Resources

Although it may not attract as much attention as other medical areas, the pandemic has had a huge impact on wound care services with many traditional routes of practice compromised during life in lockdown. But, while this continues to add pressure on the nursing community, it also offers an opportunity to retain the recent step change in innovation to tackle backlogs and build back stronger.

Domestic violence and abuse (DVA) is a real issue for many people. It is also sadly in places in our communities and life spaces. During the pandemic, the evidence seems to say things have got worse (https://commonslibrary. parliament.uk/domestic-abuseand-covid-19-a-year-into-thepandemic/). Indeed, victims were suddenly trapped at home with their abuser, with no options of respite or relief (Chambers et al, 2021).

This clinical series aims to demystify and simplify approaches to assessment and management of chronic oedema in the community, including the promotion of self-care, with the aim of improving efficiency and delivering the best evidence-based care for patients with chronic oedema. Part 1 explains what chronic oedema is, its prevalence, causes and appearance.

Moisture can affect the normal function and permeability of the skin, leaving our bodies susceptible to infection. The damaging effects of moisture-associated skin damage (MASD) impact a wide range of patient groups, however, wounds caused by moisture are often mistaken for and treated as if they are pressure ulcers. Moisture can come into contact with the skin from a number of sources, but damage can be treated in the same way, despite its cause. In the authors’ clinical opinion, if nursing staff are able to identify and treat skin damage correctly according to its aetiology, faster rates of healing, improved quality of life, and fewer resources used on wound care would be seen. This article looks at the identification of seven aetiologies of MASD following an audit, and the subsequent development and implementation of a protocol to improve and standardise skin care in the authors’ trust, which it was hoped would provide a dynamic and unified approach to the management and education of MASD.

A syringe driver is a device used for administering medications subcutaneously to patients in a range of healthcare settings (Dickman and Schneider, 2016). However, this device is most commonly used in palliative and end-of-life care, which this article will focus on. They are small, battery-operated devices allowing portability and discretion, which are placed under the skin (subcutaneously) and typically infuse medication over 24 hours before requiring replenishment (Marie Curie, 2021). Using a syringe driver does not always signify that a person has reached the last days of their life. Instead, they function as a convenient method of administering medication for those patients who are unable to take prescriptions orally. The Scottish Palliative Care Guidelines (2020) explain that their use is valuable for patients who are experiencing bowel obstruction, malabsorption, nausea, vomiting, dysphagia or reduced consciousness, such as that seen towards the end of life.

This article outlines the development of a community tissue viability service over the same five-year-period in which a number of national issues with wound care were identified through research. These included a lack of evidence-based practice, a changing community workforce and an unwarranted variation in care attributed to a lack of education and training among generalist practitioners. The author describes how a proactive approach was taken to local service development to address these issues, and how partnership working with both colleagues and industry enabled improved wound care education delivery and uptake among a generalist community workforce. These measures resulted in a reduced spend on wound care dressings year on year, despite a predicted trend for increasing costs nationally.

As the population continues to age and the incidence of dementia and associated costs increases, there will be a greater need for unpaid care with research suggesting that one in three of us will become a carer for someone with dementia during our lifetime. It is estimated that there are in excess of 700,000 people in the UK acting as primary unpaid carers for people living with dementia, all of whom make a substantial contribution to their care and support. Carers of people living with dementia can experience high levels of carer burden alongside poor health and wellbeing because of their caring roles. However, they may not identify themselves as carers or be recognised as such by health and social care professionals. Consequently, they may not have access to the support they need, thus identifying and valuing unpaid carers is the first step in supporting them. Community nurses are well placed to do this. This sixth paper relating to dementia considers the contribution of unpaid carers in the context of the families of Dhriti Singh and Gregory Brewin, who we have been following throughout this series.

Gastrointestinal disorders cover a wide spectrum of diseases which differ widely in their signs and symptoms, severity, treatment options and long-term prognosis, as well as their impact on the quality of life of those affected. They can affect any part of the gastrointestinal tract and many can occur at any age, although as with other conditions, some are more prevalent in specific age groups. This article focuses on only three of the many diseases which fall into this category to give community nurses and non-medical prescribers a brief insight into their recognition, management and treatment, with the aim of increasing confidence and knowledge of the diseases discussed.

Adult safeguarding is the process of protecting an adult’s right to live in safety, free from abuse and neglect (NHS England, 2017). High profile abuses such as Winterbourne View and Mid Staffordshire, as well as other cases, have raised the awareness of adult safeguarding, which is everybody’s responsibility. In the community setting, it is paramount that nurses from all specialisms know how to recognise, report and record abuse. The Care Act (2014) recognises ten types of adult abuse and within them there are many forms that these can take (Department of Health and Social Care, 2021). Community nurses should be able to recognise such abuse and its effect on the victim, and know how to record their concerns in a clear, robust manner, ensuring that information is shared between agencies, while also respecting confidentiality. This article provides a brief history of adult safeguarding, an overview of the types of abuse, as well as a definition of the vulnerable adult, how to recognise them, and the statutory bodies and legal frameworks to safeguard adults. Each of the four nations of the UK have their own legislation. This article is concerned with safeguarding in England and the Care Act (2014).

I qualified as a nurse in New Zealand, and first worked in the community as an agency nurse in Southwest London in 1992 while doing my OE (overseas experience), and I have been in the primary care sector ever since. I started as a community nurse before becoming a district nurse team leader and then in 1998 a tissue viability nurse (TVN). I’ve continued to work as a wound specialist nurse and am still ‘overseas’, but now in Aarhus, Denmark, where I’ve been the last 15 years. Today, I work in a team of four wound specialist nurses tasked with improving wound management for patients in a variety of community settings.