Before any members of the general public jet-off for an exotic holiday this summer, there is one person they will have to see first — and it’s not their travel agent. The majority of UK travel health and immunisation advice is provided by practice nurses, and with the growth of foreign travel this is fast becoming an integral part of the service we deliver.
At Marie Curie we like to think we are there for people living with any terminal illness and their families. We offer expert guidance to help people get the most from their time and believe that everyone living with a terminal illness should have access to the care and support they need to meet their individual needs.
In each issue of JCN we ask a clinical expert in a particular field to take a look at a therapy area and examine some everyday problems that community nurses may experience. In this issue, we look at an important precursor to compression therapy...
Compression therapy is the ‘gold standard’ for patients with lower limb problems. But achieving success is about more than simply applying compression bandaging or hosiery. We asked Trudie Young, tissue viability nurse and director of education and training at the Welsh Wound Innovation Centre, how to ensure that the limb is properly prepared to receive compression, a process that involves assessment, good skin care and debridement.
Amputation surgery can be traumatic and life-changing for patients and many struggle to come to terms with the loss of a limb. Wounds that fail to heal following surgery can have an impact on each individual’s rehabilitation process. It is important to provide the correct management for these wounds to facilitate healing and enable the patient to work towards mobilisation. Equipping community nurses with the knowledge and skills to assist patients in managing their residual limbs can improve the time from amputation to ambulation. Similarly, overcoming problems with patients' skin; achieving properly filling prosthesis; and managing the ‘wear and tear’ of prosthetic limbs are all challenging aspects in the management of this patient group.
The phasing out of the Liverpool Care Pathway and the introduction of the Leadership Alliance for the Care of Dying People’s (LACDP’s) five priorities of care has enabled clinicians working in end-of-life care to step back and re-evaluate their practice (LACDP, 2014). The review of end-of-life care services, More Care, Less Pathway (Neuberger, 2013) highlighted areas that needed urgent improvement. These included recognising when a person is dying but understanding the need for ongoing assessment; having a senior named clinician for all patients; and improving the communication skills of all clinicians involved in end-of-life care through the development of educational programmes. Non-malignant diseases are particularly challenging and in these cases it can be hard to recognise when a person is nearing the end of his or her life. Community matrons have their own unique relationship with the people on their caseload and can often provide untapped expertise and support as their condition deteriorates.
Chronic obstructive pulmonary disease (COPD) is a condition commonly seen in the community, with symptoms including breathlessness, chronic cough and wheezing. There is much that community nurses can do to support COPD patients through an acute exacerbation (AECOPD) and to optimise their care when stable. Community nurses can take an active role in providing advocacy for the patient and ensuring that their professional knowledge is updated to provide admission and a key area for COPD is a leading cause of hospital admission and a key area for service development in the community. Investment in education and clinical leadership in community nursing is vital to prepare the workforce to deal with the needs of people with COPD in the future.
The number of NHS patients requiring containment products such as pads is increasing year on year due to an ageing population. Patients with long-term conditions are increasingly being cared for at home, and although incontinence is not a disease it is often a symptom associated with other health issues. Community nurses are seeing patients with more complex needs, but incontinence is often not the primary reason for their visit. Containment products can be seen — both by patients and their carers — as the most effective way to manage incontinence and nurses are often put under pressure to prescribe pads, while continence services are being challenged to review the way care is delivered through innovation and the effective use of technology. This article will look at the redesign of a continence service that has involved the development of a community continence team (CCT), along with a summary of the initially encouraging performance indicators. The CCT aims to provide a comprehensive continence assessment with a focus on rehabilitation. The principles underpinning this service redesign could be applied to any community nursing team.
Among the challenges facing community nurses in their day-to-day practice is one that impacts greatly on patients, relatives and healthcare providers — the management of exudating skin conditions and wounds. This article looks at eosin solution, a popular treatment option for exudative dermatoses on mainland Europe, to the extent of being commercially available to the general public, but one which has dwindled in popularity in the UK. This article provides an introduction to this versatile nontoxic dye and outlines its potential application in the community setting by comparing it with the much more widely used alternative potassium permanganate.
Sarah-Jayne Lawson is a registered nurse with ID MEDICAL and currently works as a community agency nurse.
The use of compression hosiery is commonplace in the community. Traditionally, compression hosiery has been used to prevent leg ulceration, including prevention of the recurrence of leg ulcers and skin breakdown after ulcers have healed (Nelson and Bell-Syer, 2012).
