Resources

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.

A skin integrity prevalence audit was conducted in two health boards in Scotland in 2022, involving 186 care homes and assessment of 6,510 residents. Data collection involved in person and online contact with care home managers and senior care staff by specialist tissue viability nurses and care home support team members. Data was analysed to
generate prevalence rates per 1,000 residents. The findings identified an overall wound rate of 138.6 per 1,000 residents and further skin integrity needs (lower limb oedema) of 79.4 per 1,000 residents. There was variation in the incidence of wounds and lower limb oedema in the two health board settings. This is the first study at this scale and serves as an important benchmark for understanding skin integrity needs in the care home sector. There are important implications for education, training and support of care home staff as well as workforce planning for specialist nursing care to ensure appropriate prevention and management of skin care for residents.

As the UK population ages and greater numbers of people are living with long-term conditions (Office for National Statistics [ONS], 2014), increasing numbers of people are subsequently at risk of developing pressure ulcers (PUs). PUs are painful, costly and can negatively affect patient quality of life. They are particularly prevalent in the community setting, leading to high-costs in treatments, especially in those suffering from a chronic condition (Jaul et al, 2018). The prevention of PUs is therefore a key global care quality indicator, which is the focus of considerable quality improvements in primary care. Identifying a patient at risk of developing PUs is an action that should be undertaken at the first community visit. Nursing care to prevent PUs needs to be systematically planned, implemented and evaluated, following assessment of the patient and their
circumstances. As demonstrated by Clarkson et al (2019), integrating an interprofessional approach can reduce the severity of PUs in the community. There are a wide range of resources required to help prevent PUs, including nursing time, ensuring effective patient repositioning and risk assessment, as well as delivering the most appropriate pressure-relieving surfaces (Dealey et al, 2012).

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.

Diagnosing and managing lower urinary tract infections (UTIs) in women aged 65 years and over is important to ensure their health and wellbeing. This article explores how to diagnose lower UTI, considering alternative diagnoses especially in older adults, as their symptoms may mimic UTI but may indicate other underlying conditions. It also looks at how to manage and treat uncomplicated lower UTI and provides guidance on recurrent UTI, usually  defined as three or more episodes in a year.

Dementia is an umbrella term used to describe a group of symptoms characterised by behavioural changes, loss of cognitive and social functioning brought about by progressive neurological disorders. It is estimated that around one million people live with a dementia in the UK, with that figure set to rise to 1.2 million by the year 2040. We are learning more about the risk factors for developing dementia over the life course. This paper discusses the non-modifiable and modifiable risk factors for dementia and considers health promotion and health education activities that can be used by community nurses.

Palliative care of the elderly patient who wishes to die at home is an integral part of the role of community nurses. Historically, it has been found that this area is at risk of mismanagement, with poor symptom control, a breakdown in home care services and
lack of support for carers; aspects which can lead to admission to hospice or hospital. As such, this article examines the essential role of the community nurse in both practical  ways of assessment, planning and reviewing care of the patient and the family; as well
as psychological ways of supporting, guiding and listening. The article uses a case study to illustrate an example of the process of planning palliative care in the community, while acknowledging that each situation is individual to each patient, resulting in a variety of challenges. It can be seen that the community nurse is the mainstay in the whole process of palliative care of the elderly patient; providing a bespoke package of care in collaboration with the wider multidisciplinary team and thus enabling the patient to
remain at home in their final days.

The measles vaccine represents a monumental achievement in modern medicine, effectively curtailing childhood mortality and morbidity on a global scale. However, recent trends in measles vaccine uptake present a concerning scenario, with declining rates posing a threat to the progress achieved in eradicating this highly contagious disease. Here, Judith Harford, paediatric nurse practitioner, Adam Practice, Poole, Dorset delves into the pivotal role of the measles vaccine in safeguarding child health, exploring the reasons underlying vaccine hesitancy, including the controversial Lancet article, and discusses the additional impact of the Covid-19 pandemic on vaccine adoption. Drawing on global data from the World Health Organization (WHO) and Global Alliance for Vaccine and Immunisation (GAVI), this piece also assesses the consequences of dwindling measles, mumps, rubella (MMR) vaccine coverage on community well-being and offers strategies to combat vaccine hesitancy.