Aim: To explore the enablers and barriers perceived by community nurses in the promotion of oral health in an Adult Community Trust Directorate.Background: Oral healthcare promotion in community care settings is being neglected. England and Wales have witnessed marked improvements in periodontal disease; however, no improvements have been seen in older people.Method: A qualitative methodology was employed, where eight nurses from Band 5 to 7 were interviewed using a semi-structured approach. The data was analysed thematically.Findings: Data analysis was organised into four themes: Professional self-concept and the development of knowledge, skills and attitudes necessary in the promotion of oral health; the impact an organisation has on the promotion of oral health and an exploration of the enablers and barriers identified by the community nurses while delivering care; the relationships between the nurse and patient and the potential impact on oral health promotion; the concept of self-regard in relation to the promotion of oral health and its overall impact.A commitment to improving oral health and requests for additional educational input was apparent. Organisational enablers and barriers were identified, alongside the crucial role a positive self-regard for oral healthcare may play in the promotion of oral health. Conclusion:Nurses need relevant education, organisational support, adequate resources and support from a multi-disciplinary team to deliver optimal oral health promotion.
• Background Various washout policies are widely used in adults living with long-term catheters (LTC). There is currently insufficient evidence on the benefits and potential harms of prophylactic LTC washout policies in prevention of blockages and other LTC-related adverse events, such as urinary tract infections. CATHETER II tests the hypothesis that weekly prophylactic LTC washouts (normal saline or citric acid) in addition to standard LTC care reduces the incidence of catheter blockage requiring intervention compared to standard LTC care only in adults living with LTC.• MethodsCATHETER II is a pragmatic three-arm open multi-centre superiority randomised controlled trial with an internal pilot, economic analysis, and embedded qualitative study. Eligible participants are adults aged ≥18 years, who have had a LTC in use for ≥28 days, have no plans to discontinue the use of the catheter, are able to undertake the catheter washouts, and complete trial documentation or have a carer able to help them. Participants are identified from General Practitioner practices, secondary / tertiary care, community healthcare, care homes and via public advertising strategies. Participants are randomised 1:1:1 to receive a weekly saline (0.9%) washout in addition to standard LTC care, a weekly citric acid (3.23%) washout in addition to standard LTC care or standard LTC care only. Participants and/or carers will receive training to administer the washouts. Patient-reported outcomes are collected at baseline and for 24 months post-randomisation. The primary clinical outcome is catheter blockage requiring intervention up to 24 months post-randomisation expressed per 1000 catheter days. Secondary outcomes include symptomatic catheter-associated urinary tract infection requiring antibiotics, catheter change, adverse events, NHS/ healthcare use, and impact on quality of life. • DiscussionThis study will guide treatment decision-making and clinical practice guidelines regarding the effectiveness of various prophylactic catheter washout policies in men and women living with LTC. This research has received ethical approval from Wales Research Ethics Committee 6 (19/WA/0015).• Trial registration ISRCTN (ISRCTN17116445). Registered prospectively on 06 November 2019, https://doi.org/10.1186/ISRCTN17116445
The aims of the district nursing team are already many and varied: to prevent ill-health and to keep people healthy; to provide support for people living with long-term conditions; to treat curable problems and to provide nursing care to those with acute and complex needs; to offer palliative and terminal care to those who require it so that they may die in accordance with their wishes. Recent Government policy goes further, clearly placing district nurses in new flexible roles that are critical in enabling individuals to be supported at home, and in spearheading community-based health provision to improve the public health.
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