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Nurse-led empowerment strategies for patients with hypertension: a questionnaire survey. Rasjö Wrååk, G.; Törnkvist, L.; Hasselström, J.; Wändell, P.E.; Josefsson, K.
International Nursing Review
Hypertension is common and may lead to cerebrovascular and cardiovascular events and mortality. District nurses frequently encounter patients requiring blood pressure monitoring, lifestyle counsel and support. Empowerment as a method enables patients to both increase their control over their health and improve it. Aim This study aims to describe the effects of the counsel and support from district nurses to patients with hypertension. Methods A randomized controlled intervention trial. Questionnaires were answered by patients with hypertension before and after the intervention comprising district nurses’ counsel and support based upon empowerment. A specially developed card for blood pressure monitoring was also used. Results Blood pressure decreased in intervention and the control groups. The intervention group experienced significantly improved health, with better emotional and physical health, and reduced stress. Living habits did not change significantly in either group. Satisfaction with knowledge of hypertension increased significantly in both groups. The intervention group reported that their care was based upon their health needs. Limitations Conducting large multi-centre studies with long follow-ups is complicated and results sometimes have a tendency to decline with time. A shorter follow-up might have shown a greater difference between the groups. Conclusion Nursing interventions through district nurses’ counsel and support with empowerment improved patients’ health. More research is needed to evaluate nursing interventions’ effect on hypertension. Implications for nursing and health policy This study highlighted that district nurses’ counsel and support increased patients’ health and decreased stress by focusing on empowerment.

Community matrons’ experience as independent prescribers. Herklots, Annie; Baileff, Anne; Latter, Sue. British Journal of Community Nursing
Community matrons prescribe medications and treatments for arguably the most complex patients in the community setting, yet little is known about their experiences of prescribing. Drug events and inappropriate prescribing are known to account for around 16% of hospital admissions. With a remit of reducing unplanned admissions to hospital, it is important to understand community matrons’ experiences as prescribers and to examine the role of prescribing in fulfilling this agenda with consideration given to the adequacy of the prescribing support available. In this study, a qualitative research design was used and a purposive sample of seven community matrons from the south of England took part in the study. Semi-structured interviews were carried out and analysed using Braun and Clarke’s six phases of thematic analysis. The findings show that community matrons consider prescribing-related knowledge to be essential in fulfilling their role and that the ability to prescribe speeds patient access to medicines. In some instances it may be instrumental in preventing hospital admission. Community matrons prescribe a limited range of medicines regularly, while referring to GPs for other prescribing that they consider outside their competency. Community matron prescribers mostly access their support from GPs and this is considered adequate in supporting them in their prescribing role.

Factors influencing evidence-based practice for community nurses. Garland Baird, Lisa M.; Miller, Tess. British Journal of Community Nursing
Factors influencing the development of evidence-based nursing practice (EBNP) were examined in Prince Edward Island, Canada. An adapted electronic questionnaire was distributed to practicing registered nurses and nurse practitioners (n=68). An analysis of variance revealed a significant difference between nurses’ clinical practice setting and the EBNP scale. Significant differences were also found between age and education level when compared with the EBNP subscales where novice nurses were less likely to rely on experience and intuition, and expert nurses with a higher level of education reported being more skilful at synthesising and applying information from research findings into their nursing practice.

Understanding the Code: working in partnership. Griffith, Richard. British Journal of Community Nursing
In his continuing series looking at the law underpinning the standards set out in the revised Code (NMC, 2015), Richard Griffith considers standard 2, which requires district nurses to work in partnership with the people in their care. Although the right to self-determination and the requirement for consent has been a legal principle in health care for over 100 years, its emphasis has been on providing a defence for health professionals rather than promoting partnership in the district nurse-patient relationship. Recent developments in policy and law have begun to herald a change in emphasis from ‘health professional knows best’ to a more patient-focused approach to decisions about care and treatment.

Depression and mental health in the community and the role of the nurse. Mendes, Aysha. British Journal of Community Nursing
Today, as many as one in three people suffer from a mental health problem (NHS Careers, 2015), and the majority of mental health services within the UK are based in the community (mentalhealthcare.org.uk, 2014). These services may cover conditions such as depression, anxiety, eating disorders, drug and alcohol problems, and dementia among many others (NHS Choices, 2013). However, awareness of the importance of mental health and a person’s risk of developing mental illness is paramount among community nurses, particularly in light of the inseparability of mental and physical health.

Providing enhanced care in communities. – Horne, Maria. British Journal of Community Nursing
The NHS has always been a bargaining chip for politicians. Cuts to budgets; an ageing population; and more complex, comorbid long-term conditions have placed greater demands on health and care services. There continues to be pressure on GPs, community services, and the voluntary and social care sectors. Now that the political parties have presented their manifestos for the NHS, we need to consider what is right for patients and local communities.

Twitter triumph: connect, communicate, and learn. – Chinn, Teresa. British Journal of Community Nursing
During the past few years we have seen a huge growth in the use of Twitter in the health-care sector. Two years ago Ferguson (2013) questioned whether health would start to leverage the potential of social media. Ferguson is a Lecturer in the Faculty of Health at the University of Technology, Sydney, and has written extensively on nursing and the use of social media. The answer, 2 years on, is a clear and resounding ‘yes’, with health care now making great strides in using and tapping into social media—Twitter included.

Diagnosing and treating urinary tract infections in older people. – Armstrong, Kirsty
British Journal of Community Nursing
Even though diagnosing and treating urinary tract infections (UTIs) in older people can be difficult, it is essential to prevent reduction in the patients’ wellbeing. Near-patient testing can be useful, but guidelines on this discuss the use of urine dipstick testing and laboratory culture in some detail. In addition, there are significant differences in the management of males and females, those with recurrent infections, and those with catheters. Community nurses are well placed to assess and manage this common condition, implementing correct treatment and resolution, owing to the close relationships they cultivate with service users. This article discusses the diagnosis and management of UTIs in older people, highlighting the differentials and red flags that need to be addressed urgently.

Managing and preventing incontinence-associated dermatitis. – Payne, Drew
British Journal of Community Nursing
Urinary incontinence affects up to 6 million people in the UK, and about 1% of adults experience faecal incontinence (Bardsley,2013). Incontinence associated dermatitis (IAD) is a common condition for those using incontinence pads but it can be very uncomfortable, cause skin breakdown and have affect a person’s quality of life (Beldon, 2012).

The IMPROVE-IT study and ezetimibe. – Signy, James; Signy, Mark. British Journal of Community Nursing.
Cardiovascular disease is one of the major causes of mortality and morbidity in the Western world and raised lipid levels (particularly low density lipoprotein cholesterol (LDL-C)) is one of the major risk factors, with causation demonstrated in multiple large-population studies over recent decades, for example, the Framingham study (Castelli et al, 1992). Statin therapy in secondary prevention of cardiovascular diseases is widely accepted as strongly evidence-based and protective against both coronary and cerebrovascular events (Pedersen et al, 1994; Heart Protection Study Collaborative Group, 2002), and fairly well accepted in primary prevention— as evidenced by the latest National Institute for Health and Care Excellence (NICE) guidance (NICE, 2014), despite some recent controversy and argument in the medical press (Armitage et al, 2014; Diamond and Ravnskov, 2015). However, there remains concern about lack of tolerability of statin therapy in a small subset of patients, and the efficacy of any alternative lipid-lowering agents (whether as add-on or substitute therapy). There is also a paucity of evidence about further lowering of LDL levels in patients who already have low levels o f LDL-C, although a meta-analysis by the cholesterol trialists has shown a good correlation between LDL lowering and outcome in multiple trials. The 2014 NICE guidance has clearly recommended statin therapy (with atorvastatin) as first line, both in secondary and primary prevention. It also supported ezetimibe (a drug that reduces intestinal cholesterol absorption and reuptake) as adjuvant therapy and alternative therapy in statin-intolerant individuals, but did not recommend use of fibrates or nicotinic acid-based drugs in these circumstances. Despite this, there remained very little outcome evidence for the use of ezetimibe, except in a small trial of patients with impaired renal function (Baigent et al, 2011). The IMPROVE-IT study, which has been going on for 10 years, aimed to provide robust outcome evidence to support the use of ezetimibe in addition to statin therapy.

Reducing costs and avoiding hospital admissions: can mobile working help? Turner, Christopher. British Journal of Community Nursing.
The UK has an increased length of hospital stay in comparison with other European countries, and the need for further investment in community services is required if patients are to truly receive care closer to home. The increase in hospital admissions over the last few years may be attributed to the ageing UK population, as well as poor management of long-term conditions. This may be due to variations in the service provision and availability of case managers and community matrons. The poor working relationships and fragmentation of health and social care services remain a significant issue, despite renewed calls to improve integrated working, which is considered fundamental to achieving a reduction in avoidable hospital admissions. Mobile working was introduced in the NHS to help reform community health-care practice and improve continuity of care. Among other things, it provides clinicians with access to electronic patient records in real time, thus helping to reduce delays in treatment. However, we have to bear in mind that a number of factors could hinder the reduction in hospital admissions.

Safe and effective catheterisation for patients in the community. Bardsley, Alison. British Journal of Community Nursing.
Approximately 450 000 people use long-term urinary catheters in the UK. Permanent catheters are used by 3% of the community population and occupy an estimated 4% of a district nurse’s caseload in the UK. Catheterisation is defined as ‘drainage or aspiration of the bladder or urinary reservoir’ and can be intermittent or indwelling. Long-term indwelling catheterisation can be transurethral or suprapubic via the anterior abdominal wall. This article will discuss the safe and effective use of different forms of catheterisation for patients in the community setting.

Sample evaluation of caseload complexity in a community health-care NHS trust. McGarry, Anne British Journal of Community Nursing
People diagnosed with a multiple long-term conditions and those with profound and multiple learning disabilities are the most intensive users of health and social care. In addition, around 30% of patients with long-term physical conditions also have a mental health problem. The close relationship between mental and physical health is reflected in the high frequency with which illnesses of both kinds overlap in an age of multi-morbidity. This study demonstrates that those with comorbid mental health problems show poorer clinical outcomes, lower quality of life and reduced ability to manage physical symptoms effectively. This also affects their capacity to engage in treatment and make decisions, which affects not only their care and treatment but ultimately their quality of life. The NHS Call to Action demanded improvement in the service provided to support the needs of people with long-term conditions. The scale of the impact of comorbid mental health problems on costs and outcomes suggests that developing services that respond more effectively to these needs should be a priority.

Enhancing undergraduate community placements: a critical review of current literature. Dickson, Caroline A. W.; Morris, Gillian; Gable, Clare. British Journal of Community Nursing.
In the face of the UK-wide policy shift to increased home care, inspiring and enabling the next generation of community nurses is more urgent than ever. The quality of the pre-registration practice learning experience is highly influential on career choices at the point of qualification. Given that 50% of learning by pre-registration students takes place in practice, mentors have a crucial role to play in preparing the next generation of nurses to work in the community. This article discusses the findings of a systematic and critical literature review of pre-registration placements that was funded by the Queen’s Nursing Institute Scotland. The review found that students’ experiences of learning in community settings are variable, and perceptions of students and mentors are misaligned in terms of what a quality placement should look like. Although there is no clear definition of what constitutes a community placement and there is some underuse of learning environments in areas such as general practice nursing, there are also a number of examples of new and imaginative placements. While these innovations provide ‘whole experience’ placements, they are currently lacking robust evaluation, despite their potential usefulness on a larger scale. Mentors have the opportunity to provide students with a range of learning opportunities that increase preparedness for working in the community, allowing final year students in particular greater influence over their learning experience. Students undertaking community practice learning, where they have a managed level of autonomy, are more likely to feel confident to take on community nursing roles.

Management of stable chronic obstructive pulmonary disease. British Journal of Community Nursing
Chronic obstructive pulmonary disease (COPD) is a common condition. There are an estimated 3 million cases in the UK. Of these, 2 million have not got a formal diagnosis. Community nurses meet patients with COPD frequently, although COPD may not be the primary reason for the encounter, or the COPD may be present but undiagnosed. The number of patients with COPD is believed to be increasing and, with increased awareness of the condition and an emphasis on improving diagnosis, the number of cases is expected to rise. Community nurses are well placed to raise concerns that a patient in their care may have undiagnosed COPD; if the condition is subsequently diagnosed and appropriate treatment is given, outcomes will improve for that individual. Community nurses can also support patients and their families to manage the condition through all stages of the disease trajectory, from diagnosis to the end-of-life phase.