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

Journal: British journal of community nursing


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


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.

Concepts: Health care, Health economics, Medicine, Public health, Health insurance, Health, Economics, Health science


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, and High Court, NHS Trust v Mr Y & Mrs Y [2017] , and on the need to bring such cases to court before treatment is withdrawn.

Concepts: Hospital, Law, Human rights, Concepts in ethics, National Health Service, Withdrawal, Rights, Civil and political rights


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


Chronic obstructive pulmonary disease (COPD) is an umbrella term used to describe respiratory diseases characterised by airway obstruction. COPD is now an established and significant chronic disease, killing over 30 000 people in the UK every year. According to the World Health Organization, COPD will become the third biggest killer in the world by 2020. The financial and human cost of the disease is huge. To appreciate the pathophysiology of obstructive pulmonary diseases, it is first necessary to understand a number of important lung concepts. This article discusses the pathophysiology of COPD, highlighting the main mechanisms involved, provides an outline of the associated signs, symptoms and treatment of COPD and explore how health care professionals in the community/residential care settings can help manage and improve the quality of life for patients with COPD.

Concepts: Health care, Medicine, Pulmonology, Asthma, Pneumonia, Tuberculosis, Chronic obstructive pulmonary disease, Obstructive lung disease


Psoriasis affects 1.5% of the UK population and due to the ageing population it is more common in older people. The incidence of type II psoriasis peaks in patients between 57 and 62 years of age, and has different genetic markers. Chronic plaque psoriasis can be challenging for older people as the majority are treated in primary care and expected to self-manage. Community nurses can support older people with psoriasis and their families in understanding current evidence based psoriasis management, and finding solutions to these challenges.


This article reflects on the history of the NHS in Wales and how this has led to its current structure. How this structure supports integrated working across primary, community and secondary care and how further integration with social care is moving forward and its direct effects on district nursing are explored. This article describes how district nursing is meeting these challenges. Support for district nurses as part of integrated multiprofessional teams is being developed to promote appropriately staffed teams centred on meeting the requirements of people within a designated area and ensuring that home is the best and first place of care.


Diabetes UK’s revised nutrition guidelines for the prevention and management of diabetes, published recently, encourage education in self-management and include additional guidance for older people with diabetes. The incidence of diabetes in older people is increasing. Many older people with diabetes are healthy and mobile, and live in the community, but a number are frail and living in care homes. Those who are frail are at increased risk of malnutrition from a range of causes. Older people with diabetes should be assessed for malnutrition risk and referred to a dietitian if required. Management of these patients focuses on foods that are high in protein and energy foods. A case study gives an example of how a community nurse may be involved.


Best interests is the standard by which the law judges the propriety of care and treatment for adults who lack decision making capacity. The Mental Capacity Act 2005 Code of Practice argues that the best way to decide on a person’s best interests is through a multidisciplinary best interests meeting to enable all views, including those of the patient and their carers to be properly considered. In this article Richard Griffith considers the conduct of a best interest meeting and the role of district nurses in those meetings.


In light of current trends and healthcare evolutions, delegation of patient care from home nurses to health care assistants (HCAs) is increasingly important. Hygienic care is an essential component of nursing education and practice, yet it has rarely been the subject of scientific literature.