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.
Community nurses often have very busy caseloads and need a wide variety of knowledge to deal with the many different clinical scenarios that they face. This is particularly true of wound care, which can present a unique set of challenges, including infection, how to control exudate and making sure that any dressing they have chosen does not actually further harm the patient by, for example, damaging the skin when it is removed. This article outlines some of the most important areas that community nurses need to understand when it comes to wound care before going on to look at the solutions provided by one particular dressing (Actilite Protect®; Advancis Medical), which is designed for use on the full range of wounds, including acute skin tears, post-surgical wounds, chronic leg ulcers, pressure ulcers, diabetic ulcers and infected wounds. As well as presenting an overview of the dressing, this article also presents a series of case studies that illustrate the benefits of the dressing in practice.
Venous leg ulcers make up a large part of a district nurse’s caseload, with the application of compression bandaging requiring competent and skilled practitioners. At Central and North West London Foundation Trust (CNWL) Camden Integrated Primary Care (IPC) Service recruiting and retaining community nurses is a challenge, a situation which is shared across all London boroughs. In particular, it is difficult to maintain consistent standards for wound cleansing and compression bandaging, resulting in the responsibility for a large caseload falling to a small number of practitioners. Following a review of innovative products on show at the European Wound Management Association (EWMA) conference in May 2014, an alternative to traditional compression bandaging was identified as a possible solution to this problem; namely, UCS™ for effective debridement and Juxta CURES™ as an alternative to compression bandaging (both medi UK Ltd, Hereford). A total of 26 patients evaluated the products, which were found to be more clinically effective than previous regimens and also resulted in substantial cost savings.
This article highlights the normal and abnormal physiology of fluid circulation in the lower limb with particular reference to venous and lymphatic flow. Consideration is given to the assessment and diagnosis of disease and its severity, particularly the impact on the patient including chronic oedema, ulceration, cellulitis and loss of mobility. Options for disease management and prevention such as compression bandaging and hosiery are also discussed, and the gaps between theory and practice are highlighted to provide community nurses with the most up-to-date information and practical solutions.
Community nurses offer holistic nursing care to patients at home, including attending to people with leg ulcers. It is known that leg ulcers can have a significant impact on patients’ quality of life. Nonetheless, little is known about community nurses’ views and experiences of providing holistic leg ulcer care and, in particular, their insights into the impact of leg ulcers on patients’ quality of life. Using a focus group of five healthcare support workers and four individual interviews with two associate nurses and two district nurses, this study explored community nurses’ experience of attending to patients with leg ulcers. Following transcription of the data, a thematic analysis was undertaken. It was concluded that community nurses need more training to support their work in leg ulcer management and more time to deliver patient-centred care.
The accurate grading or staging (henceforth referred to as grading in this article) of pressure ulcers has become increasingly important over the past five years as healthcare organisations insist on each wound being accurately documented (National Institute for Health and Care Excellence [NICE], 2014a, b). The impetus to capture improved data on pressure ulcers has been driven both by the need to reduce the impact of these debilitating wounds on patients, but also to bring down the spiralling costs to the NHS associated with their treatment. However it is not always easy to grade a pressure ulcer and the accuracy of any conclusions can be affected by multiple factors such as the presence of necrotic tissue, the colour of the individual's skin and the skill of the clinician, whether nurse, therapist, doctor, podiatrist or healthcare assistant. This article examines the basic principles of grading pressure ulcers, particularly where there may be conflicting signs and indications, and also investigates so-called 'ungradeable' pressure damage and how community nurses might reasonably interpret the guidelines on this.
Community nurses require a wide skill set to deal with the variety of clinical presentations they meet in any given day. This includes wound care, which can present nurses with a range of management challenges, i.e. how to combat infection, which kind of dressings to use to control exudate volume and how to ensure that dressings provide patient comfort and do not further damage the wound or skin on removal. It is important, therefore, that community nurses have access to a range of versatile products that can be used in a variety of clinical situations and which are also cost-effective. This article examines some of the common wound care issues that community nurses can face, as well as looking at how a versatile wound dressing (Durafiber® Ag; Smith & Nephew) — which has a variety of applications in primary care — can help with some of these issues.
Compression bandages provide the mainstay of treatment for venous diseases and their sequellae of ulceration and oedema. Selection should depend not only on the effectiveness and cost of treatment, but also on patient acceptability. If correctly applied, compression bandages provide sustained graduated pressure. This article explores the negative impact that having a leg ulcer can have on patient quality of life and introduces a new, moisturising, odour-reducing inelastic two-layer compression bandaging system that aims to improve patient wellbeing and comfort which, in turn, promotes concordance.
Wound debridement can be challenging for community nurses, who need to be able to quickly identify a wound’s status in order to proceed with treatment. This article looks at some of the basic factors that nurses should consider when debriding and cleaning a wound, paying particular attention to assessment and ‘seeing’ the wound, and how clinicians can better remove potentially damaging material such as slough and necrosis. The article also investigates how clinicians caring for patients with leg ulceration can treat the ‘whole leg’. Finally, the authors consider the benefits of a new product, the UCS® debridement cloth (medi UK), and its ability to help community nurses gently debride and clean wounds of all types, as well as reducing the burden of using buckets of water to clean patients’ lower limbs. This has important implications for many community nurses, particularly concerning strain to the back during lower limb cleansing and the infection risk of transporting, cleaning and storing buckets in patients’ homes. There is also a time factor, as debridement cloths mean that visiting nurses can reduce the time associated with filling and emptying buckets in both clinic and home environments.
Pressure ulcers represent expensive adverse events and are a significant cause of pain and distress to patients. This article examines a SKIN bundle approach that was implemented in a Welsh nursing home to assist in the prevention of pressure damage. An educational intervention specifically designed to aid implementation was put in place and a series of audits were performed to collect nursing team members’ knowledge of pressure ulcer prevention and occurrence. The authors outline how staff’s knowledge scores increased dramatically following education and how pressure ulcer prevalence subsequently remained low.
