Resources

In each issue we investigate a hot topic currently affecting you and your community practice.

A chronic leg ulcer is defined as a defect in the skin below the knee that has persisted for more than two weeks and shows no sign of healing after three or more months (NHS, 2019). Lower limb and leg ulcer management presents a number of global health challenges in terms of nursing resources, wound care dressings and high recurrence rates. Also, the persistence and recurrence of lower limb conditions can lead to physical and emotional distress for individuals and their families, contributing to depression, lack of esteem, self-neglect, social isolation and loss of income.

The nutritional consequences of Covid-19 are not yet fully understood, but knowledge from acute respiratory distress syndrome (ARDS) suggests that patients are likely to experience skeletal muscle dysfunction, which can persist for weeks to years (Files et al, 2015) and impede return to pre-illness status. Many of the signs and symptoms noted to frequently persist after acute Covid infection, such as breathlessness, fatigue, loss of smell and taste and inflammation, can impact oral intake and potentially worsen nutritional status (Arnold et al, 2020; Carfi et al, 2020; Doykov et al, 2020; Mandal et al, 2020; Sudre et al, 2020).

The last 12 months have highlighted the vital contribution that nurses have made in treating and caring for patients across the globe during the Covid-19 pandemic. At the same time, clinical research has been placed in the spotlight, as breakthroughs in treatments for, and protection against, Covid-19 have only been made possible due to pioneering and innovative clinical research trials. This dual focus on nurses and clinical research creates a real opportunity to highlight the research that nurses are undertaking within their own areas of clinical practice to raise the profile of research within the nursing profession.

Prolonged or continuous exposure to moisture can disrupt the skin’s barrier properties and is known as moisture-associated skin damage (MASD) (Young, 2017). It can cause pain and discomfort to patients and significantly reduce their quality of life (Young, 2017). There are four distinct conditions that fall under the umbrella of MASD: incontinence-associated dermatitis (IAD), periwound and peristomal moistureassociated dermatitis and intertriginous dermatitis (Parnham et al, 2020).

This JCN clinical skills series looks at different aspects of continence care in the community, with useful tips on patient care and improving practice.

The second part of the JCN continence clinical skills series looks at the requirements to undertake a basic continence assessment for bladder and/or bowel dysfunction. Assessment is the first step in identifying the type of continence issue an individual may suffer from. It should identify, for example, key elements of underlying medical history, presenting symptoms and duration of problem, medications, allergies, mobility and cognitive ability. This assessment should be supported by investigations, e.g. bladder and/or bowel diary, fluid/dietary intake, urinalysis, assessment of any post-void residual urine and pelvic floor/rectal examinations (if competent in skill).

Awareness of the incidence of chronic oedema in the UK, and the consequences of inadequate management has grown over the last 10 years. Moffatt et al (2019) identified that over 50% of patients cared for by community nurses had an element of chronic oedema. A failure to identify and manage chronic oedema can result in the disease progressing to more advanced stages, which are more costly for patients and healthcare services to manage (Wound Care People, 2019). This article tells the story of Anne and her journey with chronic oedema. Her story exposes many inadequacies ranging from prevention to diagnosis, management, and prevention of harm. These culminated in a hospital admission and lengthy rehabilitation calculated to have cost in the region of £35,000. The use of an evidence-based care pathway is advocated and the potential impact which its use might have had for Anne at a number stages in her journey are explored. The combination of Anne’s story, and the financial analysis of the outcome and other potential outcomes had a care pathway been followed, make a powerful argument for change.

Surgical site infections (SSIs) are of serious concern for clinicians, patients and healthcare institutions worldwide. This study evaluated a new wound management pathway using Leukomed® Sorbact® (Essity) post-operative wound dressings in women with raised body mass index (BMI) undergoing lower uterine segment caesarean section (LUSCS) in the NHS Wrightington Wigan and Leigh Foundation Trust. Previous practice indicated use of a standard postoperative dressing for women with a BMI <35 and PICO™ single-use negative pressure wound therapy (NPWT) dressing for women with a BMI >35, following surgery. The new wound management pathway indicated that Leukomed Sorbact was suitable for women with a BMI ≥30–<50, gestational diabetes mellitus (GDM) or previous caesarean section with complications; NPWT dressings continued to be used for women with BMI ≥50, type 1 diabetes, previous numerous caesarean sections or at high risk of infection. Questionnaires were devised and disseminated for clinician and patient groups in relation to dressing use and patient satisfaction with the dressing.

Projections suggest that in 50 years’ time there will be an additional 8.6 million people over 65 years old in the UK. As a consequence, England will see an increase in older people who have higher levels of dependency, dementia, and comorbidity. People living with dementia are likely to have on average, an additional 4.6 chronic conditions. However, the true extent of comorbidities experienced by people with dementia may be unreported and underdiagnosed as a result of their difficulties in communicating their symptoms or in others failing to observe them. There is evidence to suggest that people with dementia are less likely to access effective treatment and monitoring of their comorbid conditions compared to people without dementia who have the same comorbid conditions. This impacts negatively on their health and wellbeing. This second paper of the series relating to dementia considers some of the complications that may arise when trying to support people with dementia and comorbid conditions, and how this impacts upon the two families introduced in the first paper.