We get our news, shopping and do our banking online, but now we can manage our health online too. I see digital NHS services at the heart of creating a better, more improved, patient-centred NHS where people feel more involved in their health and care.
Working in community nursing can at times feel quite lonely and isolating. It can be hard to keep up to date with the latest developments or catch up with colleagues while struggling with the day-to-day pressure to see more and more patients, many of whom have complex problems.
This article is the second in a two-part series on managing common lower limb problems encountered in primary care. The first article in the series (Brown, 2017) discussed the causes of oedema and its relation to underlying conditions, such as venous disease, lymphoedema and lipoedema. This article investigates skin care, the management of ‘wet legs’ and the different types of compression therapy available to non-specialist community nurses.
Chronic oedema is a soft tissue swelling present for at least three months, most commonly caused by venous and lymphatic impairment. It has a huge impact on quality of life and over time may cause social deprivation. The mainstay of treatment is compression therapy and treatment of the underlying cause. Comfort and acceptability of the compression system is essential. Clinicians need to work with patients to ensure that they are included in treatment decisions and empowered to take charge of their condition.
This article looks at some case reports undertaken during a community initiative, which explored the importance of regularly
reassessing patients’ support surface needs in relation to their general wellbeing, comfort and personal relationships on a long-term basis. The comfort and dignity of patients who are prescribed longterm specialist dynamic mattresses is discussed through real patient stories. The importance of both involving and educating patients and their carers on pressure ulcer identification and preventation is also shown through this community initiative.
Continence is an area that requires many community nurses to prescribe from the Nurse Practitioner’s Formulary to promote good patient care and appropriate service delivery. Recently in West Berkshire, with the full support of GPs, the continence advisory service has taken over the non-medical prescribing of all continence products, with the aim of providing a safe, cost-effective and timely service. This initiative is aimed at changing the way continence prescriptions are issued to patients. This second article of a two-part series, as well as featuring a case report looking at the management of a patient with multiple sclerosis (MS) and bladder dysfunction, looks at the importance of holistic assessment to ensure appropriate catheter provision in line with prescribing principles.
The knowledge needed to diagnose skin conditions in primary and community care can be elusive, daunting and confusing. By using thorough history-taking, excellent physical assessment skills and thinking ‘outside the box’, healthcare professionals can formulate a differential and working diagnosis to improve patient access to appropriate management, including medications, lifestyle changes and referral as needed. Simple history-taking tools, relevant mnemonics and good resources can help patients to be managed quickly and effectively, and thereby improve outcomes and reduce the need for time delay in diagnosis. This article intends to demystify the dermatology conundrum and give healthcare professionals the tools to simplify the treatment of common skin conditions.
This article explores the natural ageing process and the impact it can have on the nutritional status of elderly patients. In the article, the author considers the body’s ageing process and the changes patients can struggle with as a result. Recognition, identification and treatment of malnutrition with this patient group is an essential part of care within the NHS, which, if done appropriately, can improve patient quality of life - in particular, functional status. An appreciation of the physiological changes which are happening as part of the ageing process allows healthcare professionals to offer tailored advice and provide reassurance to patients.
Depression is the ‘common cold’ of elderly mental health. Many older housebound patients suffer from depression. This has often not been recognised and treated. District/community nurses are the healthcare practitioners most likely to be in contact with these clients. Their role in assessing the emotional health of clients and taking action to address mental health issues is crucial. Cognitive behavioural therapy (CBT) has a strong evidence base for treatment of depression. Knowledge of its principles could be integrated into therapeutic conversations that district/community nurses have with clients.
As a podiatrist, I have worked alongside community nurses since I graduated both here and in New Zealand. The two professions frequently attend the same patients in the community. These patients often have complex medical presentations that benefit from a team approach.
