This two-part series will discuss common lower limb problems, including venous leg ulceration, oedema (including oedema associated with lymphovenous disease), lymphoedema and lipoedema. This article will focus on the causes of these conditions and discusses the signs and symptoms to enable community nurses to diagnose and differentiate between the types of lower limb problems. Part two of the series will focus on management strategies for simple, uncomplicated venous leg ulceration and oedema, which can be successfully managed with skin care and compression therapy, without specialist skills. It will also briefly outline the management of lymphorrhoea or ‘leaking legs’, which can be challenging for nurses. The aim of this series is to enable community nurses to choose the most effective treatment in terms of efficacy and patient acceptability.
District nursing teams are under increasing pressure to cope with demands on their time and the skills to meet the needs of their local community. The author’s local nursing team has been struggling to manage the clinical skill mix required to meet the complex needs of their patients with lower leg wounds who should be treated with compression therapy. The task of managing compression therapy was mainly undertaken by nurses, but it was proving extremely time-consuming — especially when patients needed leg washing and compression treatment for bilateral leg wounds. After successfully using a Velcro™ compression system, a six-month evaluation of juxta products for the leg ulcer pathway was proposed for one community nursing team. This project was undertaken with an initial cohort of 17 patients to evaluate if switching to this product could help to improve the use of the team’s skill mix and reduce costs on wound products from the formulary by improving wound healing rates.
Psoriasis is a common skin problem that can cause significant distress to primary care patients, as well as representing a significant burden to healthcare resources. Often seen by communinity nurses, psoariasis is a condition that requires careful management as well as extensive knowledge of the different presentation. This article, the second in a series looking at the identification and treatment of psoriasis, examines the use of emollients in psoriasis treatment, focusing on the aims, benefits and efficacy of these topical treatments.
Eating difficulties affect many older people and can be a short or long-term issue, while poor nutritional status can have a huge impact upon older people’s health, wellbeing and quality of life. Nurses, carers and relatives need to identify potential problems with older patients’ nutrition so that they can manage any issues successfully. Providing adequate nutrition for older people requires a multidisciplinary approach, with the aim of improving patients’ nutrition by assessing any barriers to successful eating. Often, being alert to very subtle issues and addressing them is the key to success in helping older people achieve a healthy diet. This article will highlight some of the issues that may affect older people and lead to under-nutrition. It also provides some simple preventative measures.
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. As well as examining the problems of bladder dysfunction in people with multiple sclerosis (MS), this first article of a two-part series, looks at the background to MS and bladder problems, as well as focusing on treatments such as clean intermittent self-catheterisation (CISC). The second part of the series will feature a case study looking at the management of a patient with MS and bladder dysfunction.
This comment piece is based upon a theoretical review of the medical, mass gathering and social science literature relating to music festivals, as background to the author’s PhD study exploring voluntary risk and health in a music festival context
Jacqui Ciotkowski is a part-time bank community nurse for South Warwickshire NHS Trust and a part-time teaching assistant
This article focuses on the work of a team of community nurses running a primary care drop-in centre. As well as a full range of clinic services, the team sees a lot of leg ulcer patients for compression bandaging. A common problem with traditional compression bandaging is the amount of time that community nurses have to spend on the procedure, as well as the dangers of maintaining pressure and bandage slippage between dressing appointments, which can result in discomfort for patients and even skin damage in some cases. This also has implications for patient concordance. This article looks at a review by the team of a new compression system (juxtacures®; medi UK), which offers measurable and adjustable compression and a greater involvement by patients in their own care, which in turn can minimise the time nurses need to spend on dressing changes.
Sometimes in life, one group of professionals are disproportionately blamed for everything that is wrong with society — thus every banker was painted as a reckless gambler after the financial crash of 2008; journalists were collectively pilloried for the phone-hacking scandal; and estate agents ...well, they get blamed for pretty much everything else.
When it comes to healthcare, one group seems more routinely maligned than any other, whether for ballooning budgets or poor continuity of care. Despite plugging gaps in services, providing much needed holiday and sickness relief, and generally propping up creaking wards and community units, agency nurses often attract lurid headlines such as ‘How nursing agencies making billions are bleeding the NHS dry’ and ‘Trust pays an agency nurse £2,200 a day’. But behind the headlines, what is the truth about agency nurses? Are they really money-grabbing opportunists, or is there more to the role than meets the eye? I spoke to one agency nurse, Maggie Scott, to find out what motivates her to put flexibility above a full-time position.
The management of exudate in acute and chronic wounds is a common issue for community nurses, with too much exudate resulting in issues with infection and the breakdown of periwound skin; while too little moisture risks the wound bed becoming too dry. Nurses need to find the most cost-effective and clinically proven treatment regimen when treating wounds that produce different levels of exudate, minimising dressing changes and patient discomfort. While it can be difficult to make a choice about which dressing to use because of the vast array on offer, it is important to match the dressing to the wound and use the most appropriate dressing for the levels of exudate being produced. Similarly, using a more responsive approach to wound management — adapting treatment as the wound changes — will result in a more cost-effective approach. Advancis Medical have a range of wound management dressings that are suitable for different wound types and can handle varying levels of exudate. This allows nurses to use a step-up, step-down approach to the management of exudate as the most cost-effective dressing regimen.
