Quality of life Resources

Pressure ulcers are often preventable and highlight the broader challenges of maintaining high standards of care, especially in vulnerable patient populations, such as those with psychiatric conditions. This article highlights the difficulties pressure ulcers pose for healthcare organisations, healthcare professionals and patients, while also exploring strategies to address these challenges in clinical practice.

Laryngeal cancer falls under the umbrella term of head and neck cancers and is the second commonest cancer type within this group. The condition often presents with symptoms shared with those of other less serious diseases, making diagnosis challenging.
This article hopes to give nurses and non-medical prescribers an overview of symptoms, diagnosis, treatment, and prognosis with the aim of raising awareness and helping to get an earlier diagnosis of this devastating disease.

When caring for people with venous leg ulceration, exudate management is commonly seen as one of the main challenges for clinicians. However, unfortunately, the reason for this wound-related symptom is often not identified or fully understood and therefore the clinical interventions necessary to address the problem are not implemented (Tickle, 2016). This results in people living with wounds that are failing to heal and producing a volume of exudate that has a significant impact on their quality of life (Cunha et al, 2017). Commonly, the words ‘leaky legs’ or ‘wet legs’ are documented in patient notes as the presenting problem — this is not a clinical diagnosis; it is a symptom of an underlying condition which more than likely is venous disease. Unless this is recognised and treated correctly, those ‘leaky legs’ will continue to be a problem and potentially could have a devastating impact on the patient. It is therefore important to have a good understanding of venous disease as well as the role that exudate plays in wound healing, from initial wounding, through the stages of healing, and when (and why) it becomes a problem.

Hypertension is common and is a cause of morbidity and mortality around the world. Many affected are unaware that they have a problem, and it is found opportunistically when their blood pressure is recorded during a consultation for another problem. If the disease is inadequately treated, it can have potentially fatal outcomes. Nurses and non-medical prescribers are likely to come across patients with raised blood pressure readings during routine clinic appointments. This article hopes to give them a better understanding of the condition, its treatment and complications, with the aim of reducing the risk of serious problems and improving outcomes for all those affected by this potentially dangerous condition.

Coughs are extremely common and vary in duration and degree of severity. Coughs of any duration are a frequent reason for seeking medical advice and unresolved coughs lasting beyond eight weeks are a cause of patient anxiety and reduced quality of life. Chronic coughs are those lasting for more than eight weeks. There are many causes, some more common than others. This article hopes to give nurses and non-medical prescribers who are approached by patients asking for advice some insight into diagnosing and resolving the problem, with the aim of improving quality of life for those affected.

Faecal incontinence (FI) is the term describing the inability to control the bowels (International Continence Society [ICS], 2015). This can include the uncontrolled passage of solid or liquid stool, or flatus (wind) (Benezech et al, 2016) through the anal canal. It is recognised as a symptom rather than a diagnosis (National Institute for Health and Care Excellence [NICE], 2014) and is the result of complex interactions of many contributing factors. This series of two articles will look at this taboo condition, how it affects quality of life, highlight the anatomy and physiology which affects bowel control and then discuss conditions and contributing factors that make individuals prone to the
symptoms of FI.

A recent economic analysis has reported a £8.3 billion cost to the NHS for wound management. This overwhelming cost has meant alternate wound management strategies are needed. One example is a Hospital @ Home (H@H) negative pressure wound therapy (NPWT) service, whereby patients are discharged from hospital with an open wound and traditional NPWT (tNPWT) and/or single-use (sNPWT) is provided in their own home. The aim of the service evaluation presented here, which was conducted from the H@H nurse base within Brighton General Hospital, was to highlight the clinical outcomes of utilising NPWT in a homecare setting, to assess changes in patient quality of life through a validated instrument, and to understand the anticipated cost savings to the NHS. Thirty-one patients, all of whom had received surgical intervention resulting in an open wound requiring NPWT and were receiving H@H NPWT, were included in the evaluation. A statistically significant reduction in wound dimentions and improvement in patient reported general quality of life was found. Overall, the delivery of this H@H NPWT service enables patients to return home, with ongoing wound management which results in wound closure. The service evaluation also enabled a cost saving analysis to be reported, suggesting that this locally implemented H@H service can reduce costs of approximately £5,256 per patient by utilising H@H NPWT compared to hospital inpatient managed NPWT.

Nocturia is a common lower urinary tract symptom that mainly affects older people. Nocturia causes excess urination at night and, because of associated night-time rising, can also result in falls and fractures. Nocturia has a range of presentations, therefore it is vital that nurses understand how to assess the condition accurately to provide appropriate treatment. This article examines the effective assessment of nocturia, as well as detailing the various lifestyle treatment options that can be used, such as a targeted reduction of fluid intake, weight loss and altered medication profiles. Medication and surgical options should only be used following a trial of lifestyle interventions.