bluuebunny/crossref_metadata_2025_split huggingface dataset:
Myocardial infarction symptoms and appropriate action: awareness in people with diabetes
Authors: Wilson Valerie 
Published: May 2014

Diabetes exerts its greatest toll on the vascular system, causing micro- and macrovascular complications of the heart and circulatory system. This article explores the awareness of a group of people with either type 1 or type 2 diabetes of symptomatic myocardial infarction, and what action they would take if they experienced any of these. Aim: To explore awareness of potential myocardial infarction symptoms in a group of people with diabetes and to determine what action they would take. Method: A convenience sample of 21 non-NHS participants with either type 1 or type 2 diabetes took part in two focus groups. Results: Thematic data analysis identified the emergence of three main issues: recognising symptoms such as chest pain; not taking the symptoms of a potential myocardial infarction seriously; and reluctance to dial 999. Conclusions: This small-scale focus group study indicates that not all people with diabetes might take symptoms of potential myocardial infarction seriously or seek emergency help.
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 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.
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.
Managing and promoting change: implementing the Leg Club model
Authors: Seymour Ellen 
Published: May 2014

Patient knowledge of their disease may increase concordance to compression therapy. The Lindsay Leg Club® model (Lindsay, 2004) empowers the community nursing team to truly get to know their communities and deliver local, high-quality, evidence-based care for patients with leg ulcers and leg related problems. The author’s experience of opening a Leg Club has lead to changes in clinical practice: re-evaluation of the use of long stretch bandages in favour of short stretch; replacing conventional compression bandage systems with two piece graduated compression hosiery; increased patient concordance post healing with increased use of compression hosiery; the introduction of toe bandaging and appropriate long-term management for those patients with lymphoedema; and developing the role of the nursing auxiliary in leg ulcer care. This article won First Prize in the Compression Therapy Award at the British Journal of Nursing Clinical Practice Awards 2005.
Continence: sizing and fitting a penile sheath
Authors: Robinson John 
Published: May 2014

Male patients suffering from urinary incontinence can benefit from being fitted with a penile sheath and drainage bag rather than using incontinence pads or having to have an indwelling catheter to treat or manage their problem. In selecting a penile sheath it is important to select the correct size of sheath to fit onto the shaft of penis and length of sheath. A penile sheath fitted too small may cause problems not only in drainage of urine but also by restricting blood circulation to the shaft of the penis. A penile sheath fitted too large will cause creases to form, allowing urine leakage and causing the sheath to fail and fall off. This article explains what is required before fitting a penile sheath, examines various sheaths and alternatives, and how to fit one correctly.
Making decisions for incapable adults 1: Capacity and best interest
Authors: Griffith Richard 
Published: May 2014

The Mental Capacity Act 2005 is expected to come into force in April 2007. It will change the way decisions are made for incapable adults in England and Wales. District nurses, along with other health professionals, will be required to abide by the provisions of the Act when providing care and treatment to incapable adults. In a short series of articles, case studies will be used to illustrate how the new law will affect district nurse practice, beginning with the assessment of capacity and best interests. District nurse Mary Holt regularly visits a patient, 78-year-old Jane Harris, in her home to treat a chronic leg ulcer. Jane has been diagnosed with Alzheimer's dementia but is managing well with support from the local authority. However, Mary has noticed recently that Jane's behaviour has become a little strange. She looks unkempt and she is continually washing dishes that are not dirty. On her last visit, Jane she refused to allow the Mary to remove the dressing on her leg and treat the ulcer, which has become infected. Mary is concerned that Jane's wound needs to be treated to prevent further complications.
Informing patients of risks inherent in treatment
Authors: Griffith Richard , Tengnah Cassam 
Published: May 2014

Consent to treatment lies at the heart of autonomous decision making by patients who are entitled to make a free choice about whether to accept or refuse treatment. To help patients arrive at their decision district nurses must ensure that they give sufficient information about the nature and risks inherent in the treatment to allow an informed choice to be made. This article considers how much information regarding risks needs to be disclosed. It discusses how the law requires a different level of disclosure for patients who ask no questions about risks, those who make general enquiries about risks and those who ask specific questions about the risks inherent in treatment.
Tackling obesity as part of a lymphoedema management programme
Authors: Stigant Andrea 
Published: May 2014

All lymphoedema services are faced with the challenge of managing an ever-increasing caseload of obese patients, at an ever increasing cost to the NHS. This article explores some of the issues around the problem, reflecting on the need for careful assessment and support for this group of patients, including an assessment of their willingness to make significant lifestyle changes. Patients, and sometimes their carers, must be motivated to take responsibility for self-care if their lymphoedema problems are to be successfully resolved. Using a case-study approach the management of an individual is discussed and conclusions drawn as to a helpful approach to take when devising an individual management plan
Safeguarding research subjects who lack decision-making capacity
Authors: Griffith Richard , Tengnah Cassam 
Published: May 2014

In keeping with the Declaration of Helsinki, health-care research generally requires the informed consent of those who participate in the study. This approach upholds the autonomy of the participants but restricts research to subjects who have decision-making capacity. In order that people who lack decision making capacity can benefit from properly conducted research, the Mental Capacity Act 2005 introduced safeguards that enable researchers to investigate the care and treatment of people with incapacity while protecting this vulnerable patient group. This article outlines the requirements that must be met when conducting research with subjects who lack decision-making capacity
Community matrons and long-term conditions: an inside view
Authors: Cubby Arlene , Bowler Mandy 
Published: May 2014

This paper sets out to assess the impact of the community matron as perceived by those undertaking this relatively new nursing role. With the incidence of people living with long-term conditions continuing to rise and subsequently the costs of care set to increase, the role of community matron was identified as one approach to improve the management of these individuals living with chronic conditions. This included anticipating, coordinating and joining up care of specific high intensity patients with complex long-term conditions while supporting new ways of working to reduce unplanned hospital admissions and contain costs. Local primary care trusts (PCTs) were given guidance for the development of the community matron role with supporting frameworks for competency expectations and the use of case management techniques along with targets to achieve and a minimum case load criteria. Following the implementation of this role in 2005 a small scale study was conducted to evaluate the role using nine community matron participants working across NHS South of Tyne and Wear PCTs. Following in-depth interviews results were analysed and findings suggestive of many positive aspects of the role and areas still requiring further support and development.
Focus on negative pressure: exploring the barriers to adoption
Authors: Ousey Karen , Milne Jeanette 
Published: May 2014

Recent government documents have identified the move from hospital-based care into the community and have suggested that more complex wound care can now be provided in the community setting with therapies such as negative pressure wound therapy (NPWT). This focus group interview explores community tissue viability specialists’ experiences and attitudes towards the use of NPWT in community settings. The study was conducted in compliance with relevant ethical guidelines. Data analysis identified various themes but this paper concentrates on three; untimely referrals; cost implications and mutual benefit and understanding
The care of patients with complex long-term conditions
Authors: Kempshall Natalie 
Published: May 2014

The innovation of case management has been a controversial issue since nationwide implementation in 2005. The long-term condition (LTC) agenda remains prominent within all primary and secondary care services and the importance of patient-centred care is paramount. This article outlines the development and implementation of case management within a case study of a patient with the LTC chronic obstructive pulmonary disease. Key topics such as holistic care, individualized care planning and quality of life are reviewed to give awareness of the success of case management within the care of patients with complex LTCs.
The Bribery Act 2010: An overview for district nurses
Authors: Griffith Richard , Tengnah Cassam 
Published: May 2014

The Bribery Act 2010 has been in force for a little over a year and has already served to reinforce the need for NHS organisations to adopt a proactive approach to preventing any suggestion that their staff are accepting inducements, in the form of gifts or hospitality, that could influence their performance. The robust policies on the acceptance of gifts and hospitality demanded by the 2010 Act require district nurses to be very cautious when offered a gift by a patient or commercial organisation. This article considers the implications of the Bribery Act 2010 on district nurse practice and the implications of failing to meet its provisions.
Young people with type 1 diabetes and their transition to adult services
Authors: Kime Nicky 
Published: May 2014

More than 85% of children and young people with type 1 diabetes are not achieving the recommended target of <7.5% HbA1c and are at risk of developing long-term complications. The delivery of care, including the transition process, is a potential contributory factor towards such poor outcomes. The emphasis needs to be on joint multi-disciplinary working across all health sectors, including primary and secondary care, in order to ensure that young people receive the right support. This has important implications for the community nurse, who needs to take a more active role in the transition of young people with type 1 diabetes to adult services, especially given the emphasis on managing long-term conditions in the community. This article focuses on the results of a research study that examined the transition of young people with type 1 diabetes and looks at the role of community nurses in young peoples' diabetes care.