Resources

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.

Working within the community, we are ideally positioned to offer our patients, and everyone we meet, personalised advice in relation to their health and self-management. We can observe them in their home environment and really understand how our patients live on a day-to-day basis. This supports us to empower them to adopt health promotion strategies and make small lifestyles changes. We can empathise with the difficulties they may encounter and support them to adapt their regular routines to really make a difference. This issue’s ‘Community matters’ piece explores making every contact count (MECC) in more detail (pp. 8–12).

We are all aware of how recent lockdowns have led to an increase in reports of domestic violence. As nurses who visit patients in their own homes, we are in a unique position to make that contact count by asking questions to help victims disclose their situation. Do read how Leeds Community Healthcare (LCH) has equipped its staff not only to address issues of domestic abuse and violence with patients, but also to support employees who themselves are in an abusive relationship (pp. 69–71).

Identifying patients who may be malnourished is again something we all need to be on the look out for during routine clinical care, especially as the majority of those affected by malnutrition are living in the community. In this issue, Anne Holdoway and Hilary Franklin (pp. 30–37) take a detailed look at the development of the ‘Managing Malnutrition in the Community’ resources, which can help you to provide the best nutritional care for your patients. We also discuss dysphagia (pp. 38–42), a very real risk factor for malnutrition, with guidance on how to assess and identify those with a swallowing issue so that you can feel confident to help patients have a safe swallow.

As Christmas approaches, and we head towards 2022, we need to congratulate ourselves on all our hard work and achievements during another difficult year. For whatever reasons, this year has seemed more testing than the previous one, so we should be extremely proud of the difference we have made to our patients and the support we have given colleagues. I hope everyone takes some time to reflect and refresh and prepare for the challenges ahead, and please remember, there is a great deal of support available if you need it.

And finally, here at JCN, we would like to wish all our readers a very happy and relaxing Christmas and New Year.

Annette Bades, editor-in-chief, JCN