Vulnerable families: a study of health visitors' prioritization of their work

Changes in the NHS have supported the idea of targeting health services to those in greatest need. This has meant that health visitors are increasingly having to identify 'vulnerable' families in need of increased health visiting intervention. This paper reports on a qualitative study undertaken in order to explore the ways in which health visitors plan and organize their work in relation to the concept of vulnerability. Focus groups and semi-structured interviews were carried out with health visitors from two separate geographical areas, one an inner city area and the other suburban, in order to explore the criteria by which health visitors define vulnerability and decide to increase their levels of intervention to particular families. It was found that vulnerability was extremely difficult to define but that the health visitors used criteria which were appropriate to the particular localities in which they worked to identify vulnerable families and to increase their levels of intervention to those families. Health visitors were targeting their services within a framework of a basic minimum service to all and were assessing the health needs of individuals or families rather than planning their work on the basis of community or practice profiles.     

Community mental health nursing and early intervention in dementia: developing practice through a single case history

This paper reports on a single case history taken from the ‘Dementia Action Research and Education’ project, a 15‐month primary care intervention study that was undertaken in North Wales in the early part of 2000. The study sought to address the meaning, context and diversity of early intervention in dementia care and employed a community mental health nurse and a psychiatric social worker to undertake early and psychosocial interventions with older people with dementia (aged 75 years and over) and their families. The workers tape‐recorded, documented and analysed their interventions with 27 older people with dementia and their families over the 15‐month duration of the study. Clinical supervision was also undertaken during the intervention phase. One case history is presented in this paper to illustrate the work of the community mental health nurse and to identify areas of practice development. Greater role transparency, collaborative working and improvement in educational preparation for practice are called for.     

Collaborative lymphoedema management: developing a clinical protocol

Lymphoedema is a very distressing chronic condition prevalent in some metastatic cancers. Conservative treatment of lymphoedema in palliative care involves complete/complex decongestive therapy (CDT) using manual lymphatic drainage (MLD), compression therapy (bandaging and/or garments), skincare, and remedial exercises, adapted to the needs of the patient. The aim of this service development project was to identify current practice in a hospice palliative care service, develop new assessment tools, and implement a collaborative clinical protocol to improve access to lymphoedema management for patients in the hospice. Two audits provided new evidence about patient profiles, patient assessment, and treatment outcomes for cancer- and non-cancer-related lymphoedema. This project had a quality-improvement effect on service delivery and developed an effective partnership approach to lymphoedema management between local district nursing services and the specialist lymphoedema physiotherapist.     

Anesthetic care in developing countries: equipment and techniques

Various organizations have been formed to provide short-term surgical services in developing countries. In these countries, the ability to provide effective anesthetic care requires the team to transport most of the equipment necessary to provide perioperative care for various surgical procedures. We review the basic supplies necessary to provide such care and discuss some of the issues related to the anesthesia machines, techniques, and monitoring in developing countries. Suggestions and options for preoperative assessment, intraoperative anesthetic care, and postoperative care, including pain management, are provided.     

Teaching prioritization skills: a preceptor forum.

The Medical Specialty Preceptor Council of a large tertiary medical center selected prioritization as a theme to address with medical specialty registered nurse preceptors. Activities included exploration of the literature, personal reflection on preceptor experiences, and creation of a project that culminated in a preceptor forum. The forum included interactive poster stations staged for a drop-in session for preceptors. The stations were developed and staffed by Council members using research and ideas from colleagues.     

A university-wide health fair: a health promotion clinical practicum

Can sophomore baccalaureate students in their first clinical experience develop a health promotion activity to meet the needs of a university community? The authors describe how students, focusing on wellness and the nursing process, developed a university-wide health fair; the learning experiences, both planned and serendipitous; the importance of collaboration in health promotion and disease prevention activities; and the promotion of nursing's presence on a university campus.     

Community mental health nursing: a social network approach.

This paper describes an intervention technique that the psychiatric nurse may find useful in community mental health settings. This technique is called social network intervention. It attempts to combine the best of traditional clinical psychotherapeutic method with the advantages of a social systems approach for working with the patient in psychiatric distress. The technique is based on the assumption that the solution to a variety of human predicaments lies within the collective instrumental and affective resources of a patient's social network. The vehicle for accomplishing this is the "Network Session" during which a mental health clinician convenes the patient and his/her social network to help plan and resolve the difficulty. A Case Report demonstrating the use of the technique is included.     

Microdialysis for myocardial metabolic surveillance: developing a clinical technique

Metabolic surveillance of the myocardium is of great interest in cardiac surgery. Microdialysis allows sampling of chemical substances from the interstitial fluid for immediate analysis. The two objectives of this study were to develop a technique for simple and safe implantation of a commercially available microdialysis probe (CMA-70) into the myocardium and to obtain reference data for further use and metabolic control. Eighteen pigs were used in an experimental ischaemic heart model where the left anterior descending coronary artery was occluded for 20 min. Microdialysis was performed proximally as well as distally to the arterial occlusion site corresponding to a control and an ischaemic area in the heart. Two techniques were tried for probe implantation, using either a pacemaker wire attached to the probe tip or a needle introducer. Metabolic substrates (glucose, lactate, glycerol and pyruvate) were collected before, during and after ischaemia, for up to 6 h. Both techniques were highly effective in registering metabolic changes due to ischaemia with sharp time resolution, but the needle introducer was superior regarding probe durability. It is concluded that the CMA-70 microdialysis probe implanted with the needle introducer allows for an accurate monitoring of myocardial metabolism during a prolonged period of time. Future studies in the human heart are warranted to further validate the technique.     

A model home health clinical record system

The ideal home health clinical record system is functional, integrated, facilitates patient care, maximizes reimbursement, avoids duplication, minimizes the use of clinicians' time to document, and meets all legal and regulatory requirements. A visiting nurse association successfully created a new record system to achieve all these objectives.