It’s that time of year again where Christmas is a distant memory and the longer evenings start to bring thoughts of summer. Unfortunately, the first shoots of spring also stir the fear of allergies in many of us. Allergies have become a widespread phenomenon and at any one time can affect one-in-four people in the UK. Common allergic conditions include hay fever, asthma, atopic eczema and food allergies, and many of these become worse in the spring/summer months.
Jason Beckford-Ball looks at how the upcoming general elections may affect the NHS and asks each party...
How will the general election result influence the future NHS?
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.
Choosing the correct dressing is often key to moving a wound along the healing trajectory, with its ability to deal with problems such as pain, excess exudate production and inflammation being crucial to the healing outcome. Infection is also a serious problem in many wounds and this article looks at the basics of wound infection as well as some of the main treatments, such as topical antimicrobials. However, clinicians are faced with a huge range of wound care products, many of which have antimicrobial properties. This article considers the use of one gelling fibrous silver dressing (Durafiber® Ag; Smith and Nephew), which is specifically designed to deal with many of the problems mentioned above, particularly excess exudate production and infection. The authors also presents the results of a small, prospective multicentre case series that was carried out to assess the efficacy of Durafiber Ag in a variety of wounds.
Due to concerns over pressure ulcer incidence data, a collaborative project was undertaken with the aim of improving quality of care within residential homes, specifically in relation to pressure ulcer prevention. The project comprised a residential home staff education programme based on the SSKIN bundle. The objective was to enhance staff awareness of pressure ulcer risk and their knowledge of pressure ulcer prevention approaches, such as the appropriate use of skin care products (ProshieldTM; H&R Healthcare) and the targeted use of local pressure-relieving methods such as dermal pads (AdermaTM; Smith & Nephew). To support residential home staff in putting pressure ulcer prevention theory into practice, skin care products and dermal pads were made more easy for staff to access, thereby facilitating the desired change in practice. Implementation of the project was supervised by the local tissue viability team. Tissue viability nurses — with the support of Smith & Nephew — delivered an educational package to the staff in each residential home including the SSKIN bundle and the appropriate use of local pressure-relieving techniques. A ‘stock-box’ containing supplies of dermal pads and skin care products was provided for each residential home immediately after the training — this meant that the staff could begin using these as soon as a risk assessment identified a patient who needed off-loading. Pressure ulcer incidence data routinely captured before the project began was compared with data from a similar time period following the project — this helped the authors assess and reflect upon the impact of the project.
If left untreated, leg ulcers can descend into a cycle of tissue breakdown and healing, resulting in chronic venous leg ulcers, which are associated with considerable morbidity and impaired quality of life. Compression therapy is widely held up as the ‘gold standard’ for management of venous leg ulcers, and the provision of safe and effective compression is one of the vital skills of the community nurse. However, to provide this level of treatment it is essential that the bandage system used provides the correct amount of sub-bandage pressure, as too little will be ineffective; whereas too great a pressure may cause constriction and patient discomfort (Moffatt, 2005; Milic et al, 2010). This article highlights a study that investigated the efficacy of a two-layer bandaging system (HERO H-2®, H&R Healthcare), which was tested by a group of clinicians for its ability to provide optimum compression alongside ease of application and patient comfort.
Community nurses often have very busy caseloads and need a wide variety of knowledge to deal with the many different clinical scenarios that they face. This is particularly true of wound care, which can present a unique set of challenges, including infection, how to control exudate and making sure that any dressing they have chosen does not actually further harm the patient by, for example, damaging the skin when it is removed. This article outlines some of the most important areas that community nurses need to understand when it comes to wound care before going on to look at the solutions provided by one particular dressing (Actilite Protect®; Advancis Medical), which is designed for use on the full range of wounds, including acute skin tears, post-surgical wounds, chronic leg ulcers, pressure ulcers, diabetic ulcers and infected wounds. As well as presenting an overview of the dressing, this article also presents a series of case studies that illustrate the benefits of the dressing in practice.
Venous leg ulcers make up a large part of a district nurse’s caseload, with the application of compression bandaging requiring competent and skilled practitioners. At Central and North West London Foundation Trust (CNWL) Camden Integrated Primary Care (IPC) Service recruiting and retaining community nurses is a challenge, a situation which is shared across all London boroughs. In particular, it is difficult to maintain consistent standards for wound cleansing and compression bandaging, resulting in the responsibility for a large caseload falling to a small number of practitioners. Following a review of innovative products on show at the European Wound Management Association (EWMA) conference in May 2014, an alternative to traditional compression bandaging was identified as a possible solution to this problem; namely, UCS™ for effective debridement and Juxta CURES™ as an alternative to compression bandaging (both medi UK Ltd, Hereford). A total of 26 patients evaluated the products, which were found to be more clinically effective than previous regimens and also resulted in substantial cost savings.
Incontinence can affect people of all ages and genders and can have devastating psychological, social and financial implications for the individual and his or her family. Many people may fail to seek help with incontinence for years due to embarrassment and stigma, which in turn can lead to social isolation. The prevalence of bladder and bowel incontinence is increasing worldwide, in part due to an ageing population — more people are being looked after in residential and nursing homes than ever before and admissions to acute care due to incontinence-associated conditions have increased. All of these factors increase the burden of care on health and social care staff, potentially leading to a lack of quality services. Dignity is internationally accepted as a fundamental human right, yet a host of public inquiries (such as the Francis Report [2013] in the UK) repeatedly raise the issue of failure to respect patient’s dignity, particularly in relation to continence care. This article explores why continence care causes such complicated issues and how community nurses can help to ensure it is seen as an essential element of care, rather than being dismissed as only requiring basic skills.
Shingles is a condition caused by reactivation of the herpes virus that is responsible for varicella (chickenpox). It results in a painful, vesicular rash that can have a devastating effect on patients. It can also have long-lasting effects such as pain and increased risk of vascular conditions such as stroke for patients under the age of 40. Being that shingles is not a notifiable disease, most of the information available on its incidence is inaccurate and based mostly on estimate studies. The health prevention of this virus is of extreme importance as a vaccination programme is made available to eligible individuals. Patients that develop shingles under the age of 40 can also be assessed for the risks of developing vascular conditions.
