Among the challenges facing community nurses in their day-to-day practice is one that impacts greatly on patients, relatives and healthcare providers — the management of exudating skin conditions and wounds. This article looks at eosin solution, a popular treatment option for exudative dermatoses on mainland Europe, to the extent of being commercially available to the general public, but one which has dwindled in popularity in the UK. This article provides an introduction to this versatile nontoxic dye and outlines its potential application in the community setting by comparing it with the much more widely used alternative potassium permanganate.
Once patients’ leg ulcers are healed, it is recommended that you move them from compression bandaging into leg ulcer hosiery kits or maintenance hosiery. But nurses often have difficulty in getting patients to comply with long-term hosiery use — which does require a lot of commitment — and ulcers often return. We asked Leanne Atkin, vascular nurse specialist at Mid-Yorkshire NHS Trust, how to ensure that your patients keep healing and remain healed when they move into maintenance compression hosiery.
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....
This article highlights the normal and abnormal physiology of fluid circulation in the lower limb with particular reference to venous and lymphatic flow. Consideration is given to the assessment and diagnosis of disease and its severity, particularly the impact on the patient including chronic oedema, ulceration, cellulitis and loss of mobility. Options for disease management and prevention such as compression bandaging and hosiery are also discussed, and the gaps between theory and practice are highlighted to provide community nurses with the most up-to-date information and practical solutions.
Community nurses offer holistic nursing care to patients at home, including attending to people with leg ulcers. It is known that leg ulcers can have a significant impact on patients’ quality of life. Nonetheless, little is known about community nurses’ views and experiences of providing holistic leg ulcer care and, in particular, their insights into the impact of leg ulcers on patients’ quality of life. Using a focus group of five healthcare support workers and four individual interviews with two associate nurses and two district nurses, this study explored community nurses’ experience of attending to patients with leg ulcers. Following transcription of the data, a thematic analysis was undertaken. It was concluded that community nurses need more training to support their work in leg ulcer management and more time to deliver patient-centred care.
Compression bandages provide the mainstay of treatment for venous diseases and their sequellae of ulceration and oedema. Selection should depend not only on the effectiveness and cost of treatment, but also on patient acceptability. If correctly applied, compression bandages provide sustained graduated pressure. This article explores the negative impact that having a leg ulcer can have on patient quality of life and introduces a new, moisturising, odour-reducing inelastic two-layer compression bandaging system that aims to improve patient wellbeing and comfort which, in turn, promotes concordance.
Literature has shown that patients with leg ulcers can have a significantly poorer quality of life compared to those without leg ulcers. In addition, research has identified problematic relationships between patients with leg ulcers and practitioners, such as community nurses. The author contends that this mismatch needs to be addressed in order to improve patient quality of life through leg ulcer bandaging. He makes several recommendations for practice and highlights that community practitioners need to use innovative practice to help improve the quality of leg ulcer bandaging care they deliver. The overall aim of this article is to establish the extent of community practitioners’ understanding of the impact of leg ulcer bandaging on patient quality of life.
Edwin Tapiwa Chamanga, Tissue Viability Service Lead, Ipswich Hospital NHS Trust
This article discusses nutrition in relation to patients in the community who are living with venous leg ulcers. The author explores the complex issues surrounding the care of this patient group, which is predominantly made up of older people who often have several underlying medical conditions and may live alone in their own homes or in supported residential settings. The article covers the physiology and aetiology of venous leg ulcers and explores how nutrition plays a role in the healing process. It advocates a holistic approach, taking into account the many factors involved when considering nutritional status and suggests interventions that are available to nurses and healthcare professionals working in the community.
Jennifer Lunnon is a staff nurse in the Intensive Care Unit, Royal Devon and Exeter Hospital
Maureen Benbow gives an overview of the structure and functions of the skin and discusses the financial implications to the health service of skin failure
Maureen Benbow MSc BA RGN HERC Senior Lecturer, University of Chester
Article accepted for publication: March 2007
