In each issue of the Journal of Community Nursing we investigate a hot topic currently affecting our readers. In this issue, we take a look at end of life care and ask the question...
In recent years healthcare in the UK has focused on the numbers, with targets taking priority over patient experience. Jason Beckford-Ball investigates the effects on services and asks where we are heading in the future...
A recent Queen’s Nursing Institute (QNI) event in London looked at ‘healthcare at home’ and the JCN was there to see what the future holds for nurses tasked with providing more care in patients’ homes.
Radiotherapy is one of the mainline treatments for cancer, but less commonly understood are some of the side-effects, which include skin problems that range from being mild (dull erythema and tightening of the skin) to severe (moist desquamation with open wounds and oedema). This article highlights an ongoing study that aims to assess the implementation of a best practice skin guideline for the management of both dry and moist desquamation in patients with evidence of radiotherapy-induced skin reactions.
Audrey Scott, Macmillan Head and Neck Clinical Nurse Specialist, Mount Vernon Cancer Centre, Hertfordshire
Urinary incontinence affects quality of life in a large number of people of varying ages. For a significant number of patients the problem has to be addressed by catheterisation, a treatment method that can give rise to a host of potentially avoidable complications. Catheter stabilisation is an essential practice in avoiding unnecessary damage to the urethra and accompanying pain. While a number of products are available, there seems to be no preferred device for securing catheters. This article looks at CliniFix® (CliniMed, Buckinghamshire), a universal tube-securing device, which approaches tube fixation in a different way to strap-style-devices.
Julian Spinks, Kent-based GP with a special interest in continence
Community nurses’ caseloads may include a large number of catheterised patients and catheter-related infection is a significant problem, with up to 90–100% of those who are catheterised long-term going on to develop a catheter-associated urinary tract infection (CAUTI). For community nurses, ensuring that their skin and that of the patient has been cleansed before any catheter-related intervention is paramount. This article looks at the use of a new antimicrobial cleansing solution (octenilin®; Schülke) and whether its properties reduced the infection risk associated with catheterisation in the community.
Tim Sandle, Head of Microbiology, Bio Products Laboratory Limited, Watford
This article discusses nutrition in relation to patients in the community who are living with venous leg ulcers. The author explores the complex issues surrounding the care of this patient group, which is predominantly made up of older people who often have several underlying medical conditions and may live alone in their own homes or in supported residential settings. The article covers the physiology and aetiology of venous leg ulcers and explores how nutrition plays a role in the healing process. It advocates a holistic approach, taking into account the many factors involved when considering nutritional status and suggests interventions that are available to nurses and healthcare professionals working in the community.
Jennifer Lunnon is a staff nurse in the Intensive Care Unit, Royal Devon and Exeter Hospital
Primary Care services have become an increasingly prominent part of substance misuse delivery in the UK. They expanded in thelast decade with many general practitioners catering for substancemisuse patients in primary care. Nurses have also played a valuable part in helping GPs to work effectively in this area through liaison services and latterly, nurse prescribing clinics. This paper will examine whether problematic drug users can be stabilised and introduced to the idea of recovery, through primary care drug-based services in Islington.
Jeff Fernandez, Nurse Consultant for substance misuse at Islington Primary Care
Mark Medjesi Jones, Deputy Manager for Primary Care alcohol and drug service at Islington Primary Care
Ongoing developments in the prescribing agenda such as the new competency framework and the widening of professional responsibility within this field, are just part of other major changes taking place in health and social care today. The advantages for nurses of working in this new and rapidly evolving healthenvironment include the possibility of greater role flexibility, increased employability in multi-sectoral teams and the opportunity to run their own commissioned services. For managers, there is the possibility of providing a whole therapeutic package of care from each employee, with the distinct advantage of reducing the cost of relying on locum staff and brought-in prescribing services. This article outlines the common competency framework for prescribing, which provides a focus for the development of skill and knowledge and aims to ensure that standards are upheld across care services.
Anita Fatchett, Associate Senior Lecturer Nursing at Leeds Metropolitan University
Andrew McEwan, Non-Medical Prescribing Lead at Leeds Metropolitan University
