The Colostomy Association has launched a new service to change the lives of thousands of people living with a stoma across the world. Stoma Aid is a new initiative that will collect unused ostomy supplies in the UK and redistribute them to patients living with a stoma in developing countries that cannot afford or access supplies.
An ageing population and increase in people living with long-term conditions have heightened the practical and financial pressures on health services. Preventative public health projects are now viewed as crucial to protecting health, reducing the financial and personal costs of illness, and consequently protecting health services.
For researchers and policy-makers, nurses working in primary care are notoriously hard to reach; they are
without a management structure with a chief nurse or director of nursing at the top of the organisation, as is the case for their colleagues working in a community or hospital-based provider. So, when more than 3,400 general practice nurses (GPNs) recently completed a major Queen’s Nursing Institute (QNI) survey, it sent a clear message that the nurses had a story to tell.
Undoubtedly, the challenges faced by community nurses are on the rise due — but not limited to — several factors: the NHS being under severe financial scrutiny; the drive for a seven-day service; policies that mean more care is being delivered in the community setting; and rising patient numbers resulting in less time available to spend with each patient. Coupled with a reduction in recruitment which means that there still aren’t enough nurses in the profession, this is a potent mix of factors that has contributed to a creaking NHS.
The contribution that community nurses make in terms of patient care is immeasurable. Many patients would prefer to be treated at home if they could and there has long been a drive to move care out of hospitals and into the community.
Meningococcal disease is a contagious bacterial condition that can result in life-threatening sepsis as well as the development of extensive blistering and lesions. This article presents the topical management regimen for one young patient’s wound care in conjunction with the community and outpatient paediatric teams. Practical tips on how to manage complex wounds in children will be outlined to demonstrate that such cases can be managed effectively by nursing teams in a relaxed home environment and outpatient setting, preventing readmission and supporting the emotional recovery of the child and parents. The success of this case study and the reintegration of the child back into daily life and school was attributed to the joint working and collaboration between parents and child, and tissue viability, paediatric and community nursing teams.
There are a number of mechanisms at play that can delay wound healing. Wounds can become stuck in a prolonged inflammatory stage resulting in high volumes of wound exudate, which contains agents that contribute to delayed healing. Exudate plays an essential role in wound healing but at excessive volumes it can also facilitate biofilm formation, which can further delay healing. Maintaining optimum levels of exudate is vital for healthy wound healing, as is the prevention or disruption of biofilm formation in the wound bed. This article also looks at Sorbion Sachet S® (BSN medical), a triedandtested uperabsorbent dressing, which is now back on the Drug Tariff, but at a lower price. This article discusses the mechanisms used in the reintroduced superabsorbent dressing and how it provides a cost-effective solution to the problem of treating highly exuding chronic wounds where clinical efficacy and budgetary concerns are both top priorities.
The Mitrofanoff technique uses the appendix to create a continent ‘tunnel’ between the skin’s surface and the bladder, which is then drained using a catheter, which is inserted along the tunnel rather than via the urethra. This is a complex procedure that needs the patient to be motivated and committed to living with such lifechanging surgery. Intense preparation and long-term support from a urinary diversion nurse specialist as well as any involved community nurses is vital. Long term follow-up is vital to ensure continued good health and to anticipate any problems such as infection, stone formation or renal damage. Having access to community healthcare professionals who know about the possible dangers and can offer advice and support is also key to ensure any complications are dealt with swiftly and safely.
Many skin conditions, while no longer requiring hospitalisation, still require a level of knowledge and skill from community nurses, particularly with assessment and diagnosis. Atopic eczema is one such skin condition and can cause significant discomfort, particularly when inflamed skin becomes virally infected, leading to to complications such as eczema herpeticum and molluscum contagiosum. Both of these viral infections can increase the discomfort of eczema, leading to a variety of symptoms including blisters, sore skin, itch and rash. It is important that community nurses are able to identify skin conditions of this type and know whether to treat themselves or refer on to dermatological specialist nurses for more specialised management.
The challenge of providing safe and effective care closer to home for patients requiring ,intravenous (IV) therapy but who are not housebound can be achieved by developing community clinics. However, it is imperative that governance procedures are in place to protect the patient and the organisation. It is also recommended that medicine management is effective, infection control processes are reliable, and clinical audit is performed. Community nurses have a wealth of knowledge and experience which can be used to deliver the government's promise of community care, provide patients with a choice of where to receive their care and deliver effective treatment in an ever-changing NHS.
