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Aims A discussion on the case for nurse-led community delivery of health and social care interventions to ex-offenders. Background Ex-offenders re-enter their communities with limited pre-release preparation for the continuity of access to health care once outside prison. Once released, these individuals become hard to reach, do not consider health a priority and consequently use services to address their health and social care needs in a crisis-led way. Nevertheless, how nurses can best support these health-excluded group of individuals in the community remains vague and requires discussion. Design Discussion paper. Data sources Several databases were searched for papers published in English from 1990-2012 using the Population, Intervention and Outcome framework to help structure search. Discussion It is argued that current dominant discourses around equity of care are contradicted in the provision of health and social care services to ex-offenders in the community. Effective engagement with community interventions may be achieved if ex-offenders maintain contact with frontline providers who can support both their structural and health needs. Implication for nursing Nurses are uniquely positioned to initiate and sustain contact with ex-offenders, intervening at points of greatest need in the community to address the socially significant health and social care issues that plague them. Conclusion The use of nurses in the provision of health and social care interventions to ex-offenders is a strategy, which could increase equity in access to health care, reduce reoffending and improve both the health and life chances of these individuals. [ABSTRACT FROM AUTHOR]

Mental health services are under unprecedented pressure with overwhelming referrals and a current waiting list of 1.2 million people of all ages. The cross-government White Paper 'No health without mental health' was launched 12 years ago detailing the importance of wellbeing services in the creation of mentally healthy communities through health promotion and illness prevention. While primary care, community services and psychiatry are pivotal in the treatment of mental Illness/disorder, mental health care per se is on a continuum, and a great deal of work can be undertaken in communities by wellbeing services to prevent avoidable referrals. This paper proposes a broad framework of education and training for wellbeing/positive mental health services, primary and community care, and nurses working in Community Mental Health Treatment Teams and Home Treatment Teams to ensure all those working with potentially vulnerable adults and children are regulated and meet national standards for mandatory mental health education and training. [ABSTRACT FROM AUTHOR]

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]

District nursing services are relentless in adapting to change and continuously seek different methods to improve the care they offer to service users. One of the relatively new changes where adaptation has been necessary is the use of digital devices to record assessments and work in real time. As documented in The NHS Long Term Plan (NHS) (2019), the NHS is being required to grow into the new digital age and, subsequently, district nurses (DNs) have needed to embrace the use of a paper-lite system. Although beneficial overall, the use of technology is a threat to the person-centred nursing approach used in assessment, which is the highest fundamental value in nursing. This article will seek to conceptualise the importance of a person-centred initial assessment with a service user who has either a long-term and/or a lifelong condition whilst considering the use of digital devices, benefits, and drawbacks of their use. It will emphasise the role of the DN, encompassing the multidisciplinary services throughout, whilst also considering any recommendations for further development. [ABSTRACT FROM AUTHOR]

Despite being largely preventable, oral diseases are the major contributor to chronic conditions nationally and globally. If left untreated, oral diseases have many harmful effects throughout life on our patients including pain and infection, and can lead to difficulties with eating, sleeping, socialising and wellbeing. Oral health inequalities exist across our population, and particularly affect vulnerable, disadvantaged and socially excluded groups in society. Oral health is a key indicator for overall health, and is inextricably interlinked with general health. Hence, existing health messages that community nursing teams provide contribute towards oral health. Community nurses are in an established position to provide and reinforce positive oral health messages to their patients, as well as signpost to available dental services. This paper aims to support community nurses with a practical resource for key evidence-based oral health preventative advice, and input into how their patients can access dental care. [ABSTRACT FROM AUTHOR]

elliott l., crombie i.k., irvine l., cantrell j. & taylor j. (2004) Journal of Advanced Nursing 45(2), 117–125 The effectiveness of public health nursing: the problems and solutions in carrying out a review of systematic reviews In 1999 the Scottish Office, United Kingdom, intimated that the Chief Nursing Officer would undertake a policy review of nurses’ contribution to improving the public's health. The importance of reviewing the scientific literature on the effectiveness of public health nursing was recognized as a crucial part of the policy review. A final report was expected within a 6-month period. The reason for the short time period was to fit the policy-making schedule. This paper discusses our literature review for this work. The aim was to conduct a review of the international scientific literature that gave the greatest coverage of the role and potential role of nurses in improving the public's health in relation to 14 major health topics. This paper describes the methods used, outlines the rationale underpinning the methods, discusses the problems encountered and offers solutions to some of these problems. The initial search for relevant scientific literature revealed 709 suitable primary papers. Reviewing this number was beyond the time limit set by the funding organization. Therefore, a decision was made to concentrate on the evidence contained in systematic reviews. Reviewing systematic reviews raises a number of methodological problems to which there are often no predetermined solutions, such as ensuring that important interventions are included, assessing the relevance and quality of the reviews, and grading the strength of the evidence. Reviewing systematic reviews provides the scope to increase the number of topics that might be covered. However, it is possible that a number of interventions may be missed, particularly those that are not subject to review or those assessed using qualitative techniques. The definition of public health nursing used in the present study was also restrictive, and could be widened to include community interventions. Finally, assessing the quality of reviews and grading the evidence proved difficult and there is lack of consensus on how these tasks should be achieved. Nevertheless, the review presented policy makers with accessible information on a large number of relevant international studies. [ABSTRACT FROM AUTHOR]

Several letters to the editor and a reply are presented regarding the article in previous issues such as the White Paper entitled "Healthy lives, healthy people: our strategy for public health in England" released in July 14, 2011 and the "Move to local councils is 'misguided'" in August 2011 issue.

Discusses the public health white paper published by the Department of Health of Great Britain in November 2004. Significance of community based senior nurses to the public health agenda of the department; Areas discussed in the consultation document; Role of community matrons in maintaining the health of people with long-term health conditions.

Dementia is an umbrella term used to describe a group of symptoms characterised by behavioural changes, loss of cognitive and social functioning brought about by progressive neurological disorders. It is estimated that around one million people live with a dementia in the UK, with that figure set to rise to 1.2 million by the year 2040. We are learning more about the risk factors for developing dementia over the life course. This paper discusses the non-modifiable and modifiable risk factors for dementia and considers health promotion and health education activities that can be used by community nurses. [ABSTRACT FROM AUTHOR]

Conceptual and theoretical frameworks for person-centred community nursing practices have not yet been fully developed. There is a need to explore this further in order to guide future district nursing, which forms part of the community nursing discipline in the UK. The contemporary district nursing role is undergoing change, although there appears to be little consensus about the district nurse's (DN) vision across the UK, and little indication of the theoretical position underpinning this change. Meeting strategic requirements (National Health Service (NHS), 2019; Scottish Government (SG), 2017a&b), DNs have advancing clinical expertise and are recognised for their technical skills. However, one may contend that this emphasis on 'doing' in practice contributes to practice decisions made exclusively on task performance by strategic decision-makers, and DNs continually viewing themselves as invisible (National Assembly for Wales,, 2019; Queens Nursing Institute (QNI), 2006; Dickson 2018; 2020). District nursing education may contribute to this lack of clarity as curricula are based on borrowed theory from other disciplines that continue to focus on 'how to do', with little emphasis on 'how to be' a DN, and the continued decrease in DN numbers across the UK may be a consequence. In this paper, I explore current evidence that underpins district nursing practice, education and research in the UK, and advocate the use of the Person-centred Practice Framework (PCPF) (McCormack and McCance, 2017) as a means of unifying and guiding 'being a person-centred DN.' This will enable practitioners who can draw on multiple forms of evidence to inform their advancing practice. This article offers philosophical and pedagogical principles to underpin person-centred education going forward. I argue this will promote congruence between 'doing' and 'being' a DN, giving a voice to DNs, and direction to their specialism. [ABSTRACT FROM AUTHOR]

Stroke is the third common cause of death in the UK. It is also a leading cause of disability. The recent National Stroke Strategy (Department of Health, 2007) has provided major impetus behind changes in the ways in which stroke is prevented and treated (National Audit Office, 2010). Stroke awareness sits as a significant part of the Strategy, but there are some concerns that the Government's centrepiece campaign to increase public knowledge is not reaching some of the most vulnerable sections of our population, people from black and minority ethnic communities, despite clear evidence of increased risk among some ethnic communities. This paper describes some of the literature, mainly from the United States, which can help nurses working in community settings consider strategies for raising awareness about both stroke knowledge and risk. The paper points to three important themes: initial and prolonged engagement with local communities; self-management and cultural sensitivity. [ABSTRACT FROM AUTHOR]

Purpose: This paper represents a personal view of a newly appointed consultant practitioner trainee in frailty. This role was created as a result of a rapid workforce review of a Frailty Support Team (FST) in response to the COVID-19 pandemic. Design/methodology/approach: The FST traditionally worked alongside other community services. A "One Team" approach was developed whereby prior silos of community nursing, therapy and frailty teams became a single, locality based and mutually supportive integrated community service. This significantly increased capacity for an urgent community response for older people with complex needs and improved clinical management and coordination of care. As a workforce review identified the need for skills development, new roles for trainee advanced frailty practitioners (AFPs) and a consultant practitioner trainee in frailty were established. Findings: Staff experience of the "One Team" model was positive. The changes were thought to encourage closer and more efficient working between primary care and a range of community health services. The improved communication between professionals enabled more personalised care at home, reducing pressure on emergency hospital services. A rapid review of the workforce model has enabled the enhanced team capacity to cover a wider geographical area and improved recruitment and retention of staff by introducing a new pathway for career progression within the expanding specialism of frailty. Originality/value: The challenge of COVID-19 has prompted rapid service redesign to create an enhanced "One Team in the community." The innovative workforce model looks beyond traditional roles, values the experience and capabilities of staff and develops the skills and confidence required to provide a more integrated and person-centred specialist community pathway for people living with frailty. [ABSTRACT FROM AUTHOR]

This paper aims to discuss the infant assessment component of the new birth review. The Healthy Child Programme (HCP) is the guidance that underpins the practice of health visiting at this contact. It should be clearly stated that this article is not referring to the Newborn and Infant Physical Examinations (NIPE) undertaken by medical practitioners and midwives at birth and by GPs at six weeks respectively. From reviewing other provider organisations' health visiting standards online, through discussions at professional health visiting forums such as The National Professional Advisory Group and from the author's small qualitative study as part of a master's dissertation there appears to be a wide variation in health visiting practice. There are health visiting (HV) services that offer a universal infant assessment, while other HV services assess the infant in other ways at the request of the parent. However, some services do not undertake an infant assessment at all. The Health Visiting Core Specification states that the health visitor should be able to assess the baby's growth and be able to conduct an ongoing review. This paper discusses the historical background that underpins the different approaches and discusses the implications for different practice at a universal healthy child programme contact. The author discusses tools that evidence current practice. [ABSTRACT FROM AUTHOR]

Background: In spite of ongoing UK Government recommendations for integrated health and social care, the implementation has been slow. While there are pockets of integration happening across England, many services remain isolated and fragmented. Aim: This review aims to critically review existing evidence to identify if there are any factors enabling successful implementation of integrated health and social care for people with long-term conditions in the community. Method: A review was conducted following the principles of a systematic review. Relevant data was extracted from the identified papers and the papers were quality appraised. Results: A total of seven studies were included in the review. Data analysis and synthesis identified a number of themes in relation to enablers of integrated care, including co-location of teams, communication, integrated organisations, management and leadership, capacity and resources, and information technology. Conclusion: There is a limited amount of evidence regarding integrated health and social care teams. Although there are some consistencies within the findings, further research is needed to enhance the validity of the body of evidence available. [ABSTRACT FROM AUTHOR]

Aim: To explore the role of UK district nurses in providing care for adult patients with a terminal diagnosis by reviewing qualitative research. Design: Meta-ethnography was used to conduct the synthesis. Data sources: CINAHL, MEDLINE and British Nursing Index (BNI) were searched comprehensively for primary research relating to the role of UK district nurses in palliative care. Review methods: The abstracts and titles of 700 papers were screened against inclusion criteria, of these 97 full papers were appraised. Some 24 studies reported in 25 papers were selected for inclusion in the synthesis. Findings: In total, five key themes were identified: valuing the role; practical role; relationships with patients and families; providing psychological support; and role uncertainty. Further synthesis yielded two ‘lines of argument’. The concept of the ‘expert friend’ argues that the atypical relationship district nurses cultivate with patients underpins district nurses’ provision of palliative care and profoundly influences the nature of psychological support given. Secondly, the concept of ‘threat and opportunity’ encapsulates the threat district nurses can feel to their traditional role in palliative care through changing health and social policy, while recognising the benefits that access to specialist knowledge and better training can bring. Conclusion: The findings have implications for understanding the motivators and barriers experienced by district nurses delivering palliative care in a time of unprecedented change to community health services [ABSTRACT FROM AUTHOR]

The publication of the fourth edition of Health for All Children (Hall 4) in 2003 marked a shift in health visiting towards a more targeted service. This paper aims to explore, through the accounts of health visitors, the impacts of this changed policy context for health visiting practice and for the health visiting profession. The study, upon which this paper is based, was a qualitative exploration carried out in one NHS locality with broad socio-economic diversity. Semi-structured interviews were undertaken with 16 health visitors. The data was analysed using thematic and narrative techniques. In the study health visitors expressed concerns about the impacts of Hall 4 on health visiting practice, particularly in relation to health visiting expertise and the increase focus on child protection work shaping health visiting practice. In conjunction, health visitors' accounts suggest low morale as a profession. The paper concludes that the impacts of future policy change on health visiting practice must be fully considered; and, measures taken to prepare and support health visitors through periods of policy change. [ABSTRACT FROM AUTHOR]

AimTo explore practice teachers understanding of the process of professional education experienced by community nursing students.BackgroundThis paper analyses the concepts of situated learning and communities of practice as an underpinning theoretical framework to understand the professional education of community nurses in practice settings. The paper also highlights the strengths and limitations of the community of practice theory as applied to professional education.MethodsA qualitative grounded theory study was undertaken involving interviews with 30 community nurse practice teachers.FindingsEmerging from the data were the central components of Lave and Wenger's theory of communities of practice. The practice teachers appeared to use these components including legitimate peripheral participation, sponsorship and journeying to good effect in facilitating the development of community nurse students. The paper extends Lave and Wenger's community of practice phenomenon and identifies how communities are (re)produced over time. The development of professional practitioners over a lengthy period of time within supportive communities of practice where one person with expertise in professional education sponsors the student and takes responsibility for their journey was perceived by practice teachers to be an important and appropriate approach. An approach that was found by practice teachers to transform the student's professional identity, enabling them to undertake a complex multifaceted role using a holistic, problem solving and participative style with clients and communities. It is also an approach that was hypothesised to allow the profession itself to (re)produce in a way that supports continuity but also promotes changes in practice. [ABSTRACT FROM PUBLISHER]

The responsibility of the district nurse (DN), alongside complex case management and leadership, is to ensure Specialist Practitioner Qualification District Nurse (SPQDN) education continues to create practitioners delivering quality evidence-based care. DN leadership and its importance have come to the fore during the COVID-19 crisis, where hospital discharges have increased rapidly to make way for highly complex admissions (HM Government, 2020). This paper examines the importance of the SPQDN qualification, exploring the role of the DN within practice education. Continuation of the vital DN qualification will ensure that the numbers of qualified DNs increase, ultimately protecting community capacity. With a move towards an apprenticeship model to achieve the SPQDN, DNs must engage with and influence curriculum development to confirm courses deliver requirements of the workplace, commissioners and the 2019 NHS Long Term Plan. Expectations of the DN role within practice education have changed, moving away from the practice teacher standards to the new Nursing and Midwifery Council Standards for Student Support and Assessment. This poses new challenges in DN education in practice. The implications of this transition threaten to de-value the quality of the assessment process by removing the high standards of preparation previously demanded; ultimately, this is a risk to the provision of the quality practice education that previously existed.

Caseload profiling is being advocated as a method to measure, manage and evidence increasingly complex caseloads in district nursing. However, there is no qualitative work on district nurses' experiences of applying caseload profiling to their caseloads. The aim of the service evaluation presented in this paper was to explore a working group's experiences of implementing a caseload-profiling tool to caseloads in district nursing in one community setting. As part of the service evaluation, three semi-structured interviews were conducted during meetings of the working group. Following data collection, thematic analysis supported the identification of three themes: barriers, facilitators and significance of data collected from caseload profiling. Subthemes were identified and compared with available literature and policy to enable new insights from practitioners to be gained. The service evaluation concluded that caseload profiling is a simple process that yields rich, complex data, with the data generated from the caseload profiles providing a method to evidence the complexity of district nursing caseloads and information to support proactive caseload management and identification of service delivery priorities.

This paper discusses social prescribing as part of the wider NHS England universal personalised care model, and it describes how community nurses can engage with social prescribing systems to support community resilience. A case study based on the example of gardening, as a nature-based social prescription provided by the RHS Bridgewater Wellbeing Garden, is provided to illustrate the scope, reach and impact of non-medical, salutogenic approaches for community practitioners. The authors argue that social prescribing and, in particular, nature-based solutions, such as gardening, can be used as a non-medical asset-based approach by all health professionals working in the community as a way to promote health and wellbeing. They consider how the negative impact of social distancing resulting from COVID-19 restrictions could be diluted through collaboration between a holistic, social prescribing system and community staff. The paper presents a unique perspective on how community nurses can collaborate with link workers through social prescribing to help combat social isolation and anxiety and support resilience.

Technology provides nurses with a new set of tools to enable and improve the nurse-patient relationship. Although not all information and communication technology is 100% accurate, it still provides the ability for readings which can be used to support the management of long-term conditions in the community. Additionally, technology can empower the patient, enabling them to take control over their condition and enable the nurses who support them. It can break down barriers, such as language and distance. However, it is not without its drawbacks. This paper considers the advantages and disadvantages of community nurses using technology.

Abstract This paper examines the community nursing contribution to primary care by reporting on a qualitative evaluation study of the introduction of integrated nursing teams by an NHS community trust in one location in the United Kingdom. A pluralistic evaluation approach (Smith & Cantley 1985) was used to identify the various criteria by which the different stakeholders involved in the initiative judged the integrated nursing teams to be successful. Six teams at various stages of development were included in the study, together with other groups who had a vested interest in the performance of the teams. Data were collected by means of in-depth individual interviews with team coordinators, team facilitators, senior trust managers, GPs and practice managers; and focus group interviews with team members. The criteria for success identified by the various stakeholders provided a framework through which the overall success of the initiative was judged. Five meanings of success were identified, namely: team working; effective communication; an orientation towards the general practice; changes in working practices; and responsiveness to change. Key findings relating to each of the criteria are presented and consideration given to the implications arising for the development of Primary Care Groups (PCGs). The paper concludes that, paradoxically, by stepping aside from the traditional hierarchy inherent in the primary health care team (PHCT), integrated nursing teams may provide community nurses with the opportunity to make a more active contribution to the future development of primary care. [ABSTRACT FROM AUTHOR]

Healthcare-associated infections are a significant reason for readmission to hospital post-discharge to the community. In this paper, the authors describe some of the key findings from a programme of work conducted in a home care agency (community care organisation) in the US. A survey was conducted to explore home care nurses' knowledge, attitudes and beliefs around infection control (n=415); 400 nurse-patient visits were observed, and 50 nurses were interviewed about their infection control practices. Nurses reported high compliance with infection control practices. However, the overall average adherence rate to observed hand hygiene practices was 45.6%. Interview data provided valuable insights into specific challenges faced by nurses in a home care setting. This study provides insights that can be used to enhance infection control practice in community care in the UK. [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.

This paper presents a literature review of two commonly used osmotic laxatives, lactulose and polyethylene glycol (PEG). With increasing numbers of nurses in the community being non-medical prescribers, informed decision on choice of laxatives is required. Nurses who do not prescribe will often have a view for the benefit of their patients. Following a literature search, eight papers were selected for review. The review leads to the conclusion that, while both preparations are useful, PEG is more effective in many instances and should be the laxative of choice unless there are contraindications arising from the assessment of the patient. Non-pharmacological approaches to the management of constipation should be addressed before considering laxative use. [ABSTRACT FROM AUTHOR]

To examine the role of trained health and personal care assistants in supporting district nurses and family carers in providing palliative and end of life care in the community. In the UK, there is a policy directive to improve end of life care and to enable greater numbers of people to die at home. This places considerable demands on community nursing services and family carers. In response to this, the Complex and Palliative Continuing Care Service employing generic health and personal care assistants was developed as part of the Marie Curie Delivering Choice Programme in one city in the UK. This paper draws on findings from an independent evaluation of the scheme. The wider evaluation used a formative evaluation methodology. This paper draws on in-depth interviews with a range of stakeholders ( n = 17), in-depth interviews with bereaved carers ( n = 6) and an analysis of documentation. Stakeholders and bereaved carers perceived that the health and personal care assistants made a vital contribution to community palliative care. Careful recruitment, specific training, case management by district nursing with allocation of specific tasks and close ongoing communication were key features which stakeholders indentified. Family carers welcomed the way assistants developed relationships and became familiar and able to meet the care needs of patients. There were some problems reported which related to capacity, work flow and the need for extensive written care plans. Employing health care assistants under the supervision of district nurses appears to support patients and family at home during end of life care and contribute to good quality nursing care. The needs for community-based palliative and end of life care will increase rapidly over the course of the next 20 years, placing pressure on community nursing services and family carers. [ABSTRACT FROM AUTHOR]

This paper explores practice development and radical policy reforms found in the White Paper Healthy lives, healthy people, which place a higher priority on UK public health by integrating services under the concept of localism. As a method to improve health and reduce health inequalities, localism aims to promote public health services to be responsive, resourced, rigorous and resilient. However, issues of evidence-based practice, staff freedom to innovate against the tensions of reforms and organisational structures are significant within primary care. By promoting local and professionally driven innovation, the experiences of one community service practice development unit are discussed as an effective approach to encourage local change and innovation. Two issues of significance to innovation in nursing practice and the effectiveness of localism are the application of evidence into practice and motivating staff against the tensions of unrelenting reforms. [ABSTRACT FROM AUTHOR]

In line with recent UK and Scottish policy imperatives, there is increasing pressure for the health visiting service to assume an enhanced role in improving public health. Although health visiting has so far maintained its unique position as a primarily preventive service within the UK health service, its distinctive contribution now appears under threat. The continuing absence of a comprehensive and integrated conceptual basis for practice has a negative impact on the profession’s ability to respond to current challenges. Establishing an integrative framework to conceptualise health visiting practice would enable more sensitive, focused and appropriate research, education and evaluation in relation to practice. Work in this area could thus usefully contribute to the future development of the service at a difficult time. Our paper aims to make such a contribution. In support of our conceptual aims, we draw on a study of health visiting practice undertaken within a large conurbation in central Scotland. The study used a mixed method, collaborative approach involving 12 audio-recorded and observed health visitor–client interactions, semi-structured interviews with the 12 HVs and 12 clients, examination of related documentation and workshops with the HV participants. We critically consider prevalent models of health visiting practice and describe the more integrative conceptual approach provided by Bronfenbrenner’s ecological, ‘person-in-context’ framework. The paper subsequently explores relationships between this framework and understandings of need demonstrated by health visitors who participated in our study. Current policy emphasises the need to focus on public health and social inclusion in order to improve health. However, if this policy is to be translated into practice, we must develop a more adequate understanding of how practitioners work effectively with families and individuals in a sensitive and context-specific manner. Bronfenbrenner’s framework appears to offer a promising means of building on the current strengths of the health visiting service to further develop a ‘person-in-context’ approach to health improvement that is mindful of and responsive to multiple, inter-related influences on health. We therefore recommend further research to directly test the utility of this framework. [ABSTRACT FROM AUTHOR]

This paper sets out to assess the evidence of the use of a case management approach when dealing with long term conditions in the UK. It draws on published papers, some of which emulated or adapted strategies that were used in the USA. The review found that despite there being a unified definition of case management, patients and carers reported benefits of being case managed. However, the wide differences in the factors relating to outcome measures resulted in inconclusive evidence about the effectiveness of case management. [ABSTRACT FROM AUTHOR]

This paper describes the details of a strategy developed to evaluate intervention outcomes of a number of community-based programmes. The rationale for the development of the strategy and its reception into practice is also described. This paper contributes to the debate about qualities and characteristics of appropriate evidence for health promotion by detailing the package of tools developed. These drew on health impact assessment, theories of change and participatory appraisal. In particular, the impact of context on evaluation is highlighted. Although this work is focused on community health promotion officers in the UK, the issues are relevant to a wide range of workers such as public health nurses and community development workers internationally. Alongside the description of the evaluation process is an exploration of power and empowerment of stakeholders in public health services' planning and evaluation. Power, in terms of that afforded by tools and language, held by the different stakeholders is one of the key determinants shaping a service. This makes for a rather ambitious and complex paper; however, the authors consider it is a timely and worthy challenge to address. [ABSTRACT FROM AUTHOR]

In recent years, tackling loneliness has become the focus of increased scholarly debate, social intervention and the development of international policy. One response to the 'epidemic of loneliness' has been the development of the compassionate communities model. The diversity of compassionate communities approaches has led to scholars such as Allan Kellehear (2005; 2017) to highlight a lack of a cohesive underpinning theory to support and drive policy development. In this paper, we propose the use of 'collective memory' as a novel approach to linking loneliness, memory and identity in a way that draws out conceptual links between the role compassionate communities play in tackling social isolation and loneliness. We suggest that the service-led approach that seeks to identify and transpose strategies from one community to another is ineffective; instead, we emphasise the need to develop bespoke community-centred models that can be used by community nurses. [ABSTRACT FROM AUTHOR]

Abstract Despite considerable feminist critiques of British health visiting work which have pointed to its gendered nature, this issue has received very little attention within the professional literature. The emphasis has been upon the ‘health’ focus, often highlighting the needs of marginalized groups. The recent professional interest in women experiencing domestic violence draws upon a long-standing feminist concern which has established the extent and nature of domestic violence, and the difficulties facing women in seeking help about their situation. The present paper reports some findings from a study of British health visiting practice in relation to women experiencing domestic violence. Drawing upon interview data from 24 health visitors, this paper focuses specifically upon health visitors’ accounts of their practice in relation to both children and men when they were aware women were experiencing domestic violence. Their concerns, which include child welfare and personal safety illustrate some of the complexities facing practitioners when faced with domestic violence situations. The analysis also highlights the gendered practices inherent within health visiting work. [ABSTRACT FROM AUTHOR]

The White Paper, Towards a Healthier Scotland considerably widens the community nursing scope for health promotion, as it recognises that disadvantaged life circumstances as well as unhealthy lifestyles contribute to poor health. It has been shown that income and health are interrelated. This evidence has demonstrated that it is not how rich a nation is that determines the overall health of its inhabitants; it is how equitably its wealth is distributed that counts: countries that have narrow income differentials tend to have better health. Both the income and health divide in Britain widened considerably between 1980 and 1992. It is argued that increasing income inequality leads to social isolation and chronic stress, which can impact on psycho-social pathways and damages life expectancy. This paper suggests that community nurses can address adverse life circumstances by finding ways of improving the economic status of their most vulnerable clients, and that one way of doing this would be to ensure that clients claim their full quota of welfare entitlement, given that there is several billion pounds of social security benefits that remain unclaimed in Britain every year. [ABSTRACT FROM AUTHOR]

A diagnosis of dementia can have a significant effect, not only on the person diagnosed, but also on the person's family. Drivers within national policy and strategy to raise awareness and promote education have improved the understanding of dementia across professional groups, as well as within the wider population. However, families living with dementia still struggle to find information and support. This paper explores the common issues faced by families, and focuses on a relationship approach to care. The role of the community nurse can be central to supporting people with dementia and their families to live well in their own communities. The paper uses a casestudy approach to discuss three scenarios commonly raised by family carers and people with dementia: (1) seeking help and support at point of seeking diagnosis, (2) knowing the 'right time' to seek help and advice, and (3) when symptomatic changes affect wellbeing and relationships. [ABSTRACT FROM AUTHOR]

This paper examines the effect of parish nursing as a faith community initiative to support the work of district and community nurses and improve health outcomes. It discusses the reasons why faith communities might embark upon health initiatives, and describes the practice of parish nursing and its history and development in the UK. With reference to both quantitative and qualitative outcomes, the relevance of the practice in the UK health scene is assessed. The paper suggests that connecting with the third sector through parish nursing could enhance the work of community and district nurses; this would present additional sources of holistic care and health promotion and can be offered in an optional but complementary manner to the care provided through the NHS. [ABSTRACT FROM AUTHOR]

Purpose – The purpose of this paper is to describe the role of the screening liaison nurses for adults with learning disabilities employed by Peninsula Community Health. Design/methodology/approach – This paper reports on the national situation in regard to cancer screening for people with learning disabilities and explores the barriers which limit their participation in these screening programmes. It describes the screening liaison nurse role and presents case examples of the work they do. Findings – The local screening rates for people with learning disabilities have increased since the creation of this role in 2011. Originality/value – Increasing the uptake of cancer screening by people with learning disabilities is clearly in line with existing national priorities. To the author’s knowledge this is a unique role in this country and the authors propose that other areas would benefit from adopting this model of working. [ABSTRACT FROM AUTHOR]

Diabetes is a common long-term condition affecting many people many of whom require support with their insulin injections at home. These injections are often carried out by community nurses if individuals are unable to self-manage their condition. This paper describes a pilot project where health care support workers were trained to administer insulin at home for suitable patients. Four patients took part in the pilot study and two support workers were trained to give the insulin injections. The project was evaluated well by all those who took part. It freed up 80 hours of nursing time while also providing the support workers with an extended scope of practice and associated increased in job satisfaction. No untoward medication errors were reported as a result of this initiative. This project will now be rolled out to the wider nursing teams with a staggered approach to the delivery of the training to ensure there is not a detrimental effect on patient care.

The difference between health and social care is almost impossible to define, not least because ‘health’ is socially defined; and people with ‘social’ needs inevitably have some medical or health related problem. The two are intricately, perhaps irretrievably, intertwined. In spite of this, there has been a requirement to arrive at definitions of health and social care, which has been driven by NHS reforms embodied in the NHS and Community Care Act (Department of Health 1990). The national picture for the provision of health and social care is an inconsistent one, with some authorities jointly commissioning services, others jointly assessing clients for services, and the remainder where collaboration between the two services is either embryonic, or simply not happening. The health and social services have experienced immense upheaval in recent years, which is likely to continue for the foreseeable future. Against this backdrop, the following paper presents an important consequence of the community care reforms, which is the re-definition of certain aspects of district nursing work as ‘social care’, focusing particularly on the elusive ‘social bath’. The data presented in this paper comprise part of a larger, ethnographic study of district nursing work in which 37 district nursing sisters were interviewed in depth, following 13 days of participant observation of 130 home visits. Illustrative extracts from the data are presented and interpreted, and the likely professional implications of the findings are discussed. [ABSTRACT FROM AUTHOR]

The author reflects on community nursing as a potential career option. Topics discussed include how the Covid-19 pandemic emphasized the role of nurses within the National Health Service (NHS) and global health systems, information on the job satisfaction research of nurses, and findings of the Queen's Nursing Institute's (QNI) online survey of pre-registered nursing students in Great Britain.

Street‐level bureaucracy is an increasingly useful way to understand how strategic policy is implemented in day‐to‐day practice. This approach has uncovered the ways that individual health and social care practitioners work within institutional constraints to influence policy implementation at the micro‐level. Nonetheless, despite the diversity of settings where these street‐level bureaucrats (SLBs) work, little attention has been focused on the impact of place on policy delivery. This paper draws on empirical research to examine the ways that delivering government domestic abuse policy in the intimate space of the family home shapes the delivery of strategic policy in the everyday. Drawing on qualitative research with Health Visitors (HVs) in the UK in 2016, the study findings illuminate the ways that the material, socio‐spatial and idealised boundaries of the family home shape the implementation of policy. Key themes in the HV's narratives emerged as they described themselves as both a danger and in danger in the family home. In challenging the ontological security of the home (Giddens 1990) – privacy, security and control are key concepts here – HVs described how they shape their actions to achieve policy outcomes while simultaneously managing threats to the home, to professional identity and to self. [ABSTRACT FROM AUTHOR]

Accessible summary People with learning disabilities find it difficult to get their health checked and to get information about their health., Community learning disability nurses play an important role in supporting people with learning disabilities to stay healthy., Community learning disability nurses support people with learning disabilities to get their health checked and to get information about their health., Summary International studies have shown poor uptake of public health initiatives by people with learning disabilities. In addition, studies have shown that people with learning disabilities experience poor access to public health services. The contribution of community learning disability nurses in meeting the public health needs of people with learning disabilities has evolved differently across the UK resulting in conflicting understanding of this role. This paper reports on a study that explored and explained the contribution of community learning disability nurses in the implementation of public health policies for people with learning disabilities. The study demonstrates that community learning disability nurses are involved in health surveillance, health promotion, health facilitation, health prevention and protection, health education, and healthcare delivery. [ABSTRACT FROM AUTHOR]

Aim: To explore the experiences and challenges for residential care home staff when managing the healthcare needs of their residents, in particular those living with dementia. Background: Increasing number of older people, with complex health and social care needs are living in residential care homes. Yet there is limited appreciation of why staff sometimes struggle to manage residents' healthcare needs, or understanding of their working relationship with district nurses (DNs), whose responsibility it is to provide nursing support. Methods: This PhD study, in a metropolitan area in the United Kingdom, was conducted by an experienced DN and involved three phases. This paper focuses on the first two phases. Phase 1 data included: semi-structured interviews (n =8), reflective field notes based on non-participant observation, documentary analysis of policies, procedures and assessment tools and other contextual data from one care home (case study site). The practitioner researcher reflected on the findings from the case study, in relation to her own knowledge and experience as a DN, focusing in particular on findings that were familiar, or which surprised. In Phase 2 she fed these findings back to other care homes (n =11) to check whether the findings from the single case study were unique or resonated with others. She gathered their feedback through semi-structured interviews with senior care staff (n =14). Data were analysed using thematic data analysis. Findings: Findings highlight the complexity facing residential care homes: high levels of healthcare needs amongst residents, the demands of caring for residents living with dementia, variations in the knowledge and skill set of care staff, inequity in the level of healthcare support, the challenges of building a good relationship with DNs, and funding pressures facing care homes. Implications: Any, or all of these factors can prevent care home staff from managing the healthcare needs of their residents. [ABSTRACT FROM AUTHOR]

The article looks at the impact of current and future technology developments on the way health care professionals perform their work. It describes the transformation in patient contact after the North Manchester Community Service provided mobile devices to its district nurses in 2017. Also mentioned are a survey showing that majority of community nurses find information technology (IT) systems as more reliable than paper-based systems and the need for technology to be implemented better.

This paper presents a service evaluation on the role of Community Diabetes Nurse Specialists (CDNS), which was undertaken as a response to various changes. Quantitative and qualitative data were captured over 6 months. It was found that GPs refer patients to CDNSs four times more frequently than other health professionals. The clinical care of CDNSs mainly relates to diabetes education, insulin, assessment and self-management. Telehealth is used twice as frequently as face-to-face communications. The CDNSs do not refer patients onto other health professionals, but have multiple communications with other health professionals and agencies. They manage very complex clinical and social situations, using high-level clinical decision making and balancing person-centred care and patient safety. Structured patient education is being delivered. CDNSs mentor other staff and students, although their own formal professional development is very limited. To conclude, CDNSs are the end point for patient care in the community, managing complex patient situations, while adopting a person-centred approach. [ABSTRACT FROM AUTHOR]

As populations rise and many global health policies point towards community care, it is important that health care delivery meets demand. In Ireland, a study was undertaken on the level and context of missed care in community nursing. The study used a survey to identify the quantity of, and reasons for, missed care; a reference group to develop possible health economic implications for missed care, and a small sample of semi-structured interviews to consider the macro-environment within which missed care occurred. This paper presents the findings of the health economics and qualitative data, and the study's implications for community nursing. [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]

Early recognition of mental health problems in maltreated infants, coupled with tailored support to aid recovery, has the potential to offer significant benefits to a population whose needs have perhaps remained hidden in the past. All forms of maltreatment may adversely affect infant mental health, but perhaps none more so than emotional neglect. Universal contact with families with young children makes health visitors ideally placed to provide early support to this vulnerable group, but such practice requires considerable knowledge and understanding. This paper examines how emotional neglect can impact on an infant's mental health and explores how health visitors can assess and respond effectively to this key health need. Throughout, the term 'infant' is used to describe children from birth to age three. [ABSTRACT FROM AUTHOR]

This paper looks at homeless health issues and specifically the Opening Doors project being delivered by the Queens Nursing Institute. The paper starts by looking at the subject of homelessness generally, before moving onto the specific health issues and service provision. It then describes the Opening Doors project which is open to nurses and other health professionals working with homeless people and families with particular reference to substance misuse. The project aims to improve the healthcare of the client group by providing resources that practitioners can then apply to their daily work. The paper details the outline of the project, aims, achievements and outcomes to date, along with nurse's views on the issues of working with this client group and two case studies from services that are a part of the project to show the type of work that is being done. [ABSTRACT FROM AUTHOR]

This is the second of two papers that examine district nursing within a changing health policy and service environment. The first paper explored the current UK policy context and the way in which district nursing and community nursing services within each country are changing to meet the challenges posed. This article considers the current district nurse (DN) role, which has constantly evolved over the past 150 years, and considers the educational framework that underpins the preparation of these specialist community practitioners in relation to community colleagues such as specialist community public health nurses (SCPHNs). In the context of the current economic climate, there is concern that the apprenticeship model of staff development is replacing specialist practitioner education for DNs, solely on the basis of resource. This article explores the current challenges for DN education within the UK. The underpinning educational preparation of DN programmes is examined and key issues such as safeguarding the public are discussed. The need to develop a cohesive approach to education for post-qualification nurses in the community is advocated. These are important considerations for the future of a discipline which currently feels under threat. [ABSTRACT FROM AUTHOR]