Resources

Lower limb ulceration continues to be a common cause of suffering and its management places a significant burden on the NHS, with venous leg ulcers (VLUs) being the most common hard-to-heal wound in the UK. It is estimated that over one million patients in the UK have lower limb ulceration, of which 560,000 were categorised as VLUs at a cost of over £3 billion each year. Although self and shared care in chronic disease  management is not new, historically wound care and specifically lower limb management has been undertaken solely by healthcare professionals. This article outlines the results of implementing a lower limb wound pathway (Wounds UK, 2016), and a lower limb self-care delivery model measuring clinical outcomes and the impact on workforce pressures through limiting face-to-face healthcare professional contact up to one appointment every six weeks, when capacity and capability criteria are met. A suitability assessment was conducted and, when appropriate, patients were
managed using a self-care delivery model. Patient data were collected, anonymised and independently analysed, comparing time to healing against data on file from a previous audit using the lower limb wound pathway (Wounds UK, 2016). This highlighted VLUs in 84 of the 95 patients selected for the self-care model had healed by week 24 and a
further 10 patients had healed by week 42, with only one remaining patient reaching 42 weeks without healing. These results support the hypothesis that when suitable, patients with a VLU can self-care and deliver clinical effectiveness without compromise.

A chronic cough is often a symptom of respiratory illness, but it can be brought about by many factors, i.e. smoking, being female, abdominal obesity, low income, environmental factors, allergies, medication and increased age (Colak et al, 2017). Unfortunately, a frequent side-effect of chronic coughing is urinary incontinence (UI) — mainly stress
urinary incontinence (SUI). Although quite prevalent within this cohort of individuals, there seems to be little professional knowledge with regards to interventions to prevent or treat UI. This article looks at the causes of chronic coughing and how it impacts on UI. It also
identifies how professionals can recognise at-risk patients and start treatment options.

The UK has a population of approximately 11 million adults, 18.6% aged 65 and over (Centre for Ageing Better, 2022). Indeed, the demographic profile of the population of England and Wales and primary care records indicate that one in five people are over the age
of 65 in England (Office for National Statistics [ONS], 2018; Robards, 2020). The condition of frailty is more prevalent in the older person, and estimates provided by various studies suggest that 3% of people over the age of 65 in England have the condition (Clegg et al, 2016; Sinclair et al, 2021). Community nurse caseloads are representative of the ageing population of the UK and frailty has been recognised as a clinical condition of the older person (Leary and Bushe, 2022). Early detection of frailty by experienced nurse practitioners can assist in developing a management strategy for the patient in order to inhibit progression of the condition (Ruiz et al, 2020).

Due to its progressive nature, dementia is now the leading cause of death in England and Wales, so a palliative approach to care is beneficial because of its emphasis on supportive care. Many people with dementia also have other comorbid health conditions common
in older age, that in themselves may induce pain. However, people with dementia may have difficulty in understanding what they are feeling and in describing and locating the pain due to having issues with communicating their needs as their dementia progresses. This paper considers the recognition, assessment, treatment and management of pain in older people with dementia. It introduces the learner to what is known about the subject  and why it is important to know the person’s past history and previous ways of self-managing pain and discomfort using information gained from their family, carers and friends.

People experiencing homelessness are generally not seen in traditional models of intermediate care. An out-of-hospital care model for those experiencing homelessness has been established in Leeds. This offers good quality accommodation in community settings with a multidisciplinary team to assess people’s health and social care needs and offer step up or step down from hospital care. This has demonstrated a reduction in emergency department attendances and unplanned hospital stays, as well as an opportunity for people to be included in a home first model. Unexpected outcomes include a reduction in street sex work for the women who have been engaged on the project, less engagement with the criminal justice system, a place to facilitate prison releases, and an environment where end-oflife care can be delivered and achieve preferred place of death. Future investment is needed for out-of-hospital care to be an equitable offer in the city available to all.

The Mediterranean Diet (MedDiet) is one that has been followed by certain populations from warmer climates for thousands of years. Many of these people seem to live in good health to an advanced age. Is this due to where they live and maybe a more laid-back
lifestyle, or is their diet also responsible for this rude health? More recently, the popularity and publicity of the MedDiet seems to have grown exponentially. Will it end up being just another diet craze or is there something behind it so that we can be confident  about advising patients to adapt their diet to being more Med like? This article explores what this diet actually is and whether there is any scientific proof for the claims made about it. From the research presented, it certainly seems that the MedDiet can offset many ‘socalled’ Western diseases. This paper also looks at which elements of the diet are likely to have this effect.

Several crucial documents have identified the need for integrated care to meet patient requirements in the current financial climate, developed from the concepts of self-care and joining up care to improve health outcomes. These include the Five Year Forward View (2014), Next Steps on the Five Year Forward View (2017), NHS Long Term Plan (2019) and now the introduction of the Health and Care Act (2022) — all of which provide a contextualised approach to care. Integrated care is aimed at the way that organisations work together to support self-care (which incorporates the principles of holistic care considering physical, emotional, social, spirtual and ecomonc health [Mills, 2017]), with a commitment to improve patient outcomes by avoiding confusion and repetition. It  enhances comprehensive care planning by listening to patients — perhaps best summed up by the phrase, ‘No decision about me, without me’ (Department of Health [DH], 2012).

This article is a call to action for those involved with children and young people (CYP) who have (or might have) asthma. The evidence has been clear for some time that there is an identified peak in asthma attacks in mid-September, the ‘week 38’ phenomenon (Transformation partners in healthcare, 2022). However, what is often not discussed is that there is a time when we can perhaps pre-emptively act to avoid attack — and that time is now.

Winter is often seen to be the time to consider respiratory health. However, for patients who wheeze, entering autumn with healthy lungs is key to resilience to winter viruses and triggers. ‘Pre-emptive medicine’ is one of the key focuses in recent national
guidance (NHS England, 2021) and has been a pillar of best practice in both the National Institute for Health and Care Excellence (NICE, 2021) and British Thoracic Society/Scottish Collegiate Guidelines Network (BTS/SIGN, 2019) guidance for some time. It is known that many asthma deaths are avoidable, and that there are many
so-called modifiable factors that can contribute to mortality in asthma (Royal College of Physicians [RCP], 2015).

Taking a holistic approach and actively listening to patients is crucial in all patient encounters. It can allow you to understand patients’ concerns, values and the impact that certain behaviours or conditions might be having on their lives. Gambling disorder, often referred to as a ‘hidden addiction’ is, as Charles and Liz Ritchie point out (pp. 8–10), an extremely serious issue which can have devastating consequences for indiviuals and their families. As community nurses visiting patients in their own homes, we have a unique opportunity to identify signs of gambling harm and offer support. Clearly, it’s a topic that needs to be approached sensitively and without judgement, but recognising gambling disorder as a public health concern and addressing it within the context of a patient’s overall wellbeing can make a significant difference to their lives and the lives of those
around them.

When our son Jack told my husband and I that he was gambling, we had no idea his life was at risk. As parents, we thought we knew all the dangers to warn our children about — drinking, drugs, smoking, road safety, sexual predators.