Wound care forms a major part of any community nurse’s workload and with more acute patients being discharged earlier from hospital, as well as an ever-growing case-load of long-term conditions, it is more important than ever that nurses are confident in assessing and care-planning effective wound care. As ever, accurate assessment of the patient and the wound is the starting point and will help nurses choose the most effective treatment, resulting in improved patient outcomes and reduced costs. Poor wound care can lead to delayed healing, increased infection and inappropriate use of wound dressings, all of which impact on patients’ quality of life. In this article, the author outlines five main steps to consider in providing evidence-based, effective wound care.
Leg ulcers present a common clinical problem for community nurses. The need for assessment and maintenance can take up a lot of nursing time and issues such as pain, exudate and compression bandaging have a significant effect on the quality of life of patients. This article describes an evaluation of two new compression devices, one for people with venous insufficiency resulting in leg ulcers who need compression therapy (Juxta CURES; medi UK); another for those with leg ulcers, venous insufficiency and lymphoedema (Juxta-Fit; medi UK). This evaluation involved 16 patients and demonstrated the impact of quality of life and the potential for savings in a community nursing team, both financially and in terms of reduced nursing time.
The use of compression bandaging in venous leg ulcers has been acknowledged as ‘best practice’ for some time now, but these wounds remain a serious management problem in many patients with pain, excess exudate, limb swelling and poor mobility all affecting their quality of life. Wound care in general, and leg ulcer management specifically, are two of the most common reasons for referral to community nursing services and recent government policy aimed at managing more patients in primary care and in their own homes has also meant that nurses are now seeing more patients than ever before. All of this means that they need compression systems that are easy to apply and can deliver safe and consistent pressures to minimise risk and safeguard patients. This article presents the findings of a 40-patient multi-centre evaluation of a new inelastic compression bandage system (HERO H-2®; H&R Healthcare) designed to provide optimal compression levels, reduce odour and moisturise the skin. The evaluation demonstrated that the bandage system had a positive effect on a number of parameters including wound size, healing rates, patient comfort and mobility.
Community nurses often have people with chronic respiratory disease on their caseloads and among the vital skills needed to manage this group is the measurement of resting oxygen saturation by pulse oximetry, which can help the nurse decide whether or not to refer the patient onto a specialist oxygen service for assessment. Many elderly patients also have a diagnosis of chronic lung disease and will be receiving long-term oxygen therapy. Pulse oximetry is helpful in assessing whether the prescribed oxygen flow rate is correct for the individual — this may change over time if the patient’s condition deteriorates. This article examines the latest techniques and equipment in home oxygen therapy and the author pays particular attention to pulse oximeters, which are an affordable clinical assessment tool and can easily be added to the equipment already used by community nurses.
Wound care and nutrition are two interlinked areas that will have a serious impact on the caseload of any community nurse. Healthy eating and regular physical activity help to prevent chronic illnesses, which in turn have an effect on the development of wounds and ulcers. In particular, malnutrition can impair wound healing and so it is essential that at-risk patients are identified in the early stages using an evidence-based nutritional screening tool. If a wound has developed, adequate nutritional management plays a key role in the healing process. If necessary, patients should be referred to a registered dietitian for a detailed nutritional assessment and treatment plan. This article looks at the link between nutrition and wound care, as well as highlighting preventative measures that can be encouraged in all patients at risk of developing a wound.
Patients in the community may often have a long-term urinary catheter in place. The management of this usually falls to thecommunity nurse therefore he or she needs to understand the basic procedures involved in urethral and suprapubic catheterisation, as well as being familiar with potential complications and how to troubleshoot. Catheter blockages are the most common problem encountered in long-term catheterisation and it is important that the nurse knows how to address this methodically and identify and treat the cause. This article offers practical and evidence-based advice on some of the common issues that can arise in the management of people who have long-term catheters in place
Statistics suggest that one-in-four adults are obese, and up to 33% of school-aged children are overweight or obese (National Obesity Forum, 2015). Thus, on a daily basis, it is likely that general practice nurses (GPNs) will engage in consultations with patients who are overweight or obese, quite often while presenting for advice for another condition. This article explores how to broach this sensitive issue and the nurse’s role to reduce weight stigma in line with the new Nursing and Midwifery Council Code (NMC, 2015). Practical advice to support patients in managing their weight, and identifying appropriate onward referrals, including for bariatric surgery and eating disorders, will also be discussed.
By reading the article, you can learn all about the key principles of subjects that are vital to your role as a community nurse. Once you have read the article, visit www.jcn.co.uk/learning-zone/ to evaluate your knowledge on this topic by answering the 10 questions in the e-learning unit; all answers can be found in the article. If you answer the questions correctly, you can download your certificate, which can be used in your continuing professional development (CPD) portfolio as evidence of your continued learning.
Slough is defined as devitalised tissue made up mainly of fibrin, white blood cells and debris that collects in the wound bed (Brown, 2013). It can indicate the presence of infection, ischaemia or a dehydrated wound bed (Atkin, 2014).
Linda Harris is a podiatrist with vast experience of community practice. She is currently working with the John Lewis Partnership.
By reading the article, you can learn all about the key principles of subjects that are vital to your role as a community nurse. Once you have read the article, visit www.jcn.co.uk/learning-zone/ to evaluate your knowledge on this topic by answering the 10 questions in the e-learning unit; all answers can be found in the article. If you answer the questions correctly, you can download your certificate, which can be used in your continuing professional development (CPD) portfolio as evidence of your continued learning.
Compression therapy can play a vital role in improving the quality of life for those with chronic venous insufficiency, chronic oedema and lymphoedema (Lymphoedema Framework, 2006; World Union of Wound Healing Societies [WUWHS], 2008). In particular, compression bandaging can facilitate wound healing and oedema reduction in the treatment phase of management, before further healing and maintenance with compression hosiery.
