Resources

This month we have an extremely interesting and thought provoking 'Community matters' piece. Please take some of your precious time to read and digest.

It’s a famous maxim that the definition of insanity is repeating the same action over and over while expecting a different result.

Reluctant as we are at JCN to accuse the government of succumbing to collective madness, it is hard to reconcile the deluge of policy documents stating that care needs to be moved away from hospitals and into the community, with the fact that primary care services still appear woefully underfunded. While health ministers talk endlessly about prevention and health promotion, community and district nurses leave in their droves through burn-out and lack of opportunity, and patients with complex needs continue to take up acute beds, leaving hospitals oversubscribed with chronically ill patients who can’t be discharged.

Last November, the Nature Food journal published an article stating that life expectancy in the UK can be increased by up to 10 years by sustained adherence to a healthier diet (Fadnes et al, 2023). This immediately caught the author’s attention. If we all are clear that healthy foods are the cornerstone of having longer, healthier and more dignified lives, why is the government not prioritising making healthy food accessible to people?

The Queen’s Nursing Institute (QNI) is rebranding its leadership programme for experienced nurses working in the community, primary care and social care.

The Ambition to Lead Programme (formerly known as Aspiring Nurse Leaders programme) is also open to allied health professionals (AHPs), as well as nurses working in the community with a minimum of five years of experience.

After decades as the Cinderella service, rehabilitation is now increasingly talked about in the same breath as medicine and surgery. The Community Rehabilitation Alliance (CRA), which the Chartered Society of Physiotherapy (CSP) convenes and co-chairs, has used the power of more than 60 health interest groups to bring about this change and set the scene for future transformation. Here, Tamsin Starr showcases its achievements and future plans.

When caring for people with venous leg ulceration, exudate management is commonly seen as one of the main challenges for clinicians. However, unfortunately, the reason for this wound-related symptom is often not identified or fully understood and therefore the clinical interventions necessary to address the problem are not implemented (Tickle, 2016). This results in people living with wounds that are failing to heal and producing a volume of exudate that has a significant impact on their quality of life (Cunha et al, 2017). Commonly, the words ‘leaky legs’ or ‘wet legs’ are documented in patient notes as the presenting problem — this is not a clinical diagnosis; it is a symptom of an underlying condition which more than likely is venous disease. Unless this is recognised and treated correctly, those ‘leaky legs’ will continue to be a problem and potentially could have a devastating impact on the patient. It is therefore important to have a good understanding of venous disease as well as the role that exudate plays in wound healing, from initial wounding, through the stages of healing, and when (and why) it becomes a problem.

Selection of the most appropriate wound dressing is vital for promoting effective wound healing. With the vast number of options of wound dressings currently available, healthcare professionals may find it confusing to select the most appropriate dressing (World Union of Wound Healing Societies [WUWHS], 2020a). This article discusses the importance of wound assessment, focusing on identifying goals of treatment and the selection of an appropriate dressing to manage any identified barriers to healing. In turn, this will help community nurses provide person-centred care that promotes healing and improves overall patient wellbeing.

Lymphoedema is a long-term condition which is incurable at the present time. Due to the nature of the condition, being both long-term and manifesting in physical changes (swelling), its impact on the person and their lives can be hard to quantify. Management options need to be considered within a person-centred approach, with the four cornerstones of treatment being skin care, exercise, compression therapy and manual lymphatic drainage (MLD). Evidence for each is varied and practitioners need to determine their therapeutic benefit. Beyond the cornerstones of treatment, future developments are ongoing within the areas of surgery, such as venous anastomosis and pharmacological interventions, which may reduce the effects of continual inflammation. In the future, these developments may become part of the care delivered to those affected by lymphoedema. However currently, skin care, exercise, and compression therapy remain fundamental, with MLD included if therapeutically indicated, as well as educating and empowering those involved in selfmanagement with the support of practitioners.

The almost quarter of a million people living in the UK with a stoma are likely to encounter damage to the skin around their stoma. Community nurses are well placed to assist in skin assessment and planning of interventions to improve skin integrity if damage does occur. As part of that skin assessment process, it is important to understand the terminology used to identify issues being observed as well as the potential causes. Although general wound healing is similar across different areas of the body, wound healing products used on peristomal skin need to be considered in terms of how they might adversely affect adhesion of the stoma appliance. Sometimes simple changes to diet or skin care routine, which community nurses can suggest, is enough to improve the peristomal skin condition.