Breathlessness causes emotional and physical distress and social isolation for both patients and their families. Refractory breathlessness, i.e. that which persists even when measures to optimise the underlying condition have been implemented, is one of the most distressing symptoms experienced by patients with advanced life-limiting illnesses. This two-part series describes the experience of refractory breathlessness in patients with advanced disease living in the community, and provides guidance for their care. This, the first part in the series, outlines the experience of breathlessness and how community nurses can accurately assess patients. The second part of this series (available in the next issue of Journal of Community Nursing) will outline management techniques.
Pain is experienced by many patients in primary and secondary care and the assessment of pain is a fundamental aspect of nursing. Community nurses need to possess a strong knowledge base to inform and advise their patients, this in turn enables them to help and empower their patients to effectively control pain with minimal side-effects. This two-part series on pain provides an update on the assessment and management of acute and chronic non-malignant pain. This first part of the series examines how community nurses can recognise and categorise pain and start to draw up a plan of care for the patient. The second part in this series will deal with the management of pain.
Chronic obstructive pulmonary disease (COPD) is a serious, long-term and irreversible disease, which obstructs airflow to the lungs due to inflammation of the air passages and lung tissue damage. The most debilitating and frightening symptom is breathlessness, which can affect an individual's ability to walk, exercise, work, socialise, sleep and eat, thus having a major impact on all activities of daily living. This article aims to provide an overview of COPD to facilitate a general understanding of the disease, assist community nurses with early identification for prompt
detection and highlight the pathways and management options available. Due to its complexity, COPD can be challenging for both patients and healthcare professionals, thus the earlier it is diagnosed and management plans started, the sooner its progression can be slowed and any impact reduced.
This article examines malnutrition, a complex issue that has wideranging implications in terms of patient experience and resources - evidence suggests that malnourished people are repeat attendees at GP surgeries, incur higher prescription costs and experience twice as many hospital admissions than well-nourished people. While there have been many hospital initiatives targeted at reducing the risks of malnutrition, in the community the solution remains challenging. Recommendations include arranging services so that health and social care professionals can work together to overcome nutrition issues, making extra resources available to combat malnutrition and improving the monitoring of patients' nutritional state. As healthcare shifts to a more community-based model, there needs to be a reallocation of resources from hospitals to community to ensure that efforts to tackle malnutrition have a more realistic chance of success.
In patients with venous and lymphovenous disease, skin changes to the lower limb(s) occur gradually, and become more serious over time if left untreated. The CHRonic Oedema Signs and Symptoms (CHROSS) Checker is a tool kit consisting of an assessment chart and key cards that have been developed to help clinicians easily identify the skin changes that occur as a result of underlying venous and lymphovenous disease, when carrying out holistic patient assessment. It also provides clear guidance on which compression products can be used to manage the disease type and severity of skin change. For clinicians unfamiliar with some or all of the signs and symptoms listed on the CHROSS Checker chart, the key cards contain further information in the form of a photograph, definition and cause of each sign and symptom listed. This article will describe the theory behind the development of the CHROSS Checker tools and explain how to use them in clinical practice.
Janice Bianchi, Independent Medical Education Specialist and Honorary Lecturer, Glasgow University
Chronic obstructive pulmonary disease (COPD) is the term given to progressive airflow obstructive conditions, namely emphysema and chronic bronchitis. The disease is not reversible, but its progression can be slowed with the correct treatment and management. Within our organisation, we realised that if district nursing teams worked inter-professionally, exacerbations of COPD could be reduced simply by assessment of inhaler technique whilst making home visits. This article, a previous entry to the JCN Writing Awards, presents the a review of the literature undertaken prior to changing practice.
Annette Bades, BSc (Hons) Adult Nursing, District Nursing Sister, Lancashire Care NHS Trust
Louise Brereton, Pauline Barber & Brenda King discuss the adequacy of educational provision for nurses involved in managing patients with leg ulcers.
Rosemary Pudner considers the issues involved when managing a patient with a leg ulcer.
Michael Hughes defines incontinence and discusses its prevalence and service provision.
