gordon Adam , Challands Linda , Smith Sue , Humpage Sally , Burn Ann
Published: May 2014

Clinical guidelines and research papers help clinicians measure and understand the risk of falling in their older clients but very few provide the assessor with recommendations as to which interventions they can use to reduce the risk of a fall.

The Guide to Action for Falls Prevention tool (GtA) was developed to help professionals from a broad range of organizations to recognize factors that might increase falls risk and know which actions to take to lessen that risk. Twenty four professionals tested the GtA in a clinical setting and found it quick (15 minutes) and easy to complete. The GtA needs further evaluation to test whether it is a practical way of delivering a falls prevention intervention.
Recognition and treatment of anaphylaxis in the community
Authors: Jevon Phil
Published: May 2014

Anaphylaxis is a severe, life-threatening, generalized or systemic hypersensitivity reaction characterized by rapidly developing airway and/or breathing and/or circulation compromise usually associated with skin and mucosal changes. Calling 999 for an ambulance, positioning the patient appropriately and administering adrenaline intramuscularly are the key initial treatment and management options. The aim of this article is to discuss the recognition and treatment of anaphylaxis in the community.
Making use of clinical evidence to provide quality patient care
Authors: Fletcher Jacqui
Published: May 2014

With the increasing focus on management of health-careassociated infections (HCAIs) and recognition of the cost of this complication which is frequently related to wounds, the development of new patient friendly products to prevent and control infection are becoming a standard item within most wound care practitioners’ tool kit. While the high quality Grade 1 randomized control trial (RCT) -based evidence may be lacking, we must not ignore the evidence gleaned from our own experiences and be aware of broader patient focussed outcomes than just wound healing. Wound infection is hugely expensive both financially and to the patient in terms of pain and suffering so prevention and management of it must become a priority in wound management objectives.
Chronic oedema and lymphoedema of the lower limb
Authors: Hampton Sylvie
Published: May 2014

There is a very fine line between oedema, chronic oedema, lymph venous oedema and lymphoedema with the names ‘chronic oedema’ and ‘lymphoedema’ often used interchangeably. Therefore, there can be difficulty with diagnosis of which condition is present in the individual patient, particularly when another unrelated condition (lipoedema) can also be mistakenly diagnosed as lymphoedema. The most important thing to remember is that, although there is this fine line between the conditions, each part of the disease development cannot be entirely separated or treated completely in isolation.

The key to good outcomes in lymphovenous oedema is to treat it at the earliest stage possible to prevent deterioration, venous ulceration and the almost inevitable cellulitis that is associated with lymphoedema skin changes. This article will aim to promote an understanding of the different conditions and stages, will provide a simple identification of the condition and will discuss how lymphovenous oedema can lead eventually to the very difficult-to-treat chronic lymphoedema with ideas of how to prevent this deterioration.
Managing patients on enteral feeding tubes in the community
Authors: Omorogieva Ojo
Published: May 2014

Despite the psychological effects of enteral tube placement, the use of an enteral feeding tube is of vital importance in patients having swallowing problems and those with deficits in nutritional status. The differences in enteral feeding tubes, their complications and the varied management approaches by health professionals including review criteria have significant impact on the outcomes of patients receiving home enteral nutrition (HEN). In addition, the HEN team is a multidisciplinary team that work closely with district nurses (DNs) and community nurses who review these patients independently. Thus, there is a need to have a harmonized framework in form of algorithm that health professionals can apply in practice and will be beneficial to patients.

AIM: This study was aimed at reviewing the activities of the HEN team and developing an algorithm for the management of patients who are receiving HEN through tube feeding.

METHOD: The activities of the HEN team in terms of the clinical management approach were reviewed in relation to the HEN team policy for managing patients on enteral tube feeding, national guidelines and research evidence. Based on the review, an algorithm for the management of enteral tube feeding was developed.

CONCLUSION: Although the current HEN team clinical management approach is in line with national guidelines, the development of the algorithm for the management of patients receiving home enteral tube feeding was aimed at streamlining the various management approaches and standardizing practice.
Assessment of neuropathic pain in the community
Authors: Taverner Tarnia
Published: May 2014

The purpose of this paper is to provide the reader with evidence based-clinical guidance regarding assessing neuropathic pain. Persistent pain is a huge burden on health-care provision and the prevalence of persistent neuropathic pain is likely to increase owing to the ageing population. The provision of appropriate relieving interventions depends on accurate assessment. This paper sets out to provide the reader with simple neuropathic assessment tools that can be applied to community care. This will allow the community nurse to identify patients who have neuropathic pain and will therefore enable appropriate management.
Skin care in the older person: identifying and managing eczema
Authors: Van Onselen Julie
Published: May 2014

Eczema is a common skin condition in older people. Eczema is a long-term condition and older people may have had atopic eczema for many years; it may also be an acute condition, caused by a drug reaction. Many older people experience eczema and dermatitis for the first time as a consequence of ageing skin or triggered by environmental factors. Community nurses need to be able to assess older people's skin and recognize any signs and symptoms of eczema to ensure prompt treatment and good ongoing skin care.
Xerosis of the feet: a Title comparative two-deck study on the effectiveness of two moisturizers
Authors: Baalham Paul , Birch Ivan , Young Maria , Beale Clare
Published: May 2014

The treatment for xerosis (dry skin) is the repeated use of moisturizers to hydrate the skin. Their use is based on sound evidence of the importance of maintaining the skin's water content. Although the skin on the plantar surface of the foot is very thick, it is highly visco-elastic and copes with high levels of frictional, compressive and shear stresses applied to it by being supple and well hydrated. Problems arise when the skin becomes dry and loses its elastic properties. Fissures can occur which are often painful and can act as portals for infection. This article describes a double-blind clinical study to evaluate and compare the effectiveness of two commonly used moisturizers and to see if one was significantly better than the other at hydrating the skin of the feet. The two creams used were Aqueous Cream BP and CCS Foot Care Cream. Skin hydration levels were measured before any application of moisturizer and again after two weeks of twice daily application. Results showed that the regular use of both moisturizers had a significant hydrating effect on the skin. However, CCS Foot Care Cream had a significantly greater hydrating effect than Aqueous Cream BP.
Whistleblowing and the law
Authors: Griffith Richard , Tengnah Cassam
Published: May 2014

The Government wants to empower nurses to speak out to protect their patients without fear of being victimized or dismissed and are looking to amend the NHS Constitution to strengthen protection for staff who blow the whistle on poor practice. Currently whistleblowers are protected by the provisions of the Employment Rights Act 1996 as amended by the Public Interest Disclosure Act 1998. This allows a whistleblower to appeal to an Employment Tribunal for reinstatement if they are dismissed or victimized as a result of their actions.

The protection currently offered under the 1996 Act is not absolute and a nurse who wishes to pass on information about bad practice in the interests of their patients must be sure to follow the requirements of the Employment Rights Act 1996 and their employer's whistleblowing policy before their disclosure qualifies for protection.
Patient-reported outcome measures: an overview
Authors: Meadows Keith A
Published: May 2014

With the increasing prominence of the patients' involvement in the care they receive, the assessment of outcomes based on the patient's perspective using patient-reported outcome measures (PROMs), are increasingly accompanying the traditional clinical ways of measuring health and the effects of treatment on the patient. This article provides an overview as to what PROMs are and the different health constructs they are purported to measure. Differences between generic and disease-specific, multidimensional and index scored PROMs are also described. Factors relating to the choice of a PROM are discussed with a particular focus on the importance of developing a measurement strategy and endpoint model to ensure the appropriate PROM is selected to measure the desired outcome. Examples of the application of PROMs are given together with some of the methodological approaches to interpreting PROM data. Finally, issues on maximizing the benefits of using PROMs are briefly discussed.
Communicating and coping: essential end-of-life care skills
Authors: Cook Rosemary
Published: May 2014

The QNI has introduced a palliative care award for nurses. Rosemary Cook explains the origin of the award and why Angela Parle was chosen to receive it.
Non-concordance in lymphorrhea of the lower limbs: a case study
Authors: Jones Joanne
Published: May 2014

Obesity and a sedentary lifestyle are fast becoming major problems for not only the NHS as a whole but also the lymphoedema therapist. Lymphorrhea in this group of patients can be a recurrent problem, causing strain on already stretched services and on the patient and their family. What happens when the ideas of the patient and therapist regarding treatment are not the same? This article aims to address these issues by looking at a case study of such a patient, and the surprising outcome that resulted when the patient got his own way.
Mr Vin's story: interview with a bariatric patient
Authors: O'Neill Caitriona , Worboys Fran
Published: May 2014

The following article follows a discussion with a bariatric patient that has longstanding secondary oedema owing to venous insufficiency, post-thrombotic syndrome complicated by obesity, repeated cellulitis and chronic obstructive pulmonary disorder. The main aim of the interview was to look at the patient journey and the challenges patients may experience. Lymphoedema is a lifelong condition which will progress if it is not appropriately treated. As in Mr Vin's, case many patients suffer physical symptoms that can be debilitating such as pain, discomfort, heaviness, and distortion of the limb shape, leading to reduced mobility and function. If the ltmphoedema is recognized early with prompt and appropriate treatment; patients can avoid some of the complications. Mr Vin has been able to turn his life around following effective treatment, but his journey to this point has not been as easy one as he will explain.
Smoking cessation: promoting the health of older people who smoke
Authors: Phillips Adele
Published: May 2014

Community nurses are well placed to address smoking behaviour with older people. Smoking cessation can significantly improve the health and wellbeing of older people, and to withhold support for smoking cessation is a form of age discrimination. This paper provides advice to community nurses about how to approach discussions about smoking behaviour with older clients as part of their health education practice. It addresses some of the ethical concerns that have been raised by community nurses, explains how smoking in older people may be reduced using a harm reduction approach and through working with the concept of the smoke-free home.
The diabetic foot: an overview for community nurses
Authors: Turns Martin
Published: May 2014

Diabetic foot problems are a common complication of diabetes. They can lead to much morbidity and some mortality, with foot disease the leading cause of non-traumatic lower-limb amputation in the developed world. Diabetic foot disease is a result of three main pathologies, which can occur singly or in combination: diabetic peripheral neuropathy, peripheral arterial disease and infection. The consequences of these pathologies are ulceration, Charcot foot, painful diabetic neuropathy, gangrene and amputation. This article offers a podiatrist's view of the management of diabetic foot problems, from initial assessment to the management of complex disease. Patients with a diabetic foot problem must be assessed thoroughly and referred to the local multidisciplinary team where appropriate. Recurrence of ulcers is common, so good foot health education, adequate footwear and regular podiatry (if necessary) must be an integral part of the patient's review process. Community nurses are often the first to detect a diabetic foot ulcer in housebound patients, so they need the necessary skills to manage the ulcer effectively and refer patients appropriately.
Enhanced recovery, stomas and the community nurse
Authors: Burch Jennie
Published: May 2014

Enhanced recovery after surgery (ERAS) is gaining interest worldwide, to improve patient care in relation to their surgery. ERAS is a set of elements that are used to guide the multidisciplinary team in caring for patients before, during and after surgery. This ERAS care challenges traditional care, but it is research based and has been shown in many settings to be effective. There are no specific recommendations for post-discharge care in the remit of the community nurse, but this is extracted from the published literature and personal experience of enhanced recovery. This article will explore issues related to ERAS and how this may affect the community nurse. Issues surrounding stoma care will be explored, including how the community nurse can aid the care of this patient group.
Case management: developing practice through action research
Authors: Smith Annetta , MacKay Seonaid , McCulloch Kathleen
Published: May 2014

This article is a report of an action research study carried out with community nurses to help develop case management within their practice. Using action research principles, nurses reviewed and analysed their current practice and developed recommendations for further embedding case management as a means of supporting patients with complex care needs in their own homes. Findings indicate that a number of factors can influence the community nurse's ability to implement case management. These factors include approaches to case finding, availability of resources and interprofessional working. Important considerations for nurses were the influence of the context of care, the geographical location and the health needs of the local patient population, which meant that case management may need to be adapted to meet local circumstances.
The Lindsay Leg Club: supporting the NHS to provide leg ulcer care
Authors: McKenzie Morag
Published: May 2014

Public health services will need to cope with additional demands due to an ageing society and the increasing prevalence of chronic conditions. Lower-limb ulceration is a long-term, life-changing condition and leg ulcer management can be challenging for nursing staff. The Lindsay Leg Club model is a unique partnership between community nurses, members and the local community, which provides quality of care and empowerment for patients with leg ulcers, while also supporting and educating nursing staff. The Leg Club model works in accord with core themes of Government and NHS policy. Patient feedback on the Leg Club model is positive and the Leg Clubs provide a service to members which is well accepted by patients, yet is more economically efficient than the traditional district nursing practice of home visits. Lindsay Leg Clubs provide a valuable support service to the NHS in delivering improved quality of care while improving efficiency.
Individualisation of care and the obesity paradox
Authors: Haslam David
Published: May 2014

The obesity ‘paradox’ has recently been discussed based upon the observation that although obesity may be a major causative factor in certain conditions, its presence appears to be protective once that condition occurs. There is a growing body of persuasive evidence to support the obesity paradox in diseases including renal failure and heart failure. Recent evidence is reliable, adjusting more effectively for confounders such as smoking and intercurrent illness, which make lower weight an unhealthy state. The existence of the paradox highlights the fact that approaches to weight management are not as simple as inducing the loss of a few kilograms in overweight and obese individuals, and emphasises the importance of individualisation of care in obesity management taking into account age, ethnicity and comorbid illness. This article explores the individualisation of care in obesity, drawing attention to the obesity paradox in particular.
A practice-based survey of patients dying in hospital: can we do more to support end-of-life care at home?
Authors: Lakasing Edin , Kulkarni Sadhana , Sparkes Carly , RaviChander Radhika
Published: May 2014

An analysis of patients dying in hospital was carried out in a practice. The research showed that patients with non-malignant disease are over-represented. Despite good district nurse support, identifying those likely to die and predicting death is more difficult than with cancer. There is a high rate of admission from nursing homes, and a reluctance by patients and relatives to discuss likely death is mirrored by uncertainty among clinicians.
Continuing to learn from Francis
Authors: While Alison
Published: May 2014

‘While health service managers are aware of the need to improve the quality of care for their patients, there are clear tensions with achieving financial performance which may require major service reconfigurations.’
The role of the wound care nurse: an integrative review
Authors: Dutton Matthew , Chiarella Mary , Curtis Kate
Published: May 2014

The role of the wound care nurse has developed to meet the need for expert wound care advice. Internationally, the role has developed with a variety of different titles. Although all positions have some common tasks and obligations, there remain gaps in knowledge around the role of the wound care nurse. This article aims to determine the state of knowledge in relation to the context of practice, scope of practice and impact of the wound care nurse. An integrative review design was used to allow a broad search strategy and to gather papers from a variety of sources. A multi-method search strategy of the literature published between 1980–2011 was undertaken. This included 5 electronic databases, a thesis search and manual search. It was found that the characteristics of the patients wound care nurses care for reflect an ageing population and disease processes, including diabetes and obesity. Internationally, there is little consensus on the level of competence, educational requirements and qualifications required to practise as a wound care nurse. There was some evidence that the wound care nurse improved healing times and decreased pressure injury prevalence.
Every healthcare assistant counts in Croydon PCT
Authors: Cressey Sue
Published: May 2014

At Croydon PCT, we ensure that healthcare assistants (HCAs) are valued members of the primary care team who are offered support and training that will support registration when it happens Development of knowledge and skills is essential for everyone providing healthcare today, not only to provide safe and effective care, but to help contribute to feeling a valued member of the team. With registration looming for HCAs this becomes an issue that will need addressing sooner than later. In Croydon we think we are on track.
Just say no!
Authors: Vaughan Paul
Published: May 2014

How goes it folks? Don't the months just fly by? Before we know it, it will be Christmas all over again. Sometimes it feels like there are just not enough hours in the day to do everything and at other times it feels that time is dragging, and waiting for a decision about the regulation of healthcare assistants (HCAs) and assistant practitioners (APs) is one of those times.
Modernizing cancer care in the NHS in England
Authors: Jackson Timothy
Published: May 2014

Cancer care is increasingly becoming an area of care that healthcare assistants (HCAs) and assistant practitioners (APs) are involved in. It is important to understand policies around the care of cancer patients and the development of the healthcare support worker's role in this area of care. This article explains these developments and their relevance to HCAs and APs as well as to other healthcare providers.
The developing role of the assistant practitioner
Authors: Howard Michelle , Butcher Em
Published: May 2014

Em Butcher and Michelle Howard were the project leads for a training development for assistant practitioners and therapy assistants, they explain how the training worked and its benefits across healthcare
Understanding dementia: neurological impairment
Authors: Hobson Pat
Published: May 2014

Dementia is a disorder that affects many people today and because of our ageing society, is set to rise within the next few decades. As a result the care required to meet the needs of people with dementia will also become an issue. As a dementia care worker one of your unique roles is to maintain the quality of life for the person with dementia and enable the individual to maximize their potential. However, to enable you to fully meet the needs of the person with dementia you need to understand some of the most fundamental facts in relation to how dementia affects the person. This article will focus on one of the five defining attributes of the person centred concept: neurological impairment.
Understanding autonomic dysreflexia: a guide for HCAs
Authors: Foxley Susan
Published: May 2014

Healthcare assistants may well assist other healthcare professionals to provide bowel care for patients who have had a spinal injury. This care, often complex in nature, needs to be holistically planned for each patient, which avoids crisis management in this very bothersome problem. Autonomic Dysreflexia is classified as an acute medical emergency, whereby removal of the offending stimulus, as described by Cardozo (1997) usually offers a complete cure.
Mental health: problems linked with HIV
Authors: Peate Ian , Beary Thomas
Published: May 2014

There is rising trend in the incidences of HIV nationally and globally. A diagnosis of HIV can bring with it a myriad of problems and difficulties both physically and psychologically causing significant distress. Healthcare assistants and assistant practitioners will, as a result of this increase, come in to contact with more people who are HIV positive, these people will require care and treatment if appropriate. Poor health - physical and mental can affect anybody at any time. Those with HIV are more likely to experience a range of physical and mental health problems. The psychiatric manifestations of HIV encompass a broad spectrum of clinical presentations including affective distorters, personality changes and problems associated with cognition.
The Health Care Academy: a route into employment
Authors: McEwan Robert , Smith Alison , Laing Joan
Published: May 2014

Scotland is seeing a rise in long-term illnesses among the elderly population and life expectancy is low compared with most Western European countries (The Scottish Government, 2006). With this decline, it is imperative that Scottish people have a strong health service to rely on. Though the NHS is no stranger to problems with functioning effectively, there are training progammes which are helping to build it up and provide a competent, skilled workforce.

NHS Tayside Healthcare Academy provides training for people who are unemployed and many of its students have trained to be healthcare assistants, some are even planning to progress into the role of registered nurse. This article gives an overview of the academy and what training is available for those interested in joining the NHS workforce.
Time is of the essence
Authors: Vaughan Paul
Published: May 2014

Not to make you all jealous but here I am sitting by the pool in Skala, Kefalonia (Greek Island) writing this piece in the glorious sunshine. I have finally managed to get myself organized at this point in the year to have had a summer holiday. I have been busy organizing free workshops and a free conference for healthcare assistants (HCAs) in October and trying to make sure that the voice of HCAs and assistant practitioners (APs) is heard in all the right places. Life for all of us can be a bit like that these days, always got something to rush for and somewhere to get to and a need to get there fast. When do we in the course of our normal day take time out to think about what we are doing? So it is no surprise to me to hear from HCAs that they find little or no time to plan their personal and professional development.
Coping with respiratory problems and care advice
Authors: Vale Rosie , Cross Sue
Published: May 2014

I became a living donor transplant patient for my son Shaun, ten and a half years ago. He suffered from Cystic Fibrosis and was twenty-four years old when his health began to deteriorate rapidly. We agreed as a family that if there was any way we could help Shaun we would do anything in our power to. Shaun's consultant at the Royal Brompton Hospital consented to our attempt to provide a living donor lung transplant in an effort to save his life. My eldest son Bobby and I donated lung to Shaun. The right lower lobe was taken from Bobby and the left lower lobe was taken from myself, in an effort to give two healthy lungs to Shaun. Sir Magdi Yacoub and his team at Harefield hospital performed the operation.
Ghosts of Christmas past
Authors: Jones Menna Lloyd
Published: May 2014

‘Oh I wish it could be Christmas every day’ How many times have I heard the words of that song and I guess that while most children wish it could be Christmas every day, a lot of us I'm sure are glad that it's not.
Ageing part 2: the musculoskeletal system, the skin and the senses
Authors: Peate Ian
Published: May 2014

The first article in this series (Peate, 2007) considered the affects ageing has on the nervous and the cardiovascular systems.

This article continues with a focus on the musculoskeletal system, the skin and the five senses. The physical ability of older people is often reduced as they age. It is important for healthcare assistants and assistant practitioners to have a good understanding of why these changes are taking place and this article provides an overview of how these different systems of the body are affected.

The third and final article in the series will focus on the gastrointestinal, the endocrine, the immune and the genitourinary systems.
Living with Vacuum Assisted Closure® therapy
Authors: Westwood Nigel , Morris Clare
Published: May 2014

Why do I feel able to write about Vacuum Assisted Closure® (V.A.C.®) therapy and wound care? It's a long story and first I need to will tell you a little about me. For 25 years I was an officer in the Royal Navy, but I had to leave in 2000 after a pan-proctocolectomy because of ulcerative colitis. It became a permanent ileostomy and while my stoma and loss of earnings represented quite a shock for me and for my self image, I was able to get on with my life.
Should healthcare support workers perform smear tests?
Authors: Grainger Angela , Owen Marnel
Published: May 2014

Registered nurses will be dismayed when I say yes, I think that the competences required in taking a Papanikolaou (PAP) smear could be within a specified role remit of a healthcare assistant (HCA), or assistant practitioner (AP). The purpose of a smear is to detect pre-malignant, or malignant cells on the surface of the cervix. Prior to undertaking the smear the patient's overall health and the status of the cervix is assessed. If a patient has been referred to a gynaecologist, or has reported a physiological change such as a vaginal discharge then an advanced assessment of the patient's needs, including the taking of the cervical smear, is a more complex matter. A specialist registered practitioner should be taking the smear as part of a holistic examination.
The general practice nursing career framework
Authors: Dunbar Amanda
Published: May 2014

In recent years government policy has dictated a significant shift in the focus of healthcare, with the primary focus now being toward primary care. This area of practice has seen many changes with the number and variety of clinical roles expanding significantly in order to meet the public's demands for more flexible, local healthcare delivery. The focus of healthcare has shifted towards management of long-term conditions, with a focus on monitoring and prevention of reactive or unplanned care episodes and health promotion and public health. General practice nursing has seen the roles develop to encompass all of these roles, with an increasing amount of general practice nursing now taking the form of first contact care.
Breast screening unit
Authors: Daly Vanessa
Published: May 2014

I am an assistant practitioner (AP) in mammography at Kings College Hospital NHS Foundation Trust. As an assistant practitioner I work under the supervision of a senior radiographer, performing standard mammographic images for both screening and symptomatic clinics. I also carry out department duties.
Care at Christmas
Authors: Green Barrie
Published: May 2014

I recently asked my children what Christmas means to them, their response identified four themes; family, fun, hope and presents. Exploring it further by asking what it must be like for people who were ill in hospital at this time of year, their horror was clearly evident, my youngest could not comprehend why anyone would not be at home.
Hypothermia: causes and management
Authors: Kemp Philip
Published: May 2014

Hypothermia is a life-threatening condition which can be fatal if it is not treated immediately. However, it can be easily prevented and so it is vital that healthcare assistants and assistant practioners are aware of the signs and symptoms.
Stoma care and the role of the healthcare assistant
Authors: Burch Jennie
Published: May 2014

Stomas are relatively common within healthcare and healthcare assistants (HCAs) are likely to care for many people with stomas. This article explores the different types of stomas, what they look like, the output expected from each type of stoma, diet, the appliances used, how to change and empty an appliance and the role of the HCA in caring for ostomates.
Body fluids: Components and disorders of the blood
Authors: Peate Ian
Published: May 2014

Anatomically and histologically blood is not classified as a fluid, it should more accurately be known as connective tissue. Blood has its origins in the bones and contains potential molecular fibres - fibrinogen and as such is tissue (White et al, 2007). However, for the purpose of this series, it will be included under the category of fluid.

Blood is a red, sticky liquid that is vital for life; it is the life-giving fluid of our bodies and is pumped by the heart via the circulatory system (the blood vessels) throughout the body. Blood forms the main transport system of the body. Every cell in the body gets its nutrients from blood, without blood, cells and tissues will die. An understanding of blood can help you in your day to day work.