British Journal of Community Nursing最新文献

As the prevalence of dementia continues to rise globally, ensuring that individuals living with the condition are supported in making decisions about their lives is increasingly important. This article explores the legal, ethical and practical dimensions of decision-making capacity in dementia, with a focus on the application of the Mental Capacity Act 2006 in England and Wales. It outlines the principles and processes for assessing capacity, making best-interest decisions and the role of legal instruments such as lasting power of attorney and deprivation of liberty safeguards. The discussion highlights the importance of shared decision making and the need for community nurses to actively involve family, carers and individuals with dementia in conversations about their care and future. Two fictionalised case studies illustrate the complexities of real-life decision-making scenarios, offering insights into how legal frameworks and person-centred approaches can be integrated in practice. The article also considers the potential of decision aids to enhance autonomy and participation for people with dementia. This article aims to support community nurses in delivering compassionate, lawful and inclusive care.

Community nurses, district nurses and other healthcare practitioners undertake many home visits and may unwittingly become a link in the chain of infection. Home visits present unique challenges to infection prevention because of the varied environmental conditions encountered, informal caregiving from family members for example and patient vulnerability. Community nurses must apply standard infection prevention and control principles consistently, adapt to the home environment of each patient and support patients and carers through safe nursing practice. This article draws together the current evidence on infection prevention in the community care environment, and highlights information on the chain of infection, risk assessment, hierarchy of controls, standard precautions, environmental hygiene and caregiver engagement. Evidence from home healthcare and public health studies shows that education and structured strategic frameworks improve adherence to infection prevention practices and reduce preventable infections. By maintaining vigilance, professional judgement and sharing responsibility as a team, community nurses play a central role in safeguarding patients and public health.

The current healthcare landscape represents the vision to provide care closer to home in a more comprehensive way than ever before. However, with the existing workforce challenges within district nursing workforce and the shortfall in nurses, pressures on community-based services are expected to increase as they strive to meet this additional demand. The author explores contemporary issues related to recruitment and retention through the lens of existing government policy, which aims to address increasing caseloads, realignment of services, staff turnover and burnout and consider some of the potential solutions.

Background: Since the publication of the National Institute for Care and Health Excellence's TA943 guidance, the uptake of continuous glucose monitoring and hybrid closed loop systems in type 1 diabetes care is expanding rapidly. Community diabetes specialist nurses and general practice nurses are both integral to implementing these technologies outside of hospital settings.

Aims: To explore and understand the confidence levels, training and support available to community diabetes specialist nurses and general practice nurses in relation to continuous glucose monitoring and hybrid closed loop systems technologies, based on a national service evaluation.

Methods: A national survey was distributed to UK nurses and midwives in May 2025. Confidence was measured across five continuous glucose monitoring and hybrid closed loop systems domains, with qualitative feedback analysed thematically.

Findings: Community diabetes specialist nurses showed moderate to high confidence with continuous glucose monitoring and variable confidence with hybrid closed loop systems. General practice nurses reported low confidence across all domains, with minimal access to formal training. Differences in support structures and team composition contributed to capability gaps.

Conclusions: Tailored training, system-wide support and commissioning reform are needed to ensure equitable technology-enabled diabetes care across community and primary care settings.

Arm lymphoedema after breast cancer treatment is preventable and can be reversible if caught early. Many risk factors are modifiable and lifestyle changes adopted by patients can reduce incidence substantially. Education in risk reduction is a central tenet of specialist lymphoedema prevention programmes, however, non-specialist healthcare professionals commonly get requests for instructions and advice by breast cancer patients. In general, healthcare professionals receive inadequate education and training on the lymphatic system and may feel ill-equipped to issue advice, despite being best placed to provide it. Low-risk patients are unlikely to require lifestyle modifications to prevent lymphoedema once the treatment phase is over, unless cording or adherent axillary scars persist, but high- and medium-risk patients need education in lifetime prevention and self-treatment strategies. This article discusses risk stratification and outlines self-management strategies for at-risk cohorts. By gaining knowledge about lymphoedema prevention, healthcare professionals can confidently guide their patients on how to prevent lymphoedema and its physical and psychological sequelae.

Background: Older people often develop vitamin B12 deficiency, which is a haematological disorder but its symptoms can often be misinterpreted as normal ageing. It typically presents as megaloblastic anaemia, which causes fatigue, shortness of breath, numbness and tingling. Vitamin B12 deficiency can lead to severe thrombocytopenia and central nervous system complications in rare cases.

Case presentation: This article presents a case study of an 87-year-old man with tachycardia and hypotension and vitamin B12 deficiency-related thrombocytopenia and subarachnoid haemorrhage.

Management and outcome: The patient was treated with parenteral B12 and supportive care but died as a result of cardiopulmonary arrest on the 10th day.

Conclusions: This case highlights the importance of early recognition of vitamin B12 deficiency in older adults. Urgent and timely treatment can help to prevent fatal haematologic and neurologic complications. Community nurses can play an important role in identifying the signs and symptoms of vitamin B12 deficiency and, consequently, initiate a course of treatment to tackle this issue in a timely manner.