In 2012 a national working party consisting of experts in the care of patients with learning disabilities and the management of swallowing difficulties (dysphagia) was convened to develop guidelines to assist with the identification of at-risk patients. The aim was to improve the diagnosis and management of dysphagia in this patient population. The guidelines were also designed to improve the protection of such patients by ensuring that they are treated in a fair and equitable manner. This article provides an overview of the guidelines (Wright et al, 2012) for the community nurse.
David Wright, Professor of Pharmacy Practice, School of Pharmacy, University of East Anglia, Norwich
Tom Howseman, GP and Clinical Director of LD Commissioning, Nene and Corby CCG, St Luke’s Primary Care Centre, Northampton
Urinary tract infections are often seen in community settings and can be debilitating for patients, involving dysuria (painful urination), increased urinary frequency and urgency, suprapubic pain, haematuria (blood in the urine), and polyuria (excessive urine production). This article takes an in-depth look at these symptoms, as well as the diagnosis and management of this common problem, which mostly affects female patients.
Chetan Shah, Senior Lecturer in Pharmacy Practice/Public Health, University of Hertfordshire
Stephen Goundrey-Smith, Consultant Pharmacist, PDC Healthcare Ltd, Leicestershire
Obsession with weight has been identified as a significant problem in modern society, particularly among young women. Similarly, the phenomena of weight and shape preoccupation have been recognised as preliminary behaviours to the development of eating disorders. This study aimed to identify the current incidence of, and factors associated with, weight preoccupation, shape preoccupation, and eating disorder risk in female US university students aged 18 to 23 years. An online study was used and the findings demonstrated that 31% of respondents identified themselves as weight-preoccupied and 33% as shape-preoccupied. Overall, the study found that asking students whether they are weight-preoccupied could be an initial step in early intervention for those at risk of developing an eating disorder.
Samantha A Ramsay, Assistant Professor of Foods and Nutrition and Director of the Coordinated Programme
Laurel J Branen, Professor of Emeritus
Miranda L Snook, Research Assistant, School of Family and Consumer Sciences
All at University of Idaho, Moscow, USA
Nurses working in the community may have insufficient time to access, interpret and apply research, and, therefore, need information to be presented in a format that is easily accessible. As community nurses rise to the challenges outlined in recent health policy, it is increasingly important that they maximise their potential to deliver evidence-based practice. This article looks at a survey that aimed to identify factors influencing evidence-based practice among community nurses. The findings indicate that in order to make progress it is important to adopt a multifaceted approach, taking into account the real world in which nurses currently practice. While it is important to develop nurses’ skills in accessing and reviewing research information, constraints on time mean that it will be difficult to achieve a nursing workforce where all nurses are active in reviewing research evidence.
Kate Gerrish, Professor of Nursing Research, University of Sheffield/Sheffield Teaching Hospitals NHS Foundation Trust, School of Nursing and Midwifery
Jo Cooke, Programme Manager NIHR Collaborations and Leadership in Applied Health Research and Care for South Yorkshire (CLAHRC SY), Sheffield Teaching Hospitals NHS Foundation Trust
Self-directed learning and reflective practice are crucial tools for the community nurse, who may often work in isolation and without the help or guidance of colleagues. Community nurses are required to use independent study skills and reflection to identify their learning and professional needs. This article looks at the development of a reflective grid as a learning tool to support and facilitate reflective and self directed learning. It is hoped that the techniques detailed here can help those students and nurses who are still developing their reflective and critical skills, or find reflection difficult. The grid was also designed to facilitate a quick and easy analysis before an in-depth study of an experience, or as a stand-alone model for short reflections.
Marian Judd, Health Visitor/Practice Teacher, Great Western Hospital Trust, Swindon
Given the current healthcare landscape and the focus of government policy, the way nurses are prepared for working in people’s homes needs reconsidering. The standards for pre-registration nurse education (Nursing and Midwifery Council [NMC], 2010) do prepare nurses to work in the community at initial registration. However, staff nurses at this point of their career, or those that move from the acute sector to the community, do need to work under the supervision of a qualified district nurse during this transition.
Heather Bain, Course Leader Masters Portfolio, Robert Gordon University, Aberdeen
The Liverpool Care Pathway (LCP) is an integrated pathway developed to enhance the quality of end of life care for dying patients and their families. The purpose of this study was to introduce the LCP into a community setting and continually audit its use to provide statistical evidence as to whether the use of the pathway improved documentation in the three key areas of initial assessment and care, on-going assessment and care after death.
Acknowledgements:
Hertfordshire Community Nursing Team
West Hertfordshire Community Macmillan Team
Three GP Surgeries, Hertfordshire
Liz Garrood, End of Life Care Strategy Educator, Hertfordshire
Sarah Russell, Director of Education and Research, Hospice of St Francis, Hertfordshire.
Cheryl Manners, Team Lead, Community Nursing and Therapy, Hertfordshire.
Sharon Roberts, Community Macmillan Nurse, Palliative Care Service, Hertfordshire.
Article accepted for publication: February 2013
Inflammatory Bowel Disease (IBD) is a collective name for a number of conditions such as Ulcerative Colitis (UC) and Crohn’s Disease (CD). It produces uncontrolled, chronic inflammation of the intestinal mucosa. IBD is characterised as a chronic illness that is punctuated by disease exacerbation and remission; patients require an individual, multidisciplinary/multimodal approach to care. There is currently no permanent cure for either CD or UC, therefore treatment strategies focus on good symptom control, modification of the disease process and improving quality of life.
This article gives an overview of the condition and presents a personal patient experience.
Kathryn Foskett Senior Colorectal Clinical Nurse Specialist, The Hillingdon Hospital NHS Foundation Trust, Middlesex
Kathryn.odey@thh.nhs.uk
Article accepted for publication: March 2013
Malnutrition affects one in four acute hospital admissions and one in three admitted to care homes. While many clinical staff may fail to recognise the signs of malnutrition, the use of screening tools such as ‘MUST’ are used in both hospital and community settings. With greater identification of those at risk of malnutrition comes the responsibility of managing these individuals. This article presents the launch of the BAPEN decision trees that are designed to help healthcare professionals manage malnutrition.
Acknowledgements:
The authors wish to thank the members of the Education and Training committee of BAPEN for their creation of the structure and format of the decision trees, and for initial reviews. The core and associate groups of BAPEN have provided great input to the committee and decision tree creation. Finally Mr Pete Turner, Senior Dietitian, Royal Liverpool University Hospital, for reviewing the re-feeding decision tree.
Re-feeding decision tree kindly reproduced with permission from BAPEN.
Dr Sheldon Cooper MSc MD MRCP RNutr, BAPEN Executive officer and Chair of Education and Training Committee, Consultant Gastroenterologist and Nutrition Lead, Dudley Group NHS Foundation Trust
Anne Holdoway BSc RD MBDA, Specialist Dietitian and Chair of the Parenteral and Enteral Nutrition Group of the British Dietetic Association.
Article accepted for publication: January 2013
