Quality of life Resources

Urinary incontinence (UI) is a common and frequently under-recognised condition among postmenopausal women and may significantly affect physical comfort, psychological wellbeing and social participation. Many women delay seeking help because of embarrassment, stigma and the belief that UI is an inevitable consequence of ageing. This review explores the pathophysiological mechanisms, psychological and physical burden, social implications and barriers to help-seeking. The implications for primary care assessment and management are clear as general practice nurses (GPNs) and general practitioners (GPs) are well placed to identify unreported urinary symptoms, provide support and initiate early intervention.

Despite advances in wound care, treatment of lower limb ulceration remains suboptimal, with poor outcomes often attributed to inadequate diagnosis, failure to follow evidence-based practice, and variations in care delivery. These shortcomings result in delayed healing, reduced quality of life (QoL), and a significant economic burden on healthcare systems. Compression therapy is the recommended treatment for venous ulcers and ulcers with mixed aetiology, however there are some individuals who may not respond to compression alone or who are unsuitable due to arterial status. Recent advances in adjunctive therapies, such as the geko® device, offer promising results for these patients. This muscle pump activation (MPA) device activates the calf and foot muscle pumps, increasing venous, arterial and microvascular blood flow. This article examines the impact of leg ulceration on healthcare services and patient outcomes, while exploring the potential of the geko® device to improve healing rates and reduce associated costs.

Continence is not a life-threatening condition, but does affect an individual’s quality of life and the lives of their family and carers. This article explores the most common types of bladder and bowel problems and how to improve patient care. It looks at the prevalence of conditions, different types of continence issues, how they can affect quality of life and the complications that can occur when poorly managed.

Disorders affecting the brain cover a wide spectrum of conditions and many increase in incidence and prevalence with older age. Their symptoms are variable affecting each individual person differently, with some diseases following a progressive pattern. In these instances, as progression occurs, symptoms may impact on family and friends, as well as having a significant effect on the health and wellbeing of those affected. This article, the second of a two-part series on brain diseases, covers Parkinson’s disease, brain tumours, epilepsy and multiple sclerosis (MS). Signs and symptoms, risk factors, diagnosis, treatment and management and prognosis are explored, with the aim of giving general practice nurses (GPNs) and non-medical prescribers more knowledge and confidence in advising and supporting patients affected by any of the diseases discussed.

Chronic obstructive pulmonary disease (COPD) is a term often used for two common incurable lung conditions, chronic bronchitis and emphysema. Breathlessness is the main symptom experienced by patients, which can be frightening and patients can develop symptoms of anxiety, panic, low mood and depression. General practice nurses (GPNs) are ideally placed to address these symptoms. This article describes the importance of considering psychological well-being to improve self-management in COPD and how cognitive behavioural therapy (CBT) techniques can be used to assess and manage the psychological impact of breathlessness. Addressing mental health is a key area to improve self-management in COPD and research has found that respiratory nurses were able to learn and deliver CBT techniques to patients with COPD and improve symptoms of anxiety and depression, as well as quality of life, while also reducing use of healthcare resources (Heslop-Marshall et al, 2018). GPNs can likewise improve self-management by incorporating CBT techniques.

Malignant fungating wounds (MFWs) arise in 5–10% of all cancers. These wounds are distressing for patients, their families and caregivers, with both physical and emotional symptoms impacting greatly on quality of life. Symptoms include severe pain, bleeding, depression, malodour and negative body image. MFWs present considerable challenges in the application and retention of dressings. These wounds deviate from the normal healing trajectory and the theory of wound healing is not always appropriate; they may expand and progress during the terminal stages of a patient’s life. This article discusses the challenges of treating and managing MFWs and presents some practical solutions to the major symptoms. It also looks at dressing choice and pain management — including pharmacological and topical treatments — managing malodour, as well as assessing and addressing quality of life.

Eczema, also known as dermatitis, is a very common skin condition. There are several different types of eczema, affecting people throughout their lifespan. General practice nurses (GPNs) will see children and adults with eczema regularly and they are well placed to assess, manage and support them. Eczema is a chronic conditon and can have devasting effects on quality of life and mental health. GPNs can play an important role in supporting patients with eczema and their families in understanding how to self-manage this long-term conditon and help with coping strategies. This article outlines eczema as a long-term condition and provides practical advice for GPNs on assessment and treatment in primary care. Psychological effects and intervention and referral guidelines for eczema are also discussed.

Psoriasis is a chronic inflammatory skin condition that can have a debilitating impact on patients. It affects 2% of the UK population (Gelfand et al, 2005), and although it can develop at any age, usually occurs in adults rather than children (NHS Choices, 2015). General practice nurses (GPNs) will often encounter patients with psoriasis in their dayto- day practice, but can lack confidence when advising these patients on the effective management of the condition. This article outlines the causes of psoriasis and provides practical advice for GPNs on assessment and treatment in primary care. The author also outlines the psychological effects of psoriasis, and discusses referral guidelines.

Wounds impact a patient’s quality of life, but research shows that this is often overlooked. Lifestyle concerns are haphazardly disclosed by patients, and not always recorded and addressed by nurses. Research (Green et al, 2013a; 2013b) led to the development of a leg ulcer consultation template (LUCT), which, in turn, raised the need for a generic tool to produce an overall, self-assessed ‘quality of life’ score for any patient with a wound. The principles of the LUCT were reviewed and a new ‘wound checklist’ developed, supported by an advocacy service, to ensure utility for all patient groups. Images, simplified questions and use of a ‘pain’ and ‘quality of life’ score improved the checklist’s accessibility, and aimed to show which areas of the patient’s life were affected by the wound. Results of an evaluation have been positive, and the new checklist is available as a paper version and is being developed as a digital resource.

Chronic wounds are a complex and challenging health problem for all concerned, but most importantly for patients who have to live with them. Chronic wounds impact negatively on patients’ quality of life, often accompanied by a loss of independence and, in many cases, a sense of hopelessness. The global prevalence of wounds is predicted to rise with an ageing population, and rapidly increasing numbers of people with obesity and diabetes. In an NHS with escalating costs and a shortage of qualified nurses, it is not sustainable for nurses to continue to manage all wounds. By incorporating shared decision-making and involving patients in their own care, it will be possible to improve outcomes for all concerned.