Over 60% of individuals receive radiotherapy as part of their cancer treatment, either with curative or palliative intent. Radiotherapy is usually provided as an outpatient service, which means that community nurses need to understand the most common radiotherapy-induced side-effect, an acute skin reaction, which can range from mild erythema to confluent moist desquamation. All patients receiving external beam radiotherapy are at potential risk of developing this reaction. This article presents information on the assessment and management of what can be a debilitating side-effect.
Ellen Trueman, Senior Sister, Radiotherapy Review Clinic, St James’s Institute of Oncology, Leeds Teaching Hospitals NHS Trust; Nursing Times 2011 Winner — Cancer Nurse Leader Award
Numerous studies have shown that pain during dressing change is a major issue for patients with both acute and chronic wounds. Despite this evidence, pain is often misunderstood by clinicians and can be poorly managed. Pain can result in patients abandoning dressing regimens and clinicians need to ensure that patients have their pain reduced as much as possible and do not have to face the trauma of repeated painful dressing changes. This article presents some of the causes of pain and outlines some strategies that clinicians can use to prevent or minimise their patients’ pain.
Jacky Edwards, Burns Nurse Consultant, Burn Centre, University Hospital of South Manchester and Lead Nurse, Northern Burn Care Network
In patients with venous and lymphovenous disease, skin changes to the lower limb(s) occur gradually, and become more serious over time if left untreated. The CHRonic Oedema Signs and Symptoms (CHROSS) Checker is a tool kit consisting of an assessment chart and key cards that have been developed to help clinicians easily identify the skin changes that occur as a result of underlying venous and lymphovenous disease, when carrying out holistic patient assessment. It also provides clear guidance on which compression products can be used to manage the disease type and severity of skin change. For clinicians unfamiliar with some or all of the signs and symptoms listed on the CHROSS Checker chart, the key cards contain further information in the form of a photograph, definition and cause of each sign and symptom listed. This article will describe the theory behind the development of the CHROSS Checker tools and explain how to use them in clinical practice.
Janice Bianchi, Independent Medical Education Specialist and Honorary Lecturer, Glasgow University
Ongoing changes to the NHS (Department of Health [DH] 2010a–c) mean that clinicians responsible for the delivery of wound care need to reduce expenditure while meeting the increasing demand for the provision of quality care (DH 2010a–c). The high impact action (HIA), Your SkinmMatters, identified ‘no avoidable pressure ulcers’ in NHS care settings as a vital improvement to the quality of patient experience and cost effectiveness (NHS Institute for Innovation and Improvement, 2010).
Aaron Knowles, Tissue Viability Podiatrist;
Richie Skinner, Senior Tissue Viability Podiatrist, both at Wound Healing Centres, Eastbourne
Steve Young,Managing Director, Cambridge Health Technology;
Sylvie Hampton, Tissue Viability Consultant,Wound Healing Centres, Eastbourne
With government reforms increasingly bringing care into patients’ homes, community nurses will inevitably encounter more and more people who have a stoma. Stomas essentially involve the maintenance of a permanently open breach of the skin, therefore, the site requires expert skin care as it is vulnerable to stripping and break down. This article looks at the use of silicone-based adhesive removers, which improve quality of life and can also reduce healthcare costs as they prevent the escalation of peristomal skin dysfunction. These products also help to prevent costly ongoing treatment for the effects of stripping on sensitive peristomal skin.
Jackie Stephen-Haynes, Professor and Consultant Nurse in Tissue Viability, Birmingham City University and Worcestershire Health and Care NHS Trust
In 2012 a national working party consisting of experts in the care of patients with learning disabilities and the management of swallowing difficulties (dysphagia) was convened to develop guidelines to assist with the identification of at-risk patients. The aim was to improve the diagnosis and management of dysphagia in this patient population. The guidelines were also designed to improve the protection of such patients by ensuring that they are treated in a fair and equitable manner. This article provides an overview of the guidelines (Wright et al, 2012) for the community nurse.
David Wright, Professor of Pharmacy Practice, School of Pharmacy, University of East Anglia, Norwich
Tom Howseman, GP and Clinical Director of LD Commissioning, Nene and Corby CCG, St Luke’s Primary Care Centre, Northampton
Urinary tract infections are often seen in community settings and can be debilitating for patients, involving dysuria (painful urination), increased urinary frequency and urgency, suprapubic pain, haematuria (blood in the urine), and polyuria (excessive urine production). This article takes an in-depth look at these symptoms, as well as the diagnosis and management of this common problem, which mostly affects female patients.
Chetan Shah, Senior Lecturer in Pharmacy Practice/Public Health, University of Hertfordshire
Stephen Goundrey-Smith, Consultant Pharmacist, PDC Healthcare Ltd, Leicestershire
Obsession with weight has been identified as a significant problem in modern society, particularly among young women. Similarly, the phenomena of weight and shape preoccupation have been recognised as preliminary behaviours to the development of eating disorders. This study aimed to identify the current incidence of, and factors associated with, weight preoccupation, shape preoccupation, and eating disorder risk in female US university students aged 18 to 23 years. An online study was used and the findings demonstrated that 31% of respondents identified themselves as weight-preoccupied and 33% as shape-preoccupied. Overall, the study found that asking students whether they are weight-preoccupied could be an initial step in early intervention for those at risk of developing an eating disorder.
Samantha A Ramsay, Assistant Professor of Foods and Nutrition and Director of the Coordinated Programme
Laurel J Branen, Professor of Emeritus
Miranda L Snook, Research Assistant, School of Family and Consumer Sciences
All at University of Idaho, Moscow, USA
Nurses working in the community may have insufficient time to access, interpret and apply research, and, therefore, need information to be presented in a format that is easily accessible. As community nurses rise to the challenges outlined in recent health policy, it is increasingly important that they maximise their potential to deliver evidence-based practice. This article looks at a survey that aimed to identify factors influencing evidence-based practice among community nurses. The findings indicate that in order to make progress it is important to adopt a multifaceted approach, taking into account the real world in which nurses currently practice. While it is important to develop nurses’ skills in accessing and reviewing research information, constraints on time mean that it will be difficult to achieve a nursing workforce where all nurses are active in reviewing research evidence.
Kate Gerrish, Professor of Nursing Research, University of Sheffield/Sheffield Teaching Hospitals NHS Foundation Trust, School of Nursing and Midwifery
Jo Cooke, Programme Manager NIHR Collaborations and Leadership in Applied Health Research and Care for South Yorkshire (CLAHRC SY), Sheffield Teaching Hospitals NHS Foundation Trust
Self-directed learning and reflective practice are crucial tools for the community nurse, who may often work in isolation and without the help or guidance of colleagues. Community nurses are required to use independent study skills and reflection to identify their learning and professional needs. This article looks at the development of a reflective grid as a learning tool to support and facilitate reflective and self directed learning. It is hoped that the techniques detailed here can help those students and nurses who are still developing their reflective and critical skills, or find reflection difficult. The grid was also designed to facilitate a quick and easy analysis before an in-depth study of an experience, or as a stand-alone model for short reflections.
Marian Judd, Health Visitor/Practice Teacher, Great Western Hospital Trust, Swindon
