Resources

In order to instil confidence in your patients, you yourself need to feel confident in the care you’re providing — including the products you use.

This is why we’re publishing the results of a recent randomised controlled trial (RCT) comparing the efficacy of Exufiber® with the market leading gelling fibre dressing, in exuding venous and mixed aetiology leg ulcers.

A new report on palliative and end-of-life care in the community has been published by the Queen’s Nursing Institute (QNI) and Marie Curie.

The report by the two charities is based on a national survey of health and care staff undertaken in 2023. The majority of survey respondents were community nurses. The findings reflect how palliative and end-of-life care is delivered today, and shines a light on the challenges being faced by nurses. People at end of life need high-quality holistic care and support but worryingly, 9 out of ten respondents to the survey reported being unable to meet the needs of the people they care for, or those close to them, at least in part.

There is an old saying about ‘thinking outside the box’. The basic idea is that we are often
caught in conceptual thinking boxes which stop us seeing and discovering new ways of life and work.

Despite the phrase being widely used, the sad truth is that we often keep doing the same old things and are surprised when we get the same old results. The eminent Jungian
therapist James Hollis shared how a client said, ‘This isn’t working, but I do it very well’.

Normal wound healing follows four distinct phases: haemostasis, inflammation, proliferation and finally, maturation. If any barriers to healing occur within these four phases, the healing process will be delayed or may even stall (Mitchell, 2021). One of the common barriers to healing is hyper or overgranulation, or ‘proud flesh’. Hypergranulated wounds can cause concern to both patients and healthcare professionals, and, although common in wound care, there is a limited evidence base and currently no guidelines for management. This article discusses the causes of hypergranulation, with suggestions on how it can be managed.

Necrotising fasciitis (NF) is a life-threatening condition, consisting of a soft-tissue infection with rapidly progressive, widespread fascial necrosis and sepsis. Prompt diagnosis and  treatment are essential, but in the early stages, it is difficult to differentiate from other skin conditions such as cellulitis. A high level of suspicion and a low threshold for surgical referral are essential to avoid significant mortality. Following often lengthy hospital treatment, patients will be discharged for management in the community — usually with extensive wound care needs. As part of recovery, supported self-care is an option for some patients and the benefits may help improve outcomes.

The vast majority of wound care is undertaken by community nurses (Dhoonmoon, 2023), with £941 million attributed to venous leg ulcer care and a further £836 million spent on unspecified leg ulcer management (Guest et al, 2017). If signs and symptoms can be 
recognised and a diagnosis made, a plan of care can be drawn up and treatment implemented quickly and efficiently to reduce costs escalating further. More important though, the patient’s condition will improve quickly and deterioration in quality of life can be avoided. Nursing staff are currently encouraging patients to take a more active role in their own care, guiding them in how to look after their own long-term conditions, which can promote long lasting healing and independence.

This article provides an update on the dietary management of type 2 diabetes mellitus (T2DM) for community nurses. Dietary change can greatly modify the trajectory of T2DM. Weight changes are a key factor, as significant weight loss can put the condition into remission, and even less dramatic weight loss can have positive effects on glycaemic control and cardiovascular risk factors in individuals with T2DM. Protein intake supports various aspects of glycaemic management and is an especially important nutrient for older adults, who are more prone to T2DM. Carbohydrate restriction is widely advised in clinical practice, although current guidelines do not support this as the sole dietary management strategy for T2DM; it is simply one of various potentially effective measures. Carbohydrate quality is important and high fibre carbohydrates are the preferred source. Excessive alcohol intake can exacerbate T2DM via its damaging effects on the liver. Knowledge of the dietary management of T2DM is vital for community nurses, as it allows them to offer advanced and comprehensive care to their patients.

As part of the ‘Whatever It Takes — Cancer Care for Everyone’ programme (Wessex Cancer Alliance [WCA], 2023), the ‘What I would like to say...’ project involved two disabled researchers carrying out creative and engaging workshops and interviews with 45 disabled and neurodivergent people, with the support of Bournemouth University’s
Public Involvement in Education and Research [PIER] team. These individuals were from various community groups in the Wessex region, including Autism Hampshire’s Fareham Serendipity group; the Dorset Blind Association [DBA]; the Multiple Sclerosis [MS] Centre
Dorset; the Royal National Institute of Blind People [RNIB]; and the Bournemouth and Poole Lymphoedema and Lipoedema Support group. This article reflects on the deep and rich insights shared by attendees, which were facilitated by the PIER community researcher model, and which have already begun to impact practice. It is hoped that the outcomes of this project will contribute to improving disabled people’s experiences of accessing cancer services.

Rectal cancer is a common diagnosis which is often treated by surgical resection of the cancer. However, cancer treatment can result in changes in bowel function. Faecal incontinence can occur because of cancer treatment, as well as increased defecation. Although these symptoms will improve with time over a few months, making changes, such as dietary ones with nursing support, can help. Having a greater understanding of issues that can occur and ways in which to resolve them can improve both healthcare professional confidence and circumstances for patients with bowel dysfunction.

For many nurses working in primary care, chronic obstructive pulmonary disease (COPD) is a familiar condition. From carrying out annual reviews to supporting people living with the symptoms of cough, phlegm, breathlessness and managing their effect on day-to- 
day living, most community nurses will have some experience of supporting people living with COPD. Increasingly, though, community nurses are having to consider comorbidities as part of the review, as for many people living with COPD, this will be just one of the long-term conditions they have already been diagnosed with or of which they will be at risk. In this article, the relationship between COPD and other long-term conditions will be highlighted, along with recommendations about how to identify and manage comorbidities in order to holistically optimise outcomes.