Details

<i>Contributors</i> viii <p><i>Foreword</i> x</p> <p><i>Preface</i> xi</p> <p><b>Chapter 1 Assessment and communication (general principles) 1</b></p> <p>Background evidence 1</p> <p>The Single Assessment Process (SAP) 2</p> <p>Communication 6</p> <p>Conclusion 15</p> <p>References and further reading 15</p> <p><b>Chapter 2 Blood glucose monitoring for people with diabetes mellitus 19</b></p> <p>Background evidence 19</p> <p>Metabolic control (physiology of blood glucose) 20</p> <p>Urine versus blood testing 20</p> <p>Capillary blood glucose testing 20</p> <p>Blood glucose monitoring training and education 22</p> <p>Types of blood glucose monitoring system 23</p> <p>Limitations of blood glucose meters 23</p> <p>Contraindications for the use of blood glucose meters 23</p> <p>Maintenance and care of the meter 24</p> <p>References and further reading 26</p> <p><b>Chapter 3 Bowel management 28</b></p> <p>Background evidence 28</p> <p>Constipation 30</p> <p>Diarrhoea 38</p> <p>Irritable bowel syndrome 40</p> <p>Faecal incontinence 40</p> <p>Conclusion 46</p> <p>References and further reading 62</p> <p><b>Chapter 4 Discharge planning 65</b></p> <p>Background evidence 65</p> <p>Discharge planning process 65</p> <p>Community Care Delayed Discharge Act 2003 76</p> <p>Informal carers 76</p> <p>Risk management 77</p> <p>Training 78</p> <p>Conclusion 78</p> <p>References and further reading 82</p> <p><b>Chapter 5 Ear irrigation 84</b></p> <p>Background evidence 84</p> <p>Purpose of ear irrigation 84</p> <p>Preparation of the patient prior to irrigation 85</p> <p>Risk management 87</p> <p>Training 88</p> <p>Conclusion 88</p> <p>References and further reading 92</p> <p><b>Chapter 6 Infection prevention and control 93</b></p> <p>Glossary 93</p> <p>Background evidence 94</p> <p>Healthcare-associated infection (HCAl) 96</p> <p>The epidemiology of infection 97</p> <p>Infection prevention and control in the community 97</p> <p>Standards 99</p> <p>Outbreak of infection in the community 99</p> <p>Health clearance for healthcare workers 99</p> <p>Universal/Standard precautions 100</p> <p>Conclusion 120</p> <p>References and further reading 125</p> <p><b>Chapter 7 Intravenous therapy and central vascular access devices 131</b></p> <p>Background evidence 131</p> <p>Referrals 132</p> <p>Education and training 132</p> <p>Quality of life issues 134</p> <p>Peripherally inserted central catheters (PICCs) 135</p> <p>Skin-tunnelled cuffed catheters 138</p> <p>Implantable ports 140</p> <p>Administration of medications and/or infusions 142</p> <p>CVAD insertion complications 143</p> <p>Complications of CVADs 143</p> <p>References and further reading 174</p> <p><b>Chapter 8 Medicines management 177</b></p> <p>Background evidence 177</p> <p>Accountability, responsibility and consent 177</p> <p>Risk management 178</p> <p>Delegation of administration 179</p> <p>Storage 179</p> <p>Transportation of medication 180</p> <p>Transcribing 180</p> <p>Changes to medication doses 180</p> <p>Incident reporting 180</p> <p>Adverse drug reaction (ADR) 180</p> <p>Disposal 181</p> <p>Non-medical prescribing 181</p> <p>Administration 181</p> <p>Intravenous (IV) drug administration 183</p> <p>Diagnosis and management of anaphylaxis 183</p> <p>Conclusion 185</p> <p>References and further reading 199</p> <p><b>Chapter 9 Moving and handling 201</b></p> <p>Background evidence 201</p> <p>The legal aspects of</p> <p>manual handling 201</p> <p>Manual handling equipment 204</p> <p>Conclusion 207</p> <p>References and further reading 210</p> <p><b>Chapter 10 Nutritional support 211</b></p> <p>Background evidence 211</p> <p>Nutritional status and health 212</p> <p>Malnutrition 217</p> <p>Identifying patients at risk of malnutrition (initial nursing assessment) 217</p> <p>Nutritional risk screening tools 219</p> <p>Anthropometric assessment 221</p> <p>Diagnostic tests 222</p> <p>Referral to the community dietetic department 222</p> <p>Patients with weight loss/loss of appetite 227</p> <p>Patients who are overweight 229</p> <p>Nutritional support in the home 229</p> <p>Conclusion 242</p> <p>References and further reading 253</p> <p><b>Chapter 11 Personal hygiene 256</b></p> <p>Background evidence 256</p> <p>Assessment 256</p> <p>Multicultural needs 257</p> <p>Manual handling and risk assessment 258</p> <p>Conclusion 258</p> <p>References and further reading 271</p> <p><b>Chapter 12 Syringe driver/pump management and symptom control in palliative care 272</b></p> <p>Background evidence 272</p> <p>Education and training 273</p> <p>Prescribing and administering drugs in the community 275</p> <p>Using a syringe driver/pump 275</p> <p>Symptom management 281</p> <p>Crisis box 281</p> <p>Pain control 281</p> <p>Anxiolytics 285</p> <p>Terminal agitation/acute confusional state 285</p> <p>Anti-emetics 286</p> <p>Drugs used for excess secretions 286</p> <p>Drugs used for intestinal obstruction 286</p> <p>Steroids 286</p> <p>Rescue doses of medication 286</p> <p>Monitoring 287</p> <p>Reactions at the infusion site 287</p> <p>Ethical issues and consent 288</p> <p>Risk management 288</p> <p>Reporting adverse incidents 290</p> <p>Conclusion 291</p> <p>References and further reading 302</p> <p><b>Chapter 13 Urinary catheterisation and management 304</b></p> <p>Background evidence 304</p> <p>Risk management 304</p> <p>Training and education 304</p> <p>Catheter selection 304</p> <p>Anaesthetic/Lubricating gel 307</p> <p>Suprapubic catheterisation 307</p> <p>Intermittent catheterisation 308</p> <p>Meatal hygiene 309</p> <p>Drainage systems 309</p> <p>Infection 310</p> <p>Catheter blockage and encrustations 310</p> <p>Conclusion 312</p> <p>References and further reading 331</p> <p><b>Chapter 14 Venepuncture 333</b></p> <p>Education and training 333</p> <p>Anatomy and physiology 334</p> <p>Selecting a vein 335</p> <p>Improving venous access 336</p> <p>Selection of equipment 338</p> <p>Specimen handling and transportation 338</p> <p>Safety of staff 340</p> <p>Infection control issues 340</p> <p>Patients’ perspective of venepuncture 340 <b>vii</b></p> <p>Reducing pain during venepuncture 341</p> <p>Legal and professional issues 341</p> <p>Problem solving 342</p> <p>Conclusion 343</p> <p>References and further reading 346</p> <p><b>Chapter 15 Wound management 349</b></p> <p>Background evidence 349</p> <p>Wound healing 351</p> <p>Wound management 358</p> <p>Types of wound commonly managed by community nurses 365</p> <p>Procedural guidelines 378</p> <p>References and further reading 397</p> <p><i>Index</i> 402</p>

<p>“Overall a good manual that gives a good overview of the key aspects of a district nurses role . . . This book is ideally placed for student nurses, nurses new into the community setting and experienced district nurses as a reference guide to base their practice on.”  (<i>Nursing Times</i>, 31 January 2013)</p> <p>“As district nursing practice requires a pragmatic approach and adaptable skills, this manual is a useful resource.”  (<i>Primary Health Care</i>, 1 December 2012)</p> <p>“It is ideal for nursing students, newly qualified staff and return-to-nursing students and wanting to work in the community.  For more experienced staff it is a good point of reference.”  (<i>Journal of Community Nursing</i>, 1 July 2012)</p>

Elizabeth O’Brien is clinical team leader for district nursing in Croydon Primary Care Trust. She is involved in writing clinical guidelines clinical audit and benchmarking in connection with Croydon Primary Care Trust’s clinical governance agenda.

<p><i>“This manual, the first of its kind focused on district nursing, provides the means to build competence and confidence in nurses new to the community, or developing their skills. The comprehensive and evidence-based content provides essential information for competence in key areas of district nursing.”</i></p><p><b>From the Foreword, by Rosemary Cook CBE, Hon D Lett, MSc, PG Dip, RGN Director, The Queen’s Nursing Institute</b></p><p>Clinical skills are a fundamental aspect of district nursing care. The <i>District Nursing Manual of Clinical Procedures</i> is a practical, evidenced-based manual of clinical skills which reflects the unique challenges of district nursing care within the patient’s home. It provides a comprehensive resource for all district nurses, community nurses, students, and health-care professionals involved in the district nursing team, enabling them to practice confidently and deliver clinically effective, person-centred care.</p><p>The <i>District Nursing Manual of Clinical Procedures</i> addresses the complexity of district nursing care and encompasses key aspects of clinical practice, including those that district and community nurses often struggle with or find difficult when they are on their own in a patient’s home. It utilises the latest clinical research and expert clinical knowledge to address these challenges, and to provide the underlying theory and evidence for district nursing care.</p><p><b>Key features</b></p><ul><li>Evidenced-based manual of practical clinical skills in district nursing care</li><li>Clear, user-friendly and easy to understand</li><li>Contains recommendations for expert care within a patient’s own home</li><li>Addresses key concerns of district and community nurses working on their own within a patient’s home</li><li>Encompasses key aspects of district nursing care</li> <li>Placed in the context of person-centred care</li><li>All procedures include the rationale for each action - ‘why’ as well as ‘how’</li></ul>

"Every children's nurse, whether they are a specialist or just starting out, benefits from the experiences of others and the evidence which supports professional practice. This manual is a great asset to nurses who care for children in any setting, and it is designed to be as user-friendly as possible for nurses with all levels of expertise. Based on rigorous evidence and extensive nursing experience, I would recommend this as an excellent guide for all practitioners working to ensure children and families have the best possible experience wherever they are receiving care."—Fiona Smith, Adviser in Children and Young People's Nursing at the Royal College of Nursing

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