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Patients on district nursing caseloads have multiple physical morbidities, and related emotional concerns. District nurses are ideally placed to assess and meet patients' emotional needs but in increasingly stretched workplaces, it is difficult to find time. There is also evidence that district nurses sometimes believe they lack skills to address patients' concerns. Traditional communication skills training is useful for encouraging patients to open up about their concerns, but less helpful at finding workable solutions. District nurses can be afraid to open a ‘can of worms' of concerns that they are unable to deal with. SAGE and THYME is a person-centred, evidence-based communication skills model that addresses district nurses' concerns about time and skills. It provides a structure for conversations about concerns, and empowers patients to work with district nurses to find solutions. Research suggests that it is a promising model for district nursing practice.

Background: Majority of the progress and development in palliative care in the last decade has been improvements in physical aspects of treatment, namely pain and symptom management. Psychosocial aspects of care have improved, although not enough to meet the needs of many patients and family members. This is evident in many parts of the world and notably in Singapore, where palliative care is seen as an emerging medical and nursing specialty. Aim: To discuss the implementation of the SAGE and THYME communication model in a palliative care context. The article examines the use of the model and how its implementation can improve communication between patients and nurses. The model works by reviewing contemporary developments made in relation to improving communication in palliative care. These include, highlighting the importance of meeting individual needs, therapeutic relationship building, and advanced communication training within a Singaporean context. Results: The implementation of the SAGE and THYME model can be a useful way of enabling nurses to improve and maintain effective communication in a medically dominated health care system. The challenges and constraints in educating and training nurses with limited skills in palliative care, forms part of the review, including the cultural and attitude constraints specific to Singaporean palliative care.

Long-term conditions are the leading cause of mortality in the UK and represent a major public health challenge. While such illnesses primarily affect adults, there are various long-term conditions affecting significant numbers of children, such as asthma and diabetes. The health promotion role of health visitors means they are well placed to help prevent the development of long-term conditions in children and the wider community, in collaboration with colleagues in primary care. This paper discusses the existing and potential role of health visitors in preventing, screening for and helping children and families to live well with long-term conditions.

There is growing evidence that clinical supervision is a useful means of developing practice in nursing (Butterworth et al, 1997). There is, however, little in the way of research evidence to support various approaches to supervision for district nurses. This article reports a practice development initiative in which clinical supervision was implemented in a community trust. The rationale which underpinned the decision to implement group supervision is explored and the supervision techniques described. Recommendations are made for further work in this area, most notably in relation to evaluation.

Holistic care is the aspiration of the nursing profession yet in district nursing, it is becoming increasingly difficult to attain. Developments such as skill or grade mix and the employment of the social services carer, have carved up traditional district nursing into tasks that are allocated to a variety of nursing and related personnel, in a manner that is as cost-effective as possible. The traditional district nurse who was allowed the scope to attend to any patient need is an increasingly rare entity; some would argue rightly so. There is an exception to this, however, in the acute ‘holistic’ care of patients who are terminally ill. This paper discusses the changes to district nursing practice that have taken place in recent years and using supportive data from an ethnographic research study of district nursing work, explores why terminal care is so highly valued by the district nursing service.