JCN talks to those working in the community.
Sally Lee, social worker, North Dorset Local Social Services
W hen a client recently turned to me and said: ‘I didn’t know I could do this,’ it was not only clear that I was witnessing someone tackling a new challenge; it also brought home to me the varied and rewarding nature of my role with Integrated Neurological Services (INS).
Compression bandages provide the mainstay of treatment for venous diseases and their sequellae of ulceration and oedema. Selection should depend not only on the effectiveness and cost of treatment, but also on patient acceptability. If correctly applied, compression bandages provide sustained graduated pressure. This article explores the negative impact that having a leg ulcer can have on patient quality of life and introduces a new, moisturising, odour-reducing inelastic two-layer compression bandaging system that aims to improve patient wellbeing and comfort which, in turn, promotes concordance.
Wound debridement can be challenging for community nurses, who need to be able to quickly identify a wound’s status in order to proceed with treatment. This article looks at some of the basic factors that nurses should consider when debriding and cleaning a wound, paying particular attention to assessment and ‘seeing’ the wound, and how clinicians can better remove potentially damaging material such as slough and necrosis. The article also investigates how clinicians caring for patients with leg ulceration can treat the ‘whole leg’. Finally, the authors consider the benefits of a new product, the UCS® debridement cloth (medi UK), and its ability to help community nurses gently debride and clean wounds of all types, as well as reducing the burden of using buckets of water to clean patients’ lower limbs. This has important implications for many community nurses, particularly concerning strain to the back during lower limb cleansing and the infection risk of transporting, cleaning and storing buckets in patients’ homes. There is also a time factor, as debridement cloths mean that visiting nurses can reduce the time associated with filling and emptying buckets in both clinic and home environments.
Pressure ulcers represent expensive adverse events and are a significant cause of pain and distress to patients. This article examines a SKIN bundle approach that was implemented in a Welsh nursing home to assist in the prevention of pressure damage. An educational intervention specifically designed to aid implementation was put in place and a series of audits were performed to collect nursing team members’ knowledge of pressure ulcer prevention and occurrence. The authors outline how staff’s knowledge scores increased dramatically following education and how pressure ulcer prevalence subsequently remained low.
This article examines the role of malnutrition in chronic obstructive pulmonary disease (COPD). Until recently, weight loss was considered an inevitable consequence of COPD, however, modern research has demonstrated that weight gain is in fact achievable and can result in functional improvements. It is important that community nurses are aware of the importance of nutrition in COPD, both in screening for malnutrition and developing appropriate treatment plans, including the use of oral nutritional supplements alongside dietary advice and counselling. The current NHS policy of moving care 'closer to home' is resulting in more complex COPD patients being managed in the community and with this comes the challenge of managing reduced weight and low oral intake. It is, therefore, essential that community nurses develop the necessary skills and resources to deal with this growing group of patients.
This article looks at a telephone triage assessment clinic that was set up to improve the bowel, bladder and pelvic floor service in the authors’ locality. A pelvic floor triage questionnaire was developed to identify patients’ faecal, urinary and prolapse symptoms then, between April and December 2013, patients were referred to the colorectal pelvic floor clinic via telephone triage assessment. Investigations could also be requested directly from the telephone triage assessment clinic. The need for any investigations and patient responses to the telephone triage assessment clinic questionnaires were reviewed in the pelvic floor multidisciplinary meeting. Previously, the wait for a new pelvic floor appointment was four months and this has been reduced to two weeks (or five weeks for a new consultant appointment). The telephone triage assessment clinic has led to a reduction in waiting times, an improvement in patient experience and more efficient referral. It is also more cost effective as
it can replace a new consultant appointment.
Meticillin-resistant Staphylococcus aureus (MRSA) colonisation can lead to invasive infection and subsequently harm to patients. The prevalence of MRSA within care homes is poorly understood and, thus, the benefits of implementing a decolonisation regimen across a number of care homes was previously unknown. However, the MRSA prevalence surveillance outlined in this article showed that by proactively identifying MRSA carriers and decolonising residents, levels of MRSA fell from 10.2% in the first prevalence, to 6.8% in the second. The authors concluded that this simple strategy has the potential to reduce MRSA burden and patient harm.
Pain is experienced by many patients in primary and secondary care and the assessment of pain is a fundamental aspect of nursing. Community nurses need to possess a strong knowledge base to inform and advise their patients, this in turn enables them to help and empower their patients to effectively control pain with minimal side-effects. This two-part series on pain provides an update on the assessment and management of acute and chronic non-malignant pain. This first part of the series examines how community nurses can recognise and categorise pain and start to draw up a plan of care for the patient. The second part in this series will deal with the management of pain.
