Osteomyelitis, diabetic foot ulcers and the role of the community nurse.

Community nurses face numerous challenges in both diagnosing and effectively treating their patients. The diabetic patient has complex needs requiring a holistic approach. With a reported increase in diabetic patients, and a possible decline in some routine screening following Covid-19 pandemic, complications in diabetic patients are likely to rise. It is estimated that 25% of diabetic patients will develop a diabetic foot ulcer (DFU), with a reported 43% of DFU already infected at first presentation to a health professional. NICE categorise the level of infection in DFU based on standardised assessments such as SINBAD. A high categorised DFU has the possibility of osteomyelitis. It is imperative that osteomyelitis is treated immediately to achieve positive outcomes, benefitting the patients' health and wellbeing in addition to reducing the financial implications to the NHS.

New tools in wound care to support evidence-based best practice.

Throughout history, various wound healing and management concepts have been recorded, with some approaches such as honey, silver and larvae still in use and others such as blood-letting completely dismissed. In more recent times, dressing products have begun evolving, moving on from basic first-aid supplies to products that support positive healing by addressing the needs of the wound bed and considering underlying factors that impact healing. With an ageing population, the incidence of chronic wounds is predicted to rise, and chronic wounds can negatively impact the lives of patients physically, emotionally and financially. Clinicians continue to explore and review new approaches surrounding the management of wounds, as it is imperative that clinicians use technological advances in wound management alongside established gold standard evidence-based practice to achieve positive outcomes for patients experiencing delayed or challenging wound healing.

TIMERS: undertaking wound assessment in the community.

Community nurses regularly treat patients with chronic wounds (those persisting over 6 weeks); with the complexity of both the patients' health needs and the wound itself, this often becomes a highly time-consuming task for the nurse. Wound assessment tools are designed to support all qualified nurses, regardless of whether the nurse possesses specialist wound care knowledge or not, in delivering safe and appropriate wound care. The wound assessment tool, using the acronym TIME, has been recently amended to now be known as TIMERS (Tissue, Infection/Inflammation, Moisture, Wound edge, Repair/Regeneration, Social). This article will examine what the newly amended wound assessment tool TIMERS represents, in addition to looking at the practical issues around its implementation in community settings.

How to manage incontinence-associated dermatitis in older adults.

An estimated 14 million adults experience incontinence in England alone, and this population is at a very high risk of developing incontinence-associated dermatitis (IAD). The risk associated with developing IAD is further increased among older adults, due to the effects of the ageing process, which leave the skin thinner and more fragile. Understanding the causative factors of IAD in addition to understanding the impact of IAD on the skin enable the clinician to make informed choices regarding treatment, management and prevention. Additionally, understanding the association between IAD and pressure ulcers is a critical component of IAD management, as IAD and pressure ulcers often coexist or develop alongside each other.

Understanding and addressing dryness during wound healing.

Timely wound healing supports positive outcomes for both the patient and the clinician. The cause of a non-healing wound needs both identifying and addressing. A dry wound bed will result in a lengthy healing process, impacting both the patient and the clinician, physically and financially. It is imperative to correctly identify the cause of a non-healing wound and address the causative factors using evidence-based best practice. A non-healing wound may be attributed to various factors, such as inappropriate dressing, lack of hydration, medication or underlying medical disease. Identification of the cause will support the most appropriate management choice. In order to explain the issues of a dry wound, it is imperative that the clinician first has an understanding of the concept of moist wound healing.

Challenges in wound care for community nurses: a case review.

Wound care in primary settings can be complex if patients are discharged early and have comorbidities. With community nurses often working alone, it is imperative that support is available to guide clinical decision making, for example, through both senior or specialist nurses, guidelines, protocols, wound care formularies, care pathways and care plans. Unfortunately some patients try to dictate their care when at home. Community nurses must continue with a professional approach, ensuring care is delivered in a safe and appropriate way. The patient may sometimes seek reassurance when they feel vulnerable; in these scenarios it is essential for the nurse to establish a trusting relationship, offering fully informed explanations of procedures and gaining patient consent. This report describes a gentleman whose whose personal anxieties led him to refuse care.

Approaches to leadership and managing change in the NHS.

The NHS is continually changing as research evidence leads to new practices and technology transforms the workplace. Resistance to some changes may occur because of staff fears about adapting to and coping with new methods. This is where change models and leadership are important. This article discusses changes taking place in the NHS, and some theoretical models of change. Leadership styles are also discussed, including those most useful for the nurse to use when leading a team and implementing change.

Selecting appropriate postoperative dressings to support wound healing and reduce surgical site infection.

The appropriate choice of postoperative dressing supports effective wound healing by providing a moist wound environment and reducing the risk of surgical site infection and blistering. Wound management is complex and practitioners need to consider the location of the wound, method of wound closure, expected exudate level and length of time the dressing needs to remain in place when selecting a product. The correct dressing selection will have a positive impact wound healing and the patient's quality of life.