The QNI has recently published two major pieces of work aimed at consolidating the academic and practice profile of district nurses. The district nursing profession has developed rapidly in recent years to keep pace with the growing complexity and acuity of care delivered in the home, and there was a growing fear that the supporting documentation had not kept pace.
How exactly do you convey to students the difficulty of dealing with patients in their own homes? Here, Cathy Greaves, district and Queen’s Nurse, explains how simulated learning helped her students...
Compression therapy — and compression hosiery in particular — are well-documented therapies for people with lower limb disorders. However, choosing the correct product for patients can be difficult. Here, Rebecca Elwell, Macmillan lymphoedema clinical nurse specialist, Royal Stoke University Hospital, examines the growth of technology in the choice of compression products and asks whether digital selection can contribute to best practice.
Moisture-associated skin damage (MASD) results from an extended period of exposure to various types of moisture, commonly urine or faeces, sweat, and wound exudate1. It can result in extensive skin breakdown through erythema, maceration and eventually moisture lesions, with the most common presentations being incontinenceassociated dermatitis (IAD), intertriginous dermatitis, periwound moisture-associated dermatitis, and peristomal moisture-associated dermatitis1. MASD is not caused by moisture alone — other factors including friction, hygiene products, or microorganisms are usually involved1. MASD can be painful and effect the patient’s quality of life2, potentially resulting in moisture lesions if not properly managed.
Venous leg ulcers make up a considerable part of the community nurse’s workload and the gold standard treatment is multilayered compression bandaging applied to cleansed and debrided lower limbs. The author of this piece looks at the background to leg ulcer development; as well as how to assess patients and the principles of prevention. This article also examines the KTwo® bandaging system (Urgo Medical), which has a built-in pressure indicator to ensure that application is both consistent and effective. The make-up of the twolayer system makes it as effective as four-layer systems without the associated bulk, which means that patients find it easier to wear.
An optimal wound environment for promoting healing is dependent on maintaining moisture balance (i.e. an environment that is neither too wet, nor too dry). Practitioners need to understand what is normal and what is problematic exudate for wound healing, as well as the impact that wound fluid might be having on the patient’s quality of life. For example, if dressings chosen are unable to contain the volume being produced, this can lead to embarrassment and social isolation, as well as discomfort to the patient from wearing bulky dressings. Assessing and understanding the cause of excess exudate will help practitioners to develop goals with the patient and target treatments to achieve the best outcomes overall. This article examines what is meant by a moist wound healing environment and looks at one dressing range, Eclypse®, that has been found to contribute to moist wound healing and promote patient quality of life (Rafter et al, 2015).
The management of nutrition in people with dementia is complex as it involves weight loss due to cognitive and physical problems caused by the condition. There is a range of practical approaches that the community nurse can implement, but these must be adjusted to suit each person. Often, a large proportion of the community nurse’s time is spent supporting carers, family and friends who are looking after a relative who has dementia at home. This can be a demanding role and carers often experience physical and emotional fatigue. For those working with patients with dementia in nursing, residential and care homes, it is particularly important that staff are supported with strong leadership to provide a flexible approach to meal times and that suitable menu options are available.
Heart failure is a common chronic condition and people living with it can have periods of relative stability as well as episodes where their symptoms worsen and they require hospital admission and treatment (Chun et al, 2012), such as intravenous (IV) diuretics. Traditionally, patients who failed to respond to an increase in oral diuretics have been admitted to hospital for IV diuretics. The British Heart Foundation (BHF) funded a two-year project in 10 NHS organisations across the UK to determine if delivering IV diuretics in the patient’s home or in a community by patients and carers (BHF, 2014).The programme was led by heart failure specialist nurses working within existing community heart failure teams and was built on existing evidence that, when compared to other heart failure patients, heart failure patients times less likely to be hospitalised (BHF, 2008). As IV diuretic services become embedded into existing services, community nurses have an important role to play in working in partnership with heart failure specialist nurses to support patients having challenges of delivering IV diuretics in the home.
Urinary incontinence impacts on patients both physically and mentally, restricting employment, educational and leisure opportunities, and leading to social embarrassment and isolation. It is vital that people who are experiencing continence problems are given every opportunity to regain their continence and highquality comprehensive continence services are an essential part identify patients who may be experiencing continence problems, before going on to look at treatments and longer-term care. The author also addresses the issue of when community nurses should look to deal with continence problems themselves, or when they
This article will highlight some common skin lesions present in the older population. Skin lesions of this type may be frequently seen by community nurses and can be categorised as benign lesions, non-melanoma and melanoma skin cancers. The article contains a description of the lesions along with a guide to the correct terminology used to establish an accurate diagnosis. The prevalence and causes of these lesions along with an explanation of varying treatment options is also included.
