This article examines current guidelines and best practice statements for the treatment and management of chronic venous leg ulcers (VLUs). There is a need for continuous professional development (CPD) for community staff, who are constantly under pressure to maintain evidence-based practice when dealing with the complex, clinical and challenging environment associated with chronic venous leg ulcers. This article highlights the importance of patient assessment, management and treatment options, including the gold standard of compression therapy and new options available
The knowledge needed to diagnose skin conditions in primary and community care can be elusive, daunting and confusing. By using thorough history-taking, excellent physical assessment skills and thinking ‘outside the box’, healthcare professionals can formulate a differential and working diagnosis to improve patient access to appropriate management, including medications, lifestyle changes and referral as needed. Simple history-taking tools, relevant mnemonics and good resources can help patients to be managed quickly and effectively, and thereby improve outcomes and reduce the need for time delay in diagnosis. This article intends to demystify the dermatology conundrum and give healthcare professionals the tools to simplify the treatment of common skin conditions.
With more people living longer, an increasing amount of care and support is being given in people’s homes. The Department of Health (DH, 2012) has highlighted how complex care, which was previously only delivered in hospital, is now being provided by district nursing teams and other multidisciplinary agencies.
The community nurse may come across a range of wounds in the community setting, particularly with the rise in comorbidities such as diabetes and cardiovascular disease due to unhealthy lifestyles and an ageing population. Accurate assessment is the key to identifying the most appropriate wound treatment programme; one that will promote healing and/or relieve symptoms associated with chronic wound healing. Product choice is secondary to getting the assessment process right and accurate assessment and methodical documentation not only help protect against legal challenges, but also aim to reduce waste, dressing change frequency (and thereby nurse time), and patient discomfort. The community nurse should always seek to match their wound-healing knowledge with what they see in the wound bed and the patient’s history, which in turn will enable the nurse to make informed therapy choices and provide expert patient advice.
Urinary incontinence is a common problem in the UK, and one often seen by community nurses. While it is often associated with ageing, urinary incontinence can in fact have a number of causes and it is important that the community nurse is aware of the full range of aetiologies and presentations. Community nurses should have a good basic understanding of the causes of incontinence, be able to provide a basic first assessment, become adept at asking the right questions and be able to offer some conventional treatment and problem-solving strategies for immediate relief of symptoms. Most importantly, they should be able to identify when a patient will need referring to a specialist practitioner for more extensive assessment and investigation. This article looks at the assessment of urinary continence in the community, and outlines the common presentations that nurses should look out for.
The management of incontinence is often a neglected area of community care, even more so when allied to older people, and it is essential that community nurses consider the effect of the ageing process and its impact on continence. Often, this can involve the specific effects of dementia and the management of urinary incontinence can then become complex due to the range of practical approaches required and the need to adjust these for each patient. A large percentage of the community nurse’s time is spent supporting carers; therefore, it is essential to consider their feelings when suggesting any strategies as they may feel that they are already incorporating them in the patient’s daily activities. It is also important to focus on few key elements of advice around incontinence and to listen empathetically to appreciate the challenges experienced by carers, which will help in identifying suitable strategies.
Wound fluid, or exudate, is a normal consequence of healing but physiological circumstances within the individual or their wound can arise, which lead to excessive wound fluid production. There is a risk of maceration and excoriation of surrounding skin, which can cause distress and impact on quality of life. Therefore robust assessment and nursing intervention can successfully manage exudate and facilitate improved wound healing.
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.
The number of NHS patients requiring containment products such as pads is increasing year on year due to an ageing population. Patients with long-term conditions are increasingly being cared for at home, and although incontinence is not a disease it is often a symptom associated with other health issues. Community nurses are seeing patients with more complex needs, but incontinence is often not the primary reason for their visit. Containment products can be seen — both by patients and their carers — as the most effective way to manage incontinence and nurses are often put under pressure to prescribe pads, while continence services are being challenged to review the way care is delivered through innovation and the effective use of technology. This article will look at the redesign of a continence service that has involved the development of a community continence team (CCT), along with a summary of the initially encouraging performance indicators. The CCT aims to provide a comprehensive continence assessment with a focus on rehabilitation. The principles underpinning this service redesign could be applied to any community nursing team.
Increasing demographic changes in the type and age of patients as well as further government directives requiring more care at home, mean that there is a growing emphasis on primary care-led services. Large caseloads and patients with multiple and chronic health problems are stretching available community nursing resources. Against this background, continence promotion tends not to be a priority and at times it may seem easier and better to prescribe pads for patients with urinary incontinence. This article provides community nurses with guidance on the initial assessment and management options available for patients who present with urinary incontinence. Many patients will subsequently experience improvement in their symptoms (although not always complete resolution), with a corresponding improvement in overall quality of life.
