Before I Die: death positivity and the community nursing contribution

This article explores the contextual backdrop of the death-positive movement that inspired the discussion group Before I Die: Worcestershire, along with the motivations behind its creation. It explores the balance between practical, planning discussions and open-ended talks held by the group, emphasising the importance of creativity when responding to the topics of death and dying. The collaborative efforts between Before I Die: Worcestershire and other groups and persons involved in the death-positive movement are also highlighted. This article considers the potential of grassroots community movements to engage people to make plans for their dying, regardless of circumstances and background. It argues that death-positive movements, projects and initiatives can be a valuable way for community nurses to engage with the population they serve.

Antipsychotic Prescribing in VA-Contracted Community Nursing Homes and Incident Use Among Veterans

The Veterans Health Administration (VA) is increasingly purchasing long-term care for eligible Veterans from non-VA, community nursing homes (CNHs). Antipsychotics present safety risks for older adults, but it is unknown how the prevalent use of antipsychotics at CNHs influences whether newly admitted Veterans will initiate antipsychotic therapy. This study used 2013-2016 VA data, Medicare claims, Nursing Home Compare, and Minimum Data Set (MDS) assessments. We identified 10,531 long-stay CNH episodes for Veterans not prescribed antipsychotics 6 months before CNH admission. We categorized Veterans by whether, 12 months before admission, they were diagnosed with FDA-approved indications (including schizophrenia, Tourette’s syndrome, Huntington’s disease) for antipsychotic use. The exposure was the proportion of all CNH residents prescribed antipsychotics in the quarter preceding a Veteran’s admission. Using adjusted logistic regression, we analyzed two outcomes measured using MDS assessments collected ~100 days after CNH admission: 1) new antipsychotic use, and 2) new diagnosis for an FDA-approved indication among Veterans without these conditions at admission. Among antipsychotic-naïve Veterans admitted to CNHs, 7,924 (75.2%) lacked an antipsychotic indication. Prevalent antipsychotic use in CNHs ranged 0%-10.9% (quintile 1) and 25.7%-91.4% (quintile 5). The odds of initiating antipsychotic use increased with higher CNH antipsychotic use rates (OR=2.52, 95% CI:2.05-3.10, quintile 5 vs. 1), as did the odds of acquiring a new indication (OR=2.08, 95% CI:1.27-3.40, quintile 5 vs. 1). Provider practices may be influencing new diagnoses indicating antipsychotic use at CNHs with high antipsychotic use. It may be important for VA to consider antipsychotic use when contracting with CNHs.

Dressings and dignity in community nursing

Although dignity has been widely explored in the context of healthcare, it has rarely been the subject of empirical exploration when care is delivered by community district nursing teams. This paper demonstrates how a commonplace community nursing task (changing dressings) can constitute a clinical lens through which to explore the ways in which community nurses can influence patients' dignity. This ethnographic study involved two research methods: interviews with patients and nurses (n=22) and observations of clinical interactions (n=62). Dignity can manifest during routine interactions between community nurses and patients. Patient-participants identified malodour from their ill-bodies as a particular threat to dignity. Nurses can reinforce the dignity of their patients through relational aspects of care and the successful concealment of ‘leaky’ bodies.

Improving Detection of Client Complexity in the Community (Impact): A Study Protocol of a Pragmatic Randomized Controlled Trial

Background: Community-dwelling older clients are becoming increasingly complex. Detecting this complexity in clinical practice is limited, with greater reliance on community nurses’ clinical judgment and skills. The lack of a consistent approach to complexity impacts the level of care and support for older clients to remain in their homes for longer. Objective: To examine the effectiveness of the Patient Complexity Instrument (PCI) in addition to nurses’ clinical judgment to enhance detection of complexity, and subsequent older clients’ resource allocation compared to usual nursing assessment. Design: A pragmatic randomized controlled trial will be conducted within a community nursing service in regional Victoria, Australia. Clients 65 years and over referred to the service who are eligible for Commonwealth Home Support Programme (CHSP) funding will be randomized into Control group: usual nursing assessment or Intervention group: usual nursing assessment plus the PCI. Nurse participants are Registered Nurses currently employed in the community nursing service. Results: This study will explore whether introducing the PCI in a community nursing service enhances detection of complexity and client care resource allocation compared to nurses’ clinical judgment based on usual nursing assessment. Conclusion: This protocol outlines the study to enhance the detection of complexity by nurses delivering care for community-dwelling older people in the regional Australian context. The findings will inform the use of a standardized tool to detect complexity among community-dwelling older Australians.

Introducing the new Chronic Oedema Wet Leg Pathway

Reticence to apply compression therapy has been widely observed in clinical practice, compounded by an absence of evidenced-based pathways for application of prompt compression prior to measuring ankle brachial pressure index (ABPI). Importantly, delaying compression therapy for patients with chronic oedema and lymphorrhoea causes many avoidable complications. In 2017, Lymphoedema Network Wales (LNW) developed an evidenced-based pathway to improve the management of chronic oedema and wet legs (lymphorrhoea) for community nurses. During the past 4 years, the Chronic Oedema Wet Leg Pathway has been presented, published and used internationally, as well as being translated into different languages. It is commonly used in community nursing Teams as an evidenced-based document. However, like all documents and guidelines, when more evidence becomes available, the pathway needs updating. Therefore, this clinical focus article will present the new and enhanced Chronic Oedema Wet Leg Pathway, introducing a new level four compression section, which increases the layers of compression bandaging for patients with venous insufficiency or who are morbidly obese.