Healthy eating is a topic covered widely in the media, and is particularly relevant to healthcare, with diet and nutrition vital to the management and prevention of many conditions. Wound healing is a complex process that relies on the coordination and internal regulation of activities such as the removal of devitalised tissue and growth of fresh blood vessels. This article examines the phases of wound healing and discusses how nutrients can affect and enhance this process. Understanding the role of nutrients in wound care enables nurses to offer advice to patients whose wounds are not progressing in the expected manner. Nutrition should form part of holistic wound assessment, with any malnourished patient being referred to a dietician. It is a misconception that only underweight individuals can be malnourished and the use of a robust assessment tool will assist nurses in deciding which patients require onward referral. There appears to be a significant link between poor nutrition and delayed wound healing, with a higher risk of complications such as infection identified in malnourished patients
Exudate management in chronic wounds and hard-to-heal wounds is a vital process and community nurses need to be aware of the best practice evidence as well as correct product choice. This is particularly important when attempting to provide the optimum moist healing environment and achieve a balance of moisture in the wound bed. Another important element in chronic wounds is the promotion of autolytic debridement, which helps to ensure that healing is not complicated by any devitalised tissue, which can harbour bacteria and impede new tissue growth. This article investigates best practice in the treatment of chronic wounds, with a focus on the management of moisture in the wound bed. The author also looks at one dressing in particular, Cutimed HydroControl® (BSN medical, an SCA company), which uses an osmotic effect and a high moisture vapour transmission rate (MVTR) to ensure that excessive wound exudate is drawn away from the wound bed, while also ensuring that fresh exudate is produced to promote autolytic debridement and maintain moisture levels in dry wounds. Cutimed HydroControl is able to avoid inappropriate dressing use by facilitating the needs of both exuding and dry wounds, thereby ensuring an optimum moist wound environment
This two-part series will discuss common lower limb problems, including venous leg ulceration, oedema (including oedema associated with lymphovenous disease), lymphoedema and lipoedema. This article will focus on the causes of these conditions and discusses the signs and symptoms to enable community nurses to diagnose and differentiate between the types of lower limb problems. Part two of the series will focus on management strategies for simple, uncomplicated venous leg ulceration and oedema, which can be successfully managed with skin care and compression therapy, without specialist skills. It will also briefly outline the management of lymphorrhoea or ‘leaking legs’, which can be challenging for nurses. The aim of this series is to enable community nurses to choose the most effective treatment in terms of efficacy and patient acceptability.
District nursing teams are under increasing pressure to cope with demands on their time and the skills to meet the needs of their local community. The author’s local nursing team has been struggling to manage the clinical skill mix required to meet the complex needs of their patients with lower leg wounds who should be treated with compression therapy. The task of managing compression therapy was mainly undertaken by nurses, but it was proving extremely time-consuming — especially when patients needed leg washing and compression treatment for bilateral leg wounds. After successfully using a Velcro™ compression system, a six-month evaluation of juxta products for the leg ulcer pathway was proposed for one community nursing team. This project was undertaken with an initial cohort of 17 patients to evaluate if switching to this product could help to improve the use of the team’s skill mix and reduce costs on wound products from the formulary by improving wound healing rates.
This article focuses on the work of a team of community nurses running a primary care drop-in centre. As well as a full range of clinic services, the team sees a lot of leg ulcer patients for compression bandaging. A common problem with traditional compression bandaging is the amount of time that community nurses have to spend on the procedure, as well as the dangers of maintaining pressure and bandage slippage between dressing appointments, which can result in discomfort for patients and even skin damage in some cases. This also has implications for patient concordance. This article looks at a review by the team of a new compression system (juxtacures®; medi UK), which offers measurable and adjustable compression and a greater involvement by patients in their own care, which in turn can minimise the time nurses need to spend on dressing changes.
The management of exudate in acute and chronic wounds is a common issue for community nurses, with too much exudate resulting in issues with infection and the breakdown of periwound skin; while too little moisture risks the wound bed becoming too dry. Nurses need to find the most cost-effective and clinically proven treatment regimen when treating wounds that produce different levels of exudate, minimising dressing changes and patient discomfort. While it can be difficult to make a choice about which dressing to use because of the vast array on offer, it is important to match the dressing to the wound and use the most appropriate dressing for the levels of exudate being produced. Similarly, using a more responsive approach to wound management — adapting treatment as the wound changes — will result in a more cost-effective approach. Advancis Medical have a range of wound management dressings that are suitable for different wound types and can handle varying levels of exudate. This allows nurses to use a step-up, step-down approach to the management of exudate as the most cost-effective dressing regimen.
The community nurse may come across a range of wounds in the community setting, particularly with the rise in comorbidities such as diabetes and cardiovascular disease due to unhealthy lifestyles and an ageing population. Accurate assessment is the key to identifying the most appropriate wound treatment programme; one that will promote healing and/or relieve symptoms associated with chronic wound healing. Product choice is secondary to getting the assessment process right and accurate assessment and methodical documentation not only help protect against legal challenges, but also aim to reduce waste, dressing change frequency (and thereby nurse time), and patient discomfort. The community nurse should always seek to match their wound-healing knowledge with what they see in the wound bed and the patient’s history, which in turn will enable the nurse to make informed therapy choices and provide expert patient advice.
Nutritional intake can have an effect on many areas of a patient’s health, while malnutrition specifically has a recognised role in pressure ulcer development. In this article, the author looks at whether there is any high quality evidence to recommend specific nutritional measures when trying to prevent pressure ulcers, as well as looking at overall recommendations for malnourished patients. Nutritional screening remains essential to help identify those patients most at risk of malnutrition and allows community nurses to prepare nutritional care plans and begin to correct any nutritional deficiencies. The author recommends that community nurses perform nutritional screening at any patient contact, be that in hospital, nursing home or in the patient’s
own home. Recording the outcome of screening at regular intervals also helps to identify trends in a patient’s nutritional state and means that any reduction will be picked up quickly.
Community nurses often have very busy caseloads and need a wide variety of knowledge to deal with the many different clinical scenarios that they face. This is particularly true of wound care, which can present a unique set of challenges, including infection, how to control exudate and making sure that any dressing they have chosen does not actually further harm the patient by, for example, damaging the skin when it is removed. This article outlines some of the most important areas that community nurses need to understand when it comes to wound care before going on to look at the solutions provided by one particular dressing (Actilite Protect®; Advancis Medical), which is designed for use on the full range of wounds, including acute skin tears, post-surgical wounds, chronic leg ulcers, pressure ulcers, diabetic ulcers and infected wounds. As well as presenting an overview of the dressing, this article also presents a series of case studies that illustrate the benefits of the dressing in practice.
