Sue Hill is associate at the NHS Institute for Innovation and Improvement; David Pugh is team manager/operational manager at Bristol Community Health and chair of the National District Nurses Network (NDNN).
Urinary tract infection (UTI) is caused by the presence and multiplication of bacteria in the urinary tract, with associated tissue invasion. It is most common in women but can be more complicated in male and catheterised patients. This article highlights the importance of the correct diagnosis of UTI, which will identify ‘red flags’ to aid community nurses’ choice of management options and avoid the unnecessary prescription of antibiotics. In addition, the author makes recommendations for reducing catheter-associated UTIs (CAUTIs) in the community.
Caring for patients with indwelling catheters is common in nursing practice in all settings (Foxley, 2011), despite being the last resort for patients with long-term bladder control problems. Community nurses in particular will regularly encounter patients with indwelling catheters, ranging from those with nerve damage such as spina bifida, multiple sclerosis (MS), stroke or spinal injury; those with debilitating or terminal illness with loss of mobility; to those who may lack the cognitive ability or sufficient awareness to use the toilet. Catheterisation carries a high risk of infection, resulting in an increased burden of care and cost to healthcare providers. It can also negatively impact on patient wellbeing. Providing for these patients 'around the clock' can be a particular problem in the community, with carers and patients requiring education in how to manage both the catheters themselves, as well as the accompanying equipment at night. This article provides a background to long-term catheterisation, before looking at ways of preventing infection as well as the techniques and equipment that can better enable 24-hour care.
Skin reactions and insect bites associated with the spring and summer months are commonly seen in community settings. In this article, the author provides an overview of the most common skin reactions, including skin cancers, that can occur through increased exposure to the sun, as well as highlighting management techniques for community nurses faced with patients who have seasonal-associated skin complaints. With prevention being key, particularly where melanoma are concerned, this article provides a useful source of information for community nurses dealing with skin problems at this time of year.
In an earlier article in this journal, the author looked at malnutrition in the community from the patient's perspective (JCN, 28(2): 40–4). Here, she examines some practical tips on how community nurses can provide help for patients in danger of becoming malnourished. Malnutrition may have been caused by a chronic problem that has resulted in years of gradual deterioration and prompt action can prevent malnutrition escalating further and affecting the patient’s overall health. In this case, more detailed and supportive treatment from family, friends and healthcare services may be required to help implement changes in a patient's routine. By using some of the ideas highlighted in this article, and with regular monitoring and support, nurses can better help patients in the community to recover quickly from, or avoid, malnutrition.
End of life care became the focus of media attention in 2013 when the Liverpool Care Pathway was found to be not fit for purpose. This article looks at the policy background to end of life care in the UK, as well as the current state of provision, from a community nursing perspective. It also focuses on pressure ulceration, a key complication for patients at the end of life, offering advice on how to approach skin care for this patient group. Finally, the author examines the implications for treatment of mental capacity legislation, and how concepts such as 'advanced decisions' and ethics affect nurses trying to treat patients at the end of life.
Infection prevention and control is an enormous challenge within the hospital environment, but with the changing face of the NHS meaning that more complex care is being provided in the community and within patients' homes, the goal of zero tolerance of preventable healthcare-associated infections (HCAIs) is even more of a challenge. So-called 'super-bugs' put a tremendous strain on NHS resources, as well as compromising patients' recovery, quality of life and wellbeing, and are increasingly being seen in the community. This article looks at the provision of infection control in the community and how nurses need to organise services that involve patients in their own care. It also investigates the use of a range of infection control products, including a wash cap (octenisan® wash cap [schülke]), specifically designed for use in immobile patients.
The prescribing of medication is by far the most common form of medical intervention. However, it has been shown that up to 50% of medicines are not taken as prescribed, that medication-related problems can occur, and that up to 7% of hospital admissions can be due to adverse drug reactions. A new approach termed 'medicines optimisation' has been developed that is intended to focus attention on outcomes rather than process in relation to improving quality, the benefits, and value patients receive from their use of medicines. This article describes the role that community nurses can play in achieving the ambitions of the medicines optimisation agenda.
