Resources

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.

Here, Samantha Dorney-Smith, homeless health programme lead, Queen’s Nursing Institute (QNI); nursing fellow, Pathway; outreach nurse, Doctors of the World; secretary, London Network of Nurses and Midwives Homelessness Groups, looks at inclusion health, the groups and numbers involved, morbidity within those groups and the lack of access to services. She also explores the impact that the pandemic has had on health inequalities and introduces some nurse-led interventions which have enabled better access to services during Covid-19.