Creative arts workshops can be a hard sell for NHS trusts and local authorities, as the accepted model of care comes in the form of doctors and pills rather than artists and paint brushes. But, this is a narrative we would like to see abolished.
Urinary incontinence (UI) has been associated with chronic respiratory symptoms, which impact on patient quality of life (da Silva Paes et al, 2016). Chronic respiratory symptoms, such as coughing, wheezing, and dyspnoea, and patients with chronic chest conditions, such as asthma, bronchitis or chronic obstructive pulmonary disease (COPD), are associated with increased occurrence of UI. Women with respiratory symptoms have more severe symptoms and are more likely to have stress urinary leakage than those without. This paper provides an overview of asthma, and highlights the importance of community nurses not only addressing issues associated with respiratory diseases, such as ensuring that there is a personalised asthma action plan (PAAP) in place for those with asthma, but also assessing urinary incontinence to evaluate occurrence and decide upon measures that can be taken to prevent or lessen any leakage
Irritable bowel syndrome (IBS) is a chronic and debilitating condition effecting over 10% of the UK population with a higher preponderance among adult Caucasian females. It places a significant economic burden on the NHS with annual cost projections ranging from £45 to £200 million. Misdiagnosis is common and is reflected in the high prevalence of gastrointestinal-related surgery within this cohort, and it is essential to obtain a detailed case history to ensure correct treatment. National guidelines now recommend diet as the first line approach, with research repeatedly advocating the use of the low FODMAP diet, particularly for those with diarrhoea dominant or mixed IBS. However, specialist dietetic support is essential to ensure nutritional adequacy and prevent the use of unnecessary or highly restrictive diets. Where access to dietitians may be limited, dietetic departments are now able to recommend technology, such as dietitian-led webinars, mobile phone apps and YouTube videos to increase patient access to reliable information.
This fourth article in a seven-part series looks at scalp psoriasis. Managing this condition can be difficult as treatments are often messy, time-consuming or ineffective. The impact of scalp psoriasis can affect several aspects of daily living, notably choice of clothes, intense itching, which can be embarrassing for patient. intense itching, which can be embarrassing for patients. Finding suitable treatments can be life-changing to some. This piece focuses on treatment options, from bland and simple techniques through to the variety of treatments available on prescription. This should enable community nurses to facilitate patients in managing their scalp psoriasis when asked
Lower limb cellulitis is a common acute medical condition that results in a large number of hospital admissions (Clinical Resource Efficiency Support Team [CREST], 2005). It is a growing and costly problem. The NHS spends between £172–£254 million a year on inpatient treatment of people with lower leg cellulitis (Curtis, 2011). The clinical presentation of cellulitis is similar to other conditions and diagnostic errors are common and may prolong hospital stay (Nazarko, 2012). Community nurses are involved in caring for people at risk of cellulitis and are often responsible for referring on suspected cases and then continuing treatment upon discharge. It is essential that community nurses are aware of the evidence base for diagnosis, differential diagnosis, treatment and management, as well as the long-term prevention of cellulitis. This paper discusses the evidence base for treatment and prevention of cellulitis and presents a case study.
The publication of Guest et al’s study on the economic burden that acute and chronic wounds have on the NHS has provided a national picture and a better understanding of the true cost of wound care (Guest et al, 2015).
One thousand patients’ notes held within the Health Improvement Network (THIN) database were retrospectively examined and cost differences between having a wound or not were analysed. Indeed, from assessing wound care service delivery and costs for the year 2012/13, based on 2013/14 prices, the study estimated that the cost amounted to £5.3 billion, which is on a par with obesity treatment costs. The study also identified that the majority of wound care takes place in a community setting and is nurse-led. Guest et al (2015) has been cited in several recent studies and has even been raised in a debate in the house of Lords. The study also suggested that a ‘high proportion of wounds were unclassified’, highlighting shortcomings in undertaking wound assessment and accurate documentation.
Managing moisture to achieve the optimum ‘moist’ wound healing environment is key to facilitating wound healing. Wounds which are dry or have a low volume of exudate need moisture added for hydration. Wounds that are wet with a high volume of exudate need fluid to be removed effectively by dressings with high absorbency. Moisture imbalance can have negative consequences for patients — physically, psychologically and socially.
Pressure ulcers were the largest proportion of patient safety incidents in 2011–2012, accounting for 19% of all reports (National Institute for Health and Care Excellence [NICE], 2014). Developing strategies and incentives to help reduce pressure ulcer incidence by stressing the importance of improving nurses’ knowledge in areas of skin care and encouraging carers/relatives, together with patients, to take an active role has been shown to improve outcomes in reducing the development of pressure ulcers (NHS Commissioning Board, 2013). With guidance focusing on prevention as well as treatment, it is important that community services understand both the risks and how to stage pressure ulcers appropriately to provide timely and cost-effective treatment.
