Depending on the patient’s presenting factors, managing complex or ‘hard-to-heal’ wounds can be a significant challenge for the community nurse. Increased longevity, while a positive also means that people are surviving medical and surgical procedures which were life-threatening in the past, with a 20% reduction in avoidable deaths. The delivery of complex community wound care is not a new concept, however, it is dependent on a number of factors such as the expectations of commissioners, providers, and health and social care policymakers, as well as the patient and the skill of the clinicians performing the care. Financial cutbacks in the NHS have also had a negative impact on the delivery of some community healthcare services. This article investigates whether all of these factors have impacted on the amount of complex wounds now being managed in the community setting.
The specialty of wound care is one that has expanded exponentially in modern times with a plethora of theories and technologies, including wound bed preparation, the role of proteases, negative pressure wound therapy (NPWT), and an almost bewildering array of dressing formulations, from antimicrobials to larval-based products. However, for the clinician on the ground who may not have time to appraise all the theory — or indeed afford all of the new technologies — there is still a high premium placed on having a range of wound care dressings that can be used on a variety of wounds, are simple to use, patientfriendly, and, increasingly important in this day and age, cost-effective (Chandan et al, 2009). In a follow-up to a previous article (Morgan, 2015), this piece looks at one particular dressing (Actilite Protect®; Advancis Medical) and reviews the latest in a series of case studies that show how it can be effective in a range of wounds, in particular infected wounds, due to its innovative use of honey.
Excessive exudate production interferes with wound healing and has a detrimental effect on patients’ quality of life. Exudate management is crucial as wounds need an optimum level of moisture so that they can heal. Superabsorbent dressings can handle extreme levels of exudate, prevent leakage and reduce the frequency of dressing changes, allowing people to live a more normal life unhindered by saturated dressings that constantly need to be changed. Community nurses will often need to treat chronic wounds and may consider using superabsorbent dressings. The article takes a look at Zetuvit® Plus (HARTMANN), a superabsorbent dressing that is used for superficial, heavily exuding acute or chronic wounds with the author examining its potential role as a wound care option in the community.
Pilonidal sinus is a benign disease that involves a sinus in the natal cleft. This condition mostly affects the young and the resulting wounds can be extremely painful and debilitating. For symptomatic pilonidal disease, treatment may involve surgical intervention such as incision and drainage. The management of pilonidal wounds can be challenging, but with a systematic approach to wound care that involves patients in their own care to help prevent infection and recurrence of this painful disorder, positive results can be achieved. Treatment should not prevent patients from returning to the normal activities of daily living (both social and work-related), and nurses should aim to achieve this as quickly as possible. Psychological care is just as essential as nursing care when managing this disease. This article provides an overview of pilonidal sinuses for community nurses as well as focusing on one dressing which is designed to cope with them, in particular, the excess exudate that can be produced (Exufiber®; Mölnlycke Health Care).
With the plethora of wound contact dressings available and the demand for their use in clinical practice, clinicians need to keep abreast of what is new on the market to ensure that they provide their patients with the best treatment options, while also considering the costs involved. Preventing pain to the patient, trauma to the wound or periwound skin, and infection, are key considerations for clinicians at dressing changes (Hollinworth, 2001). With advances in wound care technology, patients should not experience pain due to adherent products causing trauma to the wound and/or ‘skin stripping’. The use of silicone dressings can help to prevent such occurrences from happening and thus promote patient wellbeing and quality of life (Upton, 2011; Yarwood-Ross, 2013). This article looks at the role of primary wound contact layers in wound management, and introduces a new silicone dressing with case reports demonstrating its positive effects in clinical practice.
In each issue of JCN we ask a clinical expert to take a look at a therapy area and examine some everyday problems that community nurses may experience. In this issue, we look at venous leg ulceration and associated oedema and ask the question...
What is the patient experience of healing in a hosiery kit?
As with many conditions, diet has a crucial but often underrated relationship with serious mental health problems. In this article the author examines how diet, nutrients and different food types can have a deleterious or beneficial effect on mental health problems such as dementia, schizophrenia and bipolar disorder. Understanding the complex reactions between healthy eating and cognitive and emotional development can help community nurses provide holistic care for their patients.
Constipation is a widespread problem although its subjective nature can mean that diagnosis and treatment can be difficult as there is often a mismatch between patients’ and clinicians’ view of the condition. Constipation is widely believed to include unsatisfactory defecation, infrequent stools and/or difficult stool passage. Thorough patient assessment and promotion of continence issues are imperative to improving services for people with constipation. This article highlights how breaking social taboos around bladder and bowel issues, helping people to acknowledge bowel issues, and referring them to the appropriate specialist nurse-led services will all help to provide a more accurate and timely diagnosis of constipation.
This article provides an overview of the common eczematous conditions that patients may present with in the community. With early diagnosis and treatment, including patient education and effective care planning, eczema can be managed succesfully by community nurses, not only releving pain, itch and irritation, but also improving patients’ quality of life. When formulating a comprehensive management plan, community nurses will need to be able to recognise, diagnose and treat the different presentations of eczema as well as understanding the main therapies, including emollient and topical steroid therapy.
Justine Hextall is a consultant dermatologist and fellow of the Royal College of Physicians.
