Resources

As we take time to reflect over the past eighteen months, I am sure that many of us find it difficult to process everything that has happened and all the changes that we have been forced to make. Throughout, we have worked to maintain the safety of our patients and teams and have barely had time to consider our own wellbeing. As we now try to return to some kind of normality, remember to take time for yourself — to renew and refresh. Consider a team night out to socialise and support each other and

have some fun in a different environment. Make plans, share thoughts and look after yourselves and each other. Read our community matters feature (pp. 10–17) — you are not alone.

It is always great to hear about inspiring initiatives in the community which are making a real difference to people lives, such as Gemma Hawtin’s wheelchair skills programme for children,‘Making Stuff Better’, to help them develop independence and participation (pp. 18–19). This piece shows how by working as a team and being open to new ideas, creativity and service improvement can flourish. The work of ERIC, the Children’s Bladder and Bowel Service, also demonstrates this, as despite the challenges of the pandemic, it has diversified to enable the charity not only to survive, but also thrive (pp. 30–31).

The journal again has a variety of clinical articles which cover conditions you face during your day-to-day caseloads. Annemarie Brown takes a thoughtful look at skin damage at the end of life and why some injury is perhaps unavoidable (pp. 36–41). There is also a useful article on catheter valves and how they can help to improve the chances of normal bladder function after removing a catheter (pp. 52–56), while the fourth part in our dementia series explores issues relating to dementia and continence and their impact on patients and families (pp. 58–62).

As always, I hope you enjoy reading this issue. If you have any ideas for articles, please get in touch, as it is always great to hear from our readers. And finally, here at JCN, we are delighted to say that our exhibition and study days are now back on the road. So, why not take a look to see when we are next in your area — www.jcn.co.uk/events/series/roadshow-study-day.

Annette Bades, editor-in-chief, JCN

n each issue of the Journal of Community Nursing, we investigate a topic currently affecting our readers. Here, Kate Upton, representative for Nursing Professions on the Crisis, Disaster and Trauma Psychology Section of the British Psychological Society, looks at "Recognising compassion fatigue and protecting wellbeing".

Since the first patient in the UK was diagnosed with Covid-19 on the 31st January 2020, the last 18 months have been unlike any we have experienced in our lifetime. The impact of the pandemic has been dramatic, turning our lives upside down and changing them beyond recognition — and not least for community nurses, like yourselves.

With the presence of Covid-19, community nurses not only had to deal with pre-existing concerns (many of which have been exasperated by the virus), but also with new challenges and pressures. Having to battle a shared enemy that appears to thrive on hiding in plain sight, many of you will have been thrust into having to operate outside of your comfort zone and in environments where you may have felt a loss of control.You will have experienced a huge shift in the way you carry out your work, having been pushed into being more open- minded and creative in managing workloads, as well as having to rapidly adapt to ever evolving new ways of providing patient care. For some, you may also have been redeployed to roles where you have needed to make use of new or rarely used skills. And, of course, underlying all of this, there is the understandable additional concern of contracting the virus and passing it on to others.

Pressure injuries are sometimes considered to be due to a lack of good nursing care. However, it has been debated as to whether the development of some pressure injuries at the end of life is inevitable. More recently, the term ‘skin failure’, which occurs in dying patients, has been introduced in the wound care literature, and it is proposed that the presence of skin failure may make pressure injury inevitable. This article defines the theories around skin failure and presents the different terminologies used to describe skin damage typically found in the dying patient, such as the Kennedy ulcer and Trombley- Brennan terminal tissue injury (TB-TTI). It also discusses the importance of healthcare professionals being able to recognise that skin changes, which appear to be pressure injuries, are due to skin failure at the end of life and be able to differentiate between these and usual pressure injuries when planning and delivering care for these patients.

Urinary and faecal incontinence are common in the older population, yet incontinence is not a normal part of ageing. Dementia can impact upon a person’s ability to remain continent, yet incontinence is unlikely to be a symptom of dementia until the latter stages of disease progression. There is a misconception that nothing can be done if a person with dementia experiences episodes of incontinence. However, many people with dementia often experience functional incontinence caused by immobility, communication difficulties, disorientation, or the inability to find the toilet, which can all be alleviated if the right support and advice is available. Improving the identification, assessment and management of continence issues can not only enable people with dementia to maintain their dignity and improve their health, but also their sense of wellbeing and quality of life. There is also the possibility to improve relationships, reduce carer burden, and reduce the risk of a premature transition into a residential care setting. This fourth paper in the series explores some of the issues relating to dementia and continence and the impact as experienced by our two case studies, Dhriti Singh and Gregory Brewin.

The author’s trust, Leeds Community Healthcare NHS Trust, has a dynamic methodology around quality and service improvement called ‘Making Stuff Better’. It is a simple phrase, but holds some meaningful principles which the staff aim to follow. 
The first is that everyone can make stuff better at work — we can all have ideas that can result in a positive difference. The second is promoting a culture of service improvement, where this approach can just happen and flourish.

The day we got the announcement from the Care Quality Commission (CQC) confirming our nursing and telehealth service had been awarded ‘outstanding’, I felt so proud. I also thought about all the NHS nurses who are so incredibly tired and hardworking, and I wished they could all be told they too are outstanding. For after the 18 months they have had, they completely deserve it. 
Of course, I already knew that the staff we have and the service we provide is truly outstanding, but having the CQC confirm this, is such a fantastic recognition of the hard work the team at Coloplast put in every single day to make life easier for people living with intimate healthcare needs. Receiving this rating means that Coloplast is the only one in its field to have received an ‘outstanding’ rating for a service like this in England.
Our extensive experience in developing products and services for people with deeply personal medical conditions, which are often associated with trauma and taboo, means that we know it makes sense to be able to deliver care based around a person, removing some of the administrative burden, plus treating them, where possible, in a place of their choice. This administrative burden includes finding information about lifestyle, returning to work, going on holidays, diet and nutrition. We can also arrange for the collection of the GP prescription when needed and signpost to other sources
or support services.
Our CQC accredited service can be trusted to deliver for patients, their families and the NHS.

In the late ‘80s, Soul II Soul released the song ‘Keep on Movin’. At the time, I thought I was invincible. I was European and Commonwealth 400m champion and it became the anthem for my trackside warm-ups. Back then, I didn’t think about my fragility or the fact that I had a congenital heart condition to consider every time I stepped onto the track. I kept on moving. And fast. It all changed when I broke my foot and was on crutches for several months. I would have given anything to get moving again; to compete for Great Britain and challenge for medals on the track against the world’s best athletes. I slowly recovered, began moving again, and after nearly two years, was once again back on the warmup track listening to Soul II Soul and dreaming of Olympic success. 
Roll forward to today; I’m a 55-year-old with two dogs, three children, a busy family life, juggling a portfolio of businesses and living with a far greater respect for my heart condition. I’m still able to relive the glory days of winning World and Olympic medals by speaking at conferences and dinners, which often reminds me that time stands still for nobody. I am now in my sixth decade and managing my health and fitness in the best way I can, with very different goals.