The accurate grading or staging (henceforth referred to as grading in this article) of pressure ulcers has become increasingly important over the past five years as healthcare organisations insist on each wound being accurately documented (National Institute for Health and Care Excellence [NICE], 2014a, b). The impetus to capture improved data on pressure ulcers has been driven both by the need to reduce the impact of these debilitating wounds on patients, but also to bring down the spiralling costs to the NHS associated with their treatment. However it is not always easy to grade a pressure ulcer and the accuracy of any conclusions can be affected by multiple factors such as the presence of necrotic tissue, the colour of the individual's skin and the skill of the clinician, whether nurse, therapist, doctor, podiatrist or healthcare assistant. This article examines the basic principles of grading pressure ulcers, particularly where there may be conflicting signs and indications, and also investigates so-called 'ungradeable' pressure damage and how community nurses might reasonably interpret the guidelines on this.
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This article examines the various elements that community nurses need to consider when attempting to provide best practice in urinary catheterisation. The author seeks to challenge what is considered best practice — particularly the requirement for all practice to be evidence based — while encouraging community nurses to think proactively about the care they are providing. The article stresses that the first principle of urinary catheterisation is to avoid the procedure where at all possible — catheterisation is potentially dangerous and can even be life-threatening if performed inappropriately. Overall, the author poses some key questions, including: should there be a difference in the care provided by community and hospital nurses; do community patients have the same needs as those in hospital; and can the manufacturers of drugs/products help to make avoiding urinary tract infections (UTIs) easier?
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