Resources

In a position statement issued by the British Society for Heart Failure (BSH, 2021), the author said that keeping heart failure specialist services intact would:
... mitigate the significant risk to those living with heart failure and prevent unnecessary pressure on other healthcare providers. The pandemic has already taught us that we need to maintain service provision for this highly vulnerable cohort.’
A statement which has hit home as cases of Covid-19, fuelled by the latest variant, continue to rise.

This article explores why we should adapt assessment of leg ulceration to be more mindful of the presence of lymphoedema. If clinicians can change the assessment process and begin to treat leg ucleration with a lymphatic component differently to venous oedema, this, in turn, can potentially reduce complications such as toe, foot and knee oedema. The introduction of simple changes in documentation and additional training can lead to improved outcomes for patients as well as potential cost savings for healthcare providers.

There are many different causes of liver disease and current estimates suggest that as many as one in 10 people have problems with their liver at some time in their life (Foundation for Liver Research, 2020). Perhaps most worrying is the fact that incidence of liver disease is increasing, with the number of deaths reported to have increased by 400% since 1970 (British Liver Trust, 2020). Most liver diseases are asymptomatic early on, frequently resulting in late diagnosis, potentially leading to a higher risk of poor outcomes. Many of the well-known liver diseases are preventable and this article, which covers fatty liver disease, hepatitis A, B and C and liver cancer, hopes to raise awareness of risk factors, recognition, causes and treatment of these conditions, and give general practice nurses (GPNs) and non-medical prescribers more confidence when caring for patients with these illnesses.

Pelvic organ prolapse (POP) and urinary incontinence (UI) are common problems experienced by women of all ages. With the publication of Seizing the opportunity to improve patient care: Pelvic floor services in 2021 and beyond (Pelvic Floor Society, 2021) comes recognition of how common pelvic floor disorders are, but how little investment
has been put into these services. Such publications highlight the need for services to be provided which encourage women to come forward to be assessed and treated. This article, the second in a two-part series, discusses conservative treatments for UI and POP, which should be considered as first-line options where possible (National Institute
for Health and Care Excellence [NICE], 2021) and are easily started in primary care.

It has been reported that one in 500 people in the UK are living with a stoma (Colostomy UK, 2022) and nearly threequarters of people with a stoma experience skin problems. Therefore, skin assessment, prompt identification of risk and preventing skin problems is the cornerstone of peristomal skin care. This article introduces common peristomal
complications, focusing on the assessment and prevention of two distinct groups of peristomal skin damage; peristomal moisture-associated skin damage (PMASD), one of the types of moisture-associated skin damage (MASD), and medical adhesive-related skin injuries (MARSI).

In 2006, the National Institute for Health and Care Excellence (NICE) released the landmark guidance on nutrition, ‘Nutrition support in adults: oral nutrition support, enteral tube feeding and parenteral nutrition’ (NICE, 2006). At the heart of NICE guidance and quality standards is the aim to integrate research into practice and reduce gaps between recommended and actual practice. However, successful implementation is dependent on national and local action. To facilitate the implementation of the NICE clinical guidance (CG32), a national multidisciplinary expert panel was convened to explore and develop strategies that would overcome barriers to implementation of the NICE guidance, facilitate access to practical tools, and enhance knowledge to improve the management of disease-related malnutrition in the community. The collaborative work undertaken by the panel, in conjunction with major stakeholders, led to the development of the ‘Managing Adult Malnutrition in the Community’ materials. This article reviews the work of both the initial panel in 2012 and subsequent expert panels, that have delivered and continue to develop resources for nurses and the wider multidisciplinary team to assist in tackling malnutrition, which affects up to three million people in the UK at any time (Elia and Russell, 2009), especially that which arises as a consequence of illness and long-term medical conditions having an impact on appetite and the ability to eat and drink.

A friend told me at the beginning of the pandemic that she had made an active decision not to judge others and their behaviour and reaction to Covid-19. She would do her best to act responsibly, but would not question or worry about what others were doing. This seemed a good approach and I have tried to reflect on it when feeling annoyed about various examples of lack of adherence to the rules.

Making decisions can be tough. Anyone who’s ever been confronted with the choice between a chocolate Hob-nob and custard cream knows that weighing up the pros and cons can involve some pretty serious soulsearching. But, while most people face a host of trivial everyday decisions about the clothes they wear or the food they eat, nurses are in a unique position in that the choices they make about patient care can literally involve life or death. 

However, with the government’s recent announcement of compulsory vaccination for all frontline NHS staff, nurses are about to find out that one decision — whether or not to be vaccinated against Covid-19 — is about to be taken out of their hands. We explore what this means for general practice nurses (GPNs), and discuss the pros and cons of Covid-19 vaccination.

Eighty percent of men diagnosed with prostate cancer will end up with erectile dysfunction after treatment (Downing et al, 2019). Yet, talking about sex, treating erectile dysfunction, and meeting the man’s needs after treatment is often lower down on the healthcare professional’s agenda. Prostate Cancer UK found that sex and erectile dysfunction is the biggest unmet need for men with prostate cancer.

Why is that? Is it because we just want to focus on managing the prostate cancer? Are the urinary problems easier to prepare a patient for and treat? Do we find it difficult to talk about sex? Do we make assumptions that because a man is over a certain age, he won’t be having sex, so we don’t need to talk about it? Do we feel that if we ask how the erections are, we might be opening a can of worms and we just don’t have time in clinic? Do we have our own hang ups about sex, prejudices or cultural beliefs that stop us being able to talk openly about sex?

Making every contact count (MECC) is not a new concept, having been part of clinical practice for many general practice, district and community nurses and driven at all levels through educational programmes by Health Education England for some years now (HEE, 2021). The need for early intervention is vital for many people diagnosed with long-term conditions, and this applies to lower limb management too. Prevention of deterioration is incredibly important within the lower limb management field of practice, and this links well with the philosophy of making every contact count because harm is occurring, and this could be prevented with proactive early intervention.