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The COVID-19 pandemic has increased workload demands for many NHS staff including those working in the community. Nurse managers can make a difference by being authentic leaders, nurturing a supportive organisation where the workload is managed participatively and self-kindness is legitimate. Unfortunately some staff may experience burnout and this article presents a personal management plan to address the symptoms of burnout and aid recovery, although it cannot promote a total recovery if the cause of the symptoms remains unaddressed.

Vaccine hesitancy is a concern both globally and within the UK. Alison While reviews the evidence relating to vaccine hesitancy, its underlying factors and the sociodemographic variations Vaccination is an important public health intervention, but its effectiveness depends upon the uptake of vaccination reaching sufficient levels to yield ‘herd’ immunity. While the majority of the UK hold positive attitudes about vaccination, some people, including health professionals, decline vaccinations. This article reviews the evidence relating to vaccine hesitancy, its underlying factors and the sociodemographic variations.

Medication is the most frequent treatment intervention, and its success depends on patients taking their medicines in line with their prescribed regimen to yield the full benefit of the treatment. Adherence is especially difficult to ensure in those with multimorbidity, who take multiple medications to manage their conditions. Non-adherence is costly for the health service, both through wastage and increased ill health. Non-adherence may be intentional or non-intentional, and many factors affect an individual's compliance with a medication regimen. There are a variety of aids that may be helpful; however, the interaction with a health professional is very important, both for understanding the reason for non-adherence and for promoting adherence.

Falls among older people are a major public health challenge, because the sequelae of falls can be severe, both in terms of mental and physical health repercussions. Building on an earlier article that discussed the reasons why older people fall, this article describes the interventions that may help reduce falls among older people. Four interventions which could be applied within UK community settings, namely, the Otago programme, the falls management exercise programme, tai chi and home assessment and modification are outlined here. District nurses are well placed to contribute to a reduction in falls among older people by identifying those susceptible to fall risks among their clients and putting in place the necessary interventions to minimise them.

Falls are common among older people and a major public health challenge. This article describes why falls are more common among older people, the potential causes of falls and what assessments should be undertaken to inform preventive interventions. District nurses are well placed to contribute to the understanding of why an older person has had a fall as part of a falls risk assessment.

There is a growing number of people who need access to high-quality endof-life care in the home setting. This requires timely assessments of needs, ensuring good symptom management and recognising the roles undertaken by carers. For some patients, a range of medications may need to be put in place to relieve end-of-life symptoms, using ‘anticipatory prescribing’. District nurses must ensure that they acknowledge the patient's voiced preferences and be mindful of the safety issues that arise with the supply of controlled drugs in the home. This article highlights the challenges faced by district nurses providing or dealing with anticipatory prescribing during end-of-life care.

Vaccine hesitancy can undermine a vaccination programme. Alison While looks at the strategies that can be used to promote vaccination uptake The success of a vaccination programme depends upon its coverage so that it provides herd immunity. Vaccine hesitancy has the potential to undermine a vaccine programme. Evidence suggests that some strategies are more effective in promoting vaccination uptake. Nurses should help in the promotion of vaccination uptake using evidence-based interventions and through ‘Making Every Contact Count’.

Social distancing has reduced the amount of touch in everyday life. This article summarises the current state of knowledge regarding the biological underpinnings of touch, varied preferences for touch, including cultural norms, and its potential psychological and physical benefits for recipients. The lack of nursing research and related evidence are noted, and suggestions are made regarding the use of consensual touch as part of non-verbal communication within community nursing practice to express compassion and help build authentic relationships between nurses and their clients.

Parents of young people with cystic fibrosis (YPWCF) play an important role during the transition from paediatric to adult health services. There is limited evidence on parental information needs and the extent to which they are met. An online survey was conducted targeting a finite population of 190 parents of YPWCF in Ireland. Fifty-nine parents responded (31% response rate). Parents reported the need for more general preparation and timing of the transfer, more information regarding the differences between adult and child health services and how their child will self-manage his/her illness in the future. Most parents received information on the timing of transfer and new healthcare providers but reported being insufficiently informed about their legal status relating to medical confidentiality for their adult child and community resources available for their child after transition to adult health services. The findings highlight the importance of information and preparation for caregivers as well as young people to promote successful transition to adult healthcare. Providing parents with clear information and anticipatory guidance are simple changes in practice that may lead to improvements in transition experiences.

Antimicrobial resistance poses a significant health risk. In this article, Alison While discusses the correct use of both antibiotics and infection prevention and control measures to minimise the speed at which resistance emerges, and improve outcomes for everyone

As survival increases worldwide, large numbers of young people will need to transition from child to adult cystic fibrosis (CF) services. Little is known about the best method for transitioning patients with CF and which transition programmes yield better outcomes. This paper provides a systematic review of the empirical literature on the outcomes and experiences of transition for young people with CF. Outcomes data were subject to a narrative synthesis and a thematic synthesis of experiences data. Structured transition programmes were associated with increased satisfaction, discussions about transition, self-care and self-advocacy skills, more independence, lower anxiety, and increased self-management and parent management of physiotherapy and nutritional supplementation. Young people's concerns included leaving behind previous caregivers, differences in care provision and infection risks. Lack of preparation was a consistent theme. The two most useful aspects of transition programmes were meeting the adult doctors/CF specialist nurse/team and visiting the adult centre. Young people want education about the differences between services, implications of their condition and self-care management. Structured transition programmes appear to impact positively on experiences but the contribution of the different components of transition programmes is unclear. The absence of high-quality studies indicates the need for more well-designed research.

Quality of life and life enrichment are important throughout the lifespan and no less during ill-health or later life. The role of the arts and gardens and their potential benefits are not prominent within healthcare practice. This paper outlines the evidence reported in two literature reviews, one addressing the arts and the other focusing on gardens and gardening so that district nurses can understand what art-based and gardening opportunities they may offer their clients and their carers.

Transition of adolescents and young adults within healthcare services has become increasingly important as more children are surviving into adulthood with long-term conditions. Yet limited empirical evidence exists regarding transition experiences. Transition is not simply about a physical transfer to another service as involves multiple components and medical, psychosocial, developmental, educational and vocational needs. Successful transition to adult services requires a person-centred, developmental, psychosocial, flexible, multidisciplinary, coordinated approach. We undertook the first Irish study to examine needs and perspectives in relation to healthcare transition for adolescents and young adults with the following long-term conditions: diabetes, cystic fibrosis, and congenital heart disease. Using a qualitative inductive approach we carried out semi-structured interviews with adolescents and young adults aged 14–25 years (n= 47), parents (n= 36) and health professionals (n= 34) which was part of a larger mixed-methods study on transition. We accessed adolescents before transition and then a different sample who had made the transition within same disease group. The sample was obtained from two children’s hospitals and four general hospitals in Ireland. Ethical approval was obtained from relevant ethics committees. Findings revealed that transition occurred between the ages of 16 and early 20s depending on the service. None of the hospitals had a transition policy and transition practices varied considerably. Adolescents worried about facing the unknown, communicating and trusting new staff and self-management. Transition process was smooth for some young adults, whilst others experienced very abrupt transfer. Parents desired greater involvement in the transition process with some perceiving a lack of recognition of the importance of their role. In paediatric services, nurses made great efforts to engage adolescents who struggled with treatment adherence and clinic attendance. Whereas after transfer, little effort was made to engage young adults if there were lapses in care, as this was generally considered the young person’s prerogative. This study has revealed that transitioning to adult care is challenging for many AYAs, irrespective of their condition, due to unmet needs in relation to information, transition preparation, and development of self-management skills. The degree to which the shift in responsibility had occurred prior to transition to adult services appeared to influence successful transition to new roles for adolescents and young adults and their parents. Interventions need to address the renegotiation of responsibility between AYAs and parents using a developmental framework over a period of time rather than a one-off ‘chat’.

Background The numbers of children with long-term illnesses surviving into adulthood and transferring from child to adult services has increased dramatically in the last 30 years. This study aimed to examine health-related quality of life pre- and post-transfer from child to adult healthcare for young people with three long-term illnesses. Methods A total of 217 young people with cystic fibrosis, congenital heart defects or diabetes attending child and adult hospital services in Dublin, Ireland completed a questionnaire survey. Multiple linear regression was used to identify predictors of five dimensions of health-related quality of life pre- and post-transfer. Results Post-transfer young people with congenital heart disease and diabetes reported significantly lower physical well-being than their pre-transfer counterparts. Pre-transfer young people with cystic fibrosis reported significantly lower physical well-being than those with diabetes, but there was no significant difference post-transfer. Pre-transfer females reported lower scores than males on the Psychological Well-being and Autonomy and Parent Relation dimensions; however, these differences disappeared post-transfer. Higher maternal overprotection scores were associated with significantly lower scores on the Psychological Well-being, Autonomy and Parent Relation, and Social Support and Peers dimensions, regardless of transfer status. Conclusions Disease group, gender and maternal overprotection were predictors of health-related quality of life pre- and post-transfer from child to adult healthcare. Transition programmes should promote self-management and discourage parental overprotection.

Antimicrobial resistance is a major concern for UK healthcare professionals, following growing evidence of multi-resistant pathogens. Poor prescribing practices, partly driven by patient demand, and poor patient adherence to prescribed regimens are two of the causes of growing antimicrobial resisitance. Improved infection prevention and control practices will not only reduce healthcare-acquired infections, but also reduce the necessity for antimicrobials. Community nurses can also support their clients to promote their own health and wellbeing, increasing resilience to infections through a healthy lifestyle which includes a well-balanced diet, good personal hygiene and the take up of offered vaccinations.

Residents living in a care home are likely to have a number of long-term conditions for which they may be taking multiple medicines. Alison While offers some valuable advice for staff in relation to the importance of good staff training and record keeping

Aim and objectives To examine the needs and perspectives regarding healthcare transition for adolescents and young adults (AYAs) with the following long-term conditions: diabetes, cystic fibrosis and congenital heart disease. Background Transition of AYAs within healthcare services has become increasingly important as more children are surviving into adulthood with long-term conditions. Yet, limited empirical evidence exists regarding transition experiences. Design Qualitative study fulfilling the completed consolidated criteria for reporting qualitative studies criteria (see Appendix S1). Methods Semi-structured interviews with AYAs aged 14-25 years (n = 47), parents (n = 37) and health professionals (n = 32), which was part of a larger mixed-methods study. Sample was recruited from two children's hospitals and four general hospitals in Ireland. Results Transfer occurred between the ages of 16-early 20s years depending on the service. None of the hospitals had a transition policy, and transition practices varied considerably. Adolescents worried about facing the unknown, communicating and trusting new staff and self-management. The transition process was smooth for some young adults, while others experienced a very abrupt transfer. Parents desired greater involvement in the transition process with some perceiving a lack of recognition of the importance of their role. In paediatric services, nurses reported following-up adolescents who struggled with treatment adherence and clinic attendance, whereas after transfer, little effort was made to engage young adults if there were lapses in care, as this was generally considered the young adults' prerogative. Conclusions The amount of preparation and the degree to which the shift in responsibility had occurred prior to transition appeared to influence successful transition for AYAs and their parents. Relevance to clinical practice Nurses in collaboration with the multidisciplinary team can help AYAs develop their self-management skills and guide parents on how to relinquish responsibility gradually prior to transition.

This paper summarises a ten-year conversation within London Journal of Primary Care (LJPC) about the nature of community-oriented integrated care (COIC) and how to develop and evaluate it. \ud COIC means integration of efforts for combined disease-treatment and health-enhancement at local, community level. COIC is similar to the World Health Organisation concept of a Community-Based Coordinating Hub - both require a local geographic area where different organisations align their activities for whole system integration and develop local communities for health. COIC is a necessary part of an integrated system for health and care because it enables multiple insights into ‘wicked problems’ and multiple services to integrate their activities for people with complex conditions, at the same time helping everyone to collaborate for the health of the local population. \ud The conversation concludes seven aspects of COIC that warrant further attention.

Background Obesity is a growing global public health problem which requires all healthcare professionals to deliver weight management care within their roles. Aim To describe nurses' perceived barriers, skills and practices regarding weight-related care and explore differences between English and Chinese nurses. Methods A cross-sectional, self-administered questionnaire survey was distributed to 588 English nurses employed in a range of clinical settings and healthcare organizations and attending a large university in London (October–November 2010), and 519 Chinese nurses working in one of the largest hospitals in Shanghai, China (February–April 2011). Perceived barriers, skills and practices regarding weight-related care were measured. Data analysis was undertaken using responses from 399 English and 466 Chinese nurses. Results English and Chinese nurses reported similar barriers to undertaking weight-related care practices which included two relatively new barriers, namely complex patients and the absence of clear practice guidelines. Both English and Chinese nurses reported being moderately skilled to perform weight-related care practices with the most mean skill scores at the moderate level. Up to 11–54% of the English nurses and 10–25% of the Chinese nurses reported providing recommended weight-related interventions for most of their patients. Generally, the English nurses reported more barriers, high-level skills and practices regarding weight-related care than the Chinese nurses. Limitations The convenience samples and self-report data may have been sources of bias. Conclusions A variety of barriers and limited skills may help explain the suboptimal weight-related practices among the nurses. Implications for nursing and health policy Skill development of pre-registration and qualified nurses is indicated as well as the development of the nurse role to include weight management care of obese patients. Evidence-based guidelines should be readily accessible to support the nurse role in weight-related care.

Many registered nurses (RNs) are not achieving the recommended daily levels of physical activity. This study collected data from 623 RNs about their personal health behaviours and their professional, physical activity-related health-promotion practices. The findings showed that 75% of the sample reported engaging in personal physical activity, 25% were at risk of hazardous drinking or active alcohol use disorders, 17% were past smokers and 11% were current smokers, 47% reported having a normal body weight-size, and 73% desired to be a normal body weight-size. Nearly half of the sample reported that they were promoting physical activity within their clinical practice. Personal physical activity behaviour, perceived health status, length of clinical practice, clinical specialty, and actual body weight-size were significantly related to the RNs' professional, physical activity-related practices. This study highlights a need for training on physical activity-related counselling, including awareness of the latest recommendations and strategies to promote physical activity. Health-care employers should also consider addressing nurses' barriers to the promotion of physical activity within their clinical practice so that all health-care contacts are able to maximise opportunities to promote active ageing.

The ward manager’s role is a complex one that involves meeting financial targets, responding to changes in organisational structures and ensuring the delivery of quality patient care. Whilst the ward manager’s role remains key to service delivery, there has been limited research on the current role from the perspective of ward managers. A survey of ward managers, exploring aspects of their working lives and potential enablers of the ward manager role, is described. The variety of activities within the role was a source of job satisfaction despite the challenge of ‘keeping on top of everything’. Potential role enablers included having protected time for the managerial aspects of the role. The study findings indicate the need to understand the role of the ward manager with particular reference to job satisfaction, and the underpinning support required to enable ward managers to execute the role effectively.