Resources

The Covid-19 pandemic has put the UK health and care workforce under unprecedented pressure. For nurses, the pandemic has highlighted and exacerbated many issues that predated the pandemic, including inequalities, inadequate working conditions and chronically excessive workloads. The recent King’s Fund report, The Courage of Compassion: Supporting nurses and midwives to deliver highquality care, investigated the key changes to working environments of nursing and midwifery staff needed to enable them to flourish and thrive at work (West et al, 2020). This piece draws out some of the key findings from the research and asks what needs to be done to better support nursing staff working in the community, now and into the future.

In 2020, the Queen’s Nursing Institute (QNI) was funded by NHS England and NHS Improvement (NHSE/I) to create a resource to support nurses working in the community who are caring for people in recovery after being infected with Covid-19 — Living with Covid-19 (Long Covid) and Beyond (www.qni.org.uk/wp-content/ uploads/2020/12/Living-with-Covid- 19-Community-and-Primary-Care- Nursing-Resource.pdf).

As the number of people over the age of 65 years increases, so will the number of people with age-related neurological conditions, such as dementia. It is predicted that by 2040, this figure will rise to over one and a half million people in the UK (Arvanitakis et al, 2019). In clinical practice, before the dementia strategy was launched, it was not uncommon to see a case presented to a ‘fast track’ continuing healthcare funding panel, an urgent funding request for end-of-life care, of a person in the advanced stages of an undiagnosed dementia. This meant that their needs for care and support, as well as those of their family members, had been unrecognised and unmet throughout their condition. Timely diagnosis of dementia can lead to several benefits, including access to a pathway of care and a network of services.

With the mass Covid-19 vaccination roll-out beginning in earnest, JCN talks to Simon Browes about the challenges facing his vaccination programme team.

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

Continence is not a life-threatening condition, but does affect patient quality of life. The first part in this new continence clinical skills series explores continence issues and how to improve patient care. It looks at the prevalence of the condition, different types of continence issues, how they can affect quality of life and the complications that can occur when poorly managed.

Lower limb haematomas caused by trauma are debilitating wounds for the elderly who are most at risk. Prompt action needs to be taken to stop the bleeding and reduce the extent of tissue damage and skin loss. Literature on the management of lower leg haematoma is sparse compared to the management of skin tears, and there may be debate regarding surgical versus conservative approach. Many patients are not suitable for surgery due to underlying comorbidities, frailty and anaesthetic risk. Conservative management should support early evacuation of the haematoma and application of compression bandaging, avoiding lengthy hospital stays and enabling patients to be managed in the community setting.

Increasing pressures experienced within community nursing are having detrimental effects on the care and treatment provided to patients. Among these is the management of venous leg ulcers, where a culture of passivity has possibly developed, resulting in significant delays in measuring patients’ ankle brachial pressure index (ABPI) and reduction in the use of full, therapeutic compression therapy. As pressures increase, so does the financial burden on the NHS and associated psychosocial impact often experienced by patients living with lower limb ulcers. Urgent reform of leg ulcer services is required to better manage these conditions and improve the quality of care received by patients. This article provides evidence from examples of successful service transformation, and puts forward recommendations for future practice.

Dementia is an umbrella term used to describe a group of symptoms characterised by behavioural changes, loss of cognitive and social functioning brought about by progressive neurological disorders. There are estimated to be 850,000 people living with dementia in the UK and estimates indicate that this will increase to one million people by 2025 and two million by 2051. Left undiagnosed, dementia can have an insidious and devastating impact on the outcomes for patients and their families. However, we know more about its causes and some of the factors that may increase a person’s risk of developing the condition. This paper is the first in a series relating to dementia that will follow two families through their progression with dementia and considers the recognition and initial cognitive tests that can be used in a primary care setting. Each of the papers in the series will build upon our understanding of both families, as they face different issues and scenarios over the life course of the dementia.

Increased rates of non-attendance/did not attend (DNA) to healthcare appointments remain a problem in the National Health Service in terms of increased costs and wasted clinician time (Stone et al, 1999; Murdock et al, 2002; Milne et al, 2006; Sims et al, 2012; National Health Service, 2019). As resources become increasingly limited, this needs to be tackled. One of the main reasons for missed appointments is forgetfulness (Kilaspy et al, 2000; Neal et al, 2005). This evaluation assessed the effect of an inexpensive short message service (SMS) reminder programme on 76 patients who attended 496 depot clinic appointments in a community mental health team (CMHT). As a result, the average DNA reduced from between 5% and 12%. Attendance was also found to be correlated with frequency of depot administration. SMS reminders could provide an inexpensive way of achieving reductions in DNA at CMHT depot clinics, but further research with a larger and randomised sample size is indicated.

This article gives a brief overview of blood disorders affecting older adults. The conditions covered within the article vary widely in their symptoms and presentation, their severity and impact on the affected person’s quality of life. Treatment options and prognosis are also very different for each condition covered, depending on the disease the patient has. Some patients are able to live a normal life once treatment has started, while for others their disease carries a far less positive outcome and a poorer prognosis. This article hopes to improve knowledge and understanding of the conditions discussed with the aim of giving community nurses and non-medical prescribers more confidence when advising patients with any of the diseases discussed.