Caring for those who are dying and in the last days of life is a common aspect of caring for people in the community. While caseloads are time-pressured, stretched nurses can do a great deal to reduce any suffering at the end of life by providing optimal assessment and care. An important feature is that nurses first need to be able to identify when death is likely. They need sensitivity and to be able to build a therapeutic relationship with the patient and those significant to them. Nurses play a key role in providing and coordinating quality care and comfort, for which good communication skills are essential. Assessment and interventions to manage pain and symptoms, as well as helping to prepare patients and their families for death, are important. Community nurses can also direct family members to relevant resources and specialists, including those for bereavement.
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.
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.
With the plethora of wound contact dressings available and the demand for their use in clinical practice, clinicians need to keep abreast of what is new on the market to ensure that they provide their patients with the best treatment options, while also considering the costs involved. Preventing pain to the patient, trauma to the wound or periwound skin, and infection, are key considerations for clinicians at dressing changes (Hollinworth, 2001). With advances in wound care technology, patients should not experience pain due to adherent products causing trauma to the wound and/or ‘skin stripping’. The use of silicone dressings can help to prevent such occurrences from happening and thus promote patient wellbeing and quality of life (Upton, 2011; Yarwood-Ross, 2013). This article looks at the role of primary wound contact layers in wound management, and introduces a new silicone dressing with case reports demonstrating its positive effects in clinical practice.
Choosing the correct dressing is often key to moving a wound along the healing trajectory, with its ability to deal with problems such as pain, excess exudate production and inflammation being crucial to the healing outcome. Infection is also a serious problem in many wounds and this article looks at the basics of wound infection as well as some of the main treatments, such as topical antimicrobials. However, clinicians are faced with a huge range of wound care products, many of which have antimicrobial properties. This article considers the use of one gelling fibrous silver dressing (Durafiber® Ag; Smith and Nephew), which is specifically designed to deal with many of the problems mentioned above, particularly excess exudate production and infection. The authors also presents the results of a small, prospective multicentre case series that was carried out to assess the efficacy of Durafiber Ag in a variety of wounds.
End of life can be a frightening and uncertain time for patients and families and the role of the community nurse can be vital in easing this phase of life. This article outlines some of the issues that community nurses should be aware of when caring for a patient who is dying at home. It identifies the signs which signify that death is approaching, and explains the need for a change in care emphasis at this point. The author also outlines some key management aspects that can improve the quality of a patient’s death, including communication, care coordination, symptom and pain control, and support for nurses and carers.
