bluuebunny/crossref_metadata_2025 huggingface dataset:
The nurse's role in diagnosing hypertrophic cardiomyopathy
Authors: Palmer Sarah Jane
Published: May 2014

Hypertrophic cardiomyopathy (HCM) is the most common inherited cardiovascular disorder and the most common cause of sudden cardiac death (SCD) in people under 30 years. Although the causes are generally well known, SCD is often the first clinical manifestation of HCM. If those at risk of SCD and other complications are identified and treated appropriately, HCM is relatively benign. Priority should lie with identifying family and first-degree relatives of SCD victims, as HCM is predominantly a familial disorder. Patients with symptoms of HCM should be thoroughly assessed by health-care professionals. Knowledge of symptoms of HCM can lead to further investigations that can aid diagnosis. Symptoms include angina, dyspnoea, syncope/presyncope, palpitations and dizziness. The nurse plays an important role in assessing the patient for signs and symptoms of HCM through competent knowledge and skills in history taking, physical examination and electrocardiogram interpretation, which may provide the basis for a referral for an echocardiogram that can lead to the diagnosis of HCM. Treatment can then be commenced, thus reducing the risk of SCD. Implantable cardiac defibrillators are a common surgical intervention in HCM that have proven to be life saving.
Accurate measurement and assessment of the QT interval
Authors: Yaldren Jo , Richley Dave
Published: May 2014

QT measurement should be included as part of the systematic interpretation of the electrocardiogram (ECG). Accurate measurement and interpretation of the QT interval will help to identify potentially fatal long QT syndrome (LQTS). The assessment of the QT interval, correction of the QT and the guidelines relating to it are complex. This article discusses the importance of this element of the ECG and offers practical advice on QT assessment based on a review of the relevant literature.
Evaluating patients' experiences of heart-valve replacement surgery
Authors: Jackson Keith , Cook Lindsey , Jackson Mark , Simbodyal Rohini , Carver Kathryn , Greig-Midlane Hazel , Timmis Ken , Ponsonby Martina
Published: May 2014

Aim

This initiative measures patient experience, specifically in heart-valve replacement surgery, by developing in-depth, robust and validated metrics which aim to deliver a better experience for patients and their parents/carers. The initiative was led by a group of patients, patient group representatives, cardiac clinicians and nurses, NHS England and NHS Improving Quality representatives, with support from Edwards Lifesciences (industry representative). A range of quality measures can be used to assess NHS services, including patient-reported experience measures (PREMs) and patient-reported outcome measures (PROMs).

Research and methods

This initiative aims to empower patients and patient organisations to provide feedback on what was important to them in their heart-valve replacement surgery. The PREMs group followed a clear methodology for development of the PREMs, which involved a seven-stage process over the course of eight workshops.

Results

Over 8 months, the group successfully developed a series of PREMs for heart-valve replacement surgery that have been reviewed by patients and service users and refined ready for wider use and validation. An updated patient experience framework was also developed with two additional components (patient choice and financial burden) being added to the existing framework developed by the Picker Institute (1987) .

Conclusion

PREMs can have quantitative and qualitative methodologies to drive service improvement and can be used alongside PROMs to produce a rounded picture of patients' views on both the process and the outcome of care. This research demonstrates that it is vital that patients are involved in developing the questions to ensure they are understood, comprehensive and relevant.
Targeting resources: A purchaser's perspective
Authors: Clarke Les
Published: May 2014

As concepts of health change and technology advances, demands for health care increase. With finite resources available for health care there is a need to ration and achieve maximum value for money. This is referred to as targeting resources. To achieve these objectives resources need to be targeted on areas of greatest need, services which are most efficient and interventions which are most effective in improving health and well being. This implies a shift from:

Treatment to prevention Secondary care to primary care Practices founded on tradition as opposed to those based on evidence Providers that do not provide value for money to those that do.

These factors have major implications for health service managers and front line practitioners.

This paper is intended to give an overview of current health policy and its implications for community health nurses’ education and practice. Moreover, it is hoped it will make nurses aware that health policy is not just a matter for politicians and bureaucrats, but something that should actively concern all front line practitioners, as it impacts directly on the very nature of the care that nurses provide.
The psychology of asthma care
Authors: Morton-Cooper Alison
Published: May 2014

This paper questions some of the assumptions underpinning the care of those with asthma, and seeks explanations from social psychology for the ways in which staff and their clients respond to social situations involving asthma symptoms.

When does a patient become an asthmatic, and what implications does this process have for continuing treatment and care?

It is suggested that practitioners should expand their world views of what is involved in care, to move beyond the traditional boundaries of comforter and technician in treatment, thus allowing patients and families to participate fully in care. Further empirical research into methods of care delivery, including nurse-run asthma clinics, is needed in order to develop appropriate, responsive and evidence-based models of care.
Guidelines for selecting pressure relieving devices in the community
Authors: Dealey Carol
Published: May 2014

At present there is insufficient research to guide the selection of pressure relieving equipment. There is also a huge range of products to choose from. This paper will discuss a pragmatic approach to the selection of equipment for patients being cared for in their own homes.

It is not sufficient to select equipment simply from a score of a risk calculator; other questions also need to be asked. This may range from the presence or absence of pressure sores to the significance of the bed height for patient transfers.

In order to aid selection, a list of criteria have been developed for each type of mattress or overlay which are commonly available.
The School nurse and sex education: professional and ethical dilemmas
Authors: Branson Kathy
Published: May 2014

Sex education in schools is carried out within a comprehensive framework of legislation and professional guidance. However, the role of the school nurse providing sex education in schools remains fraught with professional and ethical dilemmas. This paper will describe the framework within which school nurses provide sex education and discuss some of the ethical issues which arise from it.

This paper suggests that school nurses may require additional training, not only in talking to young people about sexual issues, but with regard also to nursing ethics.
The role of the specialist: time to reflect
Authors: Vaughan Barbara
Published: May 2014

It would have been hard a hundred years ago to envisage the range and depth of services which are available as an integral part of health care in the 1990s. Yet as time has moved on, technology has progressed and knowledge about health has increased. As a result, we have seen a proliferation of new areas of specialist care, all of which offer a clearly defined service which deals with a very specific aspect of our bodies or minds.
A vision of multicultural nursing
Authors: Chevannes Mel
Published: May 2014

The UKCC Code of Professional Conduct (1992) requires nurses to act responsibily and to be non-judgemental when providing care for patients and clients from all ethnic groups. Indeed, Clause 7 specifically recognises and respects the uniqueness and dignity of the patient/client. This does not howeve, amount to multicultural nursing, but sets the standard by which all nurses should act when they provide care.
Men’s health: a role for men in health visiting?
Authors: Williams Robert
Published: May 2014

This paper explores some of the important issues regarding preventive health work with men. Masculinity as the central theoretical concept is explained, but it also underpins the discussion throughout this paper. Discussion of the ‘principles’ and socio-political background of contemporary health visiting provides the context for exploring the potential for preventive health work with men, and by men, within health visiting. This paper complements a research and development paper to be published in British Journal of Community Health Nursing in 1997 which will explore health visiting ideologies surrounding men’s health, and identify concrete individual and organisational development needs at a local level.
The politics of asthma: an educationalist’s perspective
Authors: Cooper Barrie
Published: May 2014

Asthma is not yet high enough on the political agenda, despite its cost in both financial and human terms. Neither is the treatment of asthma as effective as it could be, as a result of ignorance amongst sufferers. Both children and adults are given insufficient education in the causes and treatment of asthma.

This paper describes ways in which asthma education can be approached through the present Primary School National Curriculum, and how a primary school asthma policy can be written and successfully introduced.

It is suggested that only through a long–term policy of educating all children about asthma will political action follow, to tackle the causes and to improve the treatment of the condition.
A nurse-led service: innovations in leg ulcer care
Authors: Moffatt Christine
Published: May 2014

Leg ulcer treatment has improved in the last decade, with the emphasis placed on providing specialist support to patients treated in the community. A traditional leg ulcer clinic in a London hospital developed into a nurse-led service embracing a wider multi-professional approach. Three case studies illustrate the importance of a multi-disciplinary approach to care and highlight how nursing frequently plays the most dominant role.

The development of this service was initially hampered by inter-professional conflict and resistance ot the evolving role of the nurse as leader of the team.
Assessing practice: creative partnership in action
Authors: MacLellan Maureen
Published: May 2014

The United Kingdom Central Council (UKCC) 1994 document entitled ‘Standards for Education and Practice Following Registration’ contained new standards for educational programmes leading to a specialist practitioner qualification. This paper describes the processes involved for one team in attempting to address the assessment issues arising from the design and delivery of courses, in which programme content must reflect an even split between theory and practice.

Of particular significance is the consideration that these programmes have to be delivered at degree level, with the consequence that the outcome may carry a classification. In view of this, it is suggested that there is a need to review the ways in which the degree classification is achieved. Overall course assessment should provide an accurate reflection of the composite abilities of students.

It is important therefore to establish ways of effectively assessing and grading theory and practice, and attributing equal weighting to that assessment. This paper presents the framework developed.
Managing sickle cell disease: the hospital-community interface
Authors: Thomas Veronica Nicky , Westerdale Neil
Published: May 2014

The sickle cell population is rapidly increasing, yet the interface between hospital and community care remains fragmented and uncoordinated. Historically the care for patients with sickle cell disease has been predominantly hospital-based, because of the perceived complexity of the illness and the need to be linked with specialist haematology departments. However, there is evidence to suggest that the needs of sickle cell patients are not being adequately addressed by this narrow focus. Moreover, there is a general feeling amongst clinicians in London that this group of patients has become dependent upon hospital-based services. If such dependency exists then it occurs primarily because there are limited services available to patients in the community.

This paper discusses the current management issues and resultant problems which arise from inadequate and poorly functioning community care pathways. It is suggested that immeasurable benefits can accrue for individual sufferers and families if services are developed to be consistent with current services available for other acute/chronic life threatening illnesses. In addition there are likely to be substantial gains for purchasers and providers of health care as a result of these initiatives.
The rehabilitation of Mabel – an interdisciplinary project
Authors: Woodhead Hazel , Fortey Yvonne
Published: May 2014

The aim of this article is to show how rehabilitation of a severely disabled patient was achieved through nursing and therapy professions working together as an interdisciplinary team to achieve goals mutually agreed and set by the patient.

The patient, Mabel, is a 66 year old woman with dense right-sided hemiplegia living in the community with her husband, Ted. The article describes the nursing input and skill mix which was provided to achieve the most satisfactory care. It also explores the contributions made by the community physiotherapist, the occupational therapist and the Social Services care assistant.

It was concluded that Mabel showed a marked improvement, physically, mentally and socially. She was able to move out of the sick role to become largely self caring. Although a great investment of time was required initially to set up the project, Mabel’s requirements for care decreased markedly over a 15 month period.
IT and the new modality of community mental health care
Authors: Godin Paul , Hannigan Ben
Published: May 2014

Information technology (IT) has become vital to the practice of contemporary community mental health care. Technology shapes the organisation of work around it. The twentieth century has seen the development of technologies in work associated with the treatment of mental illness, that first transformed asylums into hospitals and then enabled the development of community care. The need to focus community mental health care upon the management of the severe long term mentally ill in recent years, has made for the development of ‘case management’. This has become more refined by the use of IT towards the development of ‘clinical case management’. Yet inconsistencies in practices and information systems still require greater harmonisation for more efficiency in the management of community mental health care.
Education of Asian people with diabetes
Authors: Welch Jeanette
Published: May 2014

Prevalence of Diabetes amongst the Asian population in Britain is 2-4 times higher than that found in white Europeans. Additionally, the standards of diabetes control among Asians is relatively poor.

One of several factors affecting this state of diabetes control is poor education about diet. Studies have shown that Asians know less about diabetes than their white counterparts, despite receiving similar education programmes.

This paper identifies two areas where the community nurse can help address the problem: by adopting a respectful approach to traditional diet and by being more sympathetic in communication. Finally, the paper states that the content of education materials aimed at Asians with diabetes should be reviewed. This is in view of many elderly Asians’ poor grasp of the English language.
Association between asthma and eczema and how they are managed
Authors: Buck Sallie
Published: May 2014

Allergic asthma and atopic eczema are both chronic inflammatory conditions with an underlying immunological basis. There is no cure for either condition but both have a variety of excellent treatments available that should improve the quality of the patients life.

Most asthma is now managed in the primary setting by practice nurses, the more severe cases only being referred to secondary care. At this time there is little structured care in the community for patients with atopic eczema. Community nurses of all persuasions are ideally placed to address this imbalance of care.

Guidelines for the management of asthma have been widely distributed and taken heed of. Guidelines for the management of atopic eczema in primary care need similar advertisement.
What has happened to breakfast?
Authors: While Alison
Published: May 2014

The beginning of the school year has revealed yet again what some children eat for their breakfast as they travel to school on public transport. Amazing dexterity is displayed as they juggle their school bags with quantities of confectionery which would make all dentists despair of the quest for improvement in oral health. There is clearly no easy answer to inspiring young people to adopt healthy eating habits. As a health visitor, I am always struck how most, if not all, parents express a concern to provide the very best diet for the new family member. Yet somehow, a continuing interest in nutrition become diluted over time as other parenting challenges come to the fore.
New vision
Authors: Beese Jacqueline
Published: May 2014

Much media attention has recently been focused on the inadequacies of care in the community, particularly in relation to mental health. As with any contentious subject it is difficult to have a debate that does not dwell on extremes. However, hardly a month passes without an announcement of yet another enquiry into tragedies arising from failures in care for people with long-term mental illness. The fundamental challenge for all those working with this client group is how to target an effective service.
The muddle of community health care for the elderly
Authors: Newton John
Published: May 2014

Hospital stays are getting shorter as a matter of policy, and the need for adequate discharge planning is well recognised - so why do elderly people not get the services they need after discharge from hospital?
As community nurses we must choose our own destiny
Authors: While Alison
Published: May 2014

The review of The Regulation of Nurses, Midwives and Health Visitors Act 1997 is well underway, but its not too late to participate in this debate regarding the future shape of professional regulation. The consultative process does not close until 27 February 1998.
Prevention and care of children with infectious gastroenteritis
Authors: Purssell Edward
Published: May 2014

Infectious gastroenteritis is a common cause of morbidity among children. Although it rarely causes death in the developed world, in other areas it is a leading cause of mortality. Many children are admitted to hospital with gastroenteritis although there is evidence that this may not always be necessary. This paper examines some of the main causes of gastroenteritis in children, and what implications this has for nurses working in the community. Control measures in institutions are discussed in the light of research that suggests that gastrointestinal pathogens are widely distributed in the environment in some buildings frequented by children. Furthermore it highlights research that has changed the way in which gastroenteritis is treated for most children, such as immediate feeding and not diluting milk. The treatment of gastroenteritis is therefore primarily supportive, and many of the interventions are those in which nurses are ideally placed to assist families in providing. Nurses working in a variety of settings are therefore in an ideal position to reduce the impact of gastroenteritis through education of children and adults, supporting parents of sick children and, if necessary, through care in hospital.
Cardiac liaison: crossing the primary secondary care interface
Authors: Wright Lucy , Done Kharren
Published: May 2014

A cardiac liaison nursing service was the key element of the innovative Southampton Heart Integrated care Project (SHIP). Cardiac liaison nurses provided continuous integrated care, both within and outside hospital to patients with a myocardial infarction or newly diagnosed angina. The principal characteristic of this model of liaison nursing was the facilitation of patient follow-up care in the community with the primary aims of improving quality of life and symptom control and minimising the risk of further cardiac events and death. Once patients were referred to the primary care team, cardiac liaison nurses did not provide direct patient care, but supported practice nurses in the provision of long term follow-up for patients with established ischaemic heart disease. This model of liaison nursing differs from the more traditional approach in which direct care is provided by a hospital based nurse after patients' discharge to the community. This paper describes the innovative cardiac liaison nurse service in Southampton, examines the challenges encountered in crossing the primary secondary care interface and highlights the relative advantages of this different kind of liaison nursing.
Is health for all just around the corner?
Authors: While Alison
Published: May 2014

The Government has now published the long-awaited Green Paper Our Healthier Nation - a contract for health (Department of Health, 1998) which sets out two ambitions, namely:
Assessment of significant harm: improving professional practice
Authors: Ayre Patrick
Published: May 2014

Judging whether a child is suffering or is likely to suffer ‘significant harm’ has become a critical task for professionals working in the field of child health. Yet little guidance is available about what the phrase means in its entirety or how it should be applied in practice. This study set out to clarify the position by examining how the phrase was used in practice by a selected sample of experienced health and social work staff. The evidence collected suggests flaws in the general approach adopted by professionals to identification and assessment in child protection cases. The data indicate a heavy concentration of attention on the weaknesses of families being assessed rather than their strengths and on parents rather than children. Problems are identified in responding effectively to long-term, chronic abuse such as emotional abuse and neglect.
Are we clinically effective?
Authors: While Alison
Published: May 2014

Government policy emphasizes the importance of public health and the contribution made by community nurses. In so doing, it provides community nursing with a powerful opportunity and also a great challenge. Importantly, community nursing must be seen as really contributing to the health of the population not only through rhetoric but also evidenced by published rigorous research.
A hospital treats patients -- it does not provide care
Authors: Dimond Bridgit
Published: May 2014

The Government has set up a Royal Commission to advise health professionals on the provision of care for the elderly including financial provision. This article examines some of the current problems that arise across the NHS and local authority boundaries. Some of the possible solutions to these problems are examined and discussed.
Recent developments in diabetes: equipment and technology
Authors: Spencer Sue
Published: May 2014

This article presents a brief overview of recent developments in technology and equipment in diabetes management, and is intended to complement the Focus on Diabetes supplement published in this journal in March 1998. The information presented here is limited to that which is immediately relevant to busy nurses working in the community, who often have to explain the purpose and use of new equipment to patients and relatives, or have to decide which equipment might help patients manage their diabetes better. The pros and cons of specific types of equipment are not discussed. Readers wanting more detailed information should contact their local diabetes team or the British Diabetic Association. It is hoped that the information given in this article will assist community nurses in providing patients and carers with appropriate advice or will suggest a contact number where they can obtain advice and support.
An approach to management for comunity health professionals
Authors: Parkin Paul
Published: May 2014

Community nurses have always had a significant management role both in the organisation and delivery of direct patient/client care and in the more strategic aspects such as multidisciplinary teamwork; audit and quality assurance; developing services based on assessment of needs; and inter-agency negotiation and liason. This role will be further enhanced in the future through the involvement of primary care groups in the purchasing and commissioning of primary care services. In order to accord with other healthcare professionals, community nurses need to develop a sound but straightforward management approach. The art of effective management is to balance achieving the needs of the ‘task’ while maintaining a ‘people’ focus which encourages personal development and commitment. This article suggests a framework for management which combines a focus on the more strategic aspects of planning and decision making together with one of the more subtle skills of inter-personal dynamics to achieve collaboration and a successful outcome.
The Clear Advantage urinary incontinence sheath for men
Authors: Doherty Willie
Published: May 2014

All too often in the past urinary sheaths have been dismissed as having failed their user and carer simply because they have been poorly fitted or incorrectly measured. This article looks at the progressive development of the urinary incontinence sheath, from the various ‘home-made’ appliances that people with bladder problems conjured up, to today’s more effective, more reliable products, such as the Clear Advantage all-silicone urinary incontinence sheath from Seton Continence Care.
Clinical governance and record keeping: legal issues issues
Authors: Tingle John
Published: May 2014

This article examines the recent NHS White Paper (Department of Health, 1997). The author argues that it is essential to acknowledge the key legal issues and principles of clinical risk management in order to effectively implement clinical governance provisions. Good record keeping is identified as an area which needs to be addressed and improved in order to develop effective clinical governance.
Nurse consultants
Authors: Hesketh Jo
Published: May 2014

Tony Blair’s announcement of a new bred of elite nurse consultant, received a mixed reception that at this year’s Nurse of the Year Awards with members of the nursing profession giving the initiative a highly cautious yet qualified welcome.
Peanut allergy in school-age children: the school nurse’s role
Authors: Campbell Dawn H
Published: May 2014

Children who suffer from peanut allergy are likely to form an increasing part of the population requiring healthcare intervention. In the case of school-age children these interventions will be derived from a need for education, support and guidance. These needs may best be met by the school nurse who is in a unique position to accurately target interventions by working in partnership with children, parents and school staff members. In a climate where the role of the school nurse has been under scrutiny and where school nursing services have faced cuts, this is an area where the practice of the school nurse is expanding and where he/she can demonstrate positive care outcomes.
Eldercare: towards a new specialty
Authors: Nolan Mike , Tolson Debbie
Published: May 2014

This issue of the British Journal of Community Nursing, with its focus on older people, provides a timely reminder of the importance of work with this client group. Not only is 1999 the International Year of the Older Person but there are also likely to be significant policy and practice developments in the UK with both the Royal Commission on Long-Term Care and the Prime Minister’s Carers Strategy Project due to report shortly, as well as the establishment of a National Service Framework to set standards of NHS care for older people announced by Frank Dobson in December 1998. It is therefore perhaps appropriate that nurses working in the community reflect upon their potentially significant, but as yet largely unrealized, role in eldercare. This term was adopted by the Health Advisory Service (HAS) in their major thematic review of the needs of older people completed in 1997 (HAS, 1997). According to the Director of the HAS eldercare was intended to:
Marie Curie nursing service: an overview
Authors: Barnes Alison
Published: May 2014

This article outlines the history and service provided by the Marie Curie nursing service which complements and liaises with, but does not replace, the district nursing service. The Marie Curie service provides ongoing nursing care for people with cancer in their own homes and offers support for carers. The district nurse as the prime carer assesses the need for care, writes the care plan and assess the appropriate grade of Marie Curie nurse required for each individual patient. The Marie Curie nursing service has been developing since 1958 and recent developments have included the introduction of team leaders, clinical supervision and national vocational qualifications.
The Sims Portex Catheter Valve: an alternative to the leg bag
Authors: Doherty Willie
Published: May 2014

Any patients who would normally use a catheter and leg bag could benefit from exchanging their leg bag for a catheter valve, as long as they have the manual dexterity to open their valve at regular intervals and remember to do so. The Sims Portex Catheter Valve is a lightweight and compact catheter valve that is discrete and offers more comfort than a leg bag system, especially to the more mobile patient. This article examines this type of catheter valve and assesses its relevance for use in both the community and the acute sector.
Larval therapy in the management of wounds: clinical update
Authors: Courtenay M
Published: May 2014

Larval therapy (LT) involves the introduction of sterile blowfly larvae into a wound. Although much remains to be learned about LT, its role in wound management is being increasingly recognized. LT is currently used on a variety of wounds in a number of hospital and community settings throughout the UK. This article reviews the literature on LT and a brief description of the life cycle of the greenbottle fly (Lucilia sericata) is outlined. The method of application of LT to wounds and the mechanism by which this treatment works is described. Current work on the clinical management and effectiveness of LT in the treatment of wounds in the UK is presented.
Larval therapy in the treatment of wounds: case history
Authors: Johnson Sue
Published: May 2014

Mr Houston is an 84-year-old widower who resides in a privately run nursing home. He has a complex medical history and suffers from emphysema, chronic bronchitis, hypertension, transient ischaemic attacks and had a cerebrovascular accident in 1996. He presented to his local vascular clinic with left-sided chest pain resulting from extensive stenosis of the distal superficial femoral and popliteal artery.
District nurses and home carers 1: a communication package
Authors: Jones-Tattum Lisa , Redworth Fiona , Atkin Jackie , Williams Iona
Published: May 2014

This article — the first in a series of three — outlines the development of a communication package devised to enhance communication and collaboration between a district nursing team and a social service home care team. Poor communication results in fragmented and uncoordinated care; the fundamental objective of this care intervention was to assist the improvement of patient care by enhancing communication and collaboration between the two teams. This article provides the rationale for the development and implementation of this package drawing on relevant literature to justify the approaches undertaken.
Some frequently asked questions (FAQs) about the Internet
Authors: Sweeney John
Published: May 2014

Computers are now as much a part of nursing as of other areas of modern life. Increasingly patients are using this tool to search the Internet for support and advice. With this development it is important that nurses too have a grasp of what is available online and how it can be accessed. The many uses of the Internet and the relevance to nursing of the World Wide Web, e-mail and online discussion groups are discussed here, and a number of useful sites are indicated. Some suggestions and guidance are given to encourage the ‘net naive’ to venture online and sample the wide variety of information and educational opportunities available.
The district nurses role as patient advocate: case study
Authors: Pettitt Kate
Published: May 2014

Controversy exists regarding whether or not nurses should act act as patient advocates. This article describes a case study in which a district nurse (DN) acted as an advocate for a patient, who was removed from his GP’s register. A structured approach using six stages of advocacy (Bateman, 1995) is applied to this case scenario. Legal, ethical and professional issues are explored to determine the DN’s position in advocacy. By acting as patient advocate the DN enhanced the therapeutic relationship with the patient and improved his access to health care. Although the extent to which a DN can act as advocate is somewhat limited, advocacy positively complimented and contributed to the role of the DN in this case study.
Using EMDR to treat post-traumatic stress disorder in a prison setting
Authors: Kitchiner Neil J
Published: May 2014

This article describes the treatment of a young man who developed post-traumatic stress disorder (PTSD) following the sudden unexpected miscarriage of his unborn child. He was diagnosed with this anxiety disorder while serving a term of imprisonment. He was treated with a controversial psychological treatment for PTSD, eye movement desensitisation reprocessing (EMDR) therapy, during one, 1-hour session. After this session, his progress was monitored by a further three follow-up appointments at 1 week, 1 month and 3 months, where the self-report questionnaires were repeated and compared with pre-treatment scores. These demonstrated improvement post-treatment and at a 3-month follow-up session. The discussion arising from the treatment will concentrate on EMDR as an effective treatment for PTSD, particularly within a prison setting. Data from recent research highlight the potential risks of PTSD within a community population and the implications for midwives and nurses who treat and care for traumatized patients are discussed.
Faculty practice: a model to bridge the theory–practice divide
Authors: Allen Deborah
Published: May 2014

It has been suggested that as a result of nurse education withdrawing from the clinical setting and becoming established in institutions of higher education, there has been a separation of theory from practice. Recognition of the theory–practice gap by clinicians and professional bodies has led to calls for nurse educators to retain a clinical focus. Faculty practice is described and critically discussed as a model of practice to bridge the theory–practice divide. In this article, the author presents the results of a 6-month pilot study to implement such a model within a community trust, and suggests that the development of such initiatives will foster collaborative working and improve nurse education and patient care.
Recording wounds: Polaroids new medically-designed cameras
Authors: Clarke Gwen
Published: May 2014

Wound management is an important and increasingly complex area of nursing practice. Community nurses, in particular, spend a considerable amount of time assessing, evaluating and managing chronic, non-healing wounds. The rapid rise in the number of wound care products, combined with the emphasis on clinical governance and risk management, and increases in litigation have meant that accurate documentation and record keeping have become an essential part of care (UKCC, 1992, 1998). A standardized approach to assessment, classification, measurement and evaluation should be adopted to maximize optimal patient outcomes. There are a number of techniques for measuring wounds, ranging from manual measurement using tracing to computer-based imaging. Photography is a simple and quick form of documentation, which provides an accurate and objective record of the wound. This article highlights the benefits of using the new Polaroid Macro 5 SLR camera in wound documentation.
What should be the limits of nurse prescribing?
Authors: While Alison
Published: May 2014

The Department of Health and Medicine Control Agency are inviting views regarding the extension of nurse prescribing (DoH, 2000a). In part, this desire to extend nurse prescribing reflects the aspirations of the NHS Plan (DoH, 2000b) to develop the role of nurses in primary care and also stakeholders’ views that the current Nurse Prescribers’ Formulary (NPF) is too limited and does not enable nurses to maximize their skills or widen access to medicines for therapeutic use.
Smoking cessation: working in partnership
Authors: Clarke Gwen
Published: May 2014

Many people will undoubtedly have started this year full of enthusiasm, ideas and resolutions about how to make their lifestyle a healthier one. Unfortunately, after a few months many of these resolutions have been forgotten and for some old habits prevail and good intentions are forgotten. Current figures show that only about 2% of smokers succeed in giving up in any year (Royal College of Physicians (RCP), 2000), which reflects the ambivalent attitude towards smoking cessation in the UK.
An overview of the development of nurse prescribing
Authors: Courtenay M
Published: May 2014

This article provides an overview of nurse prescribing in the UK. The initial recommendations for nurse prescribing, perceived benefits of prescribing and the findings from evaluation studies are reported. Current education and training courses available for nurse prescribers are described. The development of nurse prescribing has been slow and it could be argued out-dated as many practitioners are excluded from this initiative. It is important that nurse prescribers receive adequate time and funding to undertake appropriate training and education in this area.
The scope for community-based intervention in stroke rehabilitation
Authors: Walker Marion F , Pound Kate
Published: May 2014

The aftermath of stroke is commonly managed in the community, often exclusively by the GP. However, a significant proportion of community stroke patients have considerable impairments and disabilities which often go undetected and consequently untreated by the primary healthcare team. This article describes and quantifies the disabilities experienced by stroke patients living in the community and reviews the evidence for community rehabilitation. The roles of the occupational therapist and community nurse in the management of stroke rehabilitation are discussed. The authors conclude that an opportunity exists for better collaboration between the occupational therapist and the community nurse.
Legal issues arising in community nursing 7: record keeping
Authors: Dimond Bridgit
Published: May 2014

This article examines the principles which apply to record keeping in the community setting and some of the legal issues which arise. Some problems may arise because records are left with clients and a second set of records may be kept centrally. Issues such as access to records and future developments arising from clinical governance are also explored.
Community nursing research on the up
Authors: Pollard Tom
Published: May 2014

Community nursing research is not a new discipline, but I think it is true to say that the emergence of primary care at the heart of the health service in recent years has been a tremendous spur to development. A recent symposium in London, organized by the charity International Conferences in Community Health Care Nursing Research, raised a number of key questions, among them ‘what should community nurses research?’, ‘how should they research?’ and ‘how should they share their research?’. Clearly I have a vested interest in the last question – it benefits BJCN (and its readers) to be chosen as a means of disseminating research – but the first two questions produced some useful insights.
Critique of a protocol for annual review of older people with diabetes
Authors: Forbes Angus , Berry Jakki , While Alison
Published: May 2014

In this article we present a critical evaluation of the development of a protocol to support district nurses in the domiciliary annual review of older people with diabetes. We discuss the protocol’s development, identifying its limitations and making recommendations for its use. We conclude that although the protocol is a useful starting point its validity is challenged by a lack of primary research regarding the care of older people with diabetes. More work is needed to identify appropriate remedial therapy following the annual review. The health education component also requires development to better reflect the different needs of older people.
Geriatric assessment in primary care: formulating best practice
Authors: Philp I , Newton P , McKee KJ , Dixon S , Rowse G , Bath PA
Published: May 2014

Comprehensive geriatric assessment (CGA) is a structured approach to measuring physical, mental and social functioning of older people to identify needs and to plan care. Meta-analysis of trials of CGA suggest that it is cost-effective, but there is no agreed approach to its implementation in primary care. Our aim was to develop a best-practice model for geriatric assessment in primary care. We took an iterative approach to development, combining expert and local stakeholder opinion, and using semi-structured interviews to assess patient and practitioner experience in nine general practices in Sheffield. Patients were aged 75 and over, living at home. The best-practice model was the use of a standardised instrument (EASY-Care) to unselected patients aged 75 years and over living at home or in residential care, administered by a practice nurse in the context of an over-75s health check. There was high patient and practitioner acceptability, and significant cost savings were noted. Key beneficial features were the assessment of mental health and sources of support; goal-setting; generation of a disability score; and high patient satisfaction from contact with nursing staff. We conclude that geriatric assessment in primary care is feasible, economical and beneficial to patients and practitioners to be beneficial. Nursing staff are central to successful implementation of geriatric assessment in primary care.
Principles for pressure ulcer prevention in the community
Authors: Gibson Louise
Published: May 2014

This article aims to examine the prevention of pressure ulcers in the community. Pressure ulcers continue to cause needless distress and anxiety for patients, carers and their families. Health professionals in the community often face extreme challenges when caring for patients who are at risk of developing pressure ulcers. This could be due to lack of appropriate assessment skills and having insufficient time to conduct an appropriate assessment. Having an understanding and awareness of the function of the skin and the aetiology of pressure ulcer development can assist the health professional in attempting to take a proactive approach to prevent pressure ulcer formation in the community setting.
OpSite Plus in the management of exuding wounds
Authors: Fear Mair
Published: May 2014

This article discusses the use of OpSite Plus™ (formerly known as OpSite Post-Op™) in the community setting. This semipermeable film dressing with an absorbent pad was evaluated by the community hospital and by practice and district nurses within Plymouth’s NHS Primary Care Trust.
Compression bandaging and the clinical governance agenda
Authors: Dowsett Caroline , Scanlon Liz
Published: May 2014

This article explores the concept of compression bandaging for venous leg ulcer management within the framework of clinical governance. It considers areas, such as clinical evidence, clinical audit, clinical risk-management, quality assurance and professional development, and relates this to everyday practice in the management of venous leg ulcers using compression-bandaging. It acknowledges that the elements of clinical governance are not new to nurses, but provide the relevant information that brings together clinical issues with nursing policy and government directives.
Patients’ experiences of leg ulceration
Authors: Price Patricia
Published: May 2014

For many patients with chronic leg ulceration, day-to-day living can be a difficult and traumatic experience. The possible time scales to recovery can be very long, with periods of time where little progress may appear to be happening and patients can face a future in which recurrence is a real possibility. The symptoms of the experience often dominate a patient’s life to such an extent that he/she may grade symptom relief higher than healing if asked to prioritise their treatment options (Harmer et al, 1994). Clinicians are only too aware of these problems but, although developing quickly, research work in this area is in its infancy. Unfortunately there is little agreement about what the concept of ‘the patient perspective’ involves, but most research has focused on investigating the impact of a disease or disorder on everyday living. This article will focus on health-related quality of life, with a brief review of the impact of wounds on body image.
Use of a charcoal dressing with silver on an MRSA-infected wound
Authors: Jackson Lorraine
Published: May 2014

This article explores the rationale for the dressing selection in the treatment of a methicillin-resistant Staphylococcus aureus (MRSA) surgical wound infection. It looks at the evidence to support the selection of the dressing for the actions it performs in reducing infection. It considers the implications of the immunosuppressed patient and the necessity to remove the risk of MRSA from both a medical and a quality of life issue, as infection to a dialysis access point in an already compromised person is a serious problem. The cost implications and the dilemma that is faced when treating an MRSA infection are discussed, giving consideration to the potential resistance issues. Bacteria are known to impair the repair process and as they proliferate in the wound each process involved in healing is affected, it is only when this equilibrium is in balance that the normal process of wound healing can occur. Therefore, the dressing selection process involved those dressings with the ability to reduce bacterial colonization and restore the wound balance.
Looking forward to the coming year
Authors: Pollard Tom
Published: May 2014

This will be a challenging year for primary care. Public dissatisfaction with the health service as a whole has not abated over the Christmas break, and the release of figures illustrating the wide variations in health spending between different areas of England has been a seasonal gift to critics of the Government’s plans. Scotland, Wales and Northern Ireland too show wide regional disparities in health spending, although costs arising from geographical isolation account for some of the variation. The challenge for the government in Westminster and the devolved assemblies will be to fulfil promises of higher spending while addressing the need for real reform to deliver local independence and flexibility.