Skin tears are a largely preventable common injury, particularly in the elderly. However, if not managed appropriately, they have the potential to develop into problematic wounds. This article discusses their classification, why they are common in ageing skin, gives advice on correct wound management strategies and how assessing the patient and their environment and simple strategies can be employed to prevent their reoccurrence.
On primary infection, the varicella zoster virus is responsible for the development of chickenpox, after which the virus becomes dormant. Upon reactivation of the latent virus, shingles results. The incidence and severity of shingles increases with age, and is associated with significant morbidity and mortality. Early intervention with antiviral medications is crucial to help resolve the rash and reduce any potential complications induced by the virus.
Lower limb cellulitis is a common acute medical condition that results in a large number of hospital admissions (Clinical Resource Efficiency Support Team [CREST], 2005). It is a growing and costly problem. The NHS spends between £172–£254 million a year on inpatient treatment of people with lower leg cellulitis (Curtis, 2011). The clinical presentation of cellulitis is similar to other conditions and diagnostic errors are common and may prolong hospital stay (Nazarko, 2012). Community nurses are involved in caring for people at risk of cellulitis and are often responsible for referring on suspected cases and then continuing treatment upon discharge. It is essential that community nurses are aware of the evidence base for diagnosis, differential diagnosis, treatment and management, as well as the long-term prevention of cellulitis. This paper discusses the evidence base for treatment and prevention of cellulitis and presents a case study.
Stroke is a major cause of mortality and lifelong disability, despite advances in diagnosis and treatment. The risk factors of stroke are well-known and many are modifiable through lifestyle adjustments, however, the incidence of first-time stroke is increasing year-on-year. Primary stroke prevention is an important health promotion issue and successful implementation could lead to a reduction in the incidence of stroke and relieve a costly burden to the NHS. Nurses play an important role in providing information and advice to patients in secondary prevention of stroke, and could play an equal role in primary prevention. Providing advice on lifestyle behaviours such as smoking, alcohol consumption, diet and exercise all fall under the remit of the nurse in health promotion and in secondary stroke care. By providing a primary prevention service, community nurses could work as case managers for a larger multidisciplinary team and provide prevention advice and treatment.
Pressure ulcers result in pain and poor quality of life for patients as well as being regarded as an indicator of poor practice for nurses and healthcare organisations. Similarly, prevention of pressure ulcers is preferable to treatment, which can be expensive. This article considers the latest guidance on the prevention of pressure ulcers and looks at some of the innovations such as pressure relieving devices and the use of dressing products, which nurses can use to provide holistic care. Finally, the author reiterates that despite the use of guidelines and innovative products, the nurse must also rely on their clinical judgement.
Due to concerns over pressure ulcer incidence data, a collaborative project was undertaken with the aim of improving quality of care within residential homes, specifically in relation to pressure ulcer prevention. The project comprised a residential home staff education programme based on the SSKIN bundle. The objective was to enhance staff awareness of pressure ulcer risk and their knowledge of pressure ulcer prevention approaches, such as the appropriate use of skin care products (ProshieldTM; H&R Healthcare) and the targeted use of local pressure-relieving methods such as dermal pads (AdermaTM; Smith & Nephew). To support residential home staff in putting pressure ulcer prevention theory into practice, skin care products and dermal pads were made more easy for staff to access, thereby facilitating the desired change in practice. Implementation of the project was supervised by the local tissue viability team. Tissue viability nurses — with the support of Smith & Nephew — delivered an educational package to the staff in each residential home including the SSKIN bundle and the appropriate use of local pressure-relieving techniques. A ‘stock-box’ containing supplies of dermal pads and skin care products was provided for each residential home immediately after the training — this meant that the staff could begin using these as soon as a risk assessment identified a patient who needed off-loading. Pressure ulcer incidence data routinely captured before the project began was compared with data from a similar time period following the project — this helped the authors assess and reflect upon the impact of the project.
Shingles is a condition caused by reactivation of the herpes virus that is responsible for varicella (chickenpox). It results in a painful, vesicular rash that can have a devastating effect on patients. It can also have long-lasting effects such as pain and increased risk of vascular conditions such as stroke for patients under the age of 40. Being that shingles is not a notifiable disease, most of the information available on its incidence is inaccurate and based mostly on estimate studies. The health prevention of this virus is of extreme importance as a vaccination programme is made available to eligible individuals. Patients that develop shingles under the age of 40 can also be assessed for the risks of developing vascular conditions.
Pressure ulcer prevention is a challenge both in acute care and in community care, although prevalence is hard to determine due to differing ways of assessing and reporting both ulcers and risk of ulceration. Those who are acutely ill or have compromised mobility, or are older, or who have multiple co-morbidities are at greater risk of pressure ulcer development.
Acknowledgements:
All District Nursing Staff, Greater Glasgow & Clyde
Lynne Watret, MN, PGCertTLHE, MA, RGN, CNS Tissue Viability
Fiona Middler, BA, Master in Primary Care, Clinical Effectiveness Coordinator, Primary Care, Greater Glasgow & Clyde
Article accepted for publication: August 2012
Jane Alder & Rosemarie Winter describe an information technology system which contributes to the prevention and management of pressure sores in community nursing.
Jane Alder BSc (Hons), RGN, DN, Dip HE, ENB N49, N18 was professional Lead Nurse - District Nursing, United Bristol Healthcare Trust, Bristol, at the time of writing and now works as District Nurse - Lead, East Gloucestershire NHS Trust, Community Services, Gloucestershire. Rosemarie Winter BA (Hons) is Assistant Community Information Manager, United Bristol Healthcare Trust, Bristol.
Article accepted for publication April 2001.
