Caring for patients in a community setting continues to offer challenges to nurses and therapists because of the complexities of patients’ intricate and complicated conditions. The demand on district nursing is increasing as more patients are being cared for in their own homes with no additional resources to support nurses. Management of lower leg wounds dominates the workload. Compression bandaging has historically been the treatment of choice to reduce oedema and heal venous leg ulcers. However, there are safe and reliable alternatives to assist community nurses in their practice. Getting compression therapy right first time achieves many positive aspects: it improves patient quality of life, reduces costs, and enhances staff morale and job satisfaction. This article explores some of the challenges nurses face, and offers solutions with the use of the juxta range from medi UK.
Dehisced surgical wounds are a common occurrence and are seen both in primary and secondary care. The impact of a dehisced wound is far reaching. For the National Health Service, there are increased in-patient costs and additional resources in terms of an extended healing time, such as staffing and dressing materials and therapies. For the patient, a dehisced wound can impact significantly on their wellbeing and quality of life and for patients of working age, the economic impact of not being able to work can be enormous. This article discusses the incidence of wound dehiscence, outlines the types of wounds which are most likely to dehisce, and the most common reason for this, wound infection. Strategies for managing wound infection, including the use of antiseptic and antimicrobial products, together with a frequently used therapy, topical negative pressure therapy (TNPT), are also discussed.
Appropriate and accurate assessment and management of lower limb wounds requires a timely, holistic assessment of the patient and their wound, including the recording of an ankle-brachial pressure index (ABPI) (Wounds UK, 2019a). A manual ABPI procedure requires advanced skills, using a handheld ABPI device, and is undertaken by a healthcare professional who is appropriately trained. In addition, the procedure is time consuming, taking a minimum of 40 minutes, and is subjective in its results, based on the technique and skill of the operator. This article describes an innovative service evaluation project that has seen the introduction of 20 automated ABPI machines into 19 general practices and a community vascular clinic in Staffordshire. The project has included the development of a care pathway, recruitment of wound champions, and training within each of the practices. Evaluation of the project is ongoing but tracks ABPI readings, assessment and wound management of patients, onward referrals and outcomes for patients, to ensure that the project’s potential to improve patient care is realised.
Patient experiences with wound care treatment are being recognised as central to prudent care. Leg Clubs provide community-based treatment, education and ongoing health promotion and care for people with leg-related problems. This article considers the growing evidence of patients’ experiences of being treated in a Leg Club setting. Six participants from a Leg Club setting were interviewed via a semi-structured interview, and interviews were transcribed verbatim and investigated for themes using interpretative phenomenological analysis in accordance to Smith et al (2009). An overarching theme, the holistic approach to treatment, was identified, with two subthemes: Leg Club education and a sense of autonomy and trust in Leg Club staff. This study revealed the importance of a holistic approach to treatment within a Leg Club setting, and adds to, and complements, the body of evidence.
