Resources

For most people, workplace ethical dilemmas involve relatively little soul-searching. Should they tell the boss that they used the company credit card to buy her birthday present on expenses? Is it wise to let their line manager know that he ought to invest in some deodorant? And do they really need to tell HR that Darren from accounts tried to kiss them at the Christmas party?

The NHS has been grappling with concerns surrounding its whistleblowing systems and cultural health. This has been highlighted repeatedly in the press recently with coverage of the Lucy Letby trial, within which there were shown to be multiple failures in internal reporting processes. This demonstrates the need for an independent reporting line for
employees across the organisation, such as through Freedom to Speak Up guardians (Chidgey-Clark, 2023). NHS employees should have the opportunity to speak with an entirely impartial party who can process their concern and pass on the information to the appropriate team for further investigation.

The suffering caused by lower limb and leg ulcer-related conditions often languishes
in the periphery of healthcare. However, the prevalence, distress and economic implications of these conditions are far more substantial than commonly acknowledged.

The third part in our series on pressure ulcer prevention and management discusses
the different types of pressure redistribution devices currently available in clinical
practice. The modes of action of the different types, together with patient suitability
and selection are also discussed, as well as what to do and not to do when nursing
patients on these devices.

Coughs are extremely common and vary in duration and degree of severity. Coughs of any duration are a frequent reason for seeking medical advice and unresolved coughs lasting beyond eight weeks are a cause of patient anxiety and reduced quality of life. Chronic coughs are those lasting for more than eight weeks. There are many causes, some more common than others. This article hopes to give nurses and non-medical prescribers who are approached by patients asking for advice some insight into diagnosing and resolving the problem, with the aim of improving quality of life for those affected.

A skin integrity prevalence audit was conducted in two health boards in Scotland in 2022, involving 186 care homes and assessment of 6,510 residents. Data collection involved in person and online contact with care home managers and senior care staff by specialist tissue viability nurses and care home support team members. Data was analysed to
generate prevalence rates per 1,000 residents. The findings identified an overall wound rate of 138.6 per 1,000 residents and further skin integrity needs (lower limb oedema) of 79.4 per 1,000 residents. There was variation in the incidence of wounds and lower limb oedema in the two health board settings. This is the first study at this scale and serves as an important benchmark for understanding skin integrity needs in the care home sector. There are important implications for education, training and support of care home staff as well as workforce planning for specialist nursing care to ensure appropriate prevention and management of skin care for residents.

As the UK population ages and greater numbers of people are living with long-term conditions (Office for National Statistics [ONS], 2014), increasing numbers of people are subsequently at risk of developing pressure ulcers (PUs). PUs are painful, costly and can negatively affect patient quality of life. They are particularly prevalent in the community setting, leading to high-costs in treatments, especially in those suffering from a chronic condition (Jaul et al, 2018). The prevention of PUs is therefore a key global care quality indicator, which is the focus of considerable quality improvements in primary care. Identifying a patient at risk of developing PUs is an action that should be undertaken at the first community visit. Nursing care to prevent PUs needs to be systematically planned, implemented and evaluated, following assessment of the patient and their
circumstances. As demonstrated by Clarkson et al (2019), integrating an interprofessional approach can reduce the severity of PUs in the community. There are a wide range of resources required to help prevent PUs, including nursing time, ensuring effective patient repositioning and risk assessment, as well as delivering the most appropriate pressure-relieving surfaces (Dealey et al, 2012).

Faecal incontinence (FI) is the term describing the inability to control the bowels (International Continence Society [ICS], 2015). This can include the uncontrolled passage of solid or liquid stool, or flatus (wind) (Benezech et al, 2016) through the anal canal. It is recognised as a symptom rather than a diagnosis (National Institute for Health and Care Excellence [NICE], 2014) and is the result of complex interactions of many contributing factors. This series of two articles will look at this taboo condition, how it affects quality of life, highlight the anatomy and physiology which affects bowel control and then discuss conditions and contributing factors that make individuals prone to the
symptoms of FI.

Diagnosing and managing lower urinary tract infections (UTIs) in women aged 65 years and over is important to ensure their health and wellbeing. This article explores how to diagnose lower UTI, considering alternative diagnoses especially in older adults, as their symptoms may mimic UTI but may indicate other underlying conditions. It also looks at how to manage and treat uncomplicated lower UTI and provides guidance on recurrent UTI, usually  defined as three or more episodes in a year.

Dementia is an umbrella term used to describe a group of symptoms characterised by behavioural changes, loss of cognitive and social functioning brought about by progressive neurological disorders. It is estimated that around one million people live with a dementia in the UK, with that figure set to rise to 1.2 million by the year 2040. We are learning more about the risk factors for developing dementia over the life course. This paper discusses the non-modifiable and modifiable risk factors for dementia and considers health promotion and health education activities that can be used by community nurses.