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.
Sue Hill was previously a district nurse in the New Forest and is now the community nurse advisor for NHS England.
Through events and consultations held by the Queen’s Nursing Institute’s (QNI) homeless health network, community nurses are identifying emerging issues affecting their patients and their workforce.
We’ve grown used to reading headlines about the NHS on a daily basis recently — NHS in crisis; Casualty nightmare exposed; A&E performance dips to new lows — to the point where they start to lose their impact.
One of my New Year resolutions was to lose weight by the end of 2015. I’ve also vowed to start formally collecting my portfolio evidence in preparation for my own revalidation later in the year. I’m not entirely sure which of these resolutions it will be easier to stick to... Find out more.
