The government's policy of moving care closer to home means that not only will community nurses continue to see patients with chronic wounds such as leg ulcers, pressure ulcers and diabetic foot ulcers, they may also start to see an increase in the numbers of patients who have been discharged from hospital with surgical wounds, who might previously have stayed in secondary care for a longer period. It is imperative that community nurses tasked with visiting a range of patients in their own homes have an understanding of the fundamentals of wound development and management to provide basic evidence-based wound care. This article looks at some of those fundamentals, including debridement, dressing application and removal, wound cleansing, infection, and the effects of comorbidities on the wound.
Venous and lymphatic disease both result in skin changes to the lower limb. These range from early disease signs such as mild oedema and dry skin, to varicose veins, leg ulceration and chronic oedema in the later stages. Patients at all stages of disease progression are commonly encountered in the community and compression hosiery plays a key role in the prevention and management of skin changes.
For community nurses faced with expanding case-loads and patients who are now being discharged earlier into the community, the sheer range of conditions they come across means that cost-effective and practical, clinically-effective solutions are at a premium. This is particularly true in wound care, where nurses in the community need products that can be used on a variety of wound types that are also cost-effective. This article looks at the range of wound care knowledge needed by generalist nurses, before focusing on one dressing in particular, Silflex® (Advancis Medical, Nottinghamshire). With its all-round versatility, Silflex provides a balance of usability and cost-effectiveness.
Chronic wounds have many psychosocial consequences, including stress, negative mood, pain, and social isolation. In addition to these, frequent dressing changes can cause the individual anxiety and stress. This article explores how wound management can influence both psychological outcomes and, potentially, the rate of healing. Implications for practice are identified, which need to be successfully employed to ensure that patient health is maximised and that the stress and pain associated with wound care are minimised in order that wound healing is improved.
In chronic wound management the potential for healing increases following effective debridement. Indeed, it has been suggested that debridement’s effect on chronic wound healing is similar in impact to the relief of pressure in preventing pressure ulceration. Debridement can be performed using a number of methods, but larval debridement has recognised benefits, including the breakdown of necrotic tissue; removal of microbes; wound cleansing; and breakdown of biofilm. The reduction of malodour in the wound can also help increase patients’ self-esteem and overall wellbeing. This article looks at the use of larval therapy in a community setting, which can be particularly cost-effective as rapid debridement swiftly reduces the bacterial load, helping to lessen the potential for hospital admission.
Economic studies of leg ulcer management strategies have mainly concentrated on different compression, dressing and pharmaceutical products rather than different modes of delivery or systems of care.
Leg ulcer management in the community presents a number of challenges. This paper discusses the challenges and rationale of introducing a new service delivery for leg ulcer management based on patient empowerment, health promotion and education, and its implication for clinical practice. It focuses on an initiative that provides a patient-centred resource for the prevention, treatment and management of leg ulcers and associated conditions.
Ellie Lindsay BSc (Hons) RN, DN, CPT, DipHE, Independent Specialist Practitioner. Visiting Fellow, Queensland University of Technology.
Article accepted for publication: October 2012
Clinicians often find it difficult to devote sufficient time to develop proposals that will investigate issues that enhance the patient experience. Thus, clinicians need to access researchers and academics who can assist in developing research proposals, undertake service evaluation, audit current practice, provide advice on best practice and offer education that maintains clinical knowledge and skills.
The University of Huddersfield recognised the challenges faced by clinicians in undertaking research in the specialist area of skin, and in 2011 formed the Skin Interface Sciences (SIS) Research Group. This article outlines its development and achievements to date.
Karen Ousey, Reader, PhD, RGN, School of Human and Health Sciences, Centre for Health and Social Care Research, University of Huddersfield, West Yorkshire. E-Mail: k.j.ousey@hud.ac.uk
Ross Atkinson, PhD, Spinal Research, Coordinator – Greater Manchester, Neurosciences Centre & Honorary Research Associate – The University of Manchester, Manchester Academic Health Science Centre, Salford Royal NHS Foundation Trust, Salford
Leigh Fleming, PhD, Senior Research Fellow, School of Computing and Engineering, University of Huddersfield, West Yorkshire
Barbara Conway, PhD, Professor, School of Applied Sciences, University of Huddersfield, West Yorkshire
Skin Interface Sciences Research Group, University of Huddersfield: sisgroup@hud.ac.uk
Article accepted for publication: December 2012
Objective: In Slovenia, community nurses usually use tap water as a cleanser for chronic wounds, but is this the best practice? The purpose of this review is to establish if there is any difference in healing and infection rates when wounds are cleaned with tap water instead of sterile saline.
Method: An electronic literature search using the key words chronic wounds, wound cleansing, tap water and saline was undertaken.
Results: Results showed that there was no increase in infection or in wound healing rates between patients whose wounds were cleaned with tap water or sterile saline. Tap water may be as safe and effective as sterile saline but only when the water comes from the properly treated supply and used at body temperature.
Conclusion: Some evidence suggests that the use of tap water of drinkable quality appears to be a safe alternative to sterile saline, and that there are numerous benefits in its use.
Acknowledgements:
This contribution is part of Master’s Degree undertaken at College of Health Care, Izola. The author is grateful for the support and assistance of Professor Dame June Clark, Swansea University.
Andreja Ljubič RN, University of Primorska, Faculty of Health Sciences Izola, Slovenia and Health Center Postojna, Postojna, Slovenia.
Article accepted for publication: January 2012
Throughout history, it has been observed that wounds tended to heal more quickly with fewer complications when larvae found their way onto open wounds. Larval therapy (LT) is used for the debridement of chronic wounds and to create a wound bed conductive to effective healing. The aim of this article is to discuss the effectiveness of larval therapy for the debridement of chronic wounds through a critical analysis of the relevant literature.
Laura Wood, BA (Nursing). Previously Staff Nurse, AMU, Heartlands Hospital, Birmingham
Mark Hughes RGN, DN, HV, BSc (Hons), MSc, PGCE, Lecturer, University of Birmingham
Article accepted for publication: December 2012
Venous leg ulcers are a common problem in the community, with which nurses should be familiar if they are to combat the pain, social isolation and depression that accompany this debilitating condition.
It is important that community nurses know how to assess, diagnose and treat leg ulcers, as well as being familiar with the different types of compression available.
If community nurses apply the information contained in this article, as well as completing the associated online test, they will be better equipped to provide evidence-based care and advice for patients living with venous leg ulceration.
