Use of continence pads to manage urinary incontinence in older people

Urinary incontinence is a symptom that should be investigated and whenever possible treated in order to enable the person to regain continence. Sometimes, it is not possible or appropriate to promote continence, and the focus shifts to that of managing incontinence sensitively to enable the person to maintain dignity and avoid the complications of poorly managed urinary incontinence. This article examines how nurses and health professionals can promote wellbeing by assessing a person's need for incontinence pads, enabling the person to use the appropriate type of pad and minimising risks of skin damage, odour, embarrassment, and leakage.

Advances in wound debridement techniques

Dead and devitalised tissue interferes with the process of wound healing. Debridement is a natural process that occurs in all wounds and is crucial to healing; it reduces the bacterial burden in a wound and promotes effective inflammatory responses that encourage the formation of healthy granulation tissue (Wolcott et al, 2009). Wound care should be part of holistic patient care. Recent advances in debridement techniques include: biosurgery, hydrosurgery, mechanical debridement, and ultrasound. Biosurgery and mechanical debridement can be practiced by nonspecialist nurses and can be provided in a patient's home, thus increasing the patient's access to debridement therapy and accelerating wound healing.

Avoiding admission and facilitating early discharge through OPAT

Fifteen years ago, only a small minority of hospital inpatients were considered suitable for outpatient parenteral antimicrobial therapy (OPAT) services (Wiselka and Nicholson, 1997). Now, almost 70% of those treated with intravenous (IV) antibiotics as hospital inpatients are considered suitable (Hitchcock et al, 2009). Around 38-53% of those requiring OPAT are able to self-administer (Hills et al, 2012). The demand for IV antimicrobial therapy is increasing and the way it is being delivered is changing. The delivery of IV anti-microbial therapy in the community has the potential to make a huge difference to the way health care is delivered. It can enable people who would once have been admitted to hospital to be treated in the community. It can facilitate early hospital discharge (Nazarko, 2013a). Potentially, there are huge benefits in developing OPAT but there are also risks. People may be subjected to an invasive treatment when it is not necessary; therapy may be continued when it is no longer necessary (Nazarko, 2013b; Conant et al, 2014); and patients may be selected for OPAT who would be best treated in hospital. The key to providing safe and effective care is to work together to maximise benefits and minimise risk (Duncan et al, 2013). This article examines how acute and community services can work together to ensure appropriate selection, treatment and follow-up of patients.

Urostomy management in the community

Around 11 000 people in the UK have a urostomy. A urostomy is now usually carried out for bladder cancer. Most urostomists are older men and around half require assistance with routine care. Complications such as parastomal skin soreness are common. Community nurses can work with urostomists and formal and informal carers to encourage and enable the person to manage their urostomy independently whenever possible and provide support, advice and help when complications occur. This article provides an overview of effective care and possible complications.

Does paracetamol help or hinder healing in bacterial infections?

Community nursing teams, alongside other primary care services and nurses in working in community hospitals, are caring for people who are older, sicker and require more complex care. The nurse's ability to use evidence to make informed judgements is vitally important to patient care. Nurses often give paracetamol that is prescribed on an 'as required' basis to patients with bacterial infections who are pyrexial. This practice is supported by guidelines from the National Institute of Health and Care Excellence and the British National Formulary. This article reviews the evidence and suggests that the administration of paracetamol in people with pyrexia should be reconsidered and given on an individualised basis rather than as a routine.

Catheter-associated bladder pain: it's not always infection

This article is a case study examining the diagnosis and management of bladder dysfunction and catheter-associated pain in an older woman with diabetes and a hypotonic bladder. The incidence of diabetes has reached epidemic proportions. Although people with diabetes frequently develop lower urinary tract symptoms and voiding difficulties, this is often an unrecognised problem. As the incidence of diabetes grows, the incidence of diabetes-related bladder dysfunction will also increase. It is important that community nurses are aware of how diabetes affects bladder function and how to enable people with diabetes to manage bladder dysfunction well.

Cognitive assessment: a guide for community nurses

Ageing increases the risks of dementia and there are an estimated 667,000 people in England living with dementia. Less than half have a formal diagnosis. Community nurses are now being asked to screen older people for dementia under the Commissioning for Quality and Innovation framework. This article provides a brief explanation of common screening tools and explains the community nurse's role in identifying people who may have undiagnosed dementia.

Recurrent urinary tract infection in older women: an evidence-based approach

Ageing increases the risk of a woman developing a urinary tract infection (UTI). It also increases the risk of misdiagnosis and inappropriate antibiotic therapy being prescribed. Antibiotic therapy has costs as well as benefits and can lead to changes in gut and vaginal flora that further predispose older women to UTI. Antibiotic resistance is growing and those who do have a UTI may experience treatment failure because of resistance to commonly used antibiotics. Accurate diagnosis and effective evidence-based treatment becomes even more crucial in the face of an ageing population and increasing antimicrobial resistance. Furthermore, the need for specific evidence-based guidelines for UTI in older people is increasing.