This article examines malnutrition, a complex issue that has wideranging implications in terms of patient experience and resources - evidence suggests that malnourished people are repeat attendees at GP surgeries, incur higher prescription costs and experience twice as many hospital admissions than well-nourished people. While there have been many hospital initiatives targeted at reducing the risks of malnutrition, in the community the solution remains challenging. Recommendations include arranging services so that health and social care professionals can work together to overcome nutrition issues, making extra resources available to combat malnutrition and improving the monitoring of patients' nutritional state. As healthcare shifts to a more community-based model, there needs to be a reallocation of resources from hospitals to community to ensure that efforts to tackle malnutrition have a more realistic chance of success.
For community nurses faced with expanding case-loads and patients who are now being discharged earlier into the community, the sheer range of conditions they come across means that cost-effective and practical, clinically-effective solutions are at a premium. This is particularly true in wound care, where nurses in the community need products that can be used on a variety of wound types that are also cost-effective. This article looks at the range of wound care knowledge needed by generalist nurses, before focusing on one dressing in particular, Silflex® (Advancis Medical, Nottinghamshire). With its all-round versatility, Silflex provides a balance of usability and cost-effectiveness.
Chronic wounds have many psychosocial consequences, including stress, negative mood, pain, and social isolation. In addition to these, frequent dressing changes can cause the individual anxiety and stress. This article explores how wound management can influence both psychological outcomes and, potentially, the rate of healing. Implications for practice are identified, which need to be successfully employed to ensure that patient health is maximised and that the stress and pain associated with wound care are minimised in order that wound healing is improved.
In chronic wound management the potential for healing increases following effective debridement. Indeed, it has been suggested that debridement’s effect on chronic wound healing is similar in impact to the relief of pressure in preventing pressure ulceration. Debridement can be performed using a number of methods, but larval debridement has recognised benefits, including the breakdown of necrotic tissue; removal of microbes; wound cleansing; and breakdown of biofilm. The reduction of malodour in the wound can also help increase patients’ self-esteem and overall wellbeing. This article looks at the use of larval therapy in a community setting, which can be particularly cost-effective as rapid debridement swiftly reduces the bacterial load, helping to lessen the potential for hospital admission.
It has been estimated that around 4% of patients on community caseloads have long-term indwelling catheters (Pomfret, 2000). Healthcare professionals have a responsibility to be aware of the different closed drainage systems available, so that they can offer patients choices to suit their lifestyle and preferences. Leg bags are one option, which can be customised to maximise patient comfort and dignity. This paper discusses the impact that urinary incontinence can have on patient quality of life, and one range of leg bags that has been developed to meet patients’ specific needs.
Due to changes in national healthcare policy community staff, including nurses, are being asked to care for ever-larger and more diverse groups of patients. However, the challenge for staff and service providers is how to deliver higher standards of clinical care while ensuring that patient safety remains a priority. One of the answers is to ensure that staff who deliver any clinical skill do so competently, but reports have highlighted technical skills gaps that need to be addressed. No failings should be regarded as acceptable as they can impact on patient safety and there is a responsibility to address any areas for improvement through education and skills training. The study outlined in this article attempted to capture the perceptions and experiences of community staff to gain an insight into the gaps in clinical skills training and make recommendations for improvement.
Kathy French is a freelance nurse. She was formally a nurse advisor at the London sexual health programme and a nurse on the Independent Advisory Group for Sexual Health and HIV.
Economic studies of leg ulcer management strategies have mainly concentrated on different compression, dressing and pharmaceutical products rather than different modes of delivery or systems of care.
Leg ulcer management in the community presents a number of challenges. This paper discusses the challenges and rationale of introducing a new service delivery for leg ulcer management based on patient empowerment, health promotion and education, and its implication for clinical practice. It focuses on an initiative that provides a patient-centred resource for the prevention, treatment and management of leg ulcers and associated conditions.
Ellie Lindsay BSc (Hons) RN, DN, CPT, DipHE, Independent Specialist Practitioner. Visiting Fellow, Queensland University of Technology.
Article accepted for publication: October 2012
‘It is widely known that there are differences between men and women in the incidence and prevalence of most health conditions. Sometimes there are clear biological reasons for these differences – but often there are not.’ (Mens Health Forum – www.menshealthforum.org.uk)
Although men are starting to realise that their health outcomes could be much better with a bit of effort, they continue to die on average, years earlier than women, and for just about every disease common to both sexes, men still come off worse. It’s only in the last few years that we have started to ask ourselves why is this?
Jane DeVille-Almond, SRN, SCM HV BA(Hons) Independent Nurse Consultant/ Chair of the British Obesity Society http://www.obesitysoc.org.uk/, Senior Lecturer at the University of Wolverhampton.
Article accepted for publication: November 2012
