Stoma product selection: a guide for community nurses

With 205 000 people in the UK with a stoma, it is likely that community nurses will need to consider which stoma products are most appropriate to use with this group of patients. This article explores the three output stomas, what stoma appliances are most commonly used for each type of stoma and why. Understanding how often stoma appliances should be changed empowers the community nurse in their decision-making process to ascertain whether changes to current care are needed. There is also information available about some of the more commonly used stoma accessories and when these may be necessary. With so many stoma-related products available, it can be difficult to know what to use and when; therefore, this article seeks to offer data to aid stoma care in the community.

Using the Strengths and Difficulties Questionnaire in practice

This article is intended to draw the attention of any practitioners who are unaware of the Strengths and Difficulties Questionnaire (SDQ) to this excellent and accessible resource. It is an instrument that lends itself to the evaluation of practice by any qualified practitioner, health visitor, teacher, social worker, community nurse, school nurse or researcher who wishes, with the parents' permission, to understand whether their work with a child's family or teachers is having the desired impact. It is brief and straightforward to administer and is readily accessible online. This article explores the SDQ and its usefulness.

Stoma-related considerations in palliative patients

In the community there are about 200 000 people with a stoma. Some of these may have been performed as a palliative procedure to relieve a bowel obstruction, for example. Alternatively, the condition of the patient may have altered. A person with a stoma may, for many reasons, be approaching the end of life. There are a number of stoma-related issues that can occur at the end of life as a result of cancer treatment, such as skin around the stoma being damaged as a result of chemotherapy or changes in weight. In the palliative setting, patients may no longer be able to independently care for their stoma and may require assistance from the community nurse. Input from the community nurse may include information on changing stool consistency, as a result of disease progression or cancer treatment. Alternatively, nursing input might be necessary to train carers to perform stoma care. Community nurses can also provide knowledge to patients to improve understanding and decrease anxiety at the end of life.

Ten Years Follow-Up of a Community-Nurse Managed Intervention to Improve Diabetes Control

Background and PurposeDiabetes control measures were shown to improve, following multidisciplinary intervention managed by a nurse in short-term follow-ups. However, there is a lack of data regarding the long-term effects of such interventions. We assessed long-term diabetes management and control measures in a central multidisciplinary primary care clinic, following a brief intervention conducted by a community nurse.MethodsA cross-sectional study in a central, multidisciplinary, primary care clinic. A previous study cohort of randomly selected 100 people with diabetes was followed-up for over 10 years, following a brief intervention managed by a community nurse. Data of diabetes control measures (e.g., hemoglobin A1c [HbA1c], low-density lipoprotein [LDL], and blood pressure) and clinical use of medical services (e.g., nurse, physician, dietician, and hospitalizations) were extracted from the medical records and compared from before the intervention to short and long-term follow-ups (median of 25 months, 10.56 years respectively).ResultsDuring the follow-up period, 18 participants (median age at intervention time 73 years) died. HbA1c dropped significantly (p < .001) from before to after the intervention, and remained low. LDL and Systolic Blood pressure decreased and continued to decrease during the long-term follow-up. While the number of nurse visits per year increased, physician and dietician visits decreased. Annual foot examinations and ophthalmologist visits, which increased following the intervention, remained high. Diabetes-related hospitalizations also decreased from the point of intervention.Implications for PracticeMultidisciplinary, brief intervention managed by a community nurse, improve, and even continue to improve, most diabetes management and control measures, for more than 10 years following the intervention.

Management of work stress and burnout among community nurses arising from the COVID-19 pandemic

The COVID-19 pandemic has increased workload demands for many NHS staff including those working in the community. Nurse managers can make a difference by being authentic leaders, nurturing a supportive organisation where the workload is managed participatively and self-kindness is legitimate. Unfortunately some staff may experience burnout and this article presents a personal management plan to address the symptoms of burnout and aid recovery, although it cannot promote a total recovery if the cause of the symptoms remains unaddressed.

Community nurse-paramedics’ sphere of practice in primary care; an ethnographic study

Background Primary care, the principal function of the health care system, requires effort from all local primary health care teams. Community Paramedicine (CP) has managed to reduce the use of Emergency Medical Services (EMS) for non-emergency calls, but for the paramedic to move from traditional emergency calls to non-emergency care will mean new demands. There is a paucity of research exploring nurse-paramedics’ experiences and perceptions of their novel roles as community paramedics in Finland. This study aims to explore the community nurse-paramedics’ (CNP) experiences in their new sphere of practice. Methods A descriptive ethnographic study was conducted, to collect data through participant observation (317 h total) and semi-structured interviews (N = 22) in three hospital districts (HD) where the CNPs have worked for at least 1 year. Both data sets were combined, organised, and analysed using inductive content analysis. Results Five main categories were developed by applying inductive content analysis: the new way of thinking, the broad group of patients, the way to provide care, the diversity of multidisciplinary collaboration, and tailored support from the organisation. The CNP was identified as needing an appropriate attitude towards care and a broader way of thinking compared to the traditional practice of taking care of the patient and the family members. The diversity of multidisciplinary collaboration teams can be a sensitive but worthwhile topic for offering new possibilities. Tailored support from the organisation includes tools for future CP models. Conclusions Our results indicate the CNPs’ deep involvement in patients’ and families’ care needs and challenges with their skills and competencies. Their professional attitudes and eagerness to develop and maintain multidisciplinary collaboration can offer preventive and long-term caring solutions from which citizens, allied health, safety, and social care providers benefit locally and globally.

Process evaluation of a programme to empower community nurse leadership

Background The Nurses in the Lead (NitL) programme consists of a systematic approach and training to 1) empower community nurses in implementing evidence, targeted at encouraging functional activities of older adults, and 2) train community nurses in enabling team members to change their practice. This article aims to describe the process evaluation of NitL. Methods A mixed-methods formative process evaluation with a predominantly qualitative approach was conducted. Qualitative data were collected by interviews with community nurses (n = 7), focus groups with team members (n = 31), and reviewing seven implementation plans and 28 patient records. Quantitative data were collected among community nurses and team members (N = 90) using a questionnaire to assess barriers in encouraging functional activities and attendance lists. Data analysis was carried out through descriptive statistics and content analysis. Results NitL was largely executed according to plan. Points of attention were the use and value of the background theory within the training, completion of implementation plans, and reporting in patient records by community nurses. Inhibiting factors for showing leadership and encouraging functional activities were a lack of time and a high complexity of care; facilitating factors were structure and clear communication within teams. Nurses considered the systematic approach useful and the training educational for their role. Most team members considered NitL practical and were satisfied with the coaching provided by community nurses. To optimise NitL, community nurses recommended providing the training first and extending the training. The team members recommended continuing clinical lessons, which were an implementation strategy from the community nurses. Conclusions NitL was largely executed as planned, and appears worthy of further application in community care practice. However, adaptations are recommended to make NitL more promising in practice in empowering community nurse leadership in implementing evidence.