Self-care Resources

Here, Professor Michelle Howarth, professor in health and social care, associate director CSR (Centre for Social Responsibility), Faculty of Health, Social Care and Medicine, Edge Hill University, Rhian Last, nurse educator, Self-Care Forum self-care champion and Libby Whittaker, Self-Care Forum manager, explore the findings of a project undertaken last year on self-care, highlighting ways that community nurses can support self-care both in their day-to-day role and more strategically across primary care populations.

Necrotising fasciitis (NF) is a life-threatening condition, consisting of a soft-tissue infection with rapidly progressive, widespread fascial necrosis and sepsis. Prompt diagnosis and  treatment are essential, but in the early stages, it is difficult to differentiate from other skin conditions such as cellulitis. A high level of suspicion and a low threshold for surgical referral are essential to avoid significant mortality. Following often lengthy hospital treatment, patients will be discharged for management in the community — usually with extensive wound care needs. As part of recovery, supported self-care is an option for some patients and the benefits may help improve outcomes.

Lower limb ulceration continues to be a common cause of suffering and its management places a significant burden on the NHS, with venous leg ulcers (VLUs) being the most common hard-to-heal wound in the UK. It is estimated that over one million patients in the UK have lower limb ulceration, of which 560,000 were categorised as VLUs at a cost of over £3 billion each year. Although self and shared care in chronic disease  management is not new, historically wound care and specifically lower limb management has been undertaken solely by healthcare professionals. This article outlines the results of implementing a lower limb wound pathway (Wounds UK, 2016), and a lower limb self-care delivery model measuring clinical outcomes and the impact on workforce pressures through limiting face-to-face healthcare professional contact up to one appointment every six weeks, when capacity and capability criteria are met. A suitability assessment was conducted and, when appropriate, patients were
managed using a self-care delivery model. Patient data were collected, anonymised and independently analysed, comparing time to healing against data on file from a previous audit using the lower limb wound pathway (Wounds UK, 2016). This highlighted VLUs in 84 of the 95 patients selected for the self-care model had healed by week 24 and a
further 10 patients had healed by week 42, with only one remaining patient reaching 42 weeks without healing. These results support the hypothesis that when suitable, patients with a VLU can self-care and deliver clinical effectiveness without compromise.

Several crucial documents have identified the need for integrated care to meet patient requirements in the current financial climate, developed from the concepts of self-care and joining up care to improve health outcomes. These include the Five Year Forward View (2014), Next Steps on the Five Year Forward View (2017), NHS Long Term Plan (2019) and now the introduction of the Health and Care Act (2022) — all of which provide a contextualised approach to care. Integrated care is aimed at the way that organisations work together to support self-care (which incorporates the principles of holistic care considering physical, emotional, social, spirtual and ecomonc health [Mills, 2017]), with a commitment to improve patient outcomes by avoiding confusion and repetition. It  enhances comprehensive care planning by listening to patients — perhaps best summed up by the phrase, ‘No decision about me, without me’ (Department of Health [DH], 2012).

Delivery of health care is undergoing unprecedented changes. There are increasing requirements for care which are not matched by a comparable increase in resources. Services are frequently under pressure and at times overwhelmed; wound care is no exception. 

Many government and healthcare strategies now advocate supporting self-care in the management of long-term conditions (LTCs). This approach has been driven by the increasing number of poly-morbid, obese and elderly people in the UK, which is putting an immense strain on already stretched health and social care resources. The emphasis on promoting self-care throughout the illness trajectory has been a pivotal aspect of nursing care for more than 50 years and this approach in the management of chronic oedema has always been a key aspect of treatment plans by specialists in this field. Practitioners need to be skilled in assessing the self-care needs of patients and to be ready to adopt this approach and provide appropriate support. This article gives an overview of self-care for people with chronic oedema and focuses on how nurses can encourage and support patients to do this. A case study demonstrates the importance of thorough and accurate assessment to encourage self-care and health behaviour change.

In each issue of JCN we ask a clinical expert in a particular field to take a look at a therapy area and examine some everyday problems that community nurses may experience. In this issue, we investigate leg ulcer management....