British Journal of Community Nursing最新文献

With the government's 10-year health plan for England high on the agenda, there has never been a more poignant time for community services to drive forward their position in tackling the health inequalities in their local populations. Through the lens of recent policy and guidance, the author focuses on the potential role that community nurses will have in designing and delivering services as care is moved from hospital to local neighbourhood health centres. The unique perspective that community nurses bring, combining experience, knowledge and an insight into areas of deprivation, is widely recognised. Principles of inclusion health are considered in this article with a focus on supporting those experiencing homelessness. The author also explores barriers to implementation in the current healthcare landscape as new opportunities for development appear on the horizon.

Effective community nursing relies on the appropriate use of essential medical equipment to support patient care in the home environment. As healthcare increasingly transitions from hospital to community settings, nurses are responsible for delivering a wide range of interventions, including monitoring of vital signs, chronic disease management, wound care, and promoting safety and mobility. This article explores the core categories of equipment that enable nurses to provide safe, responsive and person-centred care at home. These include portable digital monitors, mobility aids, wound care technologies such as negative pressure systems, devices for managing long-term conditions, telehealth tools, and infection-prevention resources. The use of such equipment empowers community nurses to make timely clinical decisions, reduce avoidable hospital admissions and support patient independence. Training and competency are essential to ensure safe and effective equipment use, alongside governance measures that ensure accessibility, maintenance and documentation standards. The article also considers future trends, including the increased role of remote monitoring, digital health platforms and wearable technologies. As demands on community services grow, the integration of evidence-based medical equipment into routine practice will continue to play a pivotal role in delivering high-quality care and improving outcomes for patients in their own homes.

Background: Detecting acute ischaemic stroke in its early stages is critical for improving the patient's chances of a favorable outcome. While face, arm, speech, time (FAST) is the generally accepted tool for the prehospital screening of suspected stroke patients, it is proposed that the more extensive balance, eyes, face, arm, speech, time (BE-FAST) may improve stroke recognition.

Aims: This systematic review compares the efficacy of FAST and BE-FAST in detecting acute stroke in prehospital settings.

Methods: A systematic literature search was conducted across four databases including MEDLINE, ProQuest, CINAHL and PubMed. Included articles compared diagnostic performance of FAST and BE-FAST for ischaemic stroke recognition in the ambulance, or when used by emergency medical services. Only original research published in the English language was included.

Results: Sensitivities of FAST ranged from 64% to 97%, while specificities ranged from 13% to 76.9%, showing a wide variation across the studies. The only study that considered BE-FAST reported its sensitivity and specificity as 91% and 53%, respectively, compared to 76% and 68%, respectively, for FAST.

Conclusions: There is limited data on the performance of BE-FAST in the prehospital setting. The findings of this systematic review suggest that both FAST and BE-FAST perform reasonably for prehospital stroke recognition, although specificity of these scales is generally low. BE-FAST may be more sensitive to detect stroke, but there is insufficient evidence to draw a conclusion.

Background: Chronic wounds are highly prevalent among older adults in care homes and place significant demands on healthcare systems. This article reports on the design, implementation and early impact of a new tissue viability nursing referral pathway for care homes in NHS Lothian, developed through quality improvement methodologies.

Aims: The initiative aimed to increase direct access for registered nurses in care homes to specialist tissue viability nursing advice via a secure e-clinic referral process, supported by training, standardised equipment and a bespoke data tracker.

Methods: Using the model for improvement and plan-do-study-act cycles, a collaborative team developed a governance-compliant process that included the provision of secure email, wound cameras and structured guidance.

Results: Following pathway implementation in February 2024, annual referral rates from care homes rose from under 150 to approximately 280, suggesting a previously unmet need for tissue viability nursing support. Most referrals were for pressure ulcers and venous leg ulcers, reflecting previously known wound burdens in long-term care. Evaluation data also suggested a potential reduction of 262 district nursing visits in the first year, with care home staff reporting improved responsiveness, confidence and resident outcomes. Challenges included digital infrastructure compatibility and ongoing staff support.

Conclusions: The project demonstrates how collaborative quality improvement approaches can enhance community wound care, improve integration between health and social care sectors, and optimise use of specialist nursing resources. With an ageing population and increasing wound complexity in care homes, such models offer scalable solutions to address workforce pressures and improve equitable access to tissue viability expertise.

Background: Foot ulcer healing may be impeded because of underlying pathology and/or patient non‑compliance affecting the wound healing process. Healthcare professionals may opt to apply antimicrobial dressings to control bioburden and avert infections, ultimately achieving wound regeneration and repair.

Aims: The study evaluated and compared the effectiveness of different types of dressing on foot ulcer healing.

Methods: A single‑centre, prospective, open‑label, randomised, controlled pilot trial was conducted, comparing three treatment arms: a standard non‑antimicrobial dressing; a physical antimicrobial dressing; a rotation regimen of chemical antimicrobial dressings, each applied successively for 2 weeks per rotation. Dressings were applied throughout the trial period, up to 18 weeks or until the ulcer healed, and outcome measures were collated at weeks 0, 3, 6, 9, 12 and 18.

Results: A total of 40 patients were randomised. After 12 weeks, the median percentage wound size compared to initial foot ulcer size at baseline was 41% for the physical antimicrobial dressing, 35% for the rotation regimen arm and 9% for the non‑antimicrobial dressing (p‑value 0.21, Kruskal‑Wallis test). Out of the initial 14 patients, three required antibiotics in the physical antimicrobial arm, four in the rotation arm and three in the non‑antimicrobial arm. Up to week 6 of the trial period, the intended randomised dressing was applied in 29 out of 33 cases (88%) but treatment deviation increased thereafter.

Conclusions: Conducting a trial comparing different dressings for foot ulcers poses challenges. Deviation from planned dressing choice, either because of marked improvement or deterioration of the ulcer, systemic antibiotics use and occasional patient non‑compliance can limit generalisability of the findings.

Implications for practice: Antimicrobial dressings may promote better foot ulcer healing than standard dressings, though evidence remains inconclusive. Treatment plans should remain flexible to accommodate wound changes and patient compliance.

Artificial intelligence (AI) is increasingly embedded in primary care, offering tools to enhance clinical decision making, streamline administrative processes and support personalised care. Community nurses who provide holistic, patient-centred support across diverse populations, are required in the digital age to understand and adapt to AI's evolving and increasingly complex role. This article explores current AI applications in primary care, focusing on wound care and community care planning, outlining implications for community nursing practice, and addressing ethical and professional challenges. It concludes by emphasising the need for digital education, infrastructure investment and governance to ensure safe, equitable AI adoption.

This article discusses the author's role in redesigning wound care delivery in two primary care networks in Norfolk, responding to pressures on local leg ulcer clinics. A tissue viability nurse role was embedded into primary care, one of the first in England, enabling early intervention, consistent care and collaborative education. The initiative addressed long-standing inefficiencies through service co-design, national guideline integration and creation of new pathways. The author also conducted a pilot study on standardising wound care. Key outcomes from the study included a reduction in healing times from 19.29 to 4.12 weeks and a 74% cost saving per patient. The project also improved clinical confidence and reduced systemic burden. This model demonstrates the value of integrating specialist nursing roles in primary care to drive quality improvement and patient outcomes.

Mr H, an 85-year-old man, had undergone a heart bypass surgery 10 years ago and had been living with non-healing a leg ulcer for 9 years. He was also one of the first members of the Leg Club. With a fourlayer compression bandaging, regular wound cleansing with non-cytotoxic solutions, and application of primary dressings tailored to exudate levels, Mr H's leg ulcer healed within 8 weeks, much sooner than the expected 12-week period. Post-healing, he transitioned into the Well Leg Programme, attending monthly health-check sessions.