Fear of malignant fungating wounds.

BACKGROUND: The poor prognosis and clinical presentation of malignant fungating wounds (MFWs) can lead to service users experiencing various dimensions of fear. AIM: This article encourages district nurses (DNs) to explore the psychological factors associated with MFWs in the community setting. METHOD: The reviewed literature discusses DN practice, with supplementary sources utilised to provide a wider perspective on the multifaceted nature of the subject. FINDINGS: Guidelines advocate that DNs should promptly initiate dialogue to address fears, establish trust and enable service users with MFWs to express concerns, thus facilitating a holistic provision of care. It is crucial to leverage the multidisciplinary team and engage with other agencies to provide support for service users. Effective leadership qualities play a vital role in initiating practice changes that ultimately benefit service users, while also considering clinical governance aspects.

Trainee district nurses' understanding and perceptions of the palliative care key worker role: a qualitative study.

BACKGROUND: The district nurse is identified as a keyworker in community based palliative care. However, a dearth of research exists on trainees' views and understanding of adopting the role upon qualification. AIMS: The aim of this study was to explore the understanding and perceptions of district nurse trainees in relation to the palliative care key worker role. METHODS: Data was gathered via online semi-structured interviews (n=10) and the results were analysed using a thematic model. FINDINGS: The four evolving themes included: understanding of the palliative care key worker role scope and function; the level of preparation for the role; a juggling act and embedding the role in practice. CONCLUSION: The themes highlighted various drivers and barriers that reflect a degree of incongruence with policy and practice. Recommendations to standardise the palliative care key worker role, underpinned by formal preparation and clearly defined responsibilities may enhance future development and implementation of the role.

Legal aspects of dying and the community nurse.

In this month's Policy column, Iwan Dowie explores the legality behind caring for those approaching end of life.

The role of the district nurse providing care to service users with obsessive compulsive disorder.

Service users living with Obsessive compulsive disorder (OCD) often delay or avoid seeking diagnosis or treatment because of a fear of judgement or feelings of shame associated with their obsessions and compulsions. They may feel that their behaviour defies societal norms, which can lead to social isolation, and in turn, further contribute to health inequality. When such individuals present with physical illness and are seen by district nurses, it is imperative that behaviours are understood and approached appropriately. It is important to develop therapeutic relationships and consider their holistic wellbeing. Developing a close working relationship with the mental health team as a multidisciplinary team and using the team as a resource may contribute to the overall health outcome of service users with OCD.

Community nursing and the digital technology revolution: the past, present and future.

While very much in its infancy in terms of becoming an established tool, the use of digital technology in community nursing is steadily growing, despite the persistent barriers to, and challenges encountered in its uptake and implementation. The mobile nature and high workload of a community nurse's daily practice should facilitate the rapid uptake of time-saving technology. However, there are indications that technology may not be the panacea it was originally proclaimed to be. Francesca Ramadan elaborates on the past and present applications of digital technology in community nursing and delves into the principles that should shape the future potential of tools such as artificial intelligence, automation technologies and clinical decision support systems.

The use of PICO™ single-use negative pressure wound therapy in the community settings.

The prevalence and incidence of wounds is predicted to rise due to an ageing population, that is also likely to have an increasing number of comorbidities (Dowsett et al, 2017). This trend will invariably result in increased costs to the NHS. The estimated annual cost of wound management in 2017/2018 was £8.3 billion. The cost of managing 70% of wounds which healed was £2.7 billion while it cost £5.6 billion managing only 30% of unhealed wounds (Guest et al, 2020). In view of these figures, it is important that health professionals (HPs) recognise wounds that are not progressing to healing at an early stage and implement all available treatment modalities to ensure that the wound does not become non-healing or stalled. Therefore, this article defines non-healing wounds, how to identify wounds at risk of becoming non-healing and the timely implementation of advanced treatment modalities, such as single use negative pressure wound therapy (sNPWT).

Pressure ulcers: a clinical audit to determine compliance against the aSSKINg framework in an adult community nursing setting.

Assessment of pressure ulcer (PU) risk remains a challenge in clinical practice. The first part of this article (Martin and Holloway, 2024) discussed the evidence base underpinning the development of clinical guidelines for PUs alongside the creation of the bundle approach regarding PU prevention. This article, part two, presents the results of a clinical audit that explores compliance against a PU prevention bundle (the aSSKINg framework) in an adult community nursing setting in the south-east of England. The clinical audit was conducted between July-December 2021 and included records of 150 patients. Overall, compliance against the aSSKINg framework was poor, with only two criterion being met: equipment provision for chair and referral to the tissue viability team. Short-term recommendations are that mandatory PU training for staff in the management of PUs should be implemented, and the tissue viability nurse network should be increased. The long-term recommendation was the introduction of the aSSKINg framework as a template into the electronic patient record.

Learning Outcomes of Flipped Classroom on Community Health Nursing Course.

PURPOSE: To improve the quality of community health nursing practice, the learning outcomes of nursing students in community health nursing courses must be enhanced. Although the flipped classroom is considered an effective innovative teaching strategy, evidence of its application in community health nursing courses is limited. Therefore, this study aimed to examine the effects of a flipped classroom approach on community nursing competence, academic performance, course engagement, and learning satisfaction for a community health nursing course. DESIGN: A quasi-experimental study design was adopted between September 2021 and January 2022. METHODS: Two classes of nursing students (n = 92) from a 2-year nursing program at a university in Taiwan were recruited. The classes were randomly assigned to the intervention group (n = 50) that attended a flipped classroom and the control group (n = 42) that received traditional lecture-based instruction. FINDINGS: Compared with the control group, the intervention group demonstrated significantly greater improvements in community nursing competence (p = .012) and significantly higher academic performance (p = .005). In addition, the course engagement and learning satisfaction of the two groups were high, but not significantly different. CONCLUSIONS: A flipped classroom can be an important strategy to enhance community nursing competence and academic performance. CLINICAL EVIDENCE: The flipped classroom strategy can enhance community nursing competence of nursing students, which may improve the quality of population-based healthcare.

Understanding Thai Community Nurses' Experiences of Caring for Psychiatric Patients in Primary Care Units: A Phenomenological Study.

Background: Mental illness has been a significant public health challenge in Thailand, where there is a shortage of specialists. Consequently, community nurses (CNs) who are not specialists have been tasked with enhancing mental health outcomes in the primary care system of the country. This study aims to shed light on CNs' lived experiences of caring for psychiatric patients within the primary care units (PCUs). Methods: A phenomenological research approach and in-depth interviews were conducted with nine CNs responsible for psychiatric patient care purposefully selected at nine PCUs in southern Thailand, including Nakhon Si Thammarat, Krabi, Phangnga, and Chumporn provinces, between March and December 2019. Data analysis was carried out using Colaizzi's method. Results: The experiences of CNs were expressed through three main themes: "Confronting role expansion in long-term psychiatric care responsibilities," "Insecurity in role ambiguity," and "Duty of supportive caring for marginalized people." Conclusion: Thai CNs face significant stress when providing care for psychiatric patients, grappling with their acknowledged lack of specialization and essential expertise in the field. Alongside the issue, they knew that supportive caring for marginalized people is their duty to humanity. Primary care systems must recognize CNs' vital role in enhancing psychiatric patient care. Comprehensive training empowers them, fostering confidence and enabling better connections and care management. This can lead to improved patient outcomes and overall care quality.

Supporting distress behaviours in people with dementia in the community.

The outward signs of distress can take many forms, including agitation, aggression, apathy, anxiety and depression and is experienced by most people with dementia at some point during the disease trajectory. Supporting people with dementia who experience distress can pose a significant challenge to community nurses who may lack the time, knowledge and skills to manage distress effectively. This article discusses distress in dementia, including the interplay between stress and distress, examines the various forms of distress and its causes. The article also presents two fictionalised case studies, drawn from the authors' clinical experience, demonstrating evidence-based approaches community nurses can use in their practice to support people with dementia who experience distress.

Effectiveness of a Community-Based Ostomy Nursing Technique to Enhance the Delivery of Patient Care and Quality of Life.

This study aimed to develop and validate a community-based ostomy care training program for nursing staff, with the goal of enhancing their ostomy nursing competencies and improving patient satisfaction. Between March 2021 and October 2021, 20 registered nurses and 50 patients with enterostomy surgery who took part in the promotion of a new nursing technique in five community health service centers in the Wuxing District, Huzhou City, were enrolled in this study (forming the intervention group). In addition, 15 registered nurses and 40 patients with enterostomy surgery from four community health service centers with similar economic and health conditions in the same area were randomly selected as the control group. All community health service centers were independent institutions. The indexes before and after the promotion of the technique were compared, and the effectiveness of the training was evaluated by observing the improvement in nursing skills and changes in patient quality of life after the training. The "quality-of-life scale" was used to analyze the quality of life of patients who had undergone colostomy surgery. The new approach to ostomy care delivered in a community setting was found to improve staff knowledge and skill in ostomy care (p < 0.001), improve the quality-of-life scores of patients and reduce patient travel time and medical expenses. The promotion of ostomy nursing techniques in community health service centers has several benefits. It improves the ostomy nursing skill levels of community medical staff. This reduces the occurrence of ostomy complications. Additionally, it establishes an effective connection between tertiary hospitals and community health service centers. This connection is conducive to better nursing care for patients who have undergone ostomy surgery. The hospital - community - family nursing model can improve self-management abilities and reduce the incidence of complications of enterostomies.

Establishing a community-academic nursing partnership to lead a healthcare response during a human trafficking extraction operation.

A community-academic nursing partnership formed to care for the urgent healthcare needs of individuals extracted from human trafficking during a multidisciplinary team operation. During past human trafficking extraction operations, law enforcement and the state sexual assault nurse examiner coordinator recognized the need to meet the patients' immediate physical and emotional needs while providing essential comfort to the newly extracted individuals. To meet the immediate holistic healthcare needs during the recovery operation, the nursing faculty partnered with a local nonprofit community clinic to provide onsite trauma-informed, patient-centered healthcare and comfort items. The healthcare team consisted of advanced practice nurses, mental health nurses who triaged the patient's immediate psychological needs, sexual assault nurses who collected forensic specimens, and nurses with expertise in substance use disorder who evaluated the patient's treatment needs. The patient's physical comfort was met by providing hygiene kits, blankets, socks, food, and drinks. Trauma-informed language was utilized to help the patient feel safe and to convey respect for the patient's autonomy in making decisions during the extraction process. The innovative community-academic nursing partnership laid the groundwork for providing healthcare to future human trafficking extraction operations with plans to incorporate nursing students and graduate nursing students to increase the number of patients served while providing a rich learning experience to the students.

Self-neglect as a significant public health issue: exploring the responsibility of the SPCDN.

Self-neglect is a recognised form of abuse affecting individuals across the lifespan. Gaps are evident within current data to support its prevalence; thus, it is considered to be an under-researched and under-reported phenomenon. Evidence suggests that there are multiple risk factors which contribute to self-neglect and sources recognise it leads to poorer health outcomes. Specialist Community Practitioner District Nurses (SCPDNs) deliver care across a diverse demographic and continuously assess risk for individuals in complex environments leading and managing the care of individuals who self-neglect. It is therefore essential that SCPDNs are equipped with the knowledge and skills required to therapeutically assess the health needs of this patient group and lead on the coordination of care. This article aims to explore the subject of self-neglect as a public health concern and appraise the role and responsibilities of the SCPDN within community nursing practice.

How did student district nurses feel during the COVID-19 pandemic? A qualitative study.

BACKGROUND: The COVID-19 pandemic placed a huge strain on healthcare services around the world, including community services. Students also faced substantial disturbance to educational programmes. Student district nurses are usually employed members of staff and can be recalled to the workforce, whereas pre-registration students cannot. AIMS: This paper explores the feelings and experiences of student district nurses during the first UK national lockdown of the COVID-19 pandemic. An interpretative phenomenological approach was taken. METHOD: A semi structured 1:1 interview and focus group was held via zoom in July 2020. A total of eight student district nurses, who were all registered adult nurses, took part. Data was analysed using the Braun and Clarke model to identify themes. RESULTS: The findings related to their experience of being a community adult registered nurse on the frontline, while also being a student district nurse. Three themes were identified from the analysis: anxiety and uncertainty, management of risk and teamwork. CONCLUSION: This study highlights the contribution that community nurses made in the clinical response to the COVID-19 pandemic. It adds to a paucity of literature available from this clinical setting and specifically from the viewpoint of a student district nurse. There is much written on the strains on hospital care, but it should be remembered that district nursing is the service that never shuts its doors because it has reached capacity. This study found that a lack of communication and uncertainty about their future as students contributed to heightened stress and anxiety. Teamwork and camaraderie are a vital aspect of any team and one that can support resilience in times of heightened stress. A lack of face-to-face interaction can lead to team members feeling isolated. Digital technology can be used to reduce this feeling when possible.

Legal duty of care and the community nurse.

In this month's Policy column, the author explores the concepts of duty of care, forseeability and proximity, and how the community nurse can be better prepared when caring for the patient.

Transanal irrigation: best practice in the community.

Chronic constipation, which is common and often difficult to treat, has numerous origins, including neurological and other conditions, and adverse reactions to drugs, especially opioids. Chronic functional constipation lacks a clear underlying cause. Increasing evidence suggests that transanal irrigation (TAI) aids faecal evacuation and is well tolerated in many people with bowel dysfunction who do not adequately respond to first-line treatments. Recent papers offer insights that help nurses and other healthcare professionals implement best practice in the community, including discussing any need for assistance before starting TAI, agreeing the most appropriate device with patients and optimising the irrigation protocol. Training, careful follow-up and ongoing supervision improve adherence and success. Further studies are needed, however, and patients who do not respond adequately or are unable to tolerate TAI should be referred to a specialist service.