Pilonidal sinus is a benign disease that involves a sinus in the natal cleft. This condition mostly affects the young and the resulting wounds can be extremely painful and debilitating. For symptomatic pilonidal disease, treatment may involve surgical intervention such as incision and drainage. The management of pilonidal wounds can be challenging, but with a systematic approach to wound care that involves patients in their own care to help prevent infection and recurrence of this painful disorder, positive results can be achieved. Treatment should not prevent patients from returning to the normal activities of daily living (both social and work-related), and nurses should aim to achieve this as quickly as possible. Psychological care is just as essential as nursing care when managing this disease. This article provides an overview of pilonidal sinuses for community nurses as well as focusing on one dressing which is designed to cope with them, in particular, the excess exudate that can be produced (Exufiber®; Mölnlycke Health Care).
With the plethora of wound contact dressings available and the demand for their use in clinical practice, clinicians need to keep abreast of what is new on the market to ensure that they provide their patients with the best treatment options, while also considering the costs involved. Preventing pain to the patient, trauma to the wound or periwound skin, and infection, are key considerations for clinicians at dressing changes (Hollinworth, 2001). With advances in wound care technology, patients should not experience pain due to adherent products causing trauma to the wound and/or ‘skin stripping’. The use of silicone dressings can help to prevent such occurrences from happening and thus promote patient wellbeing and quality of life (Upton, 2011; Yarwood-Ross, 2013). This article looks at the role of primary wound contact layers in wound management, and introduces a new silicone dressing with case reports demonstrating its positive effects in clinical practice.
Wound care forms a major part of any community nurse’s workload and with more acute patients being discharged earlier from hospital, as well as an ever-growing case-load of long-term conditions, it is more important than ever that nurses are confident in assessing and care-planning effective wound care. As ever, accurate assessment of the patient and the wound is the starting point and will help nurses choose the most effective treatment, resulting in improved patient outcomes and reduced costs. Poor wound care can lead to delayed healing, increased infection and inappropriate use of wound dressings, all of which impact on patients’ quality of life. In this article, the author outlines five main steps to consider in providing evidence-based, effective wound care.
Leg ulcers present a common clinical problem for community nurses. The need for assessment and maintenance can take up a lot of nursing time and issues such as pain, exudate and compression bandaging have a significant effect on the quality of life of patients. This article describes an evaluation of two new compression devices, one for people with venous insufficiency resulting in leg ulcers who need compression therapy (Juxta CURES; medi UK); another for those with leg ulcers, venous insufficiency and lymphoedema (Juxta-Fit; medi UK). This evaluation involved 16 patients and demonstrated the impact of quality of life and the potential for savings in a community nursing team, both financially and in terms of reduced nursing time.
The use of compression bandaging in venous leg ulcers has been acknowledged as ‘best practice’ for some time now, but these wounds remain a serious management problem in many patients with pain, excess exudate, limb swelling and poor mobility all affecting their quality of life. Wound care in general, and leg ulcer management specifically, are two of the most common reasons for referral to community nursing services and recent government policy aimed at managing more patients in primary care and in their own homes has also meant that nurses are now seeing more patients than ever before. All of this means that they need compression systems that are easy to apply and can deliver safe and consistent pressures to minimise risk and safeguard patients. This article presents the findings of a 40-patient multi-centre evaluation of a new inelastic compression bandage system (HERO H-2®; H&R Healthcare) designed to provide optimal compression levels, reduce odour and moisturise the skin. The evaluation demonstrated that the bandage system had a positive effect on a number of parameters including wound size, healing rates, patient comfort and mobility.
Wound care and nutrition are two interlinked areas that will have a serious impact on the caseload of any community nurse. Healthy eating and regular physical activity help to prevent chronic illnesses, which in turn have an effect on the development of wounds and ulcers. In particular, malnutrition can impair wound healing and so it is essential that at-risk patients are identified in the early stages using an evidence-based nutritional screening tool. If a wound has developed, adequate nutritional management plays a key role in the healing process. If necessary, patients should be referred to a registered dietitian for a detailed nutritional assessment and treatment plan. This article looks at the link between nutrition and wound care, as well as highlighting preventative measures that can be encouraged in all patients at risk of developing a wound.
Amputation surgery can be traumatic and life-changing for patients and many struggle to come to terms with the loss of a limb. Wounds that fail to heal following surgery can have an impact on each individual’s rehabilitation process. It is important to provide the correct management for these wounds to facilitate healing and enable the patient to work towards mobilisation. Equipping community nurses with the knowledge and skills to assist patients in managing their residual limbs can improve the time from amputation to ambulation. Similarly, overcoming problems with patients' skin; achieving properly filling prosthesis; and managing the ‘wear and tear’ of prosthetic limbs are all challenging aspects in the management of this patient group.
Choosing the correct dressing is often key to moving a wound along the healing trajectory, with its ability to deal with problems such as pain, excess exudate production and inflammation being crucial to the healing outcome. Infection is also a serious problem in many wounds and this article looks at the basics of wound infection as well as some of the main treatments, such as topical antimicrobials. However, clinicians are faced with a huge range of wound care products, many of which have antimicrobial properties. This article considers the use of one gelling fibrous silver dressing (Durafiber® Ag; Smith and Nephew), which is specifically designed to deal with many of the problems mentioned above, particularly excess exudate production and infection. The authors also presents the results of a small, prospective multicentre case series that was carried out to assess the efficacy of Durafiber Ag in a variety of wounds.
Due to concerns over pressure ulcer incidence data, a collaborative project was undertaken with the aim of improving quality of care within residential homes, specifically in relation to pressure ulcer prevention. The project comprised a residential home staff education programme based on the SSKIN bundle. The objective was to enhance staff awareness of pressure ulcer risk and their knowledge of pressure ulcer prevention approaches, such as the appropriate use of skin care products (ProshieldTM; H&R Healthcare) and the targeted use of local pressure-relieving methods such as dermal pads (AdermaTM; Smith & Nephew). To support residential home staff in putting pressure ulcer prevention theory into practice, skin care products and dermal pads were made more easy for staff to access, thereby facilitating the desired change in practice. Implementation of the project was supervised by the local tissue viability team. Tissue viability nurses — with the support of Smith & Nephew — delivered an educational package to the staff in each residential home including the SSKIN bundle and the appropriate use of local pressure-relieving techniques. A ‘stock-box’ containing supplies of dermal pads and skin care products was provided for each residential home immediately after the training — this meant that the staff could begin using these as soon as a risk assessment identified a patient who needed off-loading. Pressure ulcer incidence data routinely captured before the project began was compared with data from a similar time period following the project — this helped the authors assess and reflect upon the impact of the project.
If left untreated, leg ulcers can descend into a cycle of tissue breakdown and healing, resulting in chronic venous leg ulcers, which are associated with considerable morbidity and impaired quality of life. Compression therapy is widely held up as the ‘gold standard’ for management of venous leg ulcers, and the provision of safe and effective compression is one of the vital skills of the community nurse. However, to provide this level of treatment it is essential that the bandage system used provides the correct amount of sub-bandage pressure, as too little will be ineffective; whereas too great a pressure may cause constriction and patient discomfort (Moffatt, 2005; Milic et al, 2010). This article highlights a study that investigated the efficacy of a two-layer bandaging system (HERO H-2®, H&R Healthcare), which was tested by a group of clinicians for its ability to provide optimum compression alongside ease of application and patient comfort.
