bluuebunny/crossref_metadata_2025 huggingface dataset:
Meeting the challenges: delivering interactive stoma care education
Authors: Lee Janice , Moore Hazel , Asbury Nicky
Published: May 2014

This article illustrates how the authors used the following frameworks: audit cycle, clinical governance, essence of care and evaluations to create a fun, interactive and transferable method of delivering an education programme in the workplace environment. The article demonstrates the benefits of using action planning, benchmarking and overcoming difficulties in delivering education across two organizational boundaries (primary and secondary care). ‘Today’s 6 × 30 minute Stoma Challenges are…’ a full and fun afternoon of interactive stoma education for primary and secondary care staff delivered in an innovative and creative way. The main objective is to enhance qualified and unqualified nurses existing knowledge and skills in relation to stoma care. Also encouraging staff development therefore enhancing the patients’ experiences regardless of whether they are in a primary or secondary care setting.
The clinical management of women with primary breast cancer
Authors: Rogers Carolyn
Published: May 2014

Breast cancer is the most common cancer in the UK. Incidence is increasing but mortality is decreasing meaning people are surviving for longer with the disease. This will undoubtedly have an impact on health professionals working in a primary care setting.

This article presents an overview of the diagnosis and current clinical management of women with primary breast cancer. It emphasizes that individualized patient care is based on many biological and pathological characteristics and is becoming increasingly the way forward in personalizing treatment for breast cancer.
Community nursing and the Next Stage Review
Authors: While Alison
Published: May 2014

The NHS Next Stage Review (Department of Health (DH), 2008a) emphasizes the need for primary care services to be user focused with people having more control over the where, when and how of care delivery especially for those with long term conditions. The importance of health promotion is also acknowledged with the expectation that health promotion should be embedded within all clinical contacts across the life span with particular emphasis upon risk identification and systematic support to achieve improved health and well-being with primary care practitioners promoting equality of opportunity for health promotion.
An essential guide to managing seated patients in the community
Authors: Collins Fiona
Published: May 2014

More and more clinicians working in the community are faced with the difficult task of advising and solving patients’ seating problems. Frequently, important education on the relationship between sitting and pressure damage is unavailable, which results in people often making inadvisable choices on seating solutions and as a consequence, spending large sums of money which is then wasted. This article aims to provide clinicians with basic information on the relationship between sitting and pressure damage, how to conduct a simple seating assessment and what different types of armchairs are available for purchase.
Management of skin conditions in the older population 2
Authors: Bianchi Janice , Cameron Janice
Published: May 2014

This is the second of two papers covering assessment and management of elderly skin. Part 1 of this clinical review focused on the importance of a comprehensive assessment of the skin and a detailed clinical history of the patient (Bianchi and Cameron, 2008). This second paper considers some common dermatological conditions seen in the older adult and explores suitable management strategies.
A product evaluation of the Trio dynamic therapy mattress
Authors: Buckland Richard
Published: May 2014

Any product, once CE marked and licensed, can be used to treat a patient. The question is how do practitioners make that choice? And once made do we share our experiences of using the product with others? The purpose of this product evaluation is to test the Sidhil Trio mattress in the ‘real world’. Two nursing homes used the mattress as part of their pressure ulcer prevention care for a maximum of 12 weeks with a total of 13 residents. During this time the staff and residents were asked about what they thought of the mattress and how well they felt it performed as users. Skin assessments were also undertaken weekly to assess the primary function of the mattress; does it help in the prevention of pressure damage. Of the 13 residents one developed superficial pressure damage but other residents did improve. Other positive functions of the mattress design were found; the hinged section allowed residents to sit up in bed while maintaining a therapy function and the ‘solid’ side panels gave stability for residents when sitting on the edge of the bed.
Caring for patients with difficult-to-heal ulcers
Authors: Knight Susan , Vogensen Hanne , Haase Lone , Jrgensen Bo
Published: May 2014

This article presents Coloplast’s chronic wound care guide for community nurses, in which wound management is described in terms of assessment, treatment and reassessment. Choosing the optimal wound dressing is explained separately. Three case studies are used to demonstrate the use of the guide. Using the guide as a framework is straightforward and easily interpreted by health professionals with varying levels of wound care knowledge and experience, therefore enabling health care professionals to use evidence based practice to improve patient outcomes.
The management of chronic oedema in palliative care
Authors: Honnor Amanda
Published: May 2014

Chronic oedema is a broad term used to describe a range of conditions which may cause oedema in the limbs, trunk, head, neck and genitals. Lymphoedema is one type of chronic oedema. The problems associated with chronic oedema can be devastating and this is of particular importance for patients in the palliative phase of their disease. Community nurses have an important role to play in providing palliative care and helping to alleviate the troublesome symptoms these patients may experience. There are a range of treatments which may assist the patient; some of which require the skills of a specialist but, many of which, can be administered by a community nurse. The management of one particular aspect of chronic oedema is examined, namely lymphoedema caused by advanced cancer.
Waste management requirements of community IV therapy services
Authors: Blenkharn Ian
Published: May 2014

Healthcare professionals carry a legal and professional responsibility for the safe disposal of clinical wastes. Sharps safety is paramount, and though this is a well-recognized hazard there remains an unacceptably high incidence of sharps injury and of blood and body fluid exposures that are particularly frequent among ancillary and support staff and waste handlers. Statutory Local Authority waste collection and disposal services generally provide the most convenient and cost-effective approach to community-generated clinical wastes though there remains much room for improvement. Special arrangements will be necessary for the careful collection, packaging and disposal of not only cytotoxic and cytostatic drug wastes, and of items contaminated with these drug substances, and of controlled drugs, but of all other prescription and many non-prescription pharmaceutical products.
Ethical dilemmas in the care of people with dementia
Authors: Hope Tony
Published: May 2014

Following a two-year inquiry, the Nuffield Council on Bioethics published a report in October 2009 on the ethical dilemmas raised by dementia. Community nurses play an important role in supporting carers of people with dementia, but face ethical dilemmas of their own, for example, balancing the needs of the person with dementia and those of the carers, and deciding when to share confidential information with others. The report sets out an ethical approach to care, as well as recommendations on specific ethical dilemmas. A key conclusion is that all professionals involved in the care of people with dementia should have access to ongoing education and support to equip them to respond appropriately to ethical questions that arise.
Celebrating the 150 year anniversary of district nursing
Authors: Pountney David J
Published: May 2014

2009 marks the 150th anniversary of district nursing in the UK. District nurses can trace their roots back to the slums of Liverpool, when in 1858 Liverpool philanthropist William Rathbone employed a nurse, Mary Robinson, to care for his sick wife at home. After her death in 1859, Rathbone tasked Mary to go into the poorest districts of the city to bring healthcare to people who had no means to pay for it. Rathbone later recalled:
2020 Vision celebrates 150 years
Authors: Cook Rosemary
Published: May 2014

District nursing is at a hugely significant moment in its history. It is 150 years old this year: a wonderful anniversary which will be celebrated throughout the year. It is enormously humbling to look back at the moment when the value of skilled nursing in the home was first recognized: William Rathbone, originator of organized district nursing services in Liverpool in the 19th century, wrote of ‘the great comfort and advantage derived from trained nursing, even in a home where everything which unskilled affection could suggest was provided’. The difference skilled nursing could make in the homes of the poor and disadvantaged was, of course, immeasurably greater.
Can we afford not to fund age-related research?
Authors: Rippon Helen
Published: May 2014

Although we are living longer and healthier than ever before, health-spans are not necessarily keeping pace with extensions in lifespan. If current trends continue, we will see a sharp increase in the number of older people suffering a wide range of debilitating conditions within a generation. Help the Aged believe it is time for the Government to act now, by prioritising and investing in research into age-related illness, before it is too late.
The challenge of dementia
Authors: While Alison
Published: May 2014

The growing ageing population poses many challenges for society and health services because advancing age is associated with the increasing incidence of health problems and growing costs of meeting health needs. Old age is associated with a high prevalence of dementia. According to the Alzheimer’s Society (2009) there are 700 000 people with dementia in the UK of whom two thirds are women and one third are over 95 years of age. While 64% of those living in care homes have a form of dementia, two thirds with dementia live in the community while one third live in care homes (Alzheimer’s Society, 2009).
Alternatives to prescriptions for the supply and administration of POMs
Authors: Griffith Richard , Tengnah Cassam
Published: May 2014

The Medicines Act 1968 and its regulations authorize the supply and administration of prescription only medicines (POMs). The 1968 Act generally requires an appropriate practitioner to provide a prescription for the supply of such drugs. The Prescription Only Medicines (Human Use) Order 1997, allows for a more flexible approach to the supply and administration of prescription only medicines through the use of Patient Specific Directions (PSDs) and Patient Group Directions (PGDs). This article outlines the legal requirements for a valid prescription, PSD and PGD.
Is music what we all need?
Authors: While Alison
Published: May 2014

The daily diet of dismal economic news which is affecting all sections of society alike has the potential to bring about a state of widespread gloom and despondency. While not belittling the personal consequences of the economic turmoil, it is all too easy to join the ranks of the gloomy rather than consider ways in which health care providers and their clients can overcome despondency so that they may problem solve effectively despite the inevitable challenges of changed circumstances.
Then and Now: A day in the life of the district nurse
Authors: Pountney David J
Published: May 2014

District nursing has a long and illustrious history. This year, the profession marks its 150th anniversary. While clinical practice has changed beyond recognition, the fundamental need for community nursing at the heart of healthcare remains a constant. Former and present day district nurses recollect on their experience of how the profession has evolved and look forward to the future.
Managing chronic neuropathic pain: the role of spinal cord stimulation
Authors: Moir Liz
Published: May 2014

In October 2008 the National Institute for Health and Clinical Excellence issued guidance supporting the use of spinal cord stimulation for people with chronic neuropathic pain, considering it to be a cost-effective use of resources within the NHS. This paper will provide an overview of chronic neuropathic pain. Spinal cord stimulation (SCS) will be explained, including the physiological mechanism and technology behind this treatment. The recent NICE guidance will be discussed along with information relating to the potential impact the guidance will have on Primary Care Trusts, GPs and community practitioners. A guide is provided for clinicians in primary care regarding access to this treatment and routes for referral.
Managing pruritus in the older person
Authors: Wheeler Tracey
Published: May 2014

As one’s skin ages, pruritus becomes a significant problem where one’s skin becomes more vulnerable to the impact of underlying systemic disease, and dermatological conditions become much more common. This article briefly reviews the most common causes and treatments for pruritus. It then focuses on topical management, giving practical tips on skin care that can help to alleviate the condition. The key role of community nurses working in primary care is emphasized, with discussion of how best to motivate and maintain concordance in the independent patient.
Community nurses shall inform policy
Authors: Cook Rosemary
Published: May 2014

Of the plethora of policy documents and initiatives that accompanied the Next Stage Review of the NHS (the ‘Darzi review’), the one that should be most familiar to community nurses is the Department of Health’s Transforming Community Services (TCS) initiative. This is the one that will have a direct impact on the work done by nurses and therapists in community settings in England. Happily, it is an initiative that very directly aims to improve care to patients, so it mirrors the motivation and concerns of nurses themselves.
The future role of the nurse
Authors: While Alison
Published: May 2014

Painful funding decisions are inevitable in light of the growing public expenditure deficit. Despite protestations to the contrary, any Government will need to bring the public finances into balance to avoid calamity and dependence upon the International Monetary Fund to meet essential funding requirements. It is against this background that the future of nursing and midwifery are being debated by the NHS Employers (2009) and others.
A service development designed for the SE Wales Lymphoedema service
Authors: Taplin Naomi , Tyler Helen
Published: May 2014

With increasing awareness of cancer related lymphoedema, the demand on therapy time has dramatically increased. In order to help manage the increased number of referrals to the South East Wales Lymphoedema Rehabilitation Service (SEWLRS) a number of service developments have been implemented. The most innovative of these developments is the introduction of assessing routine breast cancer related lymphoedema patients and the teaching of simple lymph drainage (SLD) within group settings. This article discusses why such innovative service developments have been implemented and highlights the benefits that the service has seen since implementing group assessment and treatments.
Health-related quality of life and chronic venous leg ulceration: part 1
Authors: Green Julie , Jester Rebecca
Published: May 2014

Leg ulceration is a debilitating condition characterized by long periods of ulceration and a high incidence of recurrence. The quality of life of sufferers is compromised by many issues including pain and social isolation. Day-to-day care focuses predominantly on the provision of wound care, often with limited attention to the wide-ranging effects that the ulceration poses to the life of the sufferer. Part 1 of this two-part series provides a review of qualitative studies that explore the health-related quality of life of patients with chronic venous leg ulceration. Part 2 will be published in the June 2010 Wound Care Alliance supplement.
Mycobacterium tuberculosis: implications for district nurses
Authors: James Stephanie , Watson Michael
Published: May 2014

Despite the belief of many health professionals, tuberculosis is not a disease of the past but is on the increase (Department of Health (DH), 2004) and the UK has seen a year on year increase in the number of new cases (Health Protection Agency, 2008). The DH have made a number of recommendations to combat this increase and one of those recommendations is to raise awareness among health staff (2004). This review has set out to examine district nurses’ knowledge about tuberculosis and the consequences of poor knowledge. Five themes emerged from the literature search with the most prominent being the subject of adherence and how this could be addressed. The review has identified that district nurses should have a greater knowledge of tuberculosis and patient treatment could be improved by the nurse having a better understanding about tuberculosis care.
The role of community nurses in promoting self-care
Authors: Robinson Francesca
Published: May 2014

Empowering patients to take charge of their own health is one of the key themes of the new coalition government’s White Paper on Health, Equity and excellence: Liberating the NHS (Department of Health (DH), 2010).
Principles of good evidence giving
Authors: Griffith Richard , Tengnah Cassam
Published: May 2014

With increased regulation and litigation in the health-care sector, appearing in court is becoming an almost routine part of a district nurse’s role. A review of local newspapers shows that in the last 4weeks alone district nurses around the UK have given evidence in no fewer than ten different cases that have involved the coroners’ court, county court and magistrates’ court.

The prospect of appearing in court or giving evidence at fitness to practice hearings remains a daunting one. The process is still largely adversarial and cross examination is a hostile experience. This article highlights the principles of good evidence.
Health and safety at work: a guide for district nurses
Authors: Griffith Richard , Tengnah Cassam
Published: May 2014

Sickness absence across the NHS costs a billion pounds a year with accidents at work accounting for a significant proportion of that absence. Over half the major injuries in the health service are caused by avoidable slips and falls. Under the Management of Health and Safety at Work Regulations 1999 the NHS as an employer and district nurses as employees have a duty to manage health and safety effectively and to ensure that others are not put at risk by work-related activities.

Breaching a requirement of health and safety law is a criminal offence so it is essential that district nurses are able to fulfil their duty and so avoid prosecution.
Practice-based commissioning and COPD in Easington
Authors: Wells Linda
Published: May 2014

In Easington the local practice-based commissioning (PBC) group and NHS County Durham and Darlington Community Health Services set up a working group, comprising of GPs, nurses, ambulance services and social workers, to examine local care services for patients suffering from Chronic obstructive pulmonary disease (COPD). The new COPD pathway was launched in August 2008. The new clinical pathway has delivered greater efficiencies, cost savings and improved patient satisfaction.
The future: a primary care-led NHS
Authors: Cross Sue
Published: May 2014

The NHS is becoming increasingly primary care and community focused and the role of the community nurse is becoming more significant, not just in managing long-term conditions and end of life but in providing vital help and education. Helping people become more knowledgeable about maintaining both their own health and that of their families at home or within the community is vital - the desired end being less need for expensive hospital care. As the demand to implement more complex services grows, so the need for nurses to contribute to the planning and delivery of services becomes more important. Nurses in the community have the experience and practical knowledge and must use it to influence commissioning and engage proactively, and positively, with current policy agendas and with the people whose responsibility it is to implement them. Change in primary care is constant and increasingly it is the frontline deliverers of services that drive that change and help set the agenda. As more care and treatment is devolved from the secondary to primary care setting, there must be greater integration between general practice and the community nursing team, with each helping and informing the other to deliver a world class primary care service.
Self-care: a step in the right direction for patients and professionals
Authors: Richards Sara
Published: May 2014

In recent issues (Wrixon, 2010), this Journal has reported the huge cost to the NHS of the dependency culture around minor ailments and the call from professionals in primary care to encourage greater self-care. In March, self-care moved firmly onto the national agenda with the publication of a new report, Self Care: An Ethical Imperative (Banks et al, 2009). The paper, published by the Self Care Campaign group, includes a four-point manifesto calling on all political parties to support the campaign at individual, national and local level that:
Oral Aloe vera as a treatment for osteoarthritis: a summary
Authors: Cowan David
Published: May 2014

While pain relief is a basic tenet of health care, pain is under-treated in the UK (Davies and Mcvicar, 2000) and this issue remains unresolved. This paper suggests that oral Aloe vera could be used in the treatment of chronic non-cancer pain (CNCP), particularly that caused by osteoarthritis (OA). Despite being used as arthritis treatment for centuries (Yoo et al, 2008), evidence of effectiveness of Aloe vera is anecdotal or from small studies. The perceived benefits of prescribing Aloe vera for OA may be twofold: it has utility as an anti-inflammatory agent and also as a prophylactic against the gastrointestinal irritant effects of non-steroidal anti-inflammatory drugs (NSAIDs). Long-term, randomized, controlled studies are still needed to address the lack of evidence informing optimum prescribing of pain medication for people with OA (Cowan, 2007). There is no reason that so called ‘nutraceutical’ agents should not be subjected to the same rigorous randomized, controlled, double-blind trials as other ‘mainstream’ drugs. Therefore, it is appropriate to ask whether NSAID treatment and side effects can be improved by the addition of oral Aloe vera. Thus, we may then be in a more informed position to resolve the ongoing ‘Pandemonium over Painkillers’ (Cowan, 2007).
Flexible working requests and the law: a guide for district nurses
Authors: Griffith Richard , Tengnah Cassam
Published: May 2014

Flexible working provides employees with the ability to make it easier to balance work and caring responsibilities. All qualifying employees, including those who are district nurses, have a right to request an adjustment to their working hours and work patterns. Where the request is refused an appeal can be made to an employment tribunal and further action can be considered on the grounds of discrimination.
Community nursing in an uncertain future
Authors: Cook Rosemary
Published: May 2014

At the time of writing, Britain still has no certainty about its new Government. The calm before the storm continues: we have spent a year knowing that severe financial cuts have to be made in the NHS without knowing where or how. Some claim that there will have to be hospital closures, but there is no sign of anyone being willing to support such moves. Politicians have all tried for the easy win of criticizing managers and ‘bureaucracy’ while praising nurses and doctors, apparently unaware that in many case they are one and the same thing. But sometime soon the uncertainty will be resolved, and whichever party or coalition forms the next Government will have to start making cuts to save money.
Access to health records: the rights of the patient
Authors: Griffith Richard , Tengnah Cassam
Published: May 2014

From time to time patients will ask to see or request a copy of the records made about them and the treatment they received from district nurses and other health professionals. While district nurses can informally allow a patient to see the content of the records they use, a request to view or have a copy of the wider health record requires a formal request for access under the Data Protection Act 1998. This article considers the requirements for requesting and granting access to a patient to view and obtain a copy of their health record.
Care for end-of-life cancer patients should be 24/7
Authors: Hobday Mike
Published: May 2014

Up to 19 million people might not have access to 24/7 community nursing at the end of their life should they want it, because they do not live in an area where the primary care trust (PCT) provides this type of service to all patients, a new report by Macmillan Cancer Support has found. Simple changes, such as introducing 24/7 community nursing, would not only improve the quality of patients’ lives in their final weeks and months and enable them to die at home if they wish, but also make huge financial savings for the NHS. The National Audit Office (NAO) estimates that the average cost of keeping someone in hospital for their last year of life is £222 per day. In comparison the average cost of home/community care per day is £28; nearly eight times less (NAO, 2008).
Dying at home: access should be equitable
Authors: Goodman Claire
Published: May 2014

For a document that is wholly based on statistics, the recent report from the National End of Life Care Intelligence Network (NEoLCIN) on variations in place of death in England (NEoLCIN, 2010) is fascinating reading. It highlights the differences across the country in where people die and challenges assumptions about what can and can’t be achieved for people who want to die at home. Too often we judge effectiveness on the basis of the individual case. This report helps us to look beyond personal experience and individual services. It sets a benchmark against which to judge how health and social care services are supporting people to die at home.
Health-related quality of life and chronic venous leg ulceration: part 2
Authors: Green Julie , Jester Rebecca
Published: May 2014

Leg ulceration is a debilitating condition which compromises the quality of life of the sufferer, owing to factors such as pain, exudate, odour and social isolation. As nurses, much of the daily care provided for such patients focuses on the provision of wound care; often failing to fully address the wide ranging effects that the ulceration is having on the life of the sufferer. This article reviews the quantitative studies that have explored the health-related quality of life of patients with chronic venous leg ulceration and presents a synthesis of their findings.
An interview with Spencer Winch
Authors: Adderley Una J
Published: May 2014

Having now worked for the Ambulance Service for nearly 10 years, my exposure to wounds would have been as early as my first shift ‘on the road.’ During a busy 12 hour shift, ambulance crews may come into contact with wounds two or three times whether it be an elderly faller, a child fallen off their bicycle, a DIY accident, an assault, a self-harming incident or a bleeding leg ulcer. Until recently, all these wounds would have had a dressing applied, and the patient transported by front-line ambulance to the nearest emergency department (ED) or minor injuries unit (MIU). A large majority of these wounds were very minor and would most likely have required nothing more than a thorough clean, a neurovascular assessment and basic closure with steri-strips, tissue adhesive or suturing. But, there was no personnel within the ambulance service qualified to assess and close these wounds in the pre-hospital environment. This transport to hospital did not benefit the patient, the Ambulance Service or the receiving treatment centre, and so, the emergency care practitioner (ECP) role has evolved and was borne from the recommendations set out in the Department of Health’s (2005) paper Taking Healthcare to the Patient Transforming NHS Ambulance Services. One of the visions was that:
Case studies create research
Authors: Pike Cheryl
Published: May 2014

A very wise man made the following statement on a recent study day:
Should chronic wounds have a silver lining?
Authors: Jones June E
Published: May 2014

Chronic wounds are a considerable burden both financially to the NHS and in terms of morbidity and mortality for the patients. There is increased recognition that they account for a considerable portion of a community nurse caseload and can be a significant challenge to the clinician in terms of management, not least because of the expanding dressing market. This article focuses specifically on the use of silver in wound care and challenges the current trend to use silver as a ‘just-in-case’ approach to wound management. It discusses the infection continuum and the place of silver in this context before discussing the limited evidence base for its everyday use.
A new era for WCAUK
Authors: Edmonds Lee
Published: May 2014

As you will have read in previous editorials, the Wound Care Alliance UK has emerged, phoenix-like from the ashes of the Tissue Viability Nurses Association (TVNA) and the Wound Care Society (WCS). The new organization has rationalized and incorporated the best from both the TVNA and WCS organizations.
An interview with Jacqui Fletcher
Authors: Fletcher Jacqui
Published: May 2014

I was lucky enough to train at St Bartholomew’s in the 1980s when Pam Hibbs was Director of Nursing, she did the first work on pressure area care and we had a ‘wide’ range of resources – this in reality was Spenco mattresses, Pegasus Airwaves and the occasional Clinitron bed (none of which are still available) as well as a good choice of dressings. After qualification I moved hospitals and was horrified that I couldn’t just ring the porters and order a mattress and that there was a very limited choice of dressings. This infuriated me and I started to try and improve what was available. I even went on what must have been one of the first proper weeklong wound care course with Carol Dealey in Birmingham (the certificate is still up on my office wall). After that there was no going back.
Reflecting on the learning experiences of student nurses in rural Uganda
Authors: Lovett Wanda , Gidman Janice
Published: May 2014

This article presents the first author, Wanda Lovett's experiences of pre-qualifying nurse education in rural Uganda, with a particular focus on promoting effective learning within community placements. The culture and context of health care and of nurse education are very different in this area when compared to the UK. Additionally there are a number of challenges associated with the mentorship of nursing students in practice, both in relation to facilitating learning and to the assessment of competence. This article describes the author's experiences of developing a more appropriate approach that reflects adult-centred learning, to promote the level of thinking that students will need to meet the demands of their roles once qualified.
Adoption law: a district nurse's guide
Authors: Griffith Richard , Tengnah Cassam
Published: May 2014

The Government wants to see a large rise in the use of adoption as a means of giving children a secure, loving and permanent home. Guidance coming into effect from April calls for a more pragmatic approach to adoption placements, and calls for the active promotion of the adoption process by health and social care professionals. District nurses will encounter people interested in becoming prospective adopters, but who are unsure if their background or lifestyle makes them eligible. It is essential that district nurses have a working understanding of the guidance and provisions of the Adoption and Children Act 2002 to confidently advise others about adoption and clarify any issues raised.
Patients with inflammatory arthritis: an opportunity for community nurses
Authors: Chamberlain Vicky
Published: May 2014

People with Inflammatory joint disease, e.g. rheumatoid arthritis (RA), have traditionally been treated and managed within secondary care on an outpatient basis. This group of patients has varied and complex needs. With increasing emphasis on offering care closer to home, there is an opportunity for nurses based in the community to become more involved in the management and support of these patients. The level of involvement will depend on the resources available locally and will require education and support for the role. Based on recommendations in recent publications and the author's personal experience working in three different rheumatology departments, this article explores the ways in which community nurses can support people with RA in the community and identify sources for further professional development to support and maintain this.
Need to know: consent and the nurse's duty to warn of risk
Authors: Griffith Richard , Tengnah Cassam
Published: May 2014

This article, the second in a series on consent to examination and treatment, considers a district nurse's duty to warn patients of the risks inherent in treatment. The article discusses whether patients are entitled to full and honest answers to their questions about risks, and whether district nurses can lie to anxious patients about the risks of treatment.
Effective mentoring in the community setting
Authors: Pritchard Emma , Gidman Janice
Published: May 2014

As nurses, we are expected to demonstrate the linking of theory to practice, undertake continuous assessment and to facilitate reflective practice. Literature suggests that the majority of mentors feel unprepared for the role and lack confidence in their ability to support students ( Duffy, 2004 ). The main challenges facing mentors are understanding the needs of each individual and adapting and developing strategies in order to support them effectively. Whilst there is a major cognitive / intellectual component to mentorship both student and mentor often experience difficulties with these aspects of their roles ( Moseley and Davies, 2008 ). By recognizing the need to gain insight into the students individual needs mentors will be able to identify any concerns and develop action plans in order to alleviate them.
Consent to care: patients who demand or refuse treatment
Authors: Griffith Richard , Tengnah Cassam
Published: May 2014

For district nurses obtaining consent is, in most cases, a routine part of delivering care and treatment to patients. In some cases, however, patients will have strong views on the type of treatment they want for their condition and demand it be provided, or equally strong views that they want no treatment and refuse consent. In this article Richard Griffith and Cassam Tengnah consider the legal and professional obligations of district nurses faced with patients who demand or refuse treatment.
Changes to criminal records checks used to safeguard vulnerable patients
Authors: Griffith Richard , Tengnah Cassam
Published: May 2014

The Protection of Freedoms Act 2012 is introducing changes to the Criminal Records Bureau (CRB) checks carried out on those people who work with vulnerable groups. The new law is the coalition Government's response to the criticism of the Safeguarding Vulnerable Group Act 2006. It will merge the CRB and Independent Safeguarding Authority into a new Disclosure and Barring Service and will enhance the rights of applicants to challenge the CRB's right to disclose non-conviction information as part of an enhanced criminal records check. In the first of two articles on the Protection of Freedoms Act 2012, Richard Griffith and Cassam Tengnah discuss the current framework for disclosing criminal records and the impact of the changes on district nurses applying for new posts.
Hand hygiene improvement in the community: a systems approach
Authors: Storr Julie , Kilpatrick Claire
Published: May 2014

Hand hygiene compliance, which is influenced in part by human behaviour, is central to infection prevention in all care settings. This article focuses specifically on the importance of a multimodal strategy for continued hand hygiene improvement, and its relevance to community nursing. Additionally, the article addresses the challenges and opportunities of infection prevention and control in a community context, and highlights current national and international guidelines that offer a framework and set of principles for implementation and sustainability with a specific focus on the multimodal strategy associated with the WHO Guidelines on Hand Hygiene in Health Care (2009). The authors conclude with some considerations for community nurses when addressing translation of these principles into their everyday working context.
Indications for deciding compression in the treatment of chronic oedema
Authors: Linnitt Nina , Jones Joanne
Published: May 2014

There are many fabrics and compression classes to choose from in the treatment of chronic oedema/lymphoedema. This article discusses the techniques involved in producing compression garments, and how different ways of constructing a compression garment can affect the limb being treated. It ends with a short case study describing one patient’s experience with layering high compression class garments which did not control his oedema, and how, by changing the garment fabric and reducing the compression class, he has been able to achieve a marked improvement in his general condition.
District nurse clinics: accountability and practice
Authors: Griffith Richard , Tengnah Cassam
Published: May 2014

The numbers of district nurse clinics are continuing to grow in primary care and they provide timely and more cost effective intervention for patients. The clinics provide exciting opportunities for district nurses but also carry an increased risk of exposure to liability.

This article discusses some of the key areas of accountability underpinning the duty of care of district nurses working in nurse-led clinics.
Managing asthma in the community: a guide for nursing staff
Authors: Bostock-Cox Beverley
Published: May 2014

Asthma is an inflammatory condition which affects all age groups and causes significant and unecessary morbidity and mortality. Appropriate management will depend on making the correct diagnosis and offering suitable medication through a device that the patient can use. Where indicated, self management through the use of asthma action plans should be encouraged.
The role of nurses in commissioning services within primary care
Authors: Leach Katherine , Shepherd Alison Burton
Published: May 2014

This article is a critical reflection on the role of the nurse in commissioning a service within the primary care setting. It will use the fictitious example of commissioning a nurse-led crisis prevention service in the London borough of Lambeth as an exemplar to highlight the difficulties surrounding the commissioning process. In placing particular focus on the prevalence of smoking, it is suggested that designing services based around tackling “clusters” of unhealthy risk factors such as smoking, diet and excessive alcohol consumption may be a more holistic approach to delivering better healthcare outcomes for more socioeconomically deprived populations as opposed to previous national siloed attempts ( Buck and Forsini 2012 ;1). It will argue that despite multifaceted and evolving roles, community nurses are ideally placed to recognise compounding risk factors detrimental to health as they work at the interface between the individual and their environment. This awareness can be used to positively impact on the commissioning process but only if greater attention is paid towards enhancing leadership skills throughout nursing, and the rhetoric of effective collaboration across agencies is translated into practice ( Ham et al, 2012 ; NHS Commissioning Board (NHS CB), 2012 ), NHS Alliance, 2011 ).
Assessing decision-making capacity: lessons from the Court of Protection
Authors: Griffith Richard , Tengnah Cassam
Published: May 2014

There have now been several cases where the Court of Protection has been critical of the approach to the assessment of decision-making capacity adopted by health and social care professionals. There is concern that the rights of the frail and vulnerable to make unwise decisions about their health and residence are not being respected and that there is a return to the paternalistic, ‘professional knows best’ approach to care and treatment. In this article, Richard Griffith and Cassam Tengnah argue that community nurses can learn valuable lessons from recent cases in the Court of Protection that can be applied in practice when they are required to assess decision-making capacity.
Shared decision-making: nurses must respect autonomy over paternalism
Authors: Griffith Richard , Tengnah Cassam
Published: May 2014

Shared decision-making lies at the heart of the Government's reforms of the NHS in England. The slogan, ‘No decision about me without me’, underpins shared decision-making that sees patients as active participants in their treatment decisions.

In this article, Richard Griffith and Cassam Tengnah argue that for ‘no decision about me, without me’ to be a reality, district nurses must guard against paternalistic decision-making that excludes the views and wishes of their patients.
Improving patient outcomes following a cancer diagnosis
Authors: Ozdilli Julia , Wilkinson Anne , Frew Gilmour
Published: May 2014

Cancer survival is improving, incidence is increasing and, for many, cancer is now being regarded as a long-term condition. Traditional follow-up services are no longer meeting the needs of patients, nor are they sustainable. Based on a long-term conditions model, NHS Improvement is working with test sites to develop new pathways of cancer aftercare. This article describes the new self-managed pathways and how they support recovery and health and wellbeing. With half of people with a cancer diagnosis having at least one other chronic condition ( Elliott et al, 2011 ) and cancer more commonly being a disease affecting the elderly, community nurses have a role to play in sustaining self-management and supporting the seamless and coordinated delivery of these pathways. They are well placed to reinforce messages given in secondary care, to sell the benefits of a healthy lifestyle, to be aware of the local amenities to signpost patients to, and to encourage their uptake and embed self-management.
Unlicensed medicines: the right to prescribe ‘specials’ and the problem of overcharging
Authors: Griffith Richard
Published: May 2014

The Government has announced an inquiry into alleged overcharging by wholesalers and pharmacists for the supply of unlicensed medicines known as ‘specials’. This article explores what specials are, a district nurse's right to prescribe specials and why they are susceptible to gross overcharging in the NHS.
The role of the community nurse in psoriatic comorbidities interventions
Authors: Aldridge Annette
Published: May 2014

Psoriasis is a chronic disease that affects more than the skin. It has an impact on every facet of an individual's life and is associated with numerous comorbidities, such as obesity, diabetes, cardiovascular disease, psoriatic arthritis, metabolic syndrome, squamous cell carcinoma, lymphoma, depression, anxiety and other immune-related conditions, such as Crohn's disease. Obesity is inextricably linked with type 2 diabetes, hypertension, hyperlipidemia, and cardiovascular disease. Hypertension and cardiovascular disease are precursors for myocardial infarction and stroke. Lifestyle choices, such as smoking, alcohol consumption, inadequate nutrition and physical exercise are behaviours that need to be addressed. With the right education from the community nurse, patients can be informed about the decisions they make and can ultimately choose to live a healthier life.
Medically unexplained symptoms: the need for effective communication and an integrated care strategy
Authors: Gormley Kevin J
Published: May 2014

Much is already known about medically unexplained symptoms (MUS) in terms of incidence, presentation and current treatment. What needs to be urgently addressed is a strategy for dealing with patients and their conditions, particularly when they do not fall neatly into medical frameworks or pathologies where the syndrome can be easily explained. This article will consider the provision of health and social care support for patients with MUS within an interprofessional education context. The author will contend that a sensitive and valued service for this large client group is dependent upon services without professional boundaries and practitioners with a clinical interest that can work together and agree an appropriate way forward in terms of care, support and strategic service provision. The article will support the idea that clear guidelines through the National Institute for Health and Care Excellence can offer clear clinical direction for practitioners working in primary and secondary care settings to work together interprofessionally to ensure a seamless and sensitive service for people with this condition.
An evaluation of KerraMax Care in the management of moderate to heavily exuding wounds
Authors: Jones June , Barraud Jo
Published: May 2014

Highly exuding wounds are common and can result in malodour, pain, maceration, infection and unsightly soiled dressings, as well as having a negative impact on an individual's quality of life. This communication reports on the findings from an evaluation by nurses regarding the clinical effectiveness and safety of superabsorbent dressing KerraMax Care and the patient experience of KerraMax Care in the management of moderate to highly exuding wounds. A total of 54 evaluations were completed. Nurses commented on the main benefits seen clinically with KerraMax Care as being reduced maceration, exudate managed and improved wound appearance. Other changes observed in wound appearance noted were visible granulation tissue and reduced pain. The evaluation demonstrates the positive impact that good dressing selection can have on the lives of patients, improving their wound–care experience and outcome.
Lymphtaping for lymphoedema: an overview of the treatment and its uses
Authors: Bosman Joyce
Published: May 2014

Lymphtaping is recognised to be a promising method for use in the management of lymphoedema. This article gives an overview of the concept of lymphtaping and the relevant literature. Several methods of action are described about lymphtaping: increasing pressure differences within lymph vessels; lifting the skin (inducing opening of initial lymph vessels); connective tissue becoming more flexible; and the micromassage effect. Medical taping concepts have only become the subject of scientific research in the last decade as the technique is still relatively new. Several misunderstandings around lymphtaping therefore still exist. These are discussed, supported by the available evidence. The article demonstrates that lymphtaping is a promising technique in the treatment of lymphoedema, and should be another choice for contraindicating pressure therapy patients and in areas where compression is difficult or impossible to use. However, each patient should be assessed and evaluated thoroughly and individually so that the appropriate treatment and properties can be determined