bluuebunny/crossref_metadata_2025 huggingface dataset:
How to restore the public’s faith in MMR?
Authors: Pollard Tom
Published: May 2014

Does anyone else share my tooth-grinding frustration at the perpetuation of the MMR ‘debate’? Here is an issue that should have been forgotten long ago, but instead drags on for years, causes untold anxiety and puts a whole generation of children at risk of some very nasty diseases. The impact of the irresponsible knee-jerk reaction of the tabloid press in particular, and subsequent refusal to acknowledge the weight of world opinion on this matter, has left the UK’s vaccination programme in tatters. The scare has been largely confined to the UK, so why is the UK uniquely susceptible to this malaise?
Building consensus in health care: a guide to using the nominal group technique
Authors: Allen Jane , Dyas Jane , Jones Margaret
Published: May 2014

The nominal group technique has been used in the health care sector in the development of guidelines and the identification of research priorities. The methodology suits research that includes both health professionals and consumers, since it allows for the free exchange of opinions and the generation of ideas within a structured and non-hierarchical discussion forum. This article describes the process of planning and running a nominal group and uses examples from a primary-care-based study to illustrate some of the advantages of using this method, and also the practical implications of using the technique in consensus development.
The awful truth about abuse of older people
Authors: Pollard Tom
Published: May 2014

Half a million older people are currently being abused in England. This truly chilling figure, from the hard-hitting Commons Health Select Committee report, Elder Abuse, may not even reflect the whole picture. How on earth have we reached this deplorable situation?
Exploring the contribution of district nurses to public health
Authors: Arnold Phil , Topping Annie , Honey Stephanie
Published: May 2014

To date the public health role of district nursing has been less well defined than in other branches of community nursing. A qualitative study examining the public health role of district nurses was undertaken in a West Yorkshire primary care trust. The study explored the range of public health activities currently undertaken by district nurses, the agendas perceived as most conducive to input and the organizational barriers that prevented greater involvement in public health from district nurses. Focus group and individual semi-structured interviews were undertaken with 21 members of the district nursing team and analysed using thematic content analysis. The findings suggest that district nurses were already undertaking a range of public health and health education activities but much of the work was opportunistic. District nurses perceived themselves as well placed to undertake locally-based health action because of their profile in the local communities together with local intelligence. However, ineffective referral criteria were considered to be the most prohibitive barrier against making a greater contribution to health improvement.
Essence of Care: implementing continence benchmarks in primary care
Authors: Cotton Julie A
Published: May 2014

Essence of Care is a national programme which was launched in 2001. The document provides a set of national benchmarks which are evidence based. The benchmarks focus on basic care as identified in a First Class Service (DH, 1998). The programme has been implemented widely by acute services, however with community and primary care services, the take up appeared to have been spasmodic. A conference in 2003 ‘Implementing Essence of Care in Primary Care’ described the implementation of Essence of Care in Primary Care as a ‘challenge’. This article identifies the implementation of the continence benchmark within a PCT. The article details the process and the difficulties encountered within primary care, but also details the benefits of utilising the model despite a labour intensive process. In particular the article suggests the importance of incorporating the benchmarks into current systems within the PCT in order to avoid duplication and extra layers of groups and meetings. Finally the article highlights some of the benefits which the PCT consider the process has achieved to the continence service.
The law of negligence and community nursing: a case study
Authors: Griffith Richard , Channon Ceri
Published: May 2014

Liability for carelessness is given its legal expression in the law relating to negligence. It is undoubtedly a frightening prospect for any professional to face a negligence claim. As well as any damages that may be awarded, Julia faces having her professional integrity and good name challenged in court and the prospect of further action being taken against her by her employer and regulatory body. This article considers the elements of a negligence action and how these are applied to health care.
Community matron gets cautious response
Authors: Pollard Tom
Published: May 2014

Most people have welcomed the broad thrust of the Government’s latest policy document for the NHS in England, The NHS Improvement Plan (Department of Health, 2004). Further increases in NHS staff numbers, further reductions in waiting times and more money for the service are laudable, if predictable, aims. One element of the Plan, however, has caused some initial consternation among the professional organizations that represent nurses in the community. By 2008, the Government intends to have created 3000 new clinical specialist posts, those of community matron. But what is this job and who will do it?
Developing practice through the professional imagination
Authors: Winter Richard , Hungerford Kathryn , Paget Claire
Published: May 2014

How can the perspective of the service user be made real and helpful in the professional education of community nurses? This article presents one answer to this question through encouraging nurses to write fictional accounts of how their practice appears to their own service users. Arising from a research project on the ‘patchwork text’ assignment format in a professional degree course at Anglia Polytechnic University, the article presents two such accounts by community nurses undertaking the course. Their accounts illustrate the insights into professional issues that are produced by an explicitly imaginative exercise. A particularly important outcome, not expected by the researchers, was that the commentaries written by the nurses on their imagined scenarios, led, not to a discussion of ‘issues’ (as in many cases) but to a precise and practical critique of their actual practice, suggesting a further dimension of the educational value of writing fiction as part of professional education courses.
Accountability is an issue for all nurses
Authors: Gibson Louise
Published: May 2014

Superman was killed, not by kryptonite, but by a septic pressure ulcer. Actor Christopher Reeve, paralysed in a fall 7 years ago, was ultimately the victim of a preventable complication. Whose fault was this?
The Mental Capacity Bill 2004: its impact on district nurse practice
Authors: Griffith Richard , Tengnah Cassam
Published: May 2014

The government made clear its intention to reform the law relating to mentally incapable adults in the Queen’s speech at the state opening of Parliament in November 2004. In this article Richard Griffith and Cassam Tengnah outline the main provisions of the Mental Capacity Bill and assess its likely impact on district nurses who care for adults with incapacity.
Advising patients with medication-related dysphagia: caution required
Authors: Griffith Richard
Published: May 2014

District Nurse Sister Mary Evans is caring for a patient John, who is very overweight and has angina and type two diabetes. John takes medication to assist in managing these conditions, namely verapamil for the angina and metformin for the type two diabetes. Sister Evans has recently noticed a deterioration in John’s health and when pressed he admitted that he had stopped taking his medication as he was having great difficulty swallowing the tablets especially metformin which he described as a ‘big horse tablet’. Sister Evans emphasises how important it is for John to take his medication regularly and advises his wife to crush the tablets and mix it with his food to assist with swallowing and ensure that he takes the prescribed medication.
Developing motivation and empowerment in diabetes care
Authors: Rodgers Jill
Published: May 2014

Management of incurable chronic diseases, such as diabetes, relies to a great extent on the active participation of the individual with the disease. Yet a diagnosis of diabetes can have a significant psychological impact on someone which affects their motivation to participate. Management of the disease therefore requires a different approach to care than the curative approach which nurses are taught. This article examines techniques that can be used to engage people in their own care, increasing motivation and empowerment and leads to greater self-management of their condition.
Human rights and district nursing practice
Authors: Griffith Richard
Published: May 2014

The main provisions of the European Convention on Human Rights were incorporated into UK law in the Human Rights Act 1998. Human Rights were described by Lord Hoffman in Matthews v Ministry of Defence [2003] as the rights essential to the life and dignity of the individual in a democratic society. The fundamental nature of the rights demand that district nurses must inform their practice with a clear understanding of the main provisions of the Act and how they apply to health care.
Is morphine for chronic pain addictive?
Authors: Cowan David
Published: May 2014

Problematic drug use, including psychological dependence, is a major concern when considering the long-term use of strong opioids, particularly if this occurs, as has been claimed, at relatively low therapeutic doses (Glatt, 1974). While studies have generated data to challenge this assumption (Cowan et al, 2001; 2003), there is a need for more empirical evidence.A randomized, double-blind, placebo-controlled, cross-over study was undertaken to address the above fears in chronic non-cancer pain (CNCP) patients managed in the community (Cowan et al, in press).
Barbara Stuttle: a life-long champion of pioneering nurses
Authors: Pollard Tom
Published: May 2014

Barbara Stuttle is passionate about everything she does. Even when I caught her at the end of two long days the Association for Nurse Prescribing’s annual conference, she oozes passion, drive and a no-nonsense aura, coupled with a genuine (and extremely endearing) humility.
Will new matrons boost ‘grey’ health care?
Authors: While Alison
Published: May 2014

With a general election approaching, all political parties will be acutely aware of the increasing importance of the ‘grey’ vote. Older people represent a growing proportion of the electorate, and as major users of public health services, they will expect parties to develop strategies to overcome the current shortcomings in health care provision. Much will be made of investment in health services and meeting targets, however, most older people will be more concerned about the quality of health care outside hospitals.Shorter hospital stays mean that those who are admitted have only a relatively fleeting glimpse before discharge home or to intermediate care. What matters is the quality of primary care.
Health protection and age-related legislation
Authors: Griffith Richard
Published: May 2014

Community children’s nurse Debbie James has developed an innovative scheme to allow secondary school children to obtain health advice by texting her service using mobile phones. As well as general advice about spots and rubella immunization, Sister James is also receiving enquiries about children’s legal rights that also have a health protection purpose, such how old a child has to be before owning a pet or have an alcoholic drink. This article looks at how the law seeks to protect children by incrementally giving them legal rights as they develop to mature adults and how legal awareness can help inform community health practitioners’ advice to their child clients.
Community powers under the Mental Health Act: care or control?
Authors: Griffith Richard , Tengnah Cassam
Published: May 2014

District Nursing Sister Janet Jones had been visiting a young patient, Peter James, 20, at his bedsit on a weekly basis to assist him with the management of his diabetes. However some 6 months ago Peter stopped eating and began refusing to take his insulin because he believed that they had been contaminated by alien dust. Sister Jones and the GP also noticed that Peter was drinking considerable quantities of alcohol and there were reports of him engaging in bizarre sexual rituals. Concern about Peter’s mental health and refusal of treatment resulted in him being detained under the Mental Health Act 1983. Sister Jones has now received a request from the mental health unit to visit Peter at his home during a period of leave he has been granted by his responsible medical officer (RMO) and to continue visiting as part of his aftercare arrangements when he is discharged. Sister Jones wonders if the mental health team will be able to manage Peter in the community given his previous reluctance to accept treatment and how Peter will afford the aftercare package of home care support and meals on wheels provided by the local authority.
Social care for older people is failing
Authors: Pollard Tom
Published: May 2014

Inadequacies in social care provision have long been a source of frustration for district nurses. Countless times, nurses have paid their weekly visit to a client to find them unvisited, unwashed, unfed and unsupported. Despite increasingly close working between health and social services in some areas, there are still far too many people falling between the gaping gaps that exist between service commissioners and service providers.
Wills and the district nurse: the importance of caution
Authors: Griffith Richard , Channon Ceri
Published: May 2014

John Williams is 65 years old, housebound and lives alone. He is widowed – his wife died 12 months ago – and he has 3 children. The eldest two are his stepchildren, Jack (40 years) and Bert (35 years). The youngest child is his biological daughter, Sarah, who is 28 years old. He has not seen his eldest children since his wife’s funeral and Sarah has her own family and only visits occasionally. He is visited by Julie Davies, his district nurse on a daily basis due to a recent bout of ‘flu from which he is finding it difficult to recover. He has early-onset Alzheimer’s disease. Julie visits one day to find John in a very low, yet determined mood. He does not feel that he has long left in this life and has drafted a will which he would like Julie and the next door neighbour to witness. Julie notices that the will contains two bequests: one of £5000 is to his neighbour; the second, to his stepson Jack, is of the remainder of his estate ‘in full confidence that Jack will share it with the other children as he sees fit’. Julie does not want to get involved but feels pressurized by John into signing and witnessing the will. John dies a week later. Julie is notified that the will is being contested by Sarah.
NHS changes promise an uncertain future
Authors: Pollard Tom
Published: May 2014

Just as everyone was getting to grips with one reorganization of primary care, so another one comes along out of the blue to upset the apple cart again. The NHS Chief Executive, Nigel Crisp, has announced a major restructuring of primary care to begin in just a few months’ time.
Don’t ignore unqualified practitioners
Authors: Gibson Louise
Published: May 2014

The current diversity of practice in nursing is unprecedented, and continues to expand at an increasing pace. The Royal College of Nursing/Department of Health (2005) report examining advanced and specialist roles highlights that, through the development of these roles, nurses are transforming how health care is being delivered. The report highlights that nurses working in such roles see themselves as ‘maxi nurses’ not ‘mini doctors’ and that nursing skills are essential to their job.
Bandages and difficulty with bathing: introducing Seal-Tight
Authors: Lindsay Ellie
Published: May 2014

Patients with compression bandages experience difficulty with bathing due to the possibility that bandages may become wet and affect the wound. Bandage and dressing changes resulting from accidental wetting also cost the NHS considerable time and money. This product focus highlights the social and psychological impact on the patient when they are unable to bathe and offers a solution to the problem. Seal-Tight® is a product that has been newly placed on the drug tariff, making it widely available to all patients who wear bandages (or plaster casts). Seal-Tight® enables the patient to bathe, in some cases for the first time for months or even years.
A web-based programme for hospital and community student placements
Authors: Clark Carol , Stevens Christine
Published: May 2014

A web-based clinical placement information project was implemented through a partnership between one university, an acute trust and one primary care trust. The collaborative project was developed as a result of the concern regarding a lack of parity of information and learning opportunities for students between individual placements in the area and in recognition that both higher education institutions and service providers are responsible for the quality of the learning opportunities provided for students. Student nurses are given a 10–14 week hospital or community placement in an area that can be up to 30 miles away from the university campus. Problems arise from this geographical separation and the diversity of placements in the area. The web site provides a resource of contact details and information of possible learning experiences for students, outlining the aims and objectives of the placements and services in the area.
Throwing the spotlight on older people in the UK
Authors: Rossall Phil
Published: May 2014

This article, brought to you in association with Help the Aged, highlights the Charity's Spotlight report, which provides an annual snapshot of the concerns and preoccupations of the UK's older people.
Evidence that nurses make a difference
Authors: While Alison
Published: May 2014

These are difficult times for nurses and nursing. Financial expediency now takes precedence over all other considerations and not a day passes without another headline about redundancies or newly qualified nurses unable to find jobs.
Do people with cancer comply with oral chemotherapy treatments?
Authors: Escalada Paula , Griffiths Peter
Published: May 2014

Many people with cancer have oral medication as part or all of their regime. This medication is primarily self administered in the community. This mini-review aimed to determine the level of compliance of adult cancer patients with oral chemotherapy and to assess the quality of the available evidence. Searches were undertaken using three electronic databases (Medline, Embase, CINAHL) for studies which evaluated the compliance of adult cancer patients with oral antineoplastic agents through self-report, pill counts, drug/metabolite levels or microelectronic monitoring system (MEMS). Articles were selected if the follow-up was higher than 80% of patients. Six papers were identified for the review. The methodological quality of the studies was poor. The sample size of the majority of them was small and the method used to measure adherence was not entirely reliable. The results of these papers were varied and contradictory. A firm conclusion can not be drawn because the studies present significant methodological flaws. The comparison of results between studies is difficult due to the lack of a gold-standard measure of adherence and a standardised definition of non-compliance. Further research in this area is needed. However it does appear that compliance is a problem in this patient group.
Supporting older people: Care needs and care fees
Authors: Spiers Philip
Published: May 2014

In this article, brought to you in association with Help the Aged, Phillip Spiers discusses the different options for older people who are not coping at home needs and directs carers to sources of financial support with care.
Challenging the assumptions of skill mix
Authors: While Alison
Published: May 2014

The dire financial state of some NHS trusts is leading to extreme measures. Struggling PCTs are tightening their belts and re-examining their employment of trained nurses; both their clinical grading and whether health-care assistants (HCAs) can substitute in various areas of work. The possibility of employing a cheaper workforce has obvious attractions, but it will have consequences both for quality of care and the morale and long-term development of the qualified nursing workforce.
Intermittent self-catheterization: principles and practice
Authors: Robinson John
Published: May 2014

Intermittent self-catheterization (ISC) is becoming more widely used by patients to drain their urinary bladder rather than having a long-term indwelling urinary catheter. ISC can be undertaken by people of all ages to empty their bladder of urine or by a nurse or doctor to measure residual urine after the patient has passed urine. Those patients unable to undertake the procedure themselves may have the procedure undertaken by a parent, spouse, carer or nurse to drain their bladder of urine. Modern day intermittent catheters can be used almost anywhere when drainage of the urinary bladder is required.
Supporting older people: Unmet foot-care needs
Authors: Ellis Jonathan
Published: May 2014

In this article, brought to you in association with Help the Aged, Jonathan Ellis makes the case for greater emphasis on basic foot care provision by primary care organizations.
Making decisions for incapable adults 3: protection, guardians and advocates
Authors: Griffith Richard
Published: May 2014

District nurse Jane Simmons has concerns about a patient in her care who she suspects of being abused by her son. The patient has been left paralysed and unable to communicate by a stroke and cannot confirm the district nurse's suspicions. Both the nurse and the GP feel that the patient would be better managed in a care home, but her son refuses to consider the possibility. A vulnerable adult case conference concludes that this is probably because of the patient's considerable personal wealth and property. When the police confirm that there is insufficient evidence to prosecute the son, the care team wonder if the provisions of the Mental Capacity Act 2005 can be used to protect the patient.
Supporting older people: Promoting falls prevention
Authors: Holmes Pamela
Published: May 2014

In this article, brought to you in association with Help the Aged, Pamela Holmes reviews the development of falls prevention programmes in the UK, and reinforces their importance to older people.
Long-term management of patients with multiple sclerosis
Authors: Weightman Cherie
Published: May 2014

This article explores the challenges of long-term case management for patients who have multiple sclerosis (MS). Currently there is scant research into district nursing input into long-term management of patients who have MS. Until now the role of the community nurses has been confined to palliation or terminal care, focusing on the more physical manifestations of MS. The contemporary role of district nurse is going to evolve to include proactive approaches. Governmental initiatives demand proactive services, and place emphasis on self-care for patients with MS. Themes that emerge from this article relate to the pre-existing skills—such as managing patients with complex needs and the advanced assessment skills—that will be required to achieve this. What is clear is that community nurses already possess many of the prerequisite skills needed for long term management, and they should not be daunted by this prospect.
Controlled drugs and the principle of double effect
Authors: Griffith Richard
Published: May 2014

The role of district nurses in the effective management of pain in palliative care has been strengthened by recent amendments to the Misuse of Drugs (Amendment) Regulations 2005 that allow district nurses who are independent or supplementary prescribers to prescribe and administer controlled drugs. However, the right to prescribe controlled drugs also brings increased responsibility and accountability for the safe management of these medicines. In this article Richard Griffith outlines the changes to the law relating to controlled drugs and calls for a clarification of the principle of double effect, to ensure patients in intractable pain receive the analgesia they require to manage their pain and district nurses avoid liability and prosecution under the law of murder.
Chronic oedemas: identification and referral pathways
Authors: Green Tracy , Mason Wendy
Published: May 2014

In order to treat chronic oedemas correctly it is essential that the condition has been correctly identified and a differential diagnosis made as to the cause of the swelling. This article aims to provide definitions and characteristics of the different types of oedema/chronic oedema, how to recognize chronic oedema and provide suggestions for onward referral to the appropriate healthcare professionals who should be involved in the patient's care.
Assessment of lymphoedema of the lower limbs by the community nurse
Authors: Doherty Debra
Published: May 2014

Community nurses are increasingly at the frontline in supporting patients in the management of long-term conditions. They are therefore likely to be involved in identifying and providing care for people who are affected by lymphoedema. Community practitioners will need to develop the skills to recognize patients who have, or are at risk of developing, lymphoedema. Aspects of the nursing assessment of lymphoedema include taking a detailed history and conducting a comprehensive physical and psychosocial assessment of the impact of this condition. The assessment is multifaceted and will often require intervention from other members of the multidisciplinary team.
Improving care through collaborative working in tissue viability
Authors: Peach Victoria
Published: May 2014

Collaboration is necessary in order to achieve the government aim of seamless care, but research has tended to focus on inter-professional, rather than intra-professional collaboration. A group of tissue viability nursesfrom across Manchester formed a collaborative group to strengthen their influence across their trusts and to achieve improvements in care through targeting specific objectives. This article discusses the rationale for collaboration, and reports an evaluation of the tissue viability nurse group's first year.
Engaging women from South Asian communities in cardiac rehabilitation
Authors: Visram Shelina , Crosland Ann , Unsworth John , Long Sue
Published: May 2014

This study sought to describe experiences and perceptions of cardiac rehabilitation among a sample of women from South Asian communities. Data were collected via eight semi-structured interviews with staff and a focus group discussion with nine clients from a community-based, culturally sensitive cardiac rehabilitation service. A number of individual, cultural and practical barriers to participation were identified. Facilitators centred on whether the format and content of the sessions could be considered ‘appropriate’. For example, a women’s dance group proved to be successful through the selection of a familiar local venue, supportive session leader, and activity that was felt to be both enjoyable and beneficial. This study has shown that it is possible to engage hard-to-reach groups in cardiac rehabilitation and physical activity. Further work is needed to explore whether this research is applicable in other ethnic groups and whether the lessons learned could be successfully incorporated into mainstream health services.
Developing education for long-term conditions management
Authors: Casey Debbie , Mackreth Paul
Published: May 2014

This article discusses the experience of one university in the development, implementation and evaluation of a modular programme of study for practitioners working with people with long-term conditions. It addresses the complexity of developing a curriculum in response to Department of Health initiatives, at times pre-empting central guidance. It highlights the importance of partnership working underpinning every aspect of programme development. The article provides some context for the policy initiative, discusses some of the challenges in programme design, content and the requirement for work-based learning. The assessment, learning and teaching strategies are described, highlighting some of the benefits of portfolios as a means of evidencing and enhancing learning. Evaluation and progress of the programme to date is shared, highlighting some future challenges. This includes ensuring that the programme continues to complement other courses and that modules meet future challenges, including the Nursing and Midwifery Council requirements for advanced practice.
Supporting practice teachers to identify failing students
Authors: Skingley Ann , Arnott Jane , Greaves Jane , Nabb Judith
Published: May 2014

The subject of identifying and supporting failing students in community nursing education programmes has been largely overlooked in the literature, yet is of great concern to practice teachers. This article discusses the views on the topic of a group of practice teachers in the light of existing, related research and proposes a number of indicators for good practice. It is suggested that of central importance is the need for higher education institutions and practice teachers to work together in identifying students causing concern at an early stage in their studies, based on both objective and subjective observations, and to have in place documented procedures to be followed when such situations arise.
A district nurses’ guide to disability discrimination law: part 1
Authors: Griffith Richard , Tengnah Cassam
Published: May 2014

District nurses have a unique role in the continuing care of people with disabilities. Some 20% of people are considered disabled and they now have rights under the Disability Discrimination Act 1995. However, to benefit from these rights people must meet the legal definition of disabled under the Act. It is essential therefore that district nurses are able to interpret and apply this legal definition in relation to their patients in order to better advise them regarding their disability and their rights under the Act.

In the first of two articles on disability discrimination, Richard Griffith and Cassam Tengnah discuss the requirements that need to be fulfilled in order to meet the definition of disabled under the Disability Discrimination Act 1995.
Lessons from the Evercare evaluation
Authors: While Alison
Published: May 2014

Community matrons emerged as an English version of the advanced primary nurses (APNs) who are the cornerstone of United Health’s chronic disease management model, Evercare, recently tested in nine PCT pilots. Contrary to expectations, this approach to the care of the frail elderly has not yielded any significant effect on the rates of emergency admissions, emergency bed days or mortality (Boaden et al, 2006). This must be disappointing news for policy makers, but provides important lessons for all health-care providers.
Give consideration to financial abuse among the older population
Authors: Swan Amy
Published: May 2014

This article, brought to you in association with Help the Aged, considers financial exclusion, low levels of financial capability, and cognitive impairment among older people, which can lead to them becoming reliant on significant others to manage their finances.
Where is the evidence?
Authors: While Alison
Published: May 2014

The place of qualified nurses within the community care workforce continues to be contested across the country because the evidence base demonstrating the effect of nursing interventions is weak. The separation of the provider-commissioning functions is also providing the opportunity for a major reassessment of the cost of different configurations of the nursing workforce.
Lessons from the Maidstone and Tunbridge tragedy
Authors: While Alison
Published: May 2014

The recently published report (Healthcare Commission, 2007) into the outbreaks of Clostridium difficile at Maidstone and Tunbridge Wells NHS Trust makes difficult reading for nurses. It is easy though to compartmentalize and see hospital care as another world of limited relevance, however, this would be a mistake as there are lessons for everyone in the report including for those working outside hospitals. What is beyond doubt is that poor healthcare contributed to a substantial number of avoidable deaths.
No choice for the NHS: reform or bust
Authors: While Alison
Published: May 2014

There is no immediate end in sight to the financial plight of the health services, and despite the claim that there is to be a re-focusing of health care delivery to primary care, it seems that the required investment will not occur in the short term. Nor is it clear that it will become reality in the long term with the ever-growing costs of secondary care and drug treatments.
Working with socially isolated older people
Authors: Owen Tom
Published: May 2014

This article, brought to you in association with Help the Aged, highlights the problem of social exclusion and lonliness and some of the issues of working with socially isolated older people.
How to face up to the spectre of redundancy
Authors: Nazarko Linda
Published: May 2014

Primary care trust (PCT) reconfigurations are now in their final phase. Posts have been deleted and staff who have not been slotted into other posts must apply for posts within their organization. Those who are unsuccessful must find posts elsewhere. This article aims to enable you to prepare for interview and to attain a new post.
Addressing the skin-care needs of the older person
Authors: Lawton Sandra
Published: May 2014

Major skin changes are one of the many features occurring with ageing and it is estimated that 70% of elderly people have skin problems (APGS, 2000). A report into skin diseases in elderly people, highlighted that older people were noted to suffer from a lack of sensitivity to their skin care needs and related problems, training was lacking for healthcare professionals and service provision was not planned (APGS, 2000). The aim of this article is to highlight the importance of skin care in the older person and increase the nurse’s knowledge in relation to the care of ageing skin; the skin changes associated with age and practical advice and guidance when caring for an older person’s skin.
The challenge of healthcare-associated infection outside hospital
Authors: Gould Dinah
Published: May 2014

Infection control is an area of healthcare practice subject to rapid development in-line with changes in the behaviour of pathogens, advances in technology, the altered profile of people undergoing healthcare, the settings in which that care is delivered and the impact of new ways of working throughout the National Health Service. This article describes how micro-organisms responsible for healthcare-associated infection can be transferred between hospital and community settings and explains the risks of disseminating infection in relation to two types of pathogen carrying resistance to antibiotics: methicillin resistant Staphylococus aureus and glycopeptide resistant enterococci. Ability to read current literature critically, to be aware of changing policy and its impact on the risk of infection forms an important part of the community nursing role.
Home enteral feeding part 1: an overview
Authors: Fogg Louisa
Published: May 2014

Preventing or reducing malnutrition using nutritional support is proven to be effective both clinically and financially. The continuation of enteral tube feeding in the community continues to grow and the population are an increasingly elderly and disabled group, with the majority living in their own homes and requiring some or total help with their enteral tube feeding. Part 1 of this two-part article looks at some of the key aspects in the management of patients in the community, including routine monitoring, the administration of feed and medications and management of the various tubes. Part 2 will discuss some of the current areas of controversy/ debate, including the use of syringes, water type, feed hanging times and confirmation of nasogastric tube position in patients on acid reducing therapy.
Actiq: an effective oral treatment for cancer-related breakthrough pain
Authors: Laverty Diane
Published: May 2014

As a result of improved survival in cancer and the transfer of care from hospital to primary care, community nurses are taking increasing responsibility for the management of patients at all stages of the disease. Persistent or background pain is common, but between 40% and 80% of patients with advanced cancer also experience breakthrough pain (BTP), a sudden, rapidly escalating flare of pain occurring against a background of otherwise well-controlled persistent pain. While background pain can be successfully managed in most patients, BTP presents a particular challenge to community nurses, because short-acting, ‘normal release’ oral opioid drugs are absorbed too slowly to treat the typical episode. As this article explains, Actiq is an effective strong opioid with a rapid onset and short duration of action that closely matches the characteristics of an episode of BTP.
Like children, older people deserve protection
Authors: While Alison
Published: May 2014

A recent survey (Action on Elder Abuse, 2007) of 2,100 people aged 66 years and older living outside regulated care settings has found a prevalence of 4% for elder abuse with some variation across UK countries (6% Wales; 4.3% Scotland; 3.9% England; 3% Northern Ireland). This figure equates to 342,000 people and may be an underestimate. The prevalence rates were higher for women and for those aged 85 years and over.
Optimizing on smoke free legislation making the most of the opportunity
Authors: Croghan Emma
Published: May 2014

Stop smoking service provision faces significant challenges in optmizing the opportunities raised through the smoke free legislation, which prohibits smoking in a public place. There are a numebr of innovations in service provision allowing a more tailored and flexible approach to stopping smoking, where the patient requirements are central. Innovations such as cut down then stop (CDTS), combination nicotine replacement therapy (NRT) use and new drug thearpy Champix all provide increased options for the smoker.
Stoma care nursing: what the community nurse needs to know
Authors: Williams Julia
Published: May 2014

The transition from hospital to home can be a worrying period of time for a patient with a newly formed stoma. It is well documented that community care is important however this transition has been seen as a weak link in the care for a patient with a stoma (Allison 1996). In most cases, following discharge from hospital, the nurse specialist in stoma care will visit the patient at home as a means of maintaining continuity of care. It is also important that the patient’s GP, district nurse and other relevant community services are introduced so to ensure a cohesive approach to the patients care at home (Taylor, 2003). This article therefore aims to offer the community nurse an overview of stoma care nursing in order to provide the continuity of care much needed by this group of patients.
Patient empowerment: a general practice perspective
Authors: Bawden Robert , Lindsay Ellie
Published: May 2014

Patient empowerment is a frequently promoted aim for patients but is rarely put in to clinical practice. This paper describes the basic principles behind a club enabling treatment and prevention of leg ulceration in the community. These principles include patient ownership of the club, community involvement and a non-medical environment. The practical issues involved in setting up a Leg Club® are described in detail including engagement of healthcare professionals, community volunteers and appropriate transport.
A quantum shift in home care service delivery
Authors: Dawes Jonathan
Published: May 2014

I was astonished to read about the proposed changes in the delivery of home care services, hailed as: ‘one of the most radical welfare reforms in a generation.’ I have been keeping a keen eye on the ‘Dignity at home campaign’ heralded by the Observer newspaper. A key outcome measure of this campaign would be a radical overhaul in how patients take ownership of their social care packages. The new proposals do just that.
No more cooking the books
Authors: Dawes Jonathan
Published: May 2014

If there is one word that is driving current health policy it is ‘quality’. You can’t turn a page in the nursing press without being bombarded by new quality tools, quality audits, and other management ‘quality’ jargon. The Darzi review has stated that primary care services will have quality as their raison d’être. That’s an admirable aim as no one wants shoddy services, but how does one go about defining quality in district nursing services?
Effective evidence based catheter management
Authors: Nazarko Linda
Published: May 2014

People who have long term urinary catheters commonly experience problems with bypassing and leakage. Changing the catheter is not necessarily the most appropriate solution. Catheter related problems provide nurses with the opportunity to evaluate the clinical indications for continued catheterization and to remove catheters that are not clinically indicated. When catheters are clinically indicated nurses who use an evidence based approach to diagnose and treat problems provide effective care and reduce the risk of patient discomfort and recurrent problems
Letters to the editor
Authors: Ryder Elaine
Published: May 2014

On the one hand, it was so encouraging to read about the QNI's support for the future of the district nurse (DN) role—on the other hand, I despair that it has taken so long, amidst all the changes that have taken place, for anybody to take seriously the importance, value and significance of this role.
Sheltered housing: building bridges between nurses and housing staff
Authors: Parry Imogen
Published: May 2014

Sheltered housing staff and buildings are underutilized. Health staff are encouraged to work in partnership with colleagues in sheltered housing, involving them in assessments and support arrangements. The charity ERoSH has a checklist and DVD to provide guidance on how such partnership working can be improved, including making better use of communal lounges for health related activities such as falls prevention, malnutrition screening, exercise.
Future housing plans and funding for the care of older people
Authors: Oldman Joe
Published: May 2014

The Government recently launched a housing strategy for older people, which promises more inclusive housing and community design. Yet more needs to be done to ensure the strategy makes a real difference to older people’s lives. Joe Oldman explains the situation for The British Journal of Community Nursing.
Mental Capacity Act: determining best interests
Authors: Griffith Richard , Tengnah Cassam
Published: May 2014

Richard Griffith and Cassam Tengnah continue their series on the impact of the Mental Capacity Act 2005 on district nurse practice. This month’s article discusses the statutory framework for determining whether the care and treatment proposed by a district nurse is in a patient’s best interests.
Challenging times ahead
Authors: While Alison
Published: May 2014

The global economic challenges will not only affect the banks but also healthcare staff and their patients. Indeed, no-one will be unaffected. At this moment community nurses are not being properly reimbursed for the cost of using their cars to deliver care in the home as the price of petrol rises ever higher and older people are counting the cost of ever rising energy and food costs. Additionally there will be less extra money available to fund public services as the government attempts to balance its expenditure against tax receipts without further increasing government debt.
Giving the ‘flu vaccine: the Mental Capacity Act 2005 in practice
Authors: Griffith Richard , Tengnah Cassam
Published: May 2014

This article uses a real life case study to understand the legal ramifications surrounding practice when dealing with influenza immunization. There are often cases where people with diminished mental capacity refuse immunization. The Mental Capacity Act, 2005 is used as a framework to explain to the practitioner where they stand legally in such situation and how to work safely and competently within the law.
Management of the diabetic foot ulcer: exercising control
Authors: Bentley Jenny , Foster Ali
Published: May 2014

The incidence of diabetes is increasing and therefore patients with diabetic foot ulcers will become increasingly common in the community. The NHS model of Health and Social Care (Department of Health (DH), 2005) places a high emphasis on self care and disease management, and, as a long term condition, diabetes mellitus requires efficient and effective management. The supervision and organization of the care of diabetic patients is multi-factorial and for this reason, a multi-disciplinary approach is essential for effective care, without which patients with diabetic foot ulcers are at high risk of complications. Diabetic wounds present differently to other chronic wounds; unless these are adequately assessed and treated, there may be devastating consequences for the patient – the most serious being major amputation and/or death. In the first article, accurate assessment was discussed; in this second article, the management of diabetic foot ulcers is explored.
Lymphoedema Care: by Mary Woods
Authors: Coveney Elizabeth
Published: May 2014

Lymphoedema Care by Mary Woods is a text recently published by Blackwell Publishing.
Compression bandaging: avoiding pressure damage
Authors: Beldon Pauline
Published: May 2014

Venous leg ulcers account for a large percentage of the financial and healthcare burden of chronic wounds, they are costly to treat both financially and in nursing time. The prerequisites for any healthcare professional to be able to provide safe, effective compression therapy bandaging for any patient must include knowledge, ability and proven competence. Without such competence the patient is vulnerable to harm and the nurse is open to criticism, disciplinary action by the Nursing and Midwifery Council or even litigation. Pressure damage to patients’ skin under compression therapy can occur due to a number of factors and it is the responsibility of a registered nurse to ensure compression bandaging is safely and expertly applied.
Chronic oedema in advancing disease
Authors: Billingham Rebecca
Published: May 2014

Following on from the last hugely successful chronic oedema supplement, this edition aims to keep up the pace while remembering the key elements of managing chronic oedema, namely accurate assessment, diagnosis, clinical support and patient involvement and education.
BJCN/QNI survey informs the QNI’s 2020 Vision report on district nursing
Authors: Cook Rosemary
Published: May 2014

2020 Vision – focusing on the future of district nursing (QNI in press) is a new report from the Queen’s Nursing Institute (QNI), timed to coincide with the 150th anniversary of district nursing in the UK. Launched this month, the report draws on the history of district nursing to identify the core values and skills of nursing in the home, and visualizes the role of district nurses in the very different healthcare world of the next decade. This article reports the findings of the joint BJCN/QNI survey which informed part of the report.