Infection prevention is particularly important within community settings, as many of the people cared for in these environments — specifically elderly or vulnerable patients — are more at risk from infection.
Over the years, there has been a plethora of evidence-based literature on effective and ineffective wound management practices; however, some healthcare professionals continue to manage wounds using outmoded or ritualistic practices. The key areas are: frequency of dressing changes; maintenance of a moist environment to aid healing; when wounds should be cleansed; and which cleaning solutions to use. This article presents the evidence base in these key four areas and aims to dispel some of the myths and misconceptions to ensure that healthcare professionals can be confident that they are delivering upto- date, evidence-based wound care in accordance with the Code of Conduct (Nursing and Midwifery Council [NMC], 2015).
Skin changes due to aging are important to distinguish from those that are due to solar/sun damage. Knowledge of the common changes in the skin as it ages will help clinicians diagnose and manage any skin abnormalities identified in elderly skin while assessing other conditions. Before exploring such skin changes, however, it is important to understand how the sun affects the skin, causing changes that are observed as solar damage. This article highlights skin changes due to aging and solar damage and what actions need to be taken, if any, to manage them appropriately.
On primary infection, the varicella zoster virus is responsible for the development of chickenpox, after which the virus becomes dormant. Upon reactivation of the latent virus, shingles results. The incidence and severity of shingles increases with age, and is associated with significant morbidity and mortality. Early intervention with antiviral medications is crucial to help resolve the rash and reduce any potential complications induced by the virus.
Smoking has a significant negative effect on patients’ health status. The Department of Health (DH) recently announced a Tobacco Control Plan, which sets out the government’s strategy for reducing smoking rates and increasing patients’ access to smoking cessation services. This article examines the main points of the Tobacco Control Plan, as well as detailing how community nurses can use the plan to improve their own interactions with patients who smoke, as well as designing effective smoking cessation services.
Malnutrition continues to be a problem, which is estimated to cost £13 billion per annum (British Association of Parenteral and Enteral Nutrition [BAPEN], 2010). The majority of those at risk of malnutrition are living in the community. When resources are limited, it is important to identify who is most at risk so that they can receive appropriate support. This article explains the malnutrition carousel, where malnutrition leads to poor health that then further increases the risk of malnutrition. It discusses the need for balanced diets to help maintain an adequate nutritional state, highlighting which disease states are likely to cause further problems — in particular, those with swallowing problems where texture-modified diets are required. Suggested solutions are also provided to help treat suspected poor nutritional intake.
A move towards integrated health and social care provision has been a key policy driver in the UK since 2010, underpinned by a belief that this is essential to provide holistic, person-centred care while transforming service provision. Progress towards achieving integrated care has been slow, and now Brexit poses a further challenge, as attention is focused on preparations for a ‘no-deal’ scenario. Ensuring that the NHS and social care systems are able to continue to function after March 2019 is now a key concern for those leading and managing frontline services, and measures are being put in place to deal with potential disruptions caused by a no-deal Brexit. This includes dealing with issues related to the recruitment and retention of European economic area (EEA) staff into the NHS, disruptions in the supply of medicines across European Union (EU) borders, challenges to the recognition of professional qualifications and patient safety, and health protection and health security within the UK post-Brexit. The imperative to prepare for a worse-case scenario diverts attention away from other key policy drivers, such as integrated care provision. It may also serve to reinforce a view of integration as a cost-cutting exercise, rather than as an approach to promote better care for patients. A move towards the transformation of care through integrated provision offers real potential for improved patient outcomes in the future, and a revitalised health service. However, Brexit has the potential to disrupt the integration agenda as financial resources and staff time become focused on dealing with the fall-out from Brexit, rather than on frontline patient care. Community and practice-based nurses and staff are in the frontline of integrated service provision, and in the next few months may be some of the first staff to witness the negative impact of Brexit preparations on the provision of integrated care.
Here, Professor Ann Hemingway, Public Health and Wellbeing, Faculty of Health and Social Sciences, Bournemouth University and Joanne Bosanquet, Deputy Chief Nurse, Public Health England and Visiting Professor, University of Surrey, explain how nurses must be prepared for their roles as advocates and seek to have influence over local policies which impact on health and the design of healthcare services.
I have worked in and out of community nursing since qualifying as an adult nurse 12 years ago. Although I have worked alongside a diverse range of community services, including district nursing, specialist long-term condition services and rapid response, the last six years have seen my main focus in community intravenous (IV) therapy. More recently, I have been working within the Blackpool, Fylde and Wyre community IV service, where I have worked with an excellent team of eight registered nurses and one healthcare assistant to recreate what is now an established nurse-led IV service, where we are able to provide a wide range of IV therapies to the local population, without the need for hospital attendance.
