Resources

The population is ageing and so we are seeing an increase in the prevalence and incidence of age-related conditions, such as frailty and dementia. These two conditions can often go ‘hand in hand’, making it important to ensure appropriate recognition, assessment and then management of each when experienced together. This paper uses a case study approach to illustrate and discuss the issues as relating to community nurse practice.

In 2012, the National Early Warning Score (NEWS) was introduced to standardise monitoring of vital signs and improve patient safety in acute hospitals. By 2017 around two-thirds of NHS hospitals were using NEWS and an updated version, NEWS2, was released. In 2019 all acute hospital trusts and ambulance services were required to use NEWS2. Now NEWS2 is being used increasingly in care homes and community settings. People living in care homes are often frail and have multiple healthcare conditions. NEWS was never designed to monitor the health of older people, but it has the potential to improve care by enabling staff to identify people who are becoming unwell and to provide care within care homes and the person’s own home. However, if it is not introduced with care, it could lead to an increase in the number of people attending accident and emergency departments. This article examines the emerging evidence base and concludes that appropriate support and advanced care planning are of crucial importance.

I can still remember when I started my nurse training and attended my very first lecture introducing ethics into my nursing curriculum. I clearly recollect my concerns in relation to the enormity of the subject and wondered how I was going to relate the ethical principles to my daily practice. Years later, I often reflect on situations and feel that my own moral  principles and my need to respect others and their wishes has really supported my decisions.

For most people, workplace ethical dilemmas involve relatively little soul-searching. Should they tell the boss that they used the company credit card to buy her birthday present on expenses? Is it wise to let their line manager know that he ought to invest in some deodorant? And do they really need to tell HR that Darren from accounts tried to kiss them at the Christmas party?

The NHS has been grappling with concerns surrounding its whistleblowing systems and cultural health. This has been highlighted repeatedly in the press recently with coverage of the Lucy Letby trial, within which there were shown to be multiple failures in internal reporting processes. This demonstrates the need for an independent reporting line for
employees across the organisation, such as through Freedom to Speak Up guardians (Chidgey-Clark, 2023). NHS employees should have the opportunity to speak with an entirely impartial party who can process their concern and pass on the information to the appropriate team for further investigation.

The suffering caused by lower limb and leg ulcer-related conditions often languishes
in the periphery of healthcare. However, the prevalence, distress and economic implications of these conditions are far more substantial than commonly acknowledged.

The third part in our series on pressure ulcer prevention and management discusses
the different types of pressure redistribution devices currently available in clinical
practice. The modes of action of the different types, together with patient suitability
and selection are also discussed, as well as what to do and not to do when nursing
patients on these devices.