To help the British armed forces minimise mental health problems while undertaking military duties, operational psychological support is provided by military mental health nurses. This series of two articles is part of the first qualitative research completed in Afghanistan by British armed forces into the effectiveness of the military mental health nursing role. The authors aim to increase understanding of the factors that affect the delivery of nursing care during an operational deployment, including educational and clinical competency, multiprofessional and multinational boundaries, and the challenges of providing nursing care for both military personnel and local nationals. This article, the first of the two-part series, looks at the set up of the study, while the second article (featured in the next issue of JCN) will look at the study findings.
The accurate grading or staging (henceforth referred to as grading in this article) of pressure ulcers has become increasingly important over the past five years as healthcare organisations insist on each wound being accurately documented (National Institute for Health and Care Excellence [NICE], 2014a, b). The impetus to capture improved data on pressure ulcers has been driven both by the need to reduce the impact of these debilitating wounds on patients, but also to bring down the spiralling costs to the NHS associated with their treatment. However it is not always easy to grade a pressure ulcer and the accuracy of any conclusions can be affected by multiple factors such as the presence of necrotic tissue, the colour of the individual's skin and the skill of the clinician, whether nurse, therapist, doctor, podiatrist or healthcare assistant. This article examines the basic principles of grading pressure ulcers, particularly where there may be conflicting signs and indications, and also investigates so-called 'ungradeable' pressure damage and how community nurses might reasonably interpret the guidelines on this.
Community nurses require a wide skill set to deal with the variety of clinical presentations they meet in any given day. This includes wound care, which can present nurses with a range of management challenges, i.e. how to combat infection, which kind of dressings to use to control exudate volume and how to ensure that dressings provide patient comfort and do not further damage the wound or skin on removal. It is important, therefore, that community nurses have access to a range of versatile products that can be used in a variety of clinical situations and which are also cost-effective. This article examines some of the common wound care issues that community nurses can face, as well as looking at how a versatile wound dressing (Durafiber® Ag; Smith & Nephew) — which has a variety of applications in primary care — can help with some of these issues.
This article provides an overview of lymphoedema and its management. It includes information on the definition of lymphoedema, anatomy (lymphatics), lymphoedema staging, complications and the psychosocial impact. This leads onto a discussion of the management methods that can be delivered by community staff and practice nurses who have received appropriate training. Involving patients and their family/carers in all aspects of the management plan can help them to cope with this lifelong condition and promote concordance with treatment.
This article examines the various elements that community nurses need to consider when attempting to provide best practice in urinary catheterisation. The author seeks to challenge what is considered best practice — particularly the requirement for all practice to be evidence based — while encouraging community nurses to think proactively about the care they are providing. The article stresses that the first principle of urinary catheterisation is to avoid the procedure where at all possible — catheterisation is potentially dangerous and can even be life-threatening if performed inappropriately. Overall, the author poses some key questions, including: should there be a difference in the care provided by community and hospital nurses; do community patients have the same needs as those in hospital; and can the manufacturers of drugs/products help to make avoiding urinary tract infections (UTIs) easier?
Continence problems in children can be very disabling for both the child and their families/carers. The need to have an indwelling catheter can be inconvenient and, even, traumatising for the child. There is also a social stigma associated with incontinence, continence care and catheters, which should not be underestimated. This article discusses how healthcare professionals can help children and families and thereby reduce the burden, both emotional and physical, of living with a catheter and then introduces a new range of leg bags that have been designed specifically with children in mind.
Breathlessness causes emotional and physical distress and social isolation for both patients and their families. Refractory breathlessness, i.e. that which persists even when measures to optimise the underlying condition have been implemented, is one of the most distressing symptoms experienced by patients with advanced life-limiting illnesses. This two-part series describes the experience of refractory breathlessness in patients with advanced disease living in the community, and provides guidance for their care. This, the first part in the series, outlines the experience of breathlessness and how community nurses can accurately assess patients. The second part of this series (available in the next issue of Journal of Community Nursing) will outline management techniques.
JCN talks to those working in the community.
Sarah Kucukmetin, community nurse specialist, Prostate Cancer UK
In each issue of the Journal of Community Nursing we investigate a hot topic currently affecting our readers. In this issue, as we face an obesity epidemic and growing lifestyle-related conditions such as diabetes, JCN takes a look at the community nurses’ role in health prevention and asks the question...
Beth Britton is a freelance campaigner and writer specialising in issues affecting older people, health and social care, and specifically dementia. Her father had vascular dementia for the last 19 years of his life and she aims to provide support and advice to those faced with similar situations, as well as informing healthcare professionals and the wider population on how to improve dementia services.
