bluuebunny/crossref_metadata_2025 huggingface dataset:
The concept of fatalism and New Labour’s role in tackling inequalities
Authors: Green Liz
Published: May 2014

In the past, the focus for Labour administrations’ responses to inequalities within the UK has been an anti-poverty strategy. Prime Minister Tony Blair has introduced a fresh perspective on such an analysis by drawing much wider relationship issues, as well as structural ones, to define the problem and therefore come up with the solution. The sound-bite summary of these issues is social exclusion. This expansion of the definition of the problem does have implications for health policy and health workers. The past focus dating from Beveridge (1942) on dealing with disease alone is deemed as a deficient approach. Social exclusion thinking links health into every aspect of the inequalities agenda, in order to deal with the basic problem of ‘fatalism’.
Venous haemodynamics and the effects of compression stockings
Authors: Bradley Lilian
Published: May 2014

Over the years, graduated compression stockings exerting varying ankle pressures have been used with differing degrees of effectiveness in the prevention of deep venous thrombosis and ulcer recurrence, and the treatment of venous ulceration (Stemmer et al, 1980; Partsch and Horakova, 1994; Veraart et al, 1997). Whether in the hospital or community setting, nurses often have the responsibility of measuring the limb and fitting the compression stocking on the patient and it is he/she who often influences the patient on the type of stocking and level of compression required. Understanding the influence of graduated compression on the venous haemodynamics of the lower limb and having a good working knowledge of the claims of the manufacturers as to expected levels of compression from each garment will aid the nurse and patient in decision making. An awareness of the hazards of inappropriate use of compression therapy should ensure that the nurse is a safe practitioner.
Celebrating the present, challenging the future of nurse prescribing
Authors: Basford Lynn , Bowskill Dianne
Published: May 2014

As universities gear up to deliver the next wave of nurse prescriber training, this article — based in part on the experiences of the University of Derby and its partner trusts and the recent consultation document (Department of Health, 2001) — considers the issues underpinning the education and training of nurse prescribers. The collaborative, cooperative and coordinated approach seen in the training of the first wave facilitated the preparation of large numbers of practitioners to prescribe while maintaining service provision to patients in the community. The success of the programme should be celebrated, but also raises topics for debate as nurse prescribing expands to include a much wider range of nurses. The consultation document identifies the range of medicines from which it is proposed nurses will be able to prescribe and outlines the education and training parameters that will underpin the new presribing requirements. It is clear that some challenges similar to those experienced during the first wave of nurse prescribing will arise, but there are also some significant differences that have raised pertinent questions and require answers.
Teaching in partnership: linking a medical school and a community trust
Authors: Gavin James , Lempp Heidi , Elliman Alyson , Grogan Clare
Published: May 2014

Since 1997, the Croydon and Surrey Downs Community NHS Trust, together with the Department of General Practice and Primary Care at Guy’s, King’s and St Thomas’ School of Medicine, King’s College London, has offered a community-based special study module to second year medical students. The module offered an opportunity to learn how people living with a chronic infection, such as HIV/AIDS, cope with their condition while being looked after by a multidisciplinary team in the community. This article describes how interprofessional teaching and supervision between community nurse specialists and medical students, with the involvement of multidisciplinary and community-based teachers, enabled active engagement of students in their learning. We also discuss the learning outcomes for the students and the benefits for the community trust staff in the context of interprofessional teaching.
The role of bibliotherapy in health anxiety: an experimental study
Authors: Jones Freda A
Published: May 2014

Despite its high prevalence and implications for health care resources, health anxiety is generally considered difficult and expensive to manage. Structured self-help materials (bibliotherapy) using a cognitive behaviour therapy (CBT) treatment approach have been shown to be clinically effective. This experimental study investigated the effects of bibliotherapy on patients who had been identified as demonstrating health concerns. The 40 participants (patients drawn from GP surgeries) were randomly allocated to two groups, one receiving bibliotherapy and the other not. Half the patients had a medically diagnosed problem. Anxiety was assessed before and after the bibliotherapy intervention, which took the form of a cognitive-behavioural self-help booklet for health anxiety sufferers. Patients in the bibliotherapy group showed reduced levels of anxiety at post-test, even when they also had an identifiable physical problem. These results are consistent with the idea that self-help materials can be an effective and accessible intervention in CBT, although further research is recommended.
A survey of drinking and toilet facilities in local state schools
Authors: Croghan Emma L
Published: May 2014

The public health role of the school nurse has been formalised recently in several documents. Within that role, they are charged with assessing and responding to health needs of the school-aged population. Children and young people are often accused of making unhealthy choices with regard to their fluid intake, however, there have been informal reports that it is difficult to access water in school. Also, with inclusion for all children high on the agenda, do schools have adequate toileting facilities for children with special needs? This survey used school nurses to assess the access to drinking water and toilets for children and young people in 136 Midlands schools. It also assessed the cleanliness and facilities available for handwashing and other sanitary processes. It found that many schools are failing to provide the facilities they are expected to. Overcrowding and potentially insanitary conditions were found in a significant proportion of the schools surveyed. Drinking facilities and access was found to be poor. Recommendations are made to begin to address the problems seen here.
Developing wound management guidelines for community nurses
Authors: Dowsett Caroline
Published: May 2014

Quality improvements are at the forefront of the Government’s agenda and the advent of clinical governance has increased interest in the evidence base on which clinical decisions are made. Clinical guidelines are seen as an important tool in achieving evidence-based practice and there has recently been a proliferation in guideline development, nationally and locally. This article describes the rationale for the development of wound management guidelines for community nurses and the key steps that were involved in this process. It discusses and highlights the importance of an implementation strategy, and the need to evaluate, review and ensure that guidelines are up to date. It is intended to be of use to those nurses in the community who are considering undertaking guideline development.
The extended nurse prescribing curriculum
Authors: Leung John
Published: May 2014

The extension of independent nurse prescribing is underway; 38 higher education institutions are currently approved to offer the new course. This article discusses the considerations which led to the development of the new curriculum, and provides a broad overview of its content.
Treating peristomal skin problems in the community
Authors: Black Patricia
Published: May 2014

Adaptation to life with a stoma depends to a large extent on the health of the peristomal skin. This area of skin can become damaged in various ways, and the resulting discomfort or pain can make the use of a stoma appliance difficult. Problems such as these can be one of the major factors facing a community nurse in her/his care of the stoma patient. If the community nurse is able to recognize and correct these problems, this will enable the patient to carry on with a normal and productive life. Failure to correct stoma-related problems can have significant negative effects on patients’ psychosocial wellbeing. This article discusses the causes and management of the commonest stoma-related skin problems.
Let’s lift district nursing out of the doldrums
Authors: Pollard Tom
Published: May 2014

That the publication of the joint Queen’s Nursing Institute/English National Board report District Nursing: The Invisible Workforce (Low and Hesketh, 2002) has not caused much of a stir perfectly illustrates its point. In another group of public employees – police officers, teachers – disaffection on the scale implied in the report would have been discussed at length in the press. But this report has gone largely unnoticed.
Nurses’ confidence and pharmacological knowledge: a study
Authors: Sodha M , McLaughlin M , Williams G , Dhillon S
Published: May 2014

The introduction of nurse prescribing will assist the government to deliver its agenda of providing patients with faster access to advice and health services. This study evaluated the knowledge base, self-rated knowledge and confidence, for a prescribing role, in a group of community nurses in Essex. A questionnaire was distributed to 183 community nurses recruited using a random, stratified method, and 110 nurses returned completed forms. Nurse prescribers in the sample were more confident and rated their knowledge more highly when compared with non-prescribing nurses. However, prescribers’ actual medication-related knowledge, relative to their high levels of confidence, was not confirmed with performance on case scenarios. In responses to the case scenarios, prescribers did not perform as well as non-prescribers on all five analysed scenarios. The overall assessment of the nurses’ response to the OTC case scenarios showed a poor performance when compared with prescription cases. There is a need to improve community nurses’ levels of confidence and their abilities in coping with medication-related issues at pre-registration and post-registration level.
Treating fever in children: paracetamol or ibuprofen?
Authors: Purssell Edward
Published: May 2014

Community health practitioners frequently prescribe or advise parents on antipyretic medications for children with fevers. This mini-review sets out to examine the evidence for the relative effectiveness of two of the most widely available and commonly used over the counter medicines – paracetamol and ibuprofen. A systematic literature search was undertaken to identify al studies comparing the effects of the two drugs. The Medline, Embase, Cinahl and RCN databases were searched. Eight randomised controlled trials that reported temperature differences at time-points between 1 and 6 hours after administration were identified. Statistical meta-analysis showed no clear benefit for one drug over another 1 hour after administration. However, by 6 hours after administration ibuprofen was clearly superior resulting in a mean temperature 0.58°C lower than paracetamol. Both drugs appeared well tolerated and no evidence of difference in short-term adverse effects was observed. Both drugs are effective antipyretics but the longer action of ibuprofen may make it preferable in some circumstances.
Hydrocolloids in wound management: pros and cons
Authors: Finnie Alison
Published: May 2014

Hydrocolloids are interactive dressings which are well established in wound management. Because of their sophisticated composition, they can be used to manage a variety of wound types, from clean and granulating to sloughy and necrotic. While they may be more expensive per item than many other modern dressings, if used correctly they can be cost-effective, as they have a longer wear time. Hydrocolloid formulations appear to be changing and improving with ongoing research by manufacturers, but a significant limitation appears to be sensitivity reactions. Dressings that would benefit from improvement are those containing gelatin, and those containing colophony within the adhesive matrix. These known sensitizers are largely unpublicized, but can produce serious side-effects in some individuals.
Access to primary care:decision making by GP receptionists
Authors: Offredy Maxine
Published: May 2014

Current government strategy emphasizes the importance of widening access to health service to better serve the users of the system. There is also burgeoning empirical evidence in decision making in health care. Yet despite this, little attention has been given to the decision making of a key group of workers – general practice receptionists. Drawing on a larger study with general practitioners, nurse practitioners, patients and receptionists, this qualitative study explores the decision making of 15 general practice receptionists in the same number of general practices, in a variety of locations. The study documents how patients are categorised by the receptionists and the control strategies used in processing patients to access general practitioners or nurse practitioners. Implications for practice are highlighted.
The management of surgical wounds in a community setting
Authors: Dowsett Caroline
Published: May 2014

Many patients are now having minor surgical procedures carried out in the community and those patients who undergo surgery in hospital are likely to be discharged earlier due to increasing pressure on hospital beds. This article discusses the management of surgical wounds healing by both primary and secondary closure, in the community setting. Understanding the complex process of wound healing is essential if nurses are to recognize abnormalities and select appropriate treatments for patients. The stages of wound healing will be discussed in detail, including the patient’s presentation. Factors that influence this process within the patient (e.g. age, nutrition, medication and pain) and those at the wound bed (e.g. exudate, tissue type and infection) will be highlighted. Choosing the correct type of surgical wound dressing for the type of wound can contribute to wound healing, patient comfort and the cost-effectiveness of treatment. Factors that need to be taken into consideration when choosing a dressing will be outlined and suggestions made for the type of dressings that would be most appropriate. The importance of accurate and detailed documentation will be highlighted as part of this process.
A national pilot to implement pressure ulcer guidelines: results of the baseline audit
Authors: Stephens Fiona , Bick Debra
Published: May 2014

The Royal College of Nursing (RCN) national pilot audit project aims to facilitate the dissemination and implementation of the RCN clinical guideline on pressure ulcer risk assessment and prevention using an evidence-based, tailored strategy. Recent government White Papers reinforced the move towards evidence-based healthcare that includes performance measures, clinical effectiveness and ongoing professional development. Structured dissemination and implementation of the RCN guideline can aid this process by improving patient care, as well as in a culture where more patients are seeking recompense for ‘poor’ care assist in reducing litigation and complaints. This article focuses on the findings of the baseline audit. Providing a summary of the project to date, looking at site recruitment, the provisional results and recommendations of the baseline audit and local initiatives for supporting the ongoing implementation process. It describes the local, site specific feedback and education workshops and the implementation resources developed to assist the sites in the process. The project is due for completion at the end of 2002 following which the final results will be published.
Skin changes in the ‘at risk’ foot and their treatment
Authors: Springett Kate , White Richard J
Published: May 2014

The skin provides a ‘mirror’ of the patient’s general health, and any changes from normal for that person may be generalised or located to specific body sites. In the foot, poor quality skin may develop associated with a number of medical disorders such as diabetes or rheumatoid arthritis, and peripheral states such as peripheral vascular disease. In these instances the foot is ‘at risk’ of developing ulcers following even minor trauma. To manage epidermal and dermal changes efficiently, it helps to have a good understanding of the skin structure and function as well as knowledge of the more common conditions affecting the poorly viable foot. Skin physical characteristics change in the ‘at risk’ foot and skin conditions and lesions, e.g. anhydrosis, fissures, ulceration, can develop readily and left untreated, there is increased morbidity and risk of mortality. Even apparently minor skin conditions in the foot are therefore worthy of attention and appropriate treatment as introduced in this paper, as all those involved in health care have a responsibility and role in foot health education.
Patient group directions for antibiotic supply in Walk-in Centres: how legal are they?
Authors: Deave Toity , Weiss Marjorie , Salisbury Chris
Published: May 2014

Until recently antibiotics were only available on prescription. Nurses in NHS Walk-in Centres (WiCs) now supply and administer antibiotics in accordance with patient group directions (PGDs). The aim of this study was to investigate the process of antibiotic supply from WiCs. Antibiotic PGDs from ten WiCs were selected and medical notes of 50 patients who received an antibiotic at these WiCs were examined to determine compliance with PGD specifications. No consistency of approach in format and content of PGDs was found. PGDs from six WiCs complied with 15/20 or fewer PGD requirements. In the examination of patients’ records, 65% of all relevant PGD requirements were explicitly recorded. The breadth and variability of PGDs demonstrates local needs and priorities; however, low compliance levels with PGD requirements provide cause for concern. This article discusses the legality of PGDs, equity in both service provision and advice offered, compliance of medical notes with PGD requirements, implications for patients and WiC nurses, and training implications. Incomplete documentation makes it impossible to verify the quality of care provided across and within WiCs. It also suggests that uncertainty remains around the supply of medicines under PGDs.
Fluticasone and beclometasone: what are their effects on children’s growth?
Authors: Saini Kawaljeet , Griffiths Peter
Published: May 2014

Fear of growth retardation may account for the underuse of inhaled corticosteroids in children with asthma, despite compelling evidence of their effectiveness. This fear may be reduced with newer agents with lower oral bioavailability if their theoretical advantage of fewer systemic adverse effects than the standard treatment of inhaled beclometasone is realized in practice. This review aims to determine if one of the newer agents, inhaled fluticasone, has less effect on the growth of prepubertal asthmatic children than inhaled beclometasone. The outcome measure was growth velocity. Two double blind, randomized controlled trials were identified. In one of the studies the mean growth velocity in the fluticasone group was 0.7 cm/year greater than in the beclometasone group. In the second, smaller study the mean growth velocity in the fluticasone group was 0.8 cm/year greater. There is therefore some evidence that fluticasone has less (if any) adverse effect on growth.
Purple urinary bag syndrome: a harmless but alarming problem
Authors: Robinson John
Published: May 2014

Patients who are not catheterized may notice a discolouration in their urine or faeces, either occasionally or continually. Such discolouration can usually be put down to waste materials caused by medication or food. However, a comment often made by nurses who see catheterized patients is, ‘My patient’s drainage bag has turned purple’. Patients with this condition can show no underlying urine infection. It is also noticeable that the longer the drainage bag is used, the deeper the colour purple becomes. Over a period of time this discolouration then impregnates their catheter. This condition also produces a strong odour, and as air temperature increases, so does the smell. This condition is known as purple urinary bag syndrome or PUBS.
Compromised wound healing: a scientific approach to treatment
Authors: Moore Keith
Published: May 2014

A well-defined sequence of events follow dermal injury and with normal healing there is a controlled progression to re-epithelialization, scarring and restoration of an intact epidermis. In contrast compromised wounds such as diabetic ulcers, varicose ulcers and decubitus ulcers fail to heal and if not given appropriate care will enlarge and may persist for many months or even years.
So you want to do research? 2: developing the research question
Authors: Meadows Keith A
Published: May 2014

The development of the research question for a study can be where a lot of research fails. Without a well-defined and specific research question or hypothesis, findings from the research are unlikely to tell us very much. Developing a tightly-focused research question or hypothesis defines how and what data is collected and analysed and provides a context for the results. This article, the second in a series of six, focuses on the process of developing a research question or hypothesis from the initial idea through to the final research question, using examples to illustrate the key principles. Approaches to reviewing the literature, including hand searching and the use of electronic sources, are described together with their different strengths and weaknesses. An overview of the deductive and inductive approaches to research are described, as well as the underlying rationale of the null hypothesis and one and two-tailed tests. Finally, issues around the feasibility of the study, including, cost, time and relevance, are discussed in relationship to developing the research question or hypothesis.
An evaluation of community learning disability nurse teams in two London boroughs
Authors: Messent Peter R
Published: May 2014

One of the tasks for all the recently established local learning disability partnership boards is to review the role of specialist learning disability services by autumn 2003. This article presents a summary of a recent operational and strategic evaluation of community learning disability nurse teams working in two boroughs, managed by social services. Overall, local caseloads suggest that there are not enough nurses in the two boroughs. Furthermore, there is no spare capacity to address the Government’s directive that specialist staff become health facilitators, and give more time to helping primary and secondary care develop the capacity of their services for people with learning disabilities (Department of Health, 2001). Locally, these findings challenge the partnership boards and social services to adequately resource specialist services, meet Government targets and address nationally acknowledged, disproportionately high, unmet health needs in the learning disability population.
Growth factors: the wound healing therapy of the future?
Authors: Carter Kate
Published: May 2014

‘Growth factors’ is an umbrella term used to describe a variety of chemical messengers found in a wide range of tissues, which have a number of functions including the regulation of cell and tissue growth and development. Several growth factors have been proposed as ideal agents to promote wound healing. This review discusses their functions and how they can be applied in the management of chronic wounds.
The impact of diabetes on wound healing: implications of microcirculatory changes
Authors: Christopherson Katie
Published: May 2014

Diabetes is a well known cause of delayed wound healing yet the impact of diabetes on wound healing is not widely appreciated. This article examines the potential impact of diabetes-related microvascular disease on wound healing processes. The article reviews the available evidence and examines the practical consequences for nurses concerned with maintaining tissue viability.
Assessing for depression and mood disturbance in later life
Authors: Edwards Margaret
Published: May 2014

Depression has been identified as a common mental disorder in old age but frequently remains undetected. The Geriatric Depression Scale is one of the most heavily promoted scales for the screening of older people. Short versions of the scale (GDS-15 and GDS-4) are recommended for use with community patients, though most of the validation studies have been with people attending GP surgeries and outpatient departments. Changing the threshold affects the sensitivity and specificity of the scale and it has been recommended that the cut off points should be lower when the tool is used in clinical practice and higher when used for research purposes.
Nurse-led case management for older people with long-term conditions
Authors: Drennan Vari , Goodman Claire
Published: May 2014

People in the UK are successfully living longer but demonstrating an increased incidence of long-term conditions. In response to this, there has been a growth of service models that draw on the principles of case management, particularly for those older people with multiple and complex needs. Nurses working in primary care, and district nurses in particular, have always made a significant contribution to the care of older people with long-term, chronic conditions using case management techniques. However, the recent emphasis on case management has created new and expanded roles for nurses in primary care as the providers and coordinators of care. The aim of this article is to provide an overview of service models that use a case management approach and the current evidence for their effectiveness. We will then describe current examples of nurse-led case management in the UK and discuss some key issues for nurses in primary care and their patients.
Online information on primary care services for refugees and asylum-seekers
Authors: Kralj Lucy , Barriball Louise
Published: May 2014

Government initiatives concerning equitable services and information provision aim to provide for the whole community. This includes those recently arrived in England as refugees. This study evaluated the information provided online by 16 London primary care trusts (PCTs) on activities underway to meet the needs of the local refugee population and the extent to which government initiatives are being met. Information published on websites of PCTs with a refugee population estimated to be over 2.5% of the London total refugee population was surveyed using a 13-item framework based on guidelines for health professionals working in refugee health (Burnett and Fassil, 2002). The findings show a disparity between different types of information provided and variations in the overall standards achieved by individual PCTs, indicating a need for considerable work if the requirements of the public and government for access to high quality information about services are to be met. The majority of PCTs, however, provide good information regarding coordination of services and evidence of a thorough health needs assessment. The findings are relevant to health professionals working with refugees and to PCT employees involved in publishing information on the internet.
Legal requirements for safe handling in community care
Authors: Griffith Richard , Stevens Mary
Published: May 2014

Andrea is clearly aware that manually handling patients could result in back injury to her and the home care workers (McGuire and Dewar, 1993). However, she is also aware that she has a duty to her patient to provide nursing care to meet her needs. As a result of the patient’s resistance to mechanical lifting, those needs can only be met through manual handling.
Nurse prescribing: a case for clinical supervision
Authors: Jukes Mark , Millard Jeannette , Chessum Cheryl
Published: May 2014

This article will discuss the implications of nurse prescribing in mainstream primary health care and its impact on the fields of mental health and learning disabilities. Complexities and issues which require serious consideration by those nurses wishing to pursue such a specialist and extended role will be discussed in relation to these practice areas. Titchen’s (1998) critical companionship model will be illustrated as an example of one framework for clinical supervision. This is to allow the processes, competencies and contextual issues to be explored by both novice and expert prescribers. The article concludes that for safe, effective and competency-based practice, clinical supervision also assists in mediating the professional and political aspirations in support of supplementary nurse prescribing.
A survey to investigate the role of the district nurse in stroke care
Authors: Murray Jenni , Young John , Forster Anne , Ashworth Robert
Published: May 2014

The long-term needs of people who have had a stroke and their carers are not being adequately addressed. A stroke care coordinator based in primary care might improve service delivery: the district nurse has been suggested as a possible candidate. A postal survey was conducted with three primary care trusts in Bradford to investigate the current role of the district nurse in stroke care and to examine their potential as stroke care coordinator. District nurses from 24 (59%) teams responded to the survey. Twenty-two (44%) were aware of the national clinical guidelines for stroke and five (10%) had received stroke-related training within the previous year. The district nurses demonstrated insight into the types of longer-term problems experienced by people who have had a stroke and their carers. While the findings of the survey suggests that they would be a likely candidate for the stroke care coordinator role, there are major educational, training and organizational challenges to implementing this change.
Acupressure for nausea and vomiting in cancer patients receiving chemotherapy
Authors: Klein Joan , Griffiths Peter
Published: May 2014

Practitioners working with patients undergoing chemotherapy regularly encourage them to use acupressure in the form of Sea Bands™ for the relief of treatment related nausea and vomiting. This mini-review sets out to uncover and examine the evidence base for this recommendation. A mini systematic review was carried out to identify randomized controlled trials comparing the use of acupressure plus usual care with usual care alone. The population was adult patients receiving cancer chemotherapy. The outcome was nausea or vomiting duration or intensity. Searches on Medline, Embase, AMED, the Cochrane Library, Cancerlit and Cinahl identified two randomized controlled trials involving 482 patients which compared acupressure to no intervention control. The results suggest that acupressure may decrease nausea among patients undergoing chemotherapy but further work is required before conclusively advising patients on the efficacy of acupressure in preventing and treating chemotherapy induced nausea.
Necrotizing fasciitis in primary care: presentation, risk factors and treatment
Authors: Timmons John
Published: May 2014

Necrotizing skin infections, although rare, have proven difficult to manage and treat in a wide range of patient groups. The risks of extensive tissue necrosis, systemic sepsis and potentially organ failure make this disease one which health-care professionals must be aware of. Treatment involves rapid debridement and intensive therapy including broad spectrum antibiotics. Appropriate wound care is essential as is a great deal of psychological support for the patient and relatives. This article also highlights some of the risk factors which may pre-dispose a patient to infection.
Depression and COPD in older people: a review and discussion
Authors: Yohannes Abebaw Mengistu
Published: May 2014

Depression affects approximately 40% of patients with chronic obstructive pulmonary disease (COPD) and is largely untreated. This review draws on the author’s studies and the available literature, to examine the problem. Older people with COPD experience moderate levels of depression, but this goes largely unrecognized and untreated. The prevalence, severity and risk factors for depression in this population are discussed. Treatment, in the form of pulmonary rehabilitation and antidepressant drug therapy, are discuss, but in the absence of well-controlled trials, it is difficult to draw any firm conclusions about the benefits of these therapies. However, an appropriate home care package, with the support of respiratory nurses, is of some benefit to housebound patients with COPD because it helps to relieve depression and improve their quality of life, especially among those with a high level of depressive symptoms.
Understanding cachexia and excessive weight loss in cancer
Authors: Hemming Laureen , Maher David
Published: May 2014

Cachexia, a wasting condition often seen in advanced cancer, is often confused with anorexia but they are two separate conditions. It is evident that cachexia frequently leads to anorexia but anorexia alone cannot cause cachexia. The cachexia syndrome is weight loss with a specific cause – the action of cytokines, chemical messengers that are produced both by the body in response to the tumour and by the tumour to ensure its growth and spread. Treatment of cachexia is very difficult. Drugs to improve appetite have little effect, however, supplementing the diet with fish oils and vitamin E seems to be beneficial. Increasing a patient’s level of exercise, even if bed bound, does seem to have a positive effect and helps to synthesize skeletal muscle protein and delay the ravages of cachexia. Increasing exercise also has a positive effect on fatigue levels, a side-effect of cachexia.
A primary falls prevention programme for older people in Hong Kong
Authors: Sze Pan-Ching , Lam Pui-Sze , Chan Jessica , Leung Kwok-Sui
Published: May 2014

This study describes the development and implementation of a large-scale primary fall and fracture prevention programme in Hong Kong and its effect on increasing the awareness and knowledge of fall and fracture prevention among older people. The effect of promotion of community participation is also investigated in the implementation of this primary prevention programme. The programme includes educational seminars, a train-the-trainers programme and a staff training programme. The effect of the educational seminars is shown by the increase in the knowledge and awareness of fall and fracture prevention among these participants (p<0.01), while that of the train-the-trainers programme and staff-training programme is confirmed by the continuous expansion and continuation of the fall and fracture prevention programme in the community. The experience from this primary prevention programme has given us direction for future implementation of a more comprehensive prevention programme in our community.
Preventing and managing catheter-associated urinary tract infections
Authors: Godfrey Helen , Fraczyk Linda
Published: May 2014

Since the Foley catheter was introduced in the 1930s it has become one of the primary sources of hospital acquired infections and long term urinary catheters used in community based patients account for some 4% of community nurses’ time. This burden is likely to increase given the projected rise in life expectancy and size of the ageing population. This article considers the current literature around indwelling urinary catheterization and its management with a focus on long term catheterization in the community. The authors discuss contemporary strategies to manage or prevent CAUTI that are based on best practice guidelines. However, it is clear from the dearth of empirical evidence that there is an urgent need to establish well constructed research studies to investigate the prevalence of long term urinary catheterization in the community and the prevention and management of CAUTI.
District and practice nurses’ public health practice and training needs
Authors: Newby Katie , Wallace Louise , Wareing Hilary
Published: May 2014

In 2000, the UK government set out its plan to tackle poor health in Saving Lives: Our Healthier Nation. Practice and district nurses were recognized as key health professionals in achieving the integration of health improvement into the local delivery of health care. In order to respond to these changes, North Tyneside PCT undertook a training needs and skills analysis of local practice and district nurses. Thirty practice nurses and 39 district nurses returned completed questionnaires. Practice and district nurses rated their competence as lower in public health skills than in clinical skills and also rated them of less importance. Senior practice and district nurses indicated that they perceived low value in skills required to move forward public health practice within community nursing. The findings of this study have been used to develop a 5-day training programme. The approach has relevance to those concerned with making public health a reality within community services.
Does irrigation of the ear to remove impacted wax improve hearing?
Authors: Williams Deborah
Published: May 2014

Irrigation of the ear to remove impacted wax is a commonly performed nursing procedure in primary and community care. The main presenting symptom is hearing loss. This review sought to determine whether there is any evidence that irrigation of the ear to remove impacted wax improves hearing. The strategy used was that of a mini-review. Four databases were searched. Randomized controlled trials (RCTs), quasi-randomized studies and non-randomized comparative studies were considered if they demonstrated an objective measure of hearing before and after ear irrigation. Four studies were selected for critical appraisal. Only one study, a single-blind RCT, measured outcome by number of individuals that had their hearing improved by a clinically significant amount (33%). The results of this RCT may be over-estimated and so more evidence may be required before the question can be fully answered.
Whistleblowing: it’s time to overcome the negative image
Authors: Shah Fatima
Published: May 2014

The media perpetuates the stereotype of the whistleblower forced to go outside his or her organization and risk his or her career to bring wrongdoing to public awareness. In fact, NHS trusts should all have a whistleblowing policy in place which encourages people to raise genuine concerns about wrongdoing, and offer protection to those who do this. This article aims to help health workers understand the whistleblowing process and so assist them in raising concerns within their organization.
Stoma complications encountered in the community, A-Z
Authors: Burch Jennie
Published: May 2014

There can be a variety of long-term stoma-related complications that may be brought to the attention of the community nurse. Some of these problems are explored in this article. Solutions and advice are offered to assist community nurses in their care of this patient group.
Management of a high-output stoma in the community: case study
Authors: Burch Jennie
Published: May 2014

Nursing care of patients with high-output stomas in the community can be challenging. Large quantities of liquid effluent make containment and skin care high priorities. These issues can in some cases be further complicated by the need for parenteral nutrition (PN). Issues related to high output stomas will be briefly discussed and then a case study will show how one team of community nurses assisted a patient with a jejunostomy.
The impact of HETF for adults with neurological conditions
Authors: Brotherton Ailsa , Lyons Christina
Published: May 2014

The number of patients receiving home enteral tube feeding (HETF) in the UK is growing, despite little evidence that it improves survival or quality of life in many cases. There is also little work that has been done to explore the emotional impact of this invasive procedure on patients or carers. This article draws on a literature review to highlight some of the issues that may arise with patients receiving HETF, focusing particularly on the largest group of these patients: those with neurological conditions. The literature shows that emotional adjustments are required for both patient and carers following the placement of a percutaneous endoscopic gastrostomy. Therefore consideration of the likely emotional and psychological consequences of home enteral tube feeding has implications for clinical practice during the decision-making process for appropriate patient selection. There is a need for community nurses to consider these issues and ensure appropriate support is provided for patients and their carers.
Long-term conditions. 3: Being an expert patient
Authors: Mayor Vina
Published: May 2014

This third article in the series focusing on long-term conditions explores the patient perspective. Drawing on the experiences of seven people affected by a variety of long-term conditions, it illustrates how the journey towards being an expert patient is often lengthy and traumatic. Pre and post diagnosis phases are narrated, and the process of becoming an expert patient described. The articles suggests that there is significant potential for the development of a reciprocal relationship between patients and health professionals framed by mutual learning and advice.
District nurses’ triggers for referral of patients to the Macmillan nurse
Authors: Aitken Alexandra
Published: May 2014

This study aimed to identify the triggers which motivate district nurses to refer patients to the Macmillan nursing service and resulted from observation within the researcher's clinical practice, when it was noted that referral patterns from district nurses to the Macmillan nursing service were very inconsistent. A qualitative exploratory descriptive design was utilised and the analysis of the findings identified three ‘key’ themes, which motivate district nurses to refer: knowledge and skills, interprofessional issues and perception of Macmillan. Within each theme emerged an amalgam of triggers which were complex in nature, pertaining not only to patient need, but also to the needs of the district nursing service. However, it became apparent during the analysis that there was also a lack of knowledge regarding the role of the Macmillan nurse. This lack of knowledge relating to the Macmillan nurse role had been affirmed previously by several authors (Graves and Nash 1993, Clark et al 2002, Ahmed et al 2004) but the literature also reported that the Macmillan nurse role was open to confusion (Clark et al 2002, Corner 2003). This confusion may potentially affect referrals and prevent patients from receiving the services of the Macmillan nurse. This study has established a need for the development of referral criteria into the Macmillan nursing service and that there is also an identified need for further research, providing scope for the Macmillan nurse and district nurse to work collaboratively to improve palliative services in the community.
Making decisions for incapable adults 2: advanced decisions refusing care
Authors: Griffith Richard
Published: May 2014

In the second article focussing on the provisions of the new Mental Capacity Act 2005, Richard Griffith considers the impact on district nurse practice of advanced decisions refusing health care, that will allow a person to refuse even life-sustaining treatment in incapacity, and lasting powers of attorney, that will allow a person to appoint one or more people to make decisions concerning their personal welfare and property and affairs. For the first time in England and Wales a person will be able to appoint another to make consent-to-treatment decisions on their behalf that will be binding on district nurses and other health professionals.
The impact of venous ulcer pain: what can the patient teach us?
Authors: Stevens Helen
Published: May 2014

Pain is increasingly acknowledged as a problem in venous leg ulcers, but the emotional and psychological impact of pain is often underestimated. In this article, the literature regarding the impact of pain in venous ulcers is combined with an in-depth patient interview to produce a powerful personal account of the problem.
Community nurses and self-monitoring of blood glucose
Authors: Abbott Stephen , Burns Jill , Gleadell Anna , Gunnell Caroline
Published: May 2014

Self-monitoring of blood glucose (SMBG) is commonly recommended to patients with diabetes, although the rationale for this is unclear. This small research project was designed to explore the reasons why nurses working in the community recommend SMBG.

Seven interviews were carried out with community nurses caring primarily for housebound patients. Those interviewed believed that a sound evidence-base supported the recommendation that patients test their blood, but not urine, for glucose levels. Though nurses believed in the importance of patient choice and empowerment, the scope for these was limited among housebound patients. There was no evidence that patients understood how to respond to test results, or that comprehensive care planning was normal practice.

Although small, this study suggests that nurses working in community settings may need to update their knowledge. It also suggests that a national debate is necessary to disseminate better the evidence about SMBG, and its implications for nursing practice.
A deadly harvest: the effects of cold weather on older people in the UK
Authors: Gooodwin James
Published: May 2014

Excess winter mortality of some thousands of deaths of older people has occurred in the UK for the past 150 years and shows only moderate abatement. Government policies in both health and social care have had little apparent effect, other than a slow decline in seasonality due largely to secular trends. There are a number of apparent misconceptions, commonly held in the public mind and subsumed in public policy, which need to be corrected in order to reduce the toll of winter cold on older people. The evidence shows that winter deaths are to a large extent avoidable. They are not due to hypothermia as is widely believed, may not be necessarily reduced by climate change in the foreseeable future and may only be partially reduced by improving indoor warmth alone. The key is an integrated policy which reduces all risks equally. Community nursing is well placed to play a pivotal role in such policies.
Constipation and flatulence management for stoma patients
Authors: Burch Jennie
Published: May 2014

The ostomate (person with a stoma) has many issues to overcome when coming to terms with their new stoma. Some of the problems that can be associated with a colostomy are constipation and flatus. The ileostomate may also be troubled with flatulence. Causal factors for flatus may be ingested air or gut bacteria. Constipation may be a result of many factors, including diet and medication. The community nurse is in an ideal position to assist this patient group and this article offers a number of potential treatments or advice that the community nurse can provide for the ostomate. Many of the tips provided in this article are simple but may be potentially effective.
The new challenge: lifetime neighbourhoods
Authors: Kohler Mervyn
Published: May 2014

Communities as we have known them are disintegrating, and traditional services are becoming dispersed or closed altogether. But rather than cry over spilt milk, local citizens must seize the opportunity (now offered by all parties) to seriously engage with all the public authorities and reshape the neighbourhoods in which they live.