I have always been passionate about wound care and, as a practising district nurse, I learnt by experience and training to measure wounds, take photographs and undertake Doppler assessments (a non-invasive method to identify arterial insufficiency in the leg). This helped me to establish the treatment that each wound needed.
What I did not know was the effectiveness of my prescribed care and how my healing rates compared with another nurse’s care. I also could not say with any accuracy how quickly a patient could expect their wound to heal. I wish I had known…
So, my questions to you would be: Do you know? And, why is it important?
This month Hallam Medical, the nursing recruitment agency, celebrates its tenth anniversary, and over that time we have placed a lot of nurses in exciting new roles as well as developing our commitment to nurse education. During this period, there have also been a lot of changes in the wider NHS as well as in the world of community nursing. But, as we work in an ever-evolving environment, what changes can we expect in the future and, more importantly, are we actually ready for them?
Having co-founded Hallam Medical I have to say the past ten years have flown by, but despite it only being a decade, an awful lot has changed, in primary care in particular. Not only have the health needs of the general population altered significantly — witness the major growth in chronic conditions such as diabetes, heart disease and obesity for example — but the nursing profession as a whole has had to change, evolve and adapt to meet these new challenges.
The community nurse may come across a range of wounds in the community setting, particularly with the rise in comorbidities such as diabetes and cardiovascular disease due to unhealthy lifestyles and an ageing population. Accurate assessment is the key to identifying the most appropriate wound treatment programme; one that will promote healing and/or relieve symptoms associated with chronic wound healing. Product choice is secondary to getting the assessment process right and accurate assessment and methodical documentation not only help protect against legal challenges, but also aim to reduce waste, dressing change frequency (and thereby nurse time), and patient discomfort. The community nurse should always seek to match their wound-healing knowledge with what they see in the wound bed and the patient’s history, which in turn will enable the nurse to make informed therapy choices and provide expert patient advice.
Functional bowel disorders such as faecal incontinence and constipation are relatively common conditions, which have a significant negative impact on patients. This can often affect the social, psychological and financial areas of life, as well as leading patients to become isolated due in part to the social taboo surrounding bowel issues (Lukacz et al, 2011; Holroyd, 2015a). Constipation can affect up to 25% of the population at some point in their lifetimes (Belsey et al, 2010), and it is a condition that crosses all genders, ages and cultures, although it is more prevalent in the very young or older adults (Holroyd, 2015b).
Community nurses will often encounter patients with psoriasis in their day-today work, and may be involved in delivering care directly or monitoring the condition. However, psoriasis has various presentations and knowledge of these variations is beneficial for all clinicians working in the community, particularly when it comes to understanding the range of treatments available. This article, the first in a series on psoriasis, will discuss the types of psoriasis that can be encountered, while future articles will examine the different treatment options that are currently available, focusing on the National Institute for Health and Care Excellence’s (NICE, 2016) treatment pathway for managing patients with psoriasis (see Figure 1). The series will focus on each of the steps in the pathway and how they relate to nurses working in the community.
The number of patients in a community setting with percutaneous endoscopic gastrostomy (PEG) tubes is increasing year-on-year. PEGs provide a secure route of delivering artificial nutrition, hydration, and medication in patients who are unable to swallow safely, however, there are complications associated with their insertion and ongoing use. Common problems include infection, leakage, tube blockages, development of granulomas at the insertion site, and so-called ‘buried bumper syndrome’. Community nurses are ideally placed to identify these complications, and this article provides a quick reference guide to troubleshooting and managing these issues.
Donato Tallo is a nurse assessor at the hospital intervention team, Eastbourne District General Hospital, East Sussex Healthcare NHS Trust.
WHAT DOES YOUR CURRENT ROLE INVOLVE?
I work for a large NHS trust that provides integrated hospital and community-based healthcare services. I am a nurse assessor with the hospital intervention team, a multidisciplinary team consisting of nurses, physiotherapists and occupational therapists.
With over a million devices used in the NHS every year, indwelling urinary catheterisation is widely acknowledged as one of the most commonly used invasive healthcare procedures. Despite its widespread use, there is also extensive evidence of the risk of infection, blockage and bypassing associated with indwelling catheters, all of which can adversely affect patients’ health and quality of life, as well as placing a significant burden on the supportive health services that manage the caseloads of catheterised patients in both community and acute settings. This article looks at the reasons for the use of long-term catheters, the complications that can arise and the positive impact the use of a triclosan-based solution can have when instilled into the inflation balloon of the catheter. A selection of case studies highlight the use of Farco-fill® Protect (CliniMed) in complex patients whose only management option for effective bladder drainage is to use an indwelling catheter.
In each issue we investigate a hot topic currently affecting you and your community practice. Here, Jason Beckford-Ball looks at some of the challenges that lie ahead in the coming year.
