Resources

Modern day health and social care dementia practice, as with other conditions, is driven by its current evidence base. This is understood not only through a range of means, such as research, best practice, expert consensus about the most effective way to care for a person with dementia, but also through the lived experiences of people with the diagnosis and their families and supporters. Practice and care should also be guided by clinical ethics; often traditionally referred to as medical ethics.

The world of stoma care can be a complex one. Thousands of products are available on Drug Tariff in the UK, which provides the arsenal for stoma care nurses to successfully deliver care and solutions. Some of these products may be to enhance the effectiveness of the appliance used, and each appliance has a variety of characteristics that may dictate the suitability of use for each individual’s personal condition.

Many people who both attend and work in our services carry the impact of trauma. Their trauma state can be exacerbated by how they are spoken to and treated. It is a sad and shocking reality that people accessing health and care systems can find the experience worsening their condition when they are seeking help and healing.

At Coloplast, we know the formation of a stoma is a life-saving procedure for many, but it can also pose considerable challenges for individuals and takes time to adapt (Di Gesaro, 2016). This is why it is essential for everyone with a stoma to have equitable access to high quality care and specialist advice (Osborne et al, 2022).

Many healthcare professionals recommend absorbent pads for men with urinary incontinence. These can be seen as easy to use and convenient (Chartier-Kastler et al, 2011), but potential odour and skin irritation are a significant concern (Williams and Moran, 2006; Gray, 2007). They can also impact dignity and quality of life (Williams and Moran, 2006). To provide a high level of holistic care, patients should be made aware of all suitable management options appropriate for them to be empowered to manage their bladder accordingly.

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 4 looks at chronic oedema management, beginning with skin
care and exercise (Wound Care People, 2019).

Changes to skin integrity and damage to the skin can occur at the end of life (EOL), despite appropriate interventions that meet or exceed standards of care. It can also be difficult to determine which wounds can be prevented and which ones are unavoidable (Sibbald et al, 2010; Beldon 2011). It is therefore the role of the nurse and carer to consistently deliver the best end-of-life (EOL) care, support palliation of symptoms, and maintain optimal skin integrity. Best practice for EOL skin care is about maintaining skin integrity for as long as is possible, followed by a goal of a dignified death (Kennedy, 2016) in line with patient/family wishes. This article discusses factors associated with maintaining skin integrity, and how skin damage can be prevented and a skincare regimen managed in EOL patients.

This article looks at the cost and incidence of wound dehiscence, together with an overview of the most common operation sites where dehiscence is likely to occur. Patient factors predisposing to wound dehiscence are discussed, together with the most common cause, surgical site infection (SSI). The identification and management of SSI is explored, together with recommendations for wound management for both infected and non-infected dehisced wounds.

A specialist wound telehealth service was established to deliver equitable service with parity of access to wound care for all residents of 38 nursing homes in Sussex with wounds of any type (n=579). All patients were managed using a systematic telehealth approach that combined digital and in-patient consultations according to established protocols and care pathways. Data for a three-year period was analysed by hand to determine patient demographics, wound type and discharge outcomes for all patients with wounds. The results showed that the mean age of patients was 86 years, with the majority being female (80% healed and 66% deceased). Referral outcomes were referred onwards (n=92), healed (n=234) or deceased (n=253). The most prevalent wound type was pressure ulceration in both healed and deceased patient groups (60% and 59%, respectively), followed by lower limb wounds (20% and 26%, respectively). Mean time to healing or death were 103 days versus 86 days, respectively. The authors concluded that the collaborative use of a specialist wound telehealth service ensured that all residents received prompt, evidence-based wound care. Healing was achieved in this vulnerable patient population, despite the existence of numerous barriers to healing. Patients nearing end of life with a wound received palliative wound management. The time to healing in this group cannot be commented upon due to lack of comparative studies in this patient population.

Here, Carole Young, professional nurse advocate, independent tissue viability nurse consultant and associate lecturer, Anglia Ruskin University, reflects on the impact of the pandemic on specialist nurses in the last two years and considers what is needed next in terms of support and recovery of self and service. The role of compassionate leadership and professional nurse advocacy (PNA) will be discussed to share an understanding of how restorative clinical supervision (RCS) can be used to support emotional recovery and plan for future development. Models including A-EQUIP and the GROW coaching model used by PNAs to guide RCS will be explained as tools which can support personal reflection and recovery through personal actions for quality improvement.