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No / This article presents a review of key issues around caring for people in the last hours and days of life. The aim is that community nurses will be able to support patients and families, and to provide and explain decisions and interventions to promote comfort and dignity based on current evidence.

Community nurses have a critical role in caring for people and families affected by HIV/AIDS in the home setting. Despite this, there is a dearth of Australian literature describing the health needs of these clients who are referred to them. This study identified the demographic, clinical and psychoemotional aspects of adult clients with HIV/AIDS in Sydney, Australia, who were referred to community nurses and died between 1993 and 1995. Retrospective data from the records of 73 clients identified on 171 Community Nursing Referral Forms completed within the study period from an inpatient HIV/AIDS Unit was analysed using descriptive statistics and content analysis. The sample was demographically similar to the general population of people with HIV/AIDS during the study period. The most commonly identified clinical aspects of clients included oral candida, mycobacterium avium complex, anaemia, drug intolerance, cytomegalovirus, pain, fever, diarrhoea, weight loss and cough. The most commonly identified psychoemotional variables were depressed mood, anxiety, grief and nonadherence to suggested interventions, with the most common emergent theme being the physical effects of HIV/AIDS illness. Emotional support, symptom monitoring and home assessments were the most common requests made of community nurses. The study sample represented 14% of people who died following AIDS in New South Wales during this known peak period of AIDS diagnoses and deaths following AIDS. As a result of this study, documentation exists describing the characteristics of clients with advanced HIV/AIDS referred to community nurses. Current and future clients with advanced HIV/AIDS referred to community nurses may experience a similar clinical picture to that identified in this study. The findings can be used to reveal relationships amongst the key variables; lay the foundation for further comparative, theory or hypothesis driven studies; and demonstrate how this influences the community nursing role, strategies, interventions and outcomes.

This study attempted to investigate the impact of new technology, specifically tele-advice on community nurses' care of leg ulcers. Firstly, a stratified randomised controlled study was designed to measure the impact of using this technology on their levels of wound knowledge and confidence. An individual self-test questionnaire and an attitudinal scale measured nurses' knowledge and confidence respectively both pre and post-intervention. Secondly, a new visual wound assessment tool was designed to represent the state of the wound by a single numerical value; the State of the Wound Index (SWI). Thirdly, the impact of nurses' knowledge, confidence and patient variables was explored to assess their impact on the state of the wound as represented by SWI. The sample consisted of thirty-eight registered primary care nurses from two local NHS trusts in South Wales and their corresponding 38 patients with venous leg ulcers. Nurses were stratified according to their qualifications into experimental or control groups. Both groups were shown to have comparable levels of knowledge and confidence pre-intervention. Nurses in the experimental group received expert tele-advice by a Clinical Nurse Specialist (CNS) over a 12 week period regarding the care of their patient's leg ulcer, whilst those in the control group continued to care for their leg ulcer patients in the traditional way. hi the experimental group, nurses' level of knowledge increased significantly (p=0.02) whilst no improvement was observed for the control group. In terms of confidence, the experimental group reached near significance when extremely positive statements were excluded with no improvement observed for the control group. Results show that the intervention had a positively significant impact on nurses' wound care knowledge and level of confidence. A set of 18 tele-transmittable wound factors was identified by a panel of wound experts. These factors were ranked by another independent panel of leg ulcer experts and no significance could be established in their order of importance. These factors were then examined for their highest and lowest possible estimates for every wound in the sample both pre and post intervention using a Visual Analogue Scale (VAS). These estimated values formed the basis for 95% confidence interval estimates from which 100 virtual nurse assessed values were generated. These values were then used to generate SWI. This new index ranged from 0 (best possible state) to 100 (worse possible) and was seen to reliably increase when the wound deteriorated and decrease as the wound improved. Linear regression models were built to establish the relationship between SWI, patient variables and nurses' knowledge and confidence levels pre and post-intervention. These indicated that knowledge and confidence can have a positive impact on the healing process. This study has shown that there is great potential for the use of tele-advice in community nurses' care of leg ulcers. For this to succeed, it is recommended that further pre and post registration nurse training is provided to enhance their knowledge in wound care, especially in the areas of physiology and wound assessment.