The second in this four-part series exploring leg ulcer management and understanding compression therapy examines the role of assessment as the basis for optimal clinical practice. The authors explore how the findings of thorough assessment can influence treatment choice. Adopting an holistic, person-centred approach to assessment, which includes taking an ankle brachial pressure index (ABPI) reading and involves the patient in decision-making will help nurses to make effective clinical decisions and plan care in partnership with patients. This article discusses a three-stage assessment and clinical decision-making process, which involves looking at the whole person, assessing the leg and the wound. The next article in the series will examine compression hosiery and adjustable wraps for the management of the lower limb.
Compression hosiery is the mainstay of maintenance therapy to prevent recurrence of symptoms for those with venous and lymphatic disorders. Choosing the right type of hosiery is essential to ensure that the garment meets the patient’s needs and to facilitate concordance. Resources such as the CHROSS checker tool can be valuable in the selection process. Adore® (L&R) is a European Class range of compression hosiery which is suitable for those with oedema and mild–moderate symptoms of venous disease. It was evaluated in University Hospital of North Midlands NHS Trust, yielding positive outcomes for all patients. It is effective in containing chronic oedema and, due to its sheen, will potentially facilitate concordance for those wishing to wear a more attractive garment.
Necrotising fasciitis (NF) is a rare, life-threatening condition (Laube and Farrell, 2002). It is otherwise frequently known as ‘the flesh-eating disease’, hospital gangrene and necrotising erysipelas (Tsitsilonis et al, 2013). Challenging to recognise and rapidly progressing, NF is associated with high mortality and morbidity and therefore requires aggressive treatment as soon as possible. Inconsistent signs and symptoms cause NF to easily be misdiagnosed. Healthcare professionals in primary care and the community are frequently the first contact the patient has with health services in the early stages of NF. As such, a focus on raising awareness of this condition, a culture shift to accept it as the medical emergency that it is, and a high degree of suspicion are all required to improve and maintain patient safety.
There are a variety of reasons as to why a patient may require an indwelling catheter, however, these are seldom documented or communicated across healthcare services (Codd, 2013). Thus, short term catheters are at risk of becoming long-term catheters in the absence of clear documentation and forward planning. The risk of infection increases the longer a urinary catheter remains in situ. This article explores the guidance available to support appropriate urinary catheter use, catheter management, documentation, forward planning and patient education for effective catheter care. How this can be implemented to support appropriate removal of urinary catheters or ongoing care for long-term urinary catheter use for patients across the primary and secondary care services is also discussed.
The mouth is the ‘gateway’ to the body; it is central and pivitol to how we eat, communicate, laugh, cry and love. Thus, it deserves to be cared for, nurtured and respected like other areas of the body. If asked if mouth care is important to patients’ health and quality of life, the majority of healthcare professionals in any care setting will answer ‘yes’. Why is it then that the mouth or oral cavity is often neglected? This article explores different oral conditions that can develop in patients at the end of life, and the impact that they can have on their quality of life, and why oral care gets ‘missed’ and how this can be changed.
Caring for those who are dying and in the last days of life is a common aspect of caring for people in the community. While caseloads are time-pressured, stretched nurses can do a great deal to reduce any suffering at the end of life by providing optimal assessment and care. An important feature is that nurses first need to be able to identify when death is likely. They need sensitivity and to be able to build a therapeutic relationship with the patient and those significant to them. Nurses play a key role in providing and coordinating quality care and comfort, for which good communication skills are essential. Assessment and interventions to manage pain and symptoms, as well as helping to prepare patients and their families for death, are important. Community nurses can also direct family members to relevant resources and specialists, including those for bereavement.
Lipoedema is a challenging condition for patients, health and social care professionals. Lack of understanding about the condition leads to delayed diagnosis and poor support with self-management. This paper draws on key evidence, best practice guidelines for the management of lipoedema, and a patient story, to provide insights into the presentation, diagnosis, impact and management of the condition. It also identifies key points for practice for community nurses.
Here, Sharon Holroyd, lead CNS, Calderdale Bladder and Bowel Service; chairperson, Yorkshire ACA, defines stress urinary incontinence and the treatment options available, and reviews the evidence to support pelvic floor exercises as an effective rehabilitation for patients with symptoms of stress urinary incontinence.
In each issue we investigate a hot topic currently affecting you and your community practice. Here, we ask Can Community nurses take on obesity?
