District Nursing Manual of Clinical Procedures

District Nurses have to take into account the unique difficulties and challenges presented by working within the community setting. This manual presents a comprehensive, evidence based guide to a diverse range of clinical nursing procedures for district nurses and students at every stage of their career. The manual encompasses clinical procedures and guidelines for key aspects of district nursing practice – from assessment to drug administration, infection control, and wound care. The rationale for each action is clearly explained within each step–by–step guideline.

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

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.

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)