The Frailty Matters Project.

Preventing and managing frailty is a new area for many community practitioners; yet, frailty specific-education remains limited. This collaborative project aimed to understand and enhance the knowledge, confidence and capability of community nurses to manage frailty in a community setting. A person-centred coaching and educational programme was co-developed with community nurse participants to strengthen their leadership role in managing frailty within interprofessional teams. The "Frailty House" was created as an educational framework for the elements that participants described as important in order to live well with frailty, built on a foundation of leadership and coaching skills. Thematic content analysis of the data revealed the added value of combining technical knowledge and relational skills-building with peer support and coaching. All recognised the challenge of caring for people living with frailty at a difficult time and acknowledged that they would benefit hugely from further knowledge and skill development in this field.

Perceptions, practices and educational needs of community nurses to manage frailty.

Early intervention on frailty can help prevent or delay functional decline and onset of dependency. Community nurses encounter patients with frailty routinely and have opportunities to influence frailty trajectories for individuals and their carers. This study aimed to understand nurses' perceptions of frailty in a community setting and their needs for education on its assessment and management. Using an exploratory qualitative design we conducted focus groups in one Health Board in Scotland. Thematic content analysis of data was facilitated by NVivo© software. A total of 18 nurses described the meaning of frailty as vulnerability, loss and complex comorbidity and identified processes of caring for people with frailty. They identified existing educational needs necessary to support their current efforts to build capability through existing adversities. Our study indicates that current practice is largely reactive, influenced by professional judgement and intuition, with little systematic frailty-specific screening and assessment.

Managing chronic pain in adults.

The management of chronic pain is complex. Services and support for people living with chronic pain are variable despite the publication of a number of reports highlighting the problem. Due to the epidemiology of pain, nurses deliver care to patients with persistent pain in a variety of settings. It is important that nurses have the knowledge, skills and correct attitude to deliver compassionate, person-centred care, in line with best practice in chronic pain management.

Patient empowerment and choice in chronic pain management.

Service provision and access to pain services vary considerably in the UK, with only a small percentage of people with chronic pain accessing specialist services. Government policy supports giving patients more choice and control over their care. Empowerment involves ensuring patients have the knowledge, skills, attitudes and self-awareness to improve the quality of their lives. As most healthcare professionals provide care to people with chronic pain at some point, it is their responsibility to prepare patients to make informed decisions about their treatment. Empowering patients to self-manage their chronic pain can lead to improved person-centred outcomes.

Cancer pain: part 1: Pathophysiology; oncological, pharmacological, and psychological treatments: a perspective from the British Pain Society endorsed by the UK Association of Palliative Medicine and the Royal College of General Practitioners.

OBJECTIVE: This discussion document about the management of cancer pain is written from the pain specialists' perspective in order to provoke thought and interest in a multimodal approach to the management of cancer pain, not just towards the end of life, but pain at diagnosis, as a consequence of cancer therapies, and in cancer survivors. It relates the science of pain to the clinical setting and explains the role of psychological, physical, interventional and complementary therapies in cancer pain. METHODS: This document has been produced by a consensus group of relevant health care professionals in the United Kingdom and patients' representatives making reference to the current body of evidence relating to cancer pain. In the first of two parts, pathophysiology, oncological, pharmacological, and psychological treatment are considered. CONCLUSIONS: It is recognized that the World Health Organization (WHO) analgesic ladder, while providing relief of cancer pain towards the end of life for many sufferers worldwide, may have limitations in the context of longer survival and increasing disease complexity. To complement this, it is suggested that a more comprehensive model of managing cancer pain is needed that is mechanism-based and multimodal, using combination therapies including interventions where appropriate, tailored to the needs of an individual, with the aim to optimize pain relief with minimization of adverse effects.

Cancer pain: part 2: physical, interventional and complimentary therapies; management in the community; acute, treatment-related and complex cancer pain: a perspective from the British Pain Society endorsed by the UK Association of Palliative Medicine and the Royal College of General Practitioners.

OBJECTIVE: This discussion document about the management of cancer pain is written from the pain specialists' perspective in order to provoke thought and interest in a multimodal approach to the management of cancer pain, not just towards the end of life, but pain at diagnosis, as a consequence of cancer therapies, and in cancer survivors. It relates the science of pain to the clinical setting and explains the role of psychological, physical, interventional and complementary therapies in cancer pain. METHODS: This document has been produced by a consensus group of relevant healthcare professionals in the United Kingdom and patients' representatives making reference to the current body of evidence relating to cancer pain. In the second of two parts, physical, invasive and complementary cancer pain therapies; treatment in the community; acute, treatment-related and complex cancer pain are considered. CONCLUSIONS: It is recognized that the World Health Organization (WHO) analgesic ladder, whilst providing relief of cancer pain towards the end of life for many sufferers world-wide, may have limitations in the context of longer survival and increasing disease complexity. To complement this, it is suggested that a more comprehensive model of managing cancer pain is needed that is mechanism-based and multimodal, using combination therapies including interventions where appropriate, tailored to the needs of an individual, with the aim to optimize pain relief with minimization of adverse effects.

The value of thorough assessment in the management of cancer pain.

The number of patients likely to require management of cancer pain is increasing. However, although modern analgesia can help most patients achieve complete pain relief, some studies report widespread under-treatment of all types of pain. This paper describes approaches that health professionals can employ to ensure optimum pain management.