Resources

Encouraging care closer to home has long been a priority for the government and NHS (Department of Health [DH], 2019). The workforce needs to be trained and equipped to deliver this health care in a variety of community settings (Queen’s Nursing Institute [QNI], 2021). The Nursing and Midwifery Council (NMC) have consulted and responded to these societal changes, i.e. care closer to home, within their review of professional standards which will shape community nursing roles for years ahead (NMC, 2022). The specialist practice qualification (SPQ) provides the education and training to prepare community nurses for their future professional careers as clinicians and leaders and will be at the forefront of implementing these standards.

This article describes the wound infection continuum in surgical, acute and chronic wounds. The phases are: contamination, colonisation, local infection and finally spreading and systemic infection. Clinicians need to be familiar with the signs and symptoms of local infection in order to put strategies in place to prevent a ‘full blown’ wound infection and to recognise how the signs and symptoms differ by wound type. The article looks at the
most recent guidance on wound infection management strategies, together with the identification and treatment of suspected biofilms and the two-week challenge, used in clinical practice to disrupt biofilms. Wound cleansing and the use of antimicrobial dressings
and topical antiseptics are also discussed.

A leg ulcer can be defined as a break in a person’s skin which becomes chronic in nature and takes longer than two weeks to heal (NHS UK, 2019). Evidence outlined by The National Institute for Health and Care Excellence (NICE) states that the prevalence of leg ulcers in the United Kingdom is around one percent over a lifetime, which still describes a large number of people (NICE 2022; Lim et al, 2018). The prevalence of leg ulcers continues to rise and a shift in lifestyle factors, including smoking and obesity, have contributed to this (Agale, 2013). Further risk factors for developing leg ulcers include immobility, advancing age, a history of varicose veins or deep vein thrombosis (DVT) and having a sedentary lifestyle (Scottish Intercollegiate Guidelines Network [SIGN], 2010; Lim et al, 2018). The challenge of caring for these chronic wounds often falls to staff in primary care. Therefore, they should have a good understanding of leg ulcers and how best to treat them. In the author’s opinion, Leg Clubs® provide an ideal opportunity to manage lower limb wounds, while also tackling the wider holistic issues of leg ulcers, such as social isolation and loneliness.

Prescribing by a variety of professionals continues its progression in response to the growing demands for health care. Prescribing by nurses was initiated in the 1990s and supported by the National Prescribing Centre’s ‘prescribing pyramid’ or seven steps or
principles for good prescribing (NPC, 1999). This article explores a new prescribing consultation model (RAPID-CASE), which is composed of elements from the prescribing pyramid and the Competency Framework for all prescribers (Royal Pharmaceutical
Society [RPS], 2021). The RAPID-CASE consultation model is applied to a clinical scenario to illustrate how it can guide a systematic approach to decision-making, using the example of a lower limb skin tear injury.

Respiratory syncytial virus (RSV) is an acute respiratory viral infection and is the main cause of acute lower respiratory tract infection during the first year of life (Lozano et al, 2012; Nasreen et al, 2014). It usually causes a mild, self-limiting respiratory infection in adults and children, but it can be severe and cause bronchiolitis in infants. There was a reduction in RSV during the Covid-19 pandemic, but figures appear to be rising again (Agha and Avner, 2021; van Summerten et al, 2021). This literature review considers assessment, diagnosis and treatment options for RSV.

Breathing is a normal vital function which is spontaneous, regular, self-regulating, quiet and effortless and reflects the way the respiratory system functions. The function of the respiratory system is to maintain the exchange of oxygen and carbon dioxide in the
lungs and tissues and regulate the acid-base balance. Any changes in this system will affect, and may present in the form of symptoms or signs in, other body systems. Breathlessness is a common symptom in people with cardiac diseases, respiratory diseases, neuromuscular disease, anaemia, significant gastro-oesophageal
reflux and can also be caused by pain, anxiety, emotion, deconditioning and obesity. Thorough, careful and systematic history-taking and assessment may help to identify the potential cause(s), with key question to identify whether the breathlessness is
acute (sudden onset) or chronic (long-standing).

Deconditioning is a term used to describe the physical decline a person might experience following a period of inactivity. It has long been recognised, but has previously been associated with prolonged periods of immobility or hospitalisation resulting from injury or illness. As we come out of the Covid-19 pandemic and the associated periods of lockdown and shielding the more vulnerable, there is evidence that some of the population are suffering the effects of deconditioning. It is apparent that this may be with or without coexisting medical conditions and needs to be considered as an additional or stand-alone diagnosis where symptoms exist, or where worsening of an underlying medical condition could be as a result of deconditioning. This article considers the causes and effects of deconditioning, its impact on physical and mental health, and how we can approach reconditioning programmes through health and society.

The Covid-19 pandemic prompted changes in the ways that individuals access healthcare services and accelerated the transition to digital methods of care. For some, this opened doors for easier and more convenient access. For people already experiencing exclusion and marginalisation however, digital access can create additional barriers for accessing health care.