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Background: The COVID-19 pandemic placed a huge strain on healthcare services around the world, including community services. Students also faced substantial disturbance to educational programmes. Student district nurses are usually employed members of staff and can be recalled to the workforce, whereas pre-registration students cannot. Aims: This paper explores the feelings and experiences of student district nurses during the first UK national lockdown of the COVID-19 pandemic. An interpretative phenomenological approach was taken. Method: A semi structured 1:1 interview and focus group was held via zoom in July 2020. A total of eight student district nurses, who were all registered adult nurses, took part. Data was analysed using the Braun and Clarke model to identify themes. Results: The findings related to their experience of being a community adult registered nurse on the frontline, while also being a student district nurse. Three themes were identified from the analysis: anxiety and uncertainty, management of risk and teamwork. Conclusion: This study highlights the contribution that community nurses made in the clinical response to the COVID-19 pandemic. It adds to a paucity of literature available from this clinical setting and specifically from the viewpoint of a student district nurse. There is much written on the strains on hospital care, but it should be remembered that district nursing is the service that never shuts its doors because it has reached capacity. This study found that a lack of communication and uncertainty about their future as students contributed to heightened stress and anxiety. Teamwork and camaraderie are a vital aspect of any team and one that can support resilience in times of heightened stress. A lack of face-to-face interaction can lead to team members feeling isolated. Digital technology can be used to reduce this feeling when possible. [ABSTRACT FROM AUTHOR]

Technology within healthcare is a growing industry, and health professionals now use technology within their everyday working life. Within hospitals, it is the norm to see staff using handheld devices to record clinical observations and patient notes being typed into an electronic system. However, the use of technology within community settings is far behind that of hospital counterparts. It has been acknowledged that the use of technology in healthcare will improve efficiency and remove some of the bureaucracy within the NHS, and community areas are beginning to pilot different ways of implementing this. This article describes a pilot trial of using technology to aid mobile working in the author's trust and discusses how district nursing can embrace the use of paperlite culture to improve efficiency and record reliability. [ABSTRACT FROM AUTHOR]

Policies in long term conditions care continue to develop rapidly in England. Currently there is a focus on the integration of services and enabling patient and carer choice. Integration of care across disciplines and services is complex and community nursing services are commonly central to reorganization processes in long term condition care. This paper presents the findings of a mapping of the evidence on integration in long term condition services. Literature on horizontal integration including integrated teams will first be discussed, followed by an exploration of the evidence on vertical integration exemplified by integrated care pathways and disease management programmes. As a relatively recent service innovation, the mapping found a lack of evidence of the effectiveness of integration in long term conditions. Furthermore, the paper highlights the potential tension between vertical integration structures such as care pathways and the patient choice and empowerment agenda in long term conditions. [ABSTRACT FROM AUTHOR]

The COVID-19 pandemic has impacted healthcare education and delivery, including both theory and practice learning. Academic staff responded rapidly to move teaching online during the first lockdown, with many returning to practice to deliver care or upskill practice staff to work in critical care. Many pre-registration students responded by becoming paid NHS employees, contributing to care delivery while remaining on their programme of study. Practice learning partners, despite the challenges of the pandemic, continued to support students to achieve their registration status. This occurred within the context of the Emergency and Recovery Standards, published by the Nursing and Midwifery Council between March 2020 and September 2021. This paper sets out the response of students, practice learning partners and higher education institutions involved in pre-registration nursing and midwifery programmes. [ABSTRACT FROM AUTHOR]

Almost one-fifth of the population in England lives in rural areas. Compared to urban populations, the rural population is older and faces greater difficulties in accessing medical services. At the same time, healthcare teams in rural areas face particular challenges in recruiting and retaining staff, travelling between patients and keeping specialised knowledge up-to-date. Drawing upon a recent health needs assessment for people living with long-term neurological conditions in a rural English county, as well as a broader review of the literature, this paper considers the challenges of rurality and discusses potential solutions. Technological and community-based responses have often been suggested as responses to challenges of rurality. However, there is likely to be a need for up-front investment of resources and careful consideration of individual and community needs before these solutions can be applied to rural neurological care. [ABSTRACT FROM AUTHOR]

The purpose of this paper is to assess the value of accredited leg ulcer education in influencing changes in practice. This is a before and after educational evaluation that adopted a qualitative survey approach of 12 primary care nurses attending the Nurse-Led Assessment and Management of Leg Ulcers accredited CPD module at a London university. The findings revealed that 6 out of the 8 nurses who completed the final interviews were satisfied that all learning outcomes for the module had been met. All of the nurses commented they had changed at least one aspect of practice following the module with the majority stating a number of improvements had been made relating to improved knowledge, practical skills, treatment and patient concordance. The evaluation was limited to a small cohort of primary care nurses and further longitudinal research is required to investigate the effectiveness across multiple cohorts. [ABSTRACT FROM AUTHOR]

Pressure ulcers (PUs) represent a burden to the health economy and patients alike. Despite national and international guidelines regarding the management of risk, the incidence and prevalence across England remains high. Detecting early the risk of PUs is paramount, and requires using a valid risk assessment tool alongside clinical judgement and management of associated risk factors. There is a need to implement prevention strategies. Introducing care bundles for pressure ulcers, for example SKIN, SSKIN and most recently aSSKINg, is designed to guide clinicians and reduce variations in care. This article presents a review of the evidence on compliance with guidelines, frameworks, pathways or care bundles within primary and secondary care settings. This article focuses on the literature review that was conducted to inform a subsequent clinical audit of compliance with the aSSKINg framework in a Community NHS Foundation Trust in the South East of England. [ABSTRACT FROM AUTHOR]

In England, there has been a long standing tendency to seek to reform health services via large-scale structural reorganization and via seeking (at least in principle) to boost the power of health care commissioners to redesign services. Based on a review of community nursing services in an urban Primary Care Trust, this paper argues that such an approach has led to a situation where positive service development has stalled as senior managers prepare for the next reorganization (rather than focus on service improvement); where the underlying causes of failure to bring about universal transformation of community health services have not been addressed by ongoing organizational changes; and where providers now seem to look to commissioners to change services (rather than changing them themselves). In contrast, the paper argues that there is significant scope for those working in and managing community health services to focus on what is within their power to change—rather than waiting for others to do it for them. [ABSTRACT FROM AUTHOR]

The article discusses the role of the community nurse in the management of population health. Topics include reason that population health management is important, how population health management will be delivered, and historical background on the holistic approach to care of nurses, taking into consideration the role played by non-clinical factors on health outcomes.

In community nursing, the administration of insulin for people with type 2 diabetes can be delegated by registered nurses to healthcare support workers. Although a voluntary framework in England provides national guidance, little is known about its uptake. The project aim was to determine the roll-out, characteristics and support needs in relation to the delegation of insulin administration in community settings. An online survey was disseminated to community nursing services in England via social media and nursing networks. Of the 115 responding organisations, 81% (n=93) had an insulin delegation programme, with most initiated since 2018. From these services, 41% (n=3704) of insulin injections were delegated daily, with benefits for patients, staff and services reported, along with some challenges. Delegation of insulin administration is an established and valued initiative. Awareness of the national voluntary framework is increasing. National guidance is considered important to support governance arrangements and safety. [ABSTRACT FROM AUTHOR]

The 11th annual National Lymphoedema Conference, organised by the British Journal of Community Nursing in association with the British Lymphology Society and Lipoedema UK, was hosted at the America Square Conference Centre, London, on 22 February 2024. The conference, which aims to provide new insights into the latests developments in lymphoedema care and management through talks by leading experts in the field, was attended by an impressive number of delegates and exhibitors. The sessions were Chaired by BLS Trustee Rebecca Elwell, and are summarised below. [ABSTRACT FROM AUTHOR]

This paper draws on data collected as part of a comprehensive evaluation of a nurse-led rapid response service (RRS) in South Yorkshire. It reviews the assessments of the service by the RRS team themselves and by other care professionals, drawing on their views about which older people (as differentiated by their health problems) it was appropriate to refer to the RRS, and more generally about the strengths and limitations of the service. The views were collected by administering a postal semi-structured questionnaire to 120 care professionals involved in and with the RRS. The findings indicate that the service's rapid response to the patient's needs and its follow-up care were seen by all groups as positive achievements. However, referrers and service providers had contrasting interpretations about the patient eligibility criteria and disagreed strongly about the problems to which the RRS could effectively respond. These differences were a major factor in the conflicts that developed around referrals and service delivery. The findings strongly suggest that it is essential for innovative services to develop clear and consensual patient eligibility criteria and for these to be widely understood by all the professionals that are involved. [ABSTRACT FROM AUTHOR]

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. [ABSTRACT FROM AUTHOR]

The article offers information on the Lymphoedema Awareness Week to be held by the British Lymphology Society (BLS) on March 4-8, 2024 with a focus on lymphoedema in children and young people and their families.

Nursing is the largest qualified professional workforce in the UK, with TV programmes, films, books and other media sources frequently informing the general public's views of nursing roles. This study examines first year pre-registration nursing students' perceptions of community nursing roles, using a qualitative design and questionnaire. Participants included pre-registration nursing students from a university in north west England: a mean of 240 and 68.5% across all questions. Of those invited, 267 were adult nursing students; 53 were mental health nursing students; and 30 were child nursing students. Data were collected using an online questionnaire across two groups and analysed thematically. Four questions were considered relating to students' knowledge of community nursing. Results uncovered knowledge gaps, and community roles were perceived to be less dynamic than secondary care roles, correlating to clinical tasks and popularised media sources. Results provided insight into student nurse perceptions, offering an understanding from which to construct a more inclusive, community-focused nursing curriculum. [ABSTRACT FROM AUTHOR]

The economic value of community nursing is not well understood, meaning it can be a challenge to make the case for investment in the service. The breadth of the service is so vast that it can be difficult to define all the activity and measure the outcomes achieved, which is essential to assess value. A roundtable, hosted by the Healthcare Financial Management Association, considered the challenge of measuring economic value in community nursing, to identify where further work is needed. Community nursing has a key role to play in the development of integrated care systems, as it demonstrates the integration of services at a patient level. Assessment of value needs to recognise the part that the service should play in an integrated care system. However, investment and cultural change is needed within community nursing to ensure activity data is recorded accurately to enable value to be assessed. [ABSTRACT FROM AUTHOR]

Infection control has long been the focus of the attention of anyone working in healthcare, due to the risks posed to patients and staff if appropriate infection control procedures are not followed properly. This article explores a recap of important infection control measures and also outlines the Government's policy for tackling antimicrobial resistance, and its link to infection control procedures. The article covers the key points of the recent publication from NHS England on the topic of infection control. [ABSTRACT FROM AUTHOR]

COPD is a leading but under-recognized cause of morbidity and mortality worldwide. It is currently the fourth leading cause of death in the world, and the fifth commonest cause of death in England and Wales, accounting for nearly 28,000 deaths each year. Methods: The author analyses systematically the national policies around chronic obstructive pulmonary disease such us the long term conditions NSF, the expert patient program, policies around smoking cessation and NICE and BTS recommendations on COPD. Finding/Conclusion: The analysis of current national policies on chronic obstructive pulmonary disease leads to a discussion to justify the need for a National Service Framework on this chronic disease. The current and future impact on local implementation is also analysed. [ABSTRACT FROM AUTHOR]

There is increasing demand for nurses to work in primary care. This is driven in part by the need to retain current levels but also by the modernisation plans for primary care services, which require new roles for nurses, new ways of working and more nurses in primary care settings. While campaigns for increased recruitment of hospital nurses and doctors has been largely successful in recent years, primary care has still to see the impact. This article reports on a Department of Health (England) funded project that aimed to identify strategies and exemplars to assist primary care trusts (PCTs) and the workforce development confederations (WDCs) in strategic health authorities in attracting and retaining nurses to primary care at registered nurse level. It reports on the range of initiatives identified, the perceived benefits and challenges. It concludes by proposing a strategic model for planning for the recruitment and retention of primary care nurses. [ABSTRACT FROM AUTHOR]

Promoting health and preventing ill health are key standards of proficiency for pre-registration nursing education in the UK. The knowledge and skills required to fulfil this role is dependent on students developing a clear understanding of population health during their educational experience. The websites of the 60 undergraduate adult nursing programmes in England that lead to registration were explored, to see how the population health agenda is presented in the information for future candidates. It was found that only 26% of universities promote a population health agenda in the general description of the adult nursing programme, emphasising clinical skills teaching and partnerships with hospital trusts for placement provision. To embrace the breadth of 21st century nursing practice, universities should be marketing nursing proficiencies and raising awareness of the wider context in which care is delivered during recruitment. This approach to branding has the potential to challenge stereotypes and widen participation. [ABSTRACT FROM AUTHOR]

The COVID-19 pandemic has necessitated innovations in practice in almost all areas of healthcare, not least community nursing services. This article details how one organisation planned and executed a home vaccination programme for housebound members of the population in its remit. It discusses the challenges faced by the team, as well as the key learnings achieved from this programme, which will guide future home immunisation programmes. Implementation of this programme required excellent coordination between clinicians and administrative staff. Importantly, support from the procurement and IT teams and the medicines management committee went a long way in the ironing out of early hiccups and in ensuring smooth running of the programme. [ABSTRACT FROM AUTHOR]

People requiring palliative care should have their needs met by services acting in accordance with their wishes. A hospice in the south of England provides such care via a 24/7 hospice at home service. This study aimed to establish how a nurse-led night service supported patients and family carers to remain at home and avoid hospital admissions. Semi-structured interviews were carried out with family carers (n=38) and hospice-at-home staff (n=9). Through night-time phone calls and visits, family carers felt supported by specialist hospice staff whereby only appropriate hospital admission was facilitated. Staff provided mediation between family carer and other services enabling more integrated care and support to remain at home. A hospice-at-home night service can prevent unnecessary hospital admissions and meet patient wishes through specialist care at home. [ABSTRACT FROM AUTHOR]

Community nursing caseloads are vast, with differing complexities. The Sheffield Caseload Classification Tool (SCCT) was co-produced with community nurses and nurse managers to help assign patients on a community caseload according to nursing need and complexity of care. The tool comprises 12 packages of care and three complexities. The present study aimed to test the inter-rater reliability of the tool. This was a table top validation exercise conducted in one city in South Yorkshire. A purposive sample of six community nurses assessed 69 case studies using the tool and assigned a package of care and complexity of need to each. These were compared with pre-determined answers. Cronbach's alpha for the care package was 0.979, indicating very good reliability, with individual nurse reliability values also being high. Fleiss's kappa coefficient for the care packages was 0.771, indicating substantial agreement among nurses; it was 0.423 for complexity ratings, indicating moderate agreement. The SCCT can reliably assign patients to the appropriate skilled nurse and care package. It helps prioritise and plan a community nursing caseload, ensuring efficient use of staff time to deliver appropriate care to patients with differing needs. [ABSTRACT FROM AUTHOR]

The revised National Early Warning Score (NEWS2), a tool used to measure acute deterioration in hospital, has been introduced in acute NHS hospitals and ambulance services. Community nurses report that when they call 999 requesting an ambulance to take a person to hospital, they are asked to provide a NEWS score. They report that when the NEWS score is high, ambulance staff prioritise the call. The NEWS score is being introduced in the community by default. This article will outline how the NEWS score is calculated, its uses and limitations and asks if the NEWS score accurately measures acute deterioration in people living in the community and predicts the need for referral to accident and emergency services. [ABSTRACT FROM AUTHOR]

Service users can benefit in a variety of ways from a personalised approach to care. This service improvement project aimed to improve personalisation for patients being cared for by a community nursing team in the south of England. A plan, study, do, act (PDSA) approach to the project was undertaken with a community nursing team. Both quantitative and qualitative data showed improvement once the focus on personalisation had been improved. Patient and staff satisfaction scores improved and a documentation audit showed the focus on personalisation had increased. Qualitative data suggested that personalisation had also saved staff time, although this measurement was not included in the project. A focus on personalisation can be beneficial for staff and service users [ABSTRACT FROM AUTHOR]

An initial literature search identified a deficit in the non-medical prescribing evidence base in relation to V150 community practitioner nurse prescribing. Nineteen V150 prescribers from eight professional roles, and prescribing for a variety of conditions, along with three NMP leads, participated in this evaluation. The evaluation used a mixed methodology of questionnaires and telephone interviews; 19 V150 prescribers participated, with all of them completing the online questionnaire. Two of these also consented to a follow-up telephone interview. Three NMP leads completed the online questionnaire. The findings suggested a benefit to the wider health organisation with regard to reduced attendance at walk-in centres, GP practices and the emergency department. It is anticipated that the findings from this study may be prove useful to NMP leads, NMP groups and commissioners, as well as V150 prescribers. [ABSTRACT FROM AUTHOR]

The qualified district nurse (DN) role demands high levels of leadership. Attracting the right candidates to apply for the Specialist Practice Qualification District Nursing (SPQDN) education programme is essential to ensure fitness to practice on qualification. Anecdotal evidence suggested that the traditional panel interview discouraged candidates from applying and a need to improve the quality of the overall interview process was identified by the authors. The University of Central Lancashire in partnership with Lancashire Care NHS Foundation Trust adopted the National Values Based Recruitment (VBR) Framework to select candidates to gain entry onto the SPQDN course. This involved using ‘selection centres’ of varying activities including a multiple mini interview, written exercise, group discussion, and portfolio review with scores attached to each centre. The ultimate aim of utilising VBR was to align personal and profession values to both the nursing profession and the Trust whilst allowing a fairer assessment process. An evaluation of the VBR recruitment process demonstrated 100% pass rate for the course and 100% satisfaction with the interview process reported by all 16 candidates over three academic years. Interviewer feedback showed deeper insight into the candidates' skills and values aligned with the core values and skills required by future District Nurse leaders within the Trust. [ABSTRACT FROM AUTHOR]

Health technology has been proposed as a route to financial savings and improved patient safety for many years within the NHS. Nurses have a key role to play in transforming care through such technology but, despite high-level endorsement, implementation of health technology has been uneven across NHS community services. This article looks at three promising applications of health technology in community nursing: mobile access to digital care records; digital imaging; and remote face-to-face consultations. Current evidence for these technologies gives some indication of what is required before health technologies can benefit patients. Rapidly changing health technologies make it difficult for community services to make fully informed decisions when implementing them. There are challenges in predicting the full financial and efficiency impacts, in making robust estimates of costs and workload implications and in anticipating the effects on patient care and staff experience. Despite these problems, there is mounting evidence of the benefits of technological innovations available to community nurses and their patients. [ABSTRACT FROM AUTHOR]

In the article, the author discusses the case of journalist Deborah James who openly talked about her deteriorating health and progression to hospice care to assess grief in older people. Also cited are how the enforced isolation of older persons could have resulted in their unrequited loneliness, and the five stages of grief like denial, anger, depression, and acceptance.

Students who demonstrate quiet incivility can be challenging and disrupt the learning that takes place in the community setting. Recognising incivility and acting to address this behaviour with students is difficult because the behaviour is not overt or obvious to others. The most important component in attempting to manage incivility is exploring the behaviour with the student to identify the potential cause, and negotiate a strategy to improve it. It is acknowledged that the behaviour may be due to personal, academic, or professional issues. If issues are not addressed, care activity and learning are affected, and this can result in failure to achieve in practice. [ABSTRACT FROM AUTHOR]

Perceptions on safety in community care have been relatively unexplored. A project that sought to understand the multiple perspectives on safety in the NHS case-management programme was carried out in relation to the structure, process, and outcome of care. This article presents a component of the nursing perspective that highlights an important element in the structure of nursing care that could potentially impede the nurses' ability to be fully effective and safe. A single case study of the case-management programme was undertaken. Three primary care organisations from three strategic health authorities participated, and three focus groups were conducted (one within each organisation). In total, 17 case management nurses participated. Data were audiotaped and transcribed verbatim and subjected to framework analysis. Nursing staff attitudes were identified as a structure of care that influence safety outcomes, particularly their perceptions of the care setting and the implications it has on their role and patient behaviour. Greater understanding of the expected role of the community nurse is necessary, and relevant training is required for nurses to be successful in empowering patients to perform more safely. In addition, efforts need to be made to improve patients' trust in the health-care system to prevent harm and promote more effective utilisation of resources. [ABSTRACT FROM AUTHOR]

Background: The community matron (CM) role was introduced in England to provide a single point of access to patients living with comorbid long-term conditions who had, or were at risk of, frequent emergency hospitalisation. Aim: This study explored the factors that affected embedding of the CM role. The qualitative study was undertaken in community health services in two cities and a rural area in central England. Method: Participants comprised health professionals (n=30) including CMs, community service managers, and service commissioners; patients (n=10); and their family carers (n=5). Results: Findings reveal that participants were largely positive about the role. However, difficulties with role setup had led to numerous changes in service delivery, which affected how the role has embedded. Conclusion: Many aspects of the CM role are invisible to other health professionals. Invisibility of community nursing, rather than autonomy of the CM role, seems to be a key factor in the challenges of embedding the role. [ABSTRACT FROM AUTHOR]

Community matrons prescribe medications and treatments for arguably the most complex patients in the community setting, yet little is known about their experiences of prescribing. Drug events and inappropriate prescribing are known to account for around 16% of hospital admissions. With a remit of reducing unplanned admissions to hospital, it is important to understand community matrons' experiences as prescribers and to examine the role of prescribing in fulfilling this agenda with consideration given to the adequacy of the prescribing support available. In this study, a qualitative research design was used and a purposive sample of seven community matrons from the south of England took part in the study. Semi-structured interviews were carried out and analysed using Braun and Clarke's six phases of thematic analysis. The findings show that community matrons consider prescribing-related knowledge to be essential in fulfilling their role and that the ability to prescribe speeds patient access to medicines. In some instances it may be instrumental in preventing hospital admission. Community matrons prescribe a limited range of medicines regularly, while referring to GPs for other prescribing that they consider outside their competency. Community matron prescribers mostly access their support from GPs and this is considered adequate in supporting them in their prescribing role. [ABSTRACT FROM AUTHOR]

The need to effectively promote safe staffing levels in community settings challenges commissioners and providers of services to find rigorous methods of capturing workforce evidence that can be systematically used to shape effective services and skill mix for the future. This article presents a brief review of current approaches and challenges to measuring community nursing workload activity in England. Specifically, it shows phase 1 pilot results using the Cassandra Matrix activity tool and review of ongoing developments and progress to demonstrate scalability for national implementation. As part of a much larger practice development project to develop community nursing, the pilot used mixed methods to collect 10 days of workload activity data from a self-selected sample of band 5–7 nurses working in general and specialist community nursing roles in three community organisations, and to evaluate their experiences of using the tool via an electronic survey. The findings indicate that the tool has significant potential for capturing the complexity and multiple dimensions of nursing work in community contexts, and phase 2 work has led to a community version of the tool being piloted on a larger scale across six community organisations. [ABSTRACT FROM AUTHOR]

The community matron (CM) is often the key worker caring for patients with chronic, life-limiting, long-term conditions, but these patients are not always recognised as palliative cases. This study explored the experiences of CMs with regard to advance care planning (ACP) and ‘do not attempt cardiopulmonary resuscitation’ (DNACPR) decision-making to understand whether or not they felt adequately prepared for this aspect of their role, and why. Qualitative data were generated from six CMs using a broad interpretive phenomenological approach. Face-to-face recorded interviews were analysed using template analysis. The study found that although participants faced complex ethical situations around ACP and DNACPR almost on a daily basis, none had received any formal training despite the emphasis on training in national and local guidelines. Participants often struggled to get their patients accepted on to the Gold Standards Framework. The research found variability and complexity of cases to be the main barriers to clear identification of the palliative phase. [ABSTRACT FROM AUTHOR]

This article describes a study that used a qualitative approach, purposive sampling and semi-structured telephone interviews conducted with specialist palliative care nurses from six rural community teams in England. The study investigated how services were organised and the issues of delivering specialist palliative nursing care in a rural area. Qualitative content analysis was used to analyse the data. The findings showed many similarities in that the majority of patients in rural areas were not accessing hospice services and there was a greater reliance on care at home. However, the challenges in delivering care ranged from managing patient expectations, geographical distance, lack of technology to support remote working and education for the specialist palliative care teams. The study makes specific recommendations for rural community specialist palliative care teams. [ABSTRACT FROM AUTHOR]

People with learning disabilities are living longer lives. Over the past few years, research has explored the needs of people with learning disabilities, their families and learning disability professionals in relation to end-of-life care and death. However, little is known about the needs of paid carers and their experience of end-of-life care. This article discusses the development, implementation and evaluation of a study day about end-of-life care that was delivered to paid carers on two separate occasions in Berkshire Healthcare NHS Foundation Trust. A total of 43 paid carers attended and the days were well evaluated. The need for further training for paid carers who work with people with learning disabilities at the end of life was highlighted. [ABSTRACT FROM AUTHOR]

The healthcare workforce is changing, and the introduction of assistant practitioner roles in the community presents exciting opportunities for the unregistered workforce. Healthcare assistants wishing to become assistant practitioners are undertaking foundation degrees. During this period of study, they require support and supervision from a mentor to perform competencies; however, mentors are often poorly prepared for this role. This small-scale qualitative exploratory study sought to gain trainee assistant practitioner (TAP), mentor and management perspective on the level of support needed. Findings indicate that TAPs struggle for recognition and student/learner status; there was an assumption that mentors would be adequately equipped to mentor TAPs, and poor mentor preparation was linked to negative student experiences. This article considers the key factors, time and commitment, required to support TAP learners in the workplace. Further, it questions who is best placed to mentor TAPs. Recommendations include an increased level of preparation for mentors, a joint induction programme for TAPs and mentors, a raised profile of the assistant practitioner role within the wider healthcare team, recognition of the TAP as a learner, and allocated time for quality mentorship. [ABSTRACT FROM AUTHOR]

This article aims to explore and examine advanced physical assessment skills and the role of the district nurse. It will particularly highlight district nurses' perceptions of how they may implement skills learnt on a new module introduced into the Community Health Care Nursing degree at a university in London. Physical assessment skills have traditionally been viewed as part of a doctor's role; however, with the advancement of nursing roles, it is argued that it has become a key nursing skill. As Government policy continues to expect health professionals to keep patients in the community who have complex health and social care needs, the role of the district nurse presents as 'best placed' to take on this challenge (Department of Health (DH), 2005a; 2005b). Evaluation of the district nurses' perceptions of their practice is shared here, highlighting some of the challenges that they face. The article will address the complexity of developing a curriculum in response to the DH initiatives and the importance of listening to students on courses. [ABSTRACT FROM AUTHOR]

Study aims: To discover the current level of nurse-led involvement in activity promotion for older people in primary care and to explore the knowledge and attitudes of primary care nurses about health benefits of activity promotion for older people. Background: The importance of improving and maintaining activity levels in later life is well established. However, intervention studies show that the uptake of and adherence to physical activity programmes by older people are highly variable. The optimal approach to activity promotion for older people is not well understood. Although many activity promotion schemes and evaluations assume that specialist exercise trainers are needed, it remains unclear who is best placed to facilitate activity promotion for older people, and if this is something in which existing primary care practitioners (specifically nurses) could and should take a leading role. Methods: This study surveyed all nurses and health visitors working in five primary care organizations in an inner city area. A semi-structured postal questionnaire asked about their knowledge and attitudes to the benefits of exercise in later life, their current levels of involvement in promoting physical activity with older people, and their personal activity levels. Findings: The overall response rate was 54% (n=521). The responses of 391 district nurses and practice nurses are presented here. Nurses had the commitment and (depending on the focus of their work) different opportunities to promote physical activity with older patients. There were organizational and individual constraints on their ability to be involved in this aspect of health promotion work themselves, or to refer older people to local activity promotion schemes. Nurses did not have a structured approach when promoting physical activity with older people and had only a partial awareness of the limitations of their knowledge or skills when promoting activity with older people. Conclusions: For promotion of physical activity by older people to be meaningfully incorporated into primary care nursing work there is a need to develop a more strategic approach that can optimize the opportunities and interest of primary care nurses and develop the knowledge and skills of the workforce in this area of nursing work. [ABSTRACT FROM AUTHOR]

The District Nursing Clinical Error Reduction (DANCER) Programme was initiated in NHS Islington following an increase in the number of reported medication errors. The objectives were to reduce the actual degree of harm and the potential risk of harm associated with medication errors and to maintain the existing positive reporting culture, while robustly addressing performance issues. One hundred medication errors reported in 2007/08 were analysed using a framework that specifies the factors that predispose to adverse medication events in domiciliary care. Various contributory factors were identified and interventions were subsequently developed to address poor drug calculation and medication problem-solving skills and incorrectly transcribed medication administration record charts. Follow up data were obtained at 12 months and two years. The evaluation has shown that although medication errors do still occur, the programme has resulted in a marked shift towards a reduction in the associated actual degree of harm and the potential risk of harm. [ABSTRACT FROM AUTHOR]

The article focuses on "The New Primary Care" conference at Thames Valley University in London, England. The focus of the conference was the primary care white paper and its implications for nurses. The delegates to the conference was diverse from students to chief nursing officer. There was also an air of excitement during the conference.

This qualitative research using focus groups and an online questionnaire into excellent postgraduate community nurse placements concluded that student trainees need to be ensured of diverse and new experiences besides being recognized by practice staff as already qualified nurses with an array of existing experience. Their community practice teacher trainers need to be trained to cope with postgraduate versus pre-registration needs and especially aware of tailoring nurse experiences to the individual. This requires a finer awareness of their knowledge and student status along with ambivalent needs requiring guidance but space to work independently. Delphi Experts concluded trainer motivation and support most crucial elements in postgraduate placements along with clarity of expectations. Basic introduction and administration sets learning in motion and Start right, stay right! is a catchword to abide by. [ABSTRACT FROM AUTHOR]

South Staffordshire primary care trust (PCT) has seen a rise in the number of specialist nurses working in the community and the development of a wide range of intermediate care services. The Community Intervention Team (CIT) has offered the patients of East Staffordshire the choice to receive intravenous antibiotics, blood transfusions (Pott, 2009), and other intravenous therapies in their own homes rather than as hospital in-patients, for over five years. The local multiple sclerosis clinical nurse specialist (MS CNS) has worked closely with CIT when any MS patients have needed extra support at home to manage a crisis and this led the authors to consider how they could work together to prevent some of these crises occurring. In this article they authors outline how they used an award from the Queen's Nursing Institute (QNI) to help establish a community-based service to offer patients the option of receiving high-dose steroid therapy at home for treatment of a relapse, within the resources already available in the PCT. [ABSTRACT FROM AUTHOR]

The article focuses on community-based multi-disciplinary wound care team in East Lancashire in England, developed to decrease the workload of community nurses. It cites the key objectives in developing the wound care team. A list of policies and guidelines that underpin the service is presented. It examines the challenges facing the wound care team.

Provides information on the Tissue Viability Society spring 2004 conference titled "Expertise in Wound Management," held in Torquay, England in April 2004. Topics discussed; Free papers to be presented; Contact information.

This article examines the approach taken by St Gabriel's Medical Centre in Prestwich, Manchester in monitoring and managing cardiac conditions within a primary care setting. It outlines how diagnosing and assessing cardiac problems in-surgery can improve patient care and working practice for GPs and clinicians while alleviating some of the financial and operational burden on secondary and emergency care providers. The cardiac telemedicine service imports cardiac expertise into a GP's surgery providing clinicians with fast, expert ECG interpretations, enabling them to deliver timely and preventative care to their patients. [ABSTRACT FROM AUTHOR]

The article presents information about the Wounds UK 2002 held at the Harrogate International Conference Centre in Harrogate, England. The conference as jointly organized by Dalmore Associates and Mark Allen Publishing. The theme of the conference was to discuss current research and evidence-based practice in the nursing, medical, academic and clinical fields.

A quick and effective way of promoting wound healing is to carry out sharp debridement where indicated, but this procedure carries a high level of clinical risk. Minimizing risk is an essential feature of clinical governance. A new course in wound debridement was developed at King's College, London in response to local NHS trust demand which required assessment of competence for this high-risk procedure. This innovative development crossed traditional boundaries, and required high collaboration between education and practice. [ABSTRACT FROM AUTHOR]

Examines whether there is a consumerist ethic among older people in relation to health care in England. Patient involvement in health care; Relationship between aging and health care use; Cultural issues that affect access to health care services.