Resources

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.

Here at JCN HQ, we are thrilled to be celebrating the journal’s 50th anniversary. Over this half century, the journal has grown, been redesigned, constantly moved to keep up to date with the ever changing face of community nursing, and continued to provide education to help you in your dayto- day clinical practice and personal development. From starting out as a print journal 50 years ago, we now offer online resources, regional study days, Facebook live events and much more.

After two years of waiting because of the Covid-19 pandemic, TVNs from Wales, and
the UK, and the All Wales Lymphoedema Network are coming together again and
attending the Pride Cymru’s Big Weekend raising awareness in lower limb care.
This event is Wales’s biggest celebration of equality and diversity, over two days
hosting over 50,000 people in the Welsh capital to celebrate the LGBT+ community.
Following on from the massive success and pleasure of TVNs from Wales and the
UK attending Pride Cymru’s Big Weekend in 2019, this year’s #CelebrateYourLegs
is going to be BIGGER and BETTER than ever before. The All Wales Tissue Viability
Nurse Forum, along with the All Wales Lymphoedema Network, TVN2gether
and supported by JCN, Wound Care Today and industry partners, are joining the
parade and attending over the weekend of 27–28th August to champion not only
the important Pride message, but also to raise awareness of lower limb issues to the
LGBT+ community and their allies. Here, we ask Julie Evans, lead tissue viability
nurse at Powys Teaching Health Board, about Pride and the All Wales Tissue Viability
Nurse Forum’s involvement.