SciCombinator

Discover the most talked about and latest scientific content & concepts.

Journal: British journal of community nursing

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The aim of compression therapy is to apply pressure on the skin and underlying structures to counteract the force of gravity, supporting venous and lymphatic function, to prevent or minimise oedema in the affected tissues. Compression therapy to manage lymphoedema is supported by a plethora of research, as it helps to increase the velocity of flow and lymphatic contraction of the lymphatic collecting vessels. This encourages drainage to the route of the limb, which increases fluid drainage from the tissues into the lymphatics. It is becoming more apparent that with an increase in clinical knowledge of how compression therapy works, clinicians are becoming less focused on the level of compression and more concerned with the stiffness of fabrics. This article looks at how adapting compression therapy regimes can improve patient outcomes of treatment and maintenance, while empowering patients to self-manage.

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The risk of developing chronic oedema increases with age. Many factors affect the successful management of this condition, which a robust holistic assessment will identify. This article discusses some of the challenges and complications associated with managing this long-term condition, alongside comorbidities and the effects of ageing. It will consider the implications of wider issues such as social care and the current healthcare economy. The challenges of lymphoedema management can be overcome by offering a collaborative approach to care. This can be achieved by specialist practitioners offering support, advice and guidance on how to ensure satisfactory outcomes for patients in a timely manner.

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The population is ageing but many older people are living with chronic multimorbidity, which has a significant impact of all aspects of quality of life. Many of the common chronic conditions suffered by older people either precipitate or compound chronic oedema, which means a wide range of skills and in-depth knowledge is required to deliver holistic care that does not interfere with other treatment modalities. This patient group often presents with highly complex coexisting issues that require highly specialist assessment and management in collaboration with other professionals.

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Chronic oedema (CO) and lymphoedema (LO) are long-term conditions that can become more complicated or are more likely to develop with age. The ageing process can involve alterations in the structures that support the normal function of the lymphatic system or put it at greater risk of damage. The main three components (skin care, exercise and compression therapy) within the management of CO/LO can become more difficult to apply with age. This is because of reduced healing rates, decreased cardiovascular capacity and deterioration in vascular and arterial structures. The impact of ageing and how this can affect patients and treatment outcomes requires careful consideration.

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This paper presents a service evaluation on the role of Community Diabetes Nurse Specialists (CDNS), which was undertaken as a response to various changes. Quantitative and qualitative data were captured over 6 months. It was found that GPs refer patients to CDNSs four times more frequently than other health professionals. The clinical care of CDNSs mainly relates to diabetes education, insulin, assessment and self-management. Telehealth is used twice as frequently as face-to-face communications. The CDNSs do not refer patients onto other health professionals, but have multiple communications with other health professionals and agencies. They manage very complex clinical and social situations, using high-level clinical decision making and balancing person-centred care and patient safety. Structured patient education is being delivered. CDNSs mentor other staff and students, although their own formal professional development is very limited. To conclude, CDNSs are the end point for patient care in the community, managing complex patient situations, while adopting a person-centred approach.

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District nursing has a long history as a service that provides care for patients in their home environment. Demographic changes and a need to optimise out of hospital care has impacted on the acuity of patients supported and the complexity of caseload management. District nurses, in order to effectively manage such increased demands on their busy service, need to possess excellent, assertive case management skills. This study explores and evaluates the impact of the Specialist Practice Qualification in district nursing on the assertiveness and leadership skills of students. A mixed methods approach was adopted, utilising a quantitative assertiveness questionnaire at three points during the programme across the 12 participating higher education institutions, alongside qualitative semi-structured interviews. Statistical analysis of assertiveness scores demonstrated a statistically significant increase in scores across the duration of the programmes, with no difference related to the academic level of programme studied. Qualitative analysis demonstrated wide ranging positive impacts of the programme, including the acquisition of knowledge of underpinning theory, enhanced leadership skills and the development of a voice to truly advocate for the patient. The Specialist Practice Qualification has a dramatic impact on the professional performance of students selected to undertake the programme. The programme is frequently at risk as a result of cuts in post-registration funding. This study effectively demonstrates the substantial impact of the programme; a programme that should remain an option for future district nurses.

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Two cases of fraud by district nurses demonstrate that district nurses need to be familiar with the behaviour that amounts to fraudulent activity, so they are able to protect NHS assets and take appropriate action to minimise the loss of funds needed for patient care and treatment. Fraud costs the NHS billions of pounds each year and takes money away from front-line services. The Fraud Act 2006 has made the offence clearer and easier to prosecute. Offences can range from false representation about qualifications and experience, to false timesheet claims and benefit fraud. In this article, Richard Griffith outlines what constitutes fraud and the measures taken by the NHS to counter fraudulent activity.

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Venous ulcers or stasis ulcers account for 80% of lower extremity ulcerations. Approximately 1-2% of the population will suffer from the chronic debilitating condition, with chronic venous insufficiency affecting up to 50% of the adult population. There are many methods of treatment and common treatments include conventional, surgical or mechanical methods. This article examines the complications of leg ulcer management, with the emphasis on the use of antibiotics. The case study demonstrates the positive impact self-care can have as part of a treatment plan.

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After a burn injury, skin loses its protective properties, leaving the body open to a number of complications. The gold standard treatment for burn wounds is autologous skin grafting; however, this may not always be an option, due to insufficient amounts of donor skin. Wound dressings can be used as a primary treatment in those patients who are unsuitable for skin grafting. Many different materials are used to make the dressings; current materials include hydrocolloids, alginates, hydrogels, collagen and hyaluronic acid. There is currently no gold standard of burns dressing that is universally accepted. However, hydrogels have been shown to exhibit a great number of beneficial properties and are the most favourable for use in burns patients. We discuss the use of hydrogel dressings, including their properties and clinical application.

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Diabetes is a global disease, and its prevalence has increased rapidly in the last century. Many complications are associated with diabetes, and diabetic foot ulcers (DFU) are common. There is a variety of different treatments for DFU, and the aim of this article is to discuss the factors responsible for delayed wound healing in patients with diabetes, and the treatment strategies that are available.