Diabetic bladder dysfunction

More than 4.3 million people in the UK have been diagnosed with diabetes and there are thought to be a further 850 000 people living with diabetes who have not yet been diagnosed (Diabetes UK, 2024). Around half of all adults who have diabetes experience bladder dysfunction. It is one of the most common complications of diabetes, yet there is little in the medical literature and it is often unrecognised and poorly treated (Wittig et al, 2019). This article uses a case history approach to examine how diabetes can affect the bladder.

Intermittent catheterisation

When an individual has voiding difficulties, the person may require a urinary catheter. Enabling the person to choose an appropriate method of catheterisation and supporting them can have an enormous impact on the individual's health and wellbeing. Indwelling urethral catheters are suitable for some people but for others they can affect a person's lifestyle and lead to depression. Intermittent catheterisation can work well for some people. Intermittent self-catheterisation has been used to manage urinary retention for over 3500 years. It remains the 'gold standard' in terms of bladder drainage, but it is under-used and indwelling catheters remain more common. This article examines the history of intermittent catheterisation, indications for self-catheterisation and how to support people to use self-catheterisation.

Stoma care: an update

Each year an estimated 13 500 stoma surgeries are carried out in the UK (Kettle, 2019). Stoma surgery may involve the formation of a colostomy or an ileostomy. The person with a stoma may require help and support from the community nurse. This article aims to update readers on the indications for colostomy and ileostomy surgery and to enable them to support ostomates to reduce the risks of complications.

Type 2 diabetes post pandemic: enabling your patients to regain control

There are now an estimated five million people living with diabetes in the UK, most have type 2 diabetes. The COVID-19 pandemic affected access to care, led to delays in diagnoses of diabetes and many people with diabetes experienced a deterioration in their diabetes control. This article provides guidance on how nurses can work with people at risk of diabetes to prevent diabetes, to induce remission and how to use medication to treat diabetes.

Can medication increase the risk of falls? The importance of medication review

Falls are the second leading cause of unintentional injury deaths worldwide and are a major health issue for older people. One of the factors that can increase the risk of falls is medication. This article examines how medication can affect fall risk and how medication review can reduce the risk of falls.

A guide to diagnosing and treating benign prostatic hypertrophy

Benign prostatic hypertrophy (BPH) is a condition where the prostate becomes enlarged. It affects all men and is part of the ageing process. Globally, the incidence rates of BPH have risen by 70% between 2000-2019. When left untreated, it can lead to acute urinary retention, impaired bladder emptying, urinary tract infections, bladder stones, kidney failure or gross haematuria. In this article, Linda Nazarko describes the causes and consequences of BPH along with treatment options that are available for it.

Bowel care at end of life

Most people, given a choice prefer to die at home. As death approaches the dying person may say "please let me die at home, in my own bed". Many relatives promise their loved ones that they can remain at home until the end. One issue that can cause great distress and at times lead to unnecessary hospital admission is poorly managed bowel care. This article will examine how ageing, illness and medication can affect bowel function and quality of life.

Scabies: an update for community nurses

Community nurses may encounter scabies in homeless people, those living in prisons, people living at home or in people living in care homes. Scabies is more prevalent in older adults and there is evidence that this infection is becoming more prevalent and difficult to treat. The community nurse can help reduce such risks. This article aims to enable the community nurse to be aware of the clinical features of scabies and how it is treated.

Treating head lice: a case study

People who are homeless are greater risk of infections than the general public because they are often in poor health and have difficulty maintaining hygiene. This article discusses the treatment of head lice and uses a case history to outline specific issues that may arise in a person who is homeless and how these can be managed.

Red legs: how to differentiate between cellulitis, venous eczema and lipodermatosclerosis

Community nurses often encounter people with red legs. There are a number of reasons why an individual may develop red legs. The most common causes of red legs are cellulitis, venous eczema and lipodermatosclerosis. All have different causes and require different treatments. This article aims to enable readers to differentiate between these conditions which can appear similar, and to offer effective evidence-based care.

Type 2 diabetes: an update for community nurses

There are now over four million people living with diabetes in the UK, the majority having type 2 diabetes. The prevalence of type 2 diabetes is rising in line with growing obesity levels. This article will explore prevalence of type 2 diabetes, its prevention and treatment. It also provides guidance on how nurses can work with people at risk of diabetes, to prevent it, induce remission and create awareness of medications used to treat it.

Acute urinary retention: patient investigations and treatments

Acute urinary retention (AUR) is the sudden inability to pass urine. AUR is more common in men and older men are at highest risk. The most common causes are obstructive in nature-prostatic hyperplasia is responsible for more than half the cases of AUR in men. AUR can also be caused by infection, inflammation, and by iatrogenic and neurological problems. This article outlines how AUR is diagnosed and treated.

Supporting people with dementia during the COVID-19 pandemic

People with dementia have experienced great disruption to their lives due to the pandemic. Linda Nazarko highlights the way individuals have been affected and how the practice nurse can support them

People with dementia and their caregivers have been severely affected by the COVID-19 pandemic. Isolation, a reduction in formal and informal support, and disruption to routine have contributed to feelings of loneliness and anxiety in people with dementia and their caregivers. The pandemic has led to staff shortages in health and social care, changes of care workers and a reduction in the level of support provided. These changes have affected the physical and mental health of people with dementia and increased their reliance on primary care. Practice nurses have a key role to play in supporting affected individuals.

Eczema and the older person

Age-related changes lead to an increase in skin problems, and around 70% of older people have a treatable skin condition. However, ageing and poor physical health can make it difficult for older people to care for their skin. Eczema, a chronic inflammatory skin condition, where the skin becomes red, inflamed, itchy and scaly, can develop easily in older adults. This can, in turn, become infected and cause discomfort and health problems. This article explains how ageing affects the skin, how eczema can develop and how it can be treated, also touching upon the different types of eczema. It aims to equip community nurses with knowledge about this common condition and how to recognise and manage it.

Preventing catheter-related problems in community settings

Linda Nazarko explains how catheters can be managed safely in the home

Providing dignified continence care to older people at end of life

The prevalence of urinary incontinence increases as a person ages, as age-related changes make it more difficult to maintain continence. Long-term conditions and treatments prescribed to treat conditions, such as heart failure, can lead to an urgency to void the bladder. Frailty can make it difficult for an older person to respond this need. At end of life, mobility is often compromised and people can experience extreme fatigue. Caregivers can obtain support to manage an individual's incontinence during the day but often struggle alone at night. Caregivers can become exhausted and a situation can reach breaking point. Working with the older person and caregivers to determine the goals of care and how to meet them can make a huge difference. It can take the pressure off the entire family, meet a person's needs and enable the person to stay at home. This article aims to enable nurses to understand the problems older people may experience and how to work with the older person and caregivers to develop solutions that maintain dignity and enhance quality of life.

A good idea badly implemented? Revised National Early Warning Score 2 in community settings

The revised National Early Warning Score (NEWS2), a tool used to measure acute deterioration in hospital, has been introduced in acute NHS hospitals and ambulance services. Community nurses report that when they call 999 requesting an ambulance to take a person to hospital, they are asked to provide a NEWS score. They report that when the NEWS score is high, ambulance staff prioritise the call. The NEWS score is being introduced in the community by default. This article will outline how the NEWS score is calculated, its uses and limitations and asks if the NEWS score accurately measures acute deterioration in people living in the community and predicts the need for referral to accident and emergency services.

Faecal incontinence: investigation, treatment and management

Faecal incontinence (FI) is a hidden problem that is under-diagnosed, under-investigated and under treated. Up to 10% of adults can experience an episode of FI. The prevalence of FI in the adult population has been estimated at 0.8-6.2%. Recent North American research indicates a prevalence of 8.3% in adults living in the community. This article explores the reasons why adults can develop FI, the importance of assessment, what treatments are available and how intractable FI can best be managed.

Male urinary incontinence management: penile sheaths

Urinary incontinence is a hidden problem that affects 14 million adults in the UK. It affects around 30% of men aged 65 and over and can have a huge effect on quality of life. Often this distressing symptom can be treated effectively. It is important to manage incontinence while the man is undergoing investigations and treatment or when treatment is not possible. This article examines the role of urinary sheaths in the management of incontinence and provides links to further information.

Venous leg ulcers: appropriate diagnosis and evidence-based treatment

Each year around £3.3 billion is spent on wound care in the community. Community nurses care for around 730 000 with leg ulcers each year and around 284 000 people still have a leg ulcer after a year. This article explores the issue of hard to heal leg ulcers and what community nurses can do to improve healing rates and improve quality of life for people with leg ulcers.

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.