Over the years, there has been a plethora of evidence-based literature on effective and ineffective wound management practices; however, some healthcare professionals continue to manage wounds using outmoded or ritualistic practices. The key areas are: frequency of dressing changes; maintenance of a moist environment to aid healing; when wounds should be cleansed; and which cleaning solutions to use. This article presents the evidence base in these key four areas and aims to dispel some of the myths and misconceptions to ensure that healthcare professionals can be confident that they are delivering upto- date, evidence-based wound care in accordance with the Code of Conduct (Nursing and Midwifery Council [NMC], 2015).
Almost one adult in 20 in the UK has a wound, while the NHS cares for 2.2 million people with wounds annually. Most of the people in the UK with a wound are managed in primary care by nurses (Guest et al, 2015). Some wounds, such as minor burns, cuts, abrasions and surgical wounds, heal quickly and with minimal intervention. However, over half of all wounds go on to become chronic, with approximately 39% of these failing to heal after 12 months (Vowden and Vowden, 2009). One of the basic tenets of evidence-based wound care is choosing the correct dressing. This article discusses the management of chronic wounds in the community and provides guidance for community nurses on choosing appropriate dressings.
The provision of end of life care is important core work for community nursing teams. Once end of life has been recognised, a focus on palliation of symptoms and an emphasis upon assisting people to ‘live well until they die‘ becomes paramount. Breathlessness is a common distressing symptom for patients, significantly affecting their quality of life and is sometimes the cause of unnecessary admissions to hospital. This article explores the pathphysiology of breathing and breathlessness and offers some thoughts on history-taking and physical assessment, skills that nurses in advancing practice roles are now undertaking in the community setting to enhance the care they deliver to patients. This article aims to support community nurses to gain knowledge to inform the provision of effective evidence-based care and assist patients and their families to manage breathlessness at end of life.
Due to changes in national healthcare policy community staff, including nurses, are being asked to care for ever-larger and more diverse groups of patients. However, the challenge for staff and service providers is how to deliver higher standards of clinical care while ensuring that patient safety remains a priority. One of the answers is to ensure that staff who deliver any clinical skill do so competently, but reports have highlighted technical skills gaps that need to be addressed. No failings should be regarded as acceptable as they can impact on patient safety and there is a responsibility to address any areas for improvement through education and skills training. The study outlined in this article attempted to capture the perceptions and experiences of community staff to gain an insight into the gaps in clinical skills training and make recommendations for improvement.
