The number of healthcare assistants employed within the NHS has risen in accord with policies supporting the growth and increasing scope of practice of the assistant workforce. Healthcare assistants are a vital component of the community nursing team. This article presents an overview of findings of a National Institute for Health Research funded study into the roles of community nursing assistants (at bands 2, 3 and 4) working in community nursing provider organisations in England. The findings are based on national workforce data and the experiences and perceptions of senior managers, service leads and caseload holders, who employ or work directly with community nursing assistants to provide adult services nursing care.
Chronic obstructive pulmonary disease (COPD) is a serious, long-term and irreversible disease, which obstructs airflow to the lungs due to inflammation of the air passages and lung tissue damage. The most debilitating and frightening symptom is breathlessness, which can affect an individual's ability to walk, exercise, work, socialise, sleep and eat, thus having a major impact on all activities of daily living. This article aims to provide an overview of COPD to facilitate a general understanding of the disease, assist community nurses with early identification for prompt
detection and highlight the pathways and management options available. Due to its complexity, COPD can be challenging for both patients and healthcare professionals, thus the earlier it is diagnosed and management plans started, the sooner its progression can be slowed and any impact reduced.
The government's policy of moving care closer to home means that not only will community nurses continue to see patients with chronic wounds such as leg ulcers, pressure ulcers and diabetic foot ulcers, they may also start to see an increase in the numbers of patients who have been discharged from hospital with surgical wounds, who might previously have stayed in secondary care for a longer period. It is imperative that community nurses tasked with visiting a range of patients in their own homes have an understanding of the fundamentals of wound development and management to provide basic evidence-based wound care. This article looks at some of those fundamentals, including debridement, dressing application and removal, wound cleansing, infection, and the effects of comorbidities on the wound.
Venous and lymphatic disease both result in skin changes to the lower limb. These range from early disease signs such as mild oedema and dry skin, to varicose veins, leg ulceration and chronic oedema in the later stages. Patients at all stages of disease progression are commonly encountered in the community and compression hosiery plays a key role in the prevention and management of skin changes.
Hand hygiene is a term used to describe the removal of microorganisms from the hands using soap or a cleansing solution and water (hand washing), or a waterless antimicrobial agent (hand rubbing) (National Institute of Health and Clinical Excellence [NICE], 2013; World Health Organization [WHO], 2013).
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.
