Resources

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.

The menopause affects every woman, but the age at which it occurs, the symptoms  experienced, and the later development of menopause-related problems varies widely. For some, the transition is relatively smooth, but for others it is not, and the later development of postmenopausal health problems can affect general health and
wellbeing, as well as quality of life as women age. This article gives an insight into some of the commonest postmenopausal problems with a view to increasing confidence in community nurses and nonmedical prescribers in recognition and management of the conditions discussed, so that they can offer advice and treatment where appropriate and if able to do so.

There are many challenges in providing palliative and end-of-life care to people with dementia; some of which may be reduced through advance care planning (ACP) to support the person with the diagnosis to have a greater influence on their care at end-of-life.
Advance care planning has been defined as a process of discussing and recording wishes, values, and preferences for future care and treatment held between an individual, family members and their care provider(s) that takes effect when the person loses capacity. This
paper considers some of the barriers and enablers to lead to better support of ACP in families affected by dementia.

The link between physical and mental wellbeing is widely recognised, especially for those with a long-term condition. Such conditions can have a marked impact on mental health, while poor mental health can exacerbate chronic illness, thus creating a vicious circle due to the connection between the body and mind. Community nurses
are well placed to care for those with long-term conditions, not just in terms of health promotion, putting preventative measures in place, encouraging self-care etc, but also to address more complex mental health issues, and maybe even needing to advocate for patients.

Despite the medical advances of the past century, modern healthcare services often seem to treat our bodies as a series of unconnected parts, our ailments divided according to arbitrary physical labels. We may see a urologist for our weak bladder, a cardiologist for a malfunctioning heart, and a psychiatrist for any mental health issues. While it makes sense to apportion separate parts of the body to qualified specialists, these divisions can result in an inability among healthcare staff to see the ‘bigger picture’ — or to use modern healthcare terminology, to treat the patient ‘holistically’.