hronic obstructive pulmonary disease (COPD) is a progressive, life-limiting respiratory condition that primarily features symptoms of breathlessness, chronic cough, fatigue and reduced mobility (Collins et al, 2012).
Currently, the prevalence of COPD in the UK is over one million people (Health and Safety Executive [HSE], 2012), and it is the fourth leading cause of death worldwide (Halbert et al, 2003).
Allergic rhinitis (AR) is a common disorder which has a major impact on the lives of sufferers and families. Although currently there is no cure for this disease, a variety of therapeutic interventions can alleviate the symptoms. It is important that nurses are able to differentiate allergic and non-allergic rhinitis (NAR) from viral upper respiratory tract infections (URTIs) in order to best manage their patients. It is also necessary to ask appropriate questions of those patients attending for asthma review, as
they may have unrecognised and untreated disease. Familiarity with the range of medications and their administration is advocated. Patients with troublesome, non-responding symptoms need to be referred, as do those with red flag signs.
Breathlessness causes emotional and physical distress and social isolation for both patients and their families. Refractory breathlessness, i.e. that which persists even when measures to optimise the underlying condition have been implemented, is one of the most distressing symptoms experienced by patients with advanced life-limiting illnesses. This two-part series describes the experience of refractory breathlessness in patients with advanced disease living in the community, and provides guidance for their care. This, the first part in the series, outlines the experience of breathlessness and how community nurses can accurately assess patients. The second part of this series (available in the next issue of Journal of Community Nursing) will outline management techniques.
This article examines malnutrition, a complex issue that has wideranging implications in terms of patient experience and resources - evidence suggests that malnourished people are repeat attendees at GP surgeries, incur higher prescription costs and experience twice as many hospital admissions than well-nourished people. While there have been many hospital initiatives targeted at reducing the risks of malnutrition, in the community the solution remains challenging. Recommendations include arranging services so that health and social care professionals can work together to overcome nutrition issues, making extra resources available to combat malnutrition and improving the monitoring of patients' nutritional state. As healthcare shifts to a more community-based model, there needs to be a reallocation of resources from hospitals to community to ensure that efforts to tackle malnutrition have a more realistic chance of success.
Dr Ian Donald, Brian Cope & Sally Roberts describe a population of older people in care and focus on the care being delivered to them by district nurses.
Dr Ian P. Donald, MA, MD, FRCP is Consultant Physician in Elderly Care Medicine at Gloucestershire Royal Hospital. Brian Cope, RGN, NDN, CPT is Deputy Director of Nursing, Severn NHS Trust. Sally Roberts is Chief Executive, Blanchworth Care. Article accepted for publication March 2002.
Caroline Morrell describes a staff training package that was designed to increase understanding and knowledge of nutritional status of elderly people in residential homes.
Acknowledgements: - Greater Manchester Workforce Development Confederation for the grant to undertake this project.
- All the staff that participated in the training programme.
- Val Anwyl, Chief Community Dietitian who successfully obtained the funding and started up the project.
Caroline A. Morrell BSc, SRD, Cert MHS Community Dietitian, Tameside and Glossop Primary Care Trust. Article accepted for publication: July 2002
Lydia Green describes a project designed to improve the health and well-being of people resident in nursing homes and discusses how increased pro-active, additional medical input/ management, and preventative measures could have a major health gain effect.
Lydia Green BSc (Hons), Dip.N., RN., DN. Nurse Adviser - VascularCARE Programme and was Flintshire Rapid Response & Rehabilitation Team Senior Nurse. Flintshire Local Health Group Additional Medical Input into Nursing Homes Project Co-ordinator between Dec 2000-Dec 2002.
Article accepted for publication: September 2004
Mary Partis discusses the concept of a relationship approach to care for elderly people living in care homes and emphasises the importance of good communication between staff and clients
Mary B Partis MA, MSc, BA (Hons), PG Dip, RN, DN, RHV, RHVT is a Lecturer in Public Health at the School of Community & Health Sciences, City University, London
Article accepted for publication: May 2009
