SciCombinator

Discover the most talked about and latest scientific content & concepts.

Journal: British journal of community nursing

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While there is no proven cure for lipoedema, early detection is key as specialist treatments, complemented by self-management techniques, can improve symptoms and prevent progression. There is no universal approach as the correct treatment or treatments will depend on each patient’s particular circumstances; however, when chosen early and appropriately, interventions can provide huge benefits. The most common treatments in the management of lipoedema include compression, manual lymphatic drainage (MLD), tumescent liposuction, intermittent pneumatic compression therapy (IPC), kinesio taping, deep oscillation therapy, and cognitive behavioural therapy (CBT).

Concepts: Medicine, Management, Lymphatic system, Cognitive behavioral therapy, Lymph, Manual lymphatic drainage

23

The previous article in this law column considered a patient’s right to give a real consent before a district nurse could proceed with care and treatment. This article considers the district nurse’s rights and responsibilities when considering withdrawing or withholding clinically-assisted nutrition and hydration. It focuses on recent cases in the Court of Protection, M v A Hospital [2017] , and High Court, NHS Trust v Mr Y & Mrs Y [2017] , and on the need to bring such cases to court before treatment is withdrawn.

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Oral disease can have a significant impact on the health and wellbeing of the housebound patient. The aetiology of oral conditions such as dental caries and periodontal disease have been well investigated and there is a solid evidence base in how to best prevent their progress. The Department of Health document Delivering better oral health: an evidence-based toolkit for prevention is a valuable resource that outlines the current best preventative evidence in the form of practical advice for clinicians and patients. This article aims to distil and present this advice for the benefit of community nurses. It will identify areas of particular importance for people with additional needs, particularly the elderly and infirm. Outlining how to best tailor preventative advice and treatment for this patient group.

Concepts: Health care provider, Medicine, The Canon of Medicine, Illness, Dental caries, Periodontitis, Dentistry, Halitosis

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Patients on district nursing caseloads have multiple physical morbidities, and related emotional concerns. District nurses are ideally placed to assess and meet patients' emotional needs but in increasingly stretched workplaces, it is difficult to find time. There is also evidence that district nurses sometimes believe they lack skills to address patients' concerns. Traditional communication skills training is useful for encouraging patients to open up about their concerns, but less helpful at finding workable solutions. District nurses can be afraid to open a ‘can of worms’ of concerns that they are unable to deal with. SAGE and THYME is a person-centred, evidence-based communication skills model that addresses district nurses' concerns about time and skills. It provides a structure for conversations about concerns, and empowers patients to work with district nurses to find solutions. Research suggests that it is a promising model for district nursing practice.

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There are over 400 000 cataract operations now being performed annually in the UK. With the majority of those patients being older people, comorbidities such as dementia or arthritis can prevent patients putting in their own post-operative eye drops. Where there is a lack of family or other support, district nursing services are often called upon to administer these eye drops, which are typically prescribed four times a day for 4 weeks, thus potentially totalling 112 visits for drop instillation per patient. To reduce the burden of these post-operative eye drops on district nursing services, administration of an intra-operative sub-Tenon’s depot steroid injection is possible for cataract patients who then do not require any post-operative drop instillation. As a trial of this practice, 16 such patients were injected in one year, thus providing a reduction of 1792 in the number of visits requested. Taking an estimated cost of each district nurse visit of £38, this shift in practice potentially saved more than £68 000; the additional cost of the injection over the cost of eye drops was just £8.80 for the year. This practice presents an opportunity to protect valuable community nursing resources, but advocacy for change in practice would be needed with secondary care, or via commissioners.

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People are living longer, but with increased age comes greater frailty and multi-morbidity. This secondary data analysis examines transcripts from interviews with 11 frail older people and 6 informal carers to explore emotion in relation to frailty and deteriorating health. Anger and frustration were frequently experienced with declining functional ability; sadness occurred with social isolation, loss of autonomy and independence; anxiety was evident when transition to a care home was discussed; and contentment was described when connecting with others. Reluctant acceptance emerged as a coping strategy. Insights gained from analysing emotion may inform communications training courses for community nurses, though further research is required.

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The aim of this economic analysis was to estimate the economic impact of the On the Ground Education Programme (OGEP) within one local University Health Board (UHB) in Wales.

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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.

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To investigate the impact of an educational intervention on home support workers' ability to detect early pressure ulcer damage.

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Wound infection is proving to be a challenge for health care professionals. The associated complications and cost of wound infection is immense and can lead to death in extreme cases. Current management of wound infection is largely subjective and relies on the knowledge of the health care professional to identify and initiate treatment. In response, we have developed an infection prediction and assessment tool. The Wound Infection Risk-Assessment and Evaluation tool (WIRE) and its management strategy is a tool with the aim to bring objectivity to infection prediction, assessment and management. A local audit carried out indicated a high infection prediction rate. More work is being done to improve its effectiveness.