In each issue we investigate a hot topic currently affecting you and your community practice. Here, Jason Beckford-Ball looks at providing cash incentives for healthy behaviour and asks...
...Should we be paying people to get better?
Getting people to take their medicine (literally and metaphorically) has always been a problem in health care, but a new study has reignited the debate about providing cash incentives for people to adopt healthy lifestyles.
Many of us work for the NHS and experience first-hand its challenges both as nurses on the frontline and as users of the service. With the population living longer and therefore presenting with more complex conditions, this is adding to the pressure being placed on both the NHS and the staff working within it. This situation is not unique to a particular area; in fact the whole of the UK, and indeed the world, is experiencing the same pressures. Undoubtedly, one of the answers would be to recruit more experienced and skilled staff, but what if there was a simpler solution?
I recently attended the annual Queen’s Nursing Institute (QNI) conference in London and came away feeling inspired, both because I am a nurse, but most importantly because after the conference I felt that things can and will improve and everyone (not just frontline NHS staff) can do their bit to help.
Atopic eczema, also referred to as dermatitis, is an inflammatory chronic skin disease that commonly develops in childhood. This condition ranges from birth to 12 years old and affects both genders equally. Atopic eczema affects people of all ages but children in particular. The prevalence rate for atopic eczema is around 15–20% in children and 2–10% in adults (Scottish Intercollegiate Guidelines Network [SIGN], 2011), and accounts for 30% of all dermatological consultations in primary care (Shamssain, 2007).
In the current economic climate it is important that clinical quality and cost-effectiveness is maintained and community nurses must be confident that they are selecting dressings which provide multiple treatment outcomes. This can include exudate management, reducing trauma and pain at dressing change, extended wear time, and protection of the periwound area. Similarly, there has been a recent rise in the incidence of skin tears, particularly within care homes and in the elderly population, and this requires a dressing that can both protect vulnerable skin and prevent the entry of contaminants and bacteria into the wound bed. Community nurses need a dressing that can perform all of these roles and this article examines Advazorb® Border (Advancis Medical), a dressing specifically designed to manage exudate, prevent pain, trauma and skin stripping on removal, and protect the periwound skin. Crucially, in clinical practice Advazorb Border has been shown to manage skin tears appropriately while staying in place longer and the author discusses clinical evidence that shows how the dressing provides cost-effective wound management and long-term savings within clinical practice.
Repeated application/removal of adhesive dressings and tapes can cause skin stripping in and around wounds, resulting in pain, increased wound size, delayed healing, inflammation and increased risk of infection. Adhesive tapes and dressings are also used widely in many care settings to secure tubes, monitors and drains, while the more fragile skin of children and the elderly is at increased risk of epidermal stripping when adhesive dressings are removed. Here, the authors use a series of case studies to demonstrate how Appeel® Sterile Liquid Sachet and Spray applications (CliniMed Ltd), part of the Appeel Sterile Medical Adhesive Remover range, help with adhesive removal, reducing pain and trauma. This article examines how Appeel Sterile removes dressings, tapes and other medical adhesive appliances quickly and easily from both intact and broken skin, resulting in reductions in pain, trauma, use of analgesia, infection risk, cost of dressings and nursing time.
I realised very early on in my career that I was not destined to be a hospital nurse, so I messed around for a few years doing things other than nursing before landing a job as a community staff nurse.
The plan was to stay as a community nurse until my (very little) children grew up, but within 18 months I was on the district nursing course.
I became a district nursing sister, then a tissue viability nurse and then led a team of various specialist nurses while simultaneously working as a community research nurse. A few years ago I moved from clinical practice to teaching and research.
Many community nurses will have to attend patients that have a surgical wound. The desired clinical outcome for any surgical wound will be to achieve closure and skin integrity with an acceptable cosmetic result, and to avoid any complications. Patients presenting to community nurses after discharge from hospital may well have experienced postoperative complications or may be at risk of complications following suture removal. Community nurses should be aware of wound problems that may arise following surgery and how to address them appropriately.
A chronic heavily exuding wound can have a devastating impact on a patient’s quality of life, often resulting in symptoms such as increased pain, depression, anxiety and stress, as well as a loss of independence and social isolation. For community nurses, wounds with high levels of exudate can incur increasing costs, both in time and resources. It is imperative to heal these wounds as quickly as possible and the community nurse should undertake a robust and holistic assessment before implementing a clear and evidence-based management plan, potentially including wound debridement and the use of an effective absorbent dressing in combination with compression therapy, where appropriate, to manage exudate. This article examines the development of chronic wounds and the problem of excess exudate production specifically, before going onto look at the benefits of one particular superabsorbent dressing (Flivasorb®; Activa Healthcare/L&R). The author uses extensive evidence as well as clinical expertise to provide an overview of the dressing, and presents a case study to demonstrate its benefits in practice.
Respiration is vital for life and understanding how to assess patients' respiration and the different types of respiratory rate is a vital skill for all community nurses. Respiration rate is one of the four vital signs and should not be ignored when assessing a patient. This article explains the different types of respiration; provides clear guidance on how to assess respiration, and explores some of the causes of abnormal respiratory patterns and how they can be managed.
Many people with skin conditions such as eczema, psoriasis and acne, as well as scars and old or unwanted tattoos, can find their self esteem is negatively affected. This article looks at skin camouflage, a cosmetic technique that can nonetheless provide patients with a way of lessening the psychological impact of skin conditions.
