Resources

As we drift inexorably towards Christmas on a wave of sentimental TV adverts and
last-minute shopping panic, there is one question on everyone’s lips (and no, it is not ‘How did Matt Hancock finish third in the jungle?’).

The pandemic has undoubtedly had catastrophic effects on the health and wellbeing of
the population. This will continue to unravel for years to come, so it is understandable that health and social care staff are still trying to unpack, unpick and attempting to make sense
of the Covid-19 pandemic. 

When I applied to become a Queen’s Nurse in 2020, I had no idea where this journey was going to take me — it certainly has become a fulfilling accolade with many opportunities.
From a project that identified, coded and introduced an emotional health and wellbeing check for Military Veterans, to now being awarded an Elsie Wagg (Innovations) Scholarship
from the National Garden Scheme and Queen’s Nursing Institute (QNI), to create a sensory garden space using Military Veterans and learning disability patients.

The impact of the menopause, particularly in the workplace, has only recently been given
the attention it deserves. Seventyfive percent of the NHS’s workforce are women, and for nurses working in the community the figure is even higher (NHS England, 2021). ‘Women’
includes transgender, non-binary and intersex staff. The NHS and clinical leaders have responded to concerns and the menopause guidance for the NHS workforce managers was launched in November 2022 (NHS England, 2022).

Many people across the UK live with poor bowel health, suffering with chronic constipation and/or faecal incontinence, which can be debilitating and prevent those suffering from enjoying their best life possible. The ‘Cost of Constipation Report’ (2020), published by the Bowel Interest Group, documents that in fact one in seven adults are affected by constipation at any one time; while many people suffer in silence (Bowel Interest Group, 2020).

Wound management is increasingly falling to those who are not wound care specialists (Guest et al, 2020).

This clinical series aims to demystify and simplify approaches to assessment and
management of chronic oedema in the community, including the promotion of selfcare,
to improve efficiency and the delivery of evidence-based care for patients with
chronic oedema. Part 5 concludes the series and looks at chronic oedema management,
finishing with compression therapy, concordance and self-management (Wound Care
People, 2019).

There is an abundance of literature on the management of venous ulceration, however, increasing numbers of patients are presenting with ulcers of mixed aetiology — arterial and venous. Compression therapy is the gold standard treatment for venous ulcers, however, high levels of compression are contraindicated in the presence of severe arterial disease. Nevertheless, the venous element of a mixed aetiology ulcer needs to be addressed, which
can pose a dilemma for healthcare professionals caring for these patients. This article discusses the different aetiologies and current literature on how these ulcers can be managed effectively to achieve healing.

Debridement is the removal of non-viable tissue from the wound bed and surrounding skin and is an important part of wound healing and wound bed preparation. Devitalised tissue, such as necrosis, slough and hyperkeratosis, interfere with the process of wound
healing. When a wound fails to progress, there is a need to assess the wound bed and surrounding tissue and promote an optimum environment that encourages the formation of healthy granulation tissue (Young, 2014). Recent advances in debridement techniques
using monofilament fibre technology can be practised by nonspecialist nurses and used safely and effectively in a patient’s home. In a recent audit, a dataset of 486 patients who had been newly prescribed a monofilament fibre debridement pad was obtained to
validate clinical effectiveness and cost efficiency. The total cost of wound care prescribing fell by 14% or £101,723 in the six months after the intervention compared with the six months before. The average monthly expenditure per patient fell from £244 before the intervention to £209 after (Burnett et al, 2021). This evidence reinforces the National Institute for Health and Care Excellence (NICE) recommendations for use of monofilament fibre debridement in the community, based on evidence of its effectiveness and estimated cost savings (NICE, 2019).

Nurses play a key role in recognising the clinical signs of diseases. Learning to be proficient in one’s ability to define the problem accurately, through both subjective and objective assessment, will provide both the competence and confidence to refer a patient onward for appropriate investigations and/or care. Part one of this series focused on respiratory assessment, including historytaking and physical assessment (Pearce, 2022a). Although there are many non-respiratory causes of respiratory symptoms, part two in this series focuses on respiratory conditions. Two case studies are discussed followed by potential differential diagnoses. The reader can make an assessment using part one and two of this series and the papers referenced, to help consider the potential/working diagnoses.