This article examines the differences in presentation, assessment and management of wounds in children compared with adults. In particular, it looks at pressure ulcers, their prevalence in children aged 0–18 years, location and how they present. The structure and function of the skin is also discussed, with consideration of risk factors associated with formation of pressure ulcers in children. The results of an online survey into healthcare professionals’ confidence and competence of wound and pressure ulcer assessment and management in this patient population within a large NHS trust is also explored, as this identified the need to provide more education and training to enhance tissue viability services for children.
Pilonidal sinuses are a common condition, and are often found in young males. Treatment is mainly by surgery and caring for these wounds is generally undertaken by primary care practitioners. Fistulas are also challenging wounds to care for. This article offers practical advice on the management of these, often problematic, wounds. Issues, such as cleansing, selecting appropriate wound care dressings, measuring and monitoring progression to healing will be discussed; together with advice on when to refer for specialist input.
This two-part article aims to help healthcare professionals understand constipation; the possible causes, and the anatomical and functional problems. In the first part, the author explained anatomy and physiology of the lower gastrointestinal tract, what are normal bowel motions, frequency and variation, which includes the Bristol Stool Chart to view the types of bowel motions sufferers may often experience. Here, the focus is on conservative treatment interventions for constipation, exploring the four ‘Fs’ acronym (Rex, 2013): fibre (in diet); fluids (those best for health reasons); fitness (‘if you do not move, it will not move’); and finally feet, which relates to the best sitting position to help achieve bowel evacuation successfully.
This article discusses the considerations and actions taken to facilitate the discharge of a ventilated end-of-life patient called Michael, whose name has been changed for confidentiality, from a critical care unit (CCU) to his expressed preferred place of care. It focuses on how the district nurse (DN) and the single point of access (SPA) for end-of-life care teams by working between primary and secondary care services and across organisational service units were able to facilitate this discharge and achieve the wishes of Michael to die peacefully at home. For all services involved, this proved to be a complex discharge and following completion of the care episode a root cause analysis was undertaken to capture the lessons learnt and advise the CCU at a services debreif how discharges to the community from the CCU could be improved.
Financial fraud, or scamming, is a growing problem (Financial Fraud Action UK, 2014), specifically for those who may be more at risk due to vulnerabilities, such as loneliness and mental capacity. The internet is increasing opportunities for scammers to reach a broader pool of potential victims. It is an area of growing concern for professionals involved in supporting and safeguarding vulnerable people. An estimated £5–10 billion is lost to scams annually (National Trading Standards Scams Team, 2015), and this has serious implications for victims, their families, and the wider UK economy through lost commerce and consumer confidence. A cycle of crime is created by criminal networks using proceeds from scams to fund further exploitation.
Flora Doig, community nurse, Bridge of Don Clinic, NHS Grampion, Aberdeen. Discusses her community
Within the community there are a wide variety of services provided by charitable organisations, voluntary services and social services, to support the elderly throughout this difficult season. Working on the frontline, I feel a real issue is professionals actually being aware of the services available. Community nurses are ideally placed to advise, refer and encourage the use of the valuable support networks available. Thus, the key is being familiar and knowledgeable about all your local services to facilitate their use and help the most vulnerable at this time of year.
Leg ulcer management presents a significant challenge to primary care, as not only is it costly in terms of resources, but is closely linked to social isolation and low mood. Research has also demonstrated that lonely people are more likely to visit their GP, have higher use of medication, higher incidence of falls and increased risk factors for long-term care (Cohen et al, 2006), thus a greater impact on healthcare services.
With family and friends going away for Christmas, many older people find that they lose their support networks at this time of year. Coupled with an increased difficulty in going outside because of adverse weather conditions and reduced public transport, older people can feel a greater sense of loneliness and isolation during the festive season.
