"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."
—From the Foreword, by Rosemary Cook CBE, Hon D Lett, MSc, PG Dip, RGN Director, The Queen's Nursing Institute Clinical skills are a fundamental aspect of district nursing care. The District Nursing Manual of Clinical Procedures is a practical, evidence-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 healthcare professionals involved in the district nursing team, enabling them to practice competently and confidently and deliver clinically effective, person-centred care.
The District Nursing Manual of Clinical Procedures addresses the complexity of district nursing care and encompasses key aspects of clinical practice, including decision making in areas 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.
Key features
- Evidence-based manual of practical clinical skills in district nursing care
- Clear, user-friendly and easy to understand
- Contains recommendations for expert care within a patient's own home
- Addresses key concerns of district and community nurses working on their own within a patient's home
- Encompasses key aspects of district nursing care
- Placed in the context of person-centred care
- All procedures include the rationale for each action - 'why' as well as 'how'
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Table of Contents:
Contributors viii Foreword x
Preface xi
Chapter 1 Assessment and communication (general principles) 1
Background evidence 1
The Single Assessment Process (SAP) 2
Communication 6
Conclusion 15
References and further reading 15
Chapter 2 Blood glucose monitoring for people with diabetes mellitus 19
Background evidence 19
Metabolic control (physiology of blood glucose) 20
Urine versus blood testing 20
Capillary blood glucose testing 20
Blood glucose monitoring training and education 22
Types of blood glucose monitoring system 23
Limitations of blood glucose meters 23
Contraindications for the use of blood glucose meters 23
Maintenance and care of the meter 24
References and further reading 26
Chapter 3 Bowel management 28
Background evidence 28
Constipation 30
Diarrhoea 38
Irritable bowel syndrome 40
Faecal incontinence 40
Conclusion 46
References and further reading 62
Chapter 4 Discharge planning 65
Background evidence 65
Discharge planning process 65
Community Care Delayed Discharge Act 2003 76
Informal carers 76
Risk management 77
Training 78
Conclusion 78
References and further reading 82
Chapter 5 Ear irrigation 84
Background evidence 84
Purpose of ear irrigation 84
Preparation of the patient prior to irrigation 85
Risk management 87
Training 88
Conclusion 88
References and further reading 92
Chapter 6 Infection prevention and control 93
Glossary 93
Background evidence 94
Healthcare-associated infection (HCAl) 96
The epidemiology of infection 97
Infection prevention and control in the community 97
Standards 99
Outbreak of infection in the community 99
Health clearance for healthcare workers 99
Universal/Standard precautions 100
Conclusion 120
References and further reading 125
Chapter 7 Intravenous therapy and central vascular access devices 131
Background evidence 131
Referrals 132
Education and training 132
Quality of life issues 134
Peripherally inserted central catheters (PICCs) 135
Skin-tunnelled cuffed catheters 138
Implantable ports 140
Administration of medications and/or infusions 142
CVAD insertion complications 143
Complications of CVADs 143
References and further reading 174
Chapter 8 Medicines management 177
Background evidence 177
Accountability, responsibility and consent 177
Risk management 178
Delegation of administration 179
Storage 179
Transportation of medication 180
Transcribing 180
Changes to medication doses 180
Incident reporting 180
Adverse drug reaction (ADR) 180
Disposal 181
Non-medical prescribing 181
Administration 181
Intravenous (IV) drug administration 183
Diagnosis and management of anaphylaxis 183
Conclusion 185
References and further reading 199
Chapter 9 Moving and handling 201
Background evidence 201
The legal aspects of
manual handling 201
Manual handling equipment 204
Conclusion 207
References and further reading 210
Chapter 10 Nutritional support 211
Background evidence 211
Nutritional status and health 212
Malnutrition 217
Identifying patients at risk of malnutrition (initial nursing assessment) 217
Nutritional risk screening tools 219
Anthropometric assessment 221
Diagnostic tests 222
Referral to the community dietetic department 222
Patients with weight loss/loss of appetite 227
Patients who are overweight 229
Nutritional support in the home 229
Conclusion 242
References and further reading 253
Chapter 11 Personal hygiene 256
Background evidence 256
Assessment 256
Multicultural needs 257
Manual handling and risk assessment 258
Conclusion 258
References and further reading 271
Chapter 12 Syringe driver/pump management and symptom control in palliative care 272
Background evidence 272
Education and training 273
Prescribing and administering drugs in the community 275
Using a syringe driver/pump 275
Symptom management 281
Crisis box 281
Pain control 281
Anxiolytics 285
Terminal agitation/acute confusional state 285
Anti-emetics 286
Drugs used for excess secretions 286
Drugs used for intestinal obstruction 286
Steroids 286
Rescue doses of medication 286
Monitoring 287
Reactions at the infusion site 287
Ethical issues and consent 288
Risk management 288
Reporting adverse incidents 290
Conclusion 291
References and further reading 302
Chapter 13 Urinary catheterisation and management 304
Background evidence 304
Risk management 304
Training and education 304
Catheter selection 304
Anaesthetic/Lubricating gel 307
Suprapubic catheterisation 307
Intermittent catheterisation 308
Meatal hygiene 309
Drainage systems 309
Infection 310
Catheter blockage and encrustations 310
Conclusion 312
References and further reading 331
Chapter 14 Venepuncture 333
Education and training 333
Anatomy and physiology 334
Selecting a vein 335
Improving venous access 336
Selection of equipment 338
Specimen handling and transportation 338
Safety of staff 340
Infection control issues 340
Patients’ perspective of venepuncture 340 vii
Reducing pain during venepuncture 341
Legal and professional issues 341
Problem solving 342
Conclusion 343
References and further reading 346
Chapter 15 Wound management 349
Background evidence 349
Wound healing 351
Wound management 358
Types of wound commonly managed by community nurses 365
Procedural guidelines 378
References and further reading 397
Index 402
About the Author :
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.
Review :
“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.” (Nursing Times, 31 January 2013)
“As district nursing practice requires a pragmatic approach and adaptable skills, this manual is a useful resource.” (Primary Health Care, 1 December 2012)
“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.” (Journal of Community Nursing, 1 July 2012)
