End of life care became the focus of media attention in 2013 when the Liverpool Care Pathway was found to be not fit for purpose. This article looks at the policy background to end of life care in the UK, as well as the current state of provision, from a community nursing perspective. It also focuses on pressure ulceration, a key complication for patients at the end of life, offering advice on how to approach skin care for this patient group. Finally, the author examines the implications for treatment of mental capacity legislation, and how concepts such as 'advanced decisions' and ethics affect nurses trying to treat patients at the end of life.
Ongoing changes to the NHS (Department of Health [DH] 2010a–c) mean that clinicians responsible for the delivery of wound care need to reduce expenditure while meeting the increasing demand for the provision of quality care (DH 2010a–c). The high impact action (HIA), Your SkinmMatters, identified ‘no avoidable pressure ulcers’ in NHS care settings as a vital improvement to the quality of patient experience and cost effectiveness (NHS Institute for Innovation and Improvement, 2010).
Aaron Knowles, Tissue Viability Podiatrist;
Richie Skinner, Senior Tissue Viability Podiatrist, both at Wound Healing Centres, Eastbourne
Steve Young,Managing Director, Cambridge Health Technology;
Sylvie Hampton, Tissue Viability Consultant,Wound Healing Centres, Eastbourne
Mark Collier examines principles to underpin a practical patient focused approach to care for patient’s with pressure ulcers in the community.
Mark Collier B.A (Hons), RNT, RCNT, ONC, RN., is a Senior Lecturer/Nurse Consultant – Tissue Viability at the Centre for Research and Implementation for Clinical Practice (CRICP), Thames Valley University, London and Honorary Nurse Consultant – Tissue Viability, Hinchingbrooke Hospital NHS Trust (Acute), Huntingdon, Cambridgeshire.
Article accepted for publication July 2001.
Mark Collier reflects on a foreign visit in which he experienced first hand the true realities of limited resources in wound management.
Mark Collier, B.A (Hons), RNT, RCNT, ONC, RN is Lead Nurse - Tissue Viability, United Lincolnshire Hospitals NHS Trust, United Lincolnshire Hospitals Tissue Viability Collaboration (ULHTVC), c/o Pilgrim Hospital, Sibsey Road, Boston, Lincolnshire.
Article accepted for publication February 2001.
Marcia Gore discusses the sharp debridement of pressure ulcers in the community setting
Marcia Gore RN, Dip HE, BSc Hons, PGCE is Lead Nurse Tissue Viability, East Lancashire Teaching PCT
Article accepted for publication: June 2008
Student nurse Celene Gibbon reviews the literature surrounding sacral moisture lesions and sacral pressure damage and the challenges of misdiagnosis and subsequent mismanagement of the wound.
Celene Gibbon is a 3rd year student nurse, Dip/HE Adult Branch Nursing, University of Chester.
Article accepted for publication: January 2009
