The purpose of this assignment is to analyse the role of the community nurse in the delivery of health care to a client within the community setting. This shall be done by focusing on the chosen client, and the condition they suffer from, analysing the care they received and researching the relevant evidence based practice, as well as giving an overview of the role of the district nurse. For the purpose of confidentiality all persons and places have been changed in accordance with the Nursing and Midwifery Council (2002)The client focussed on for this assignment shall be referred to as Bess. She was a frail 86 year old lady who had difficulty walking and used a walking frame ...view middle of the document...
Over 75% of community patients with ulcers have ones associated with venous disease, such as incompetent valves, venous obstruction resulting in varicose veins and/or poor venous return due to varicose veins or to deep vein thrombosis. Bess had varicose veins and this along with her age was one of the contributing factors to her legs becoming ulcerated.It is important that before treatment a holistic assessment is undertaken. Compression therapy should not be used for arterial leg ulcers or where arterial insufficiency is present, (Nelson, 1996). Strong compression therapy should be avoided on patients with diabetes and rheumatoid arthritis, as they may have associated arterial or micro-vascular disease.During the initial assessment a Doppler ultrasound reading should be included, and the resultant ankle brachial pressure index (ABPI) needs to be interpreted, recorded and documented.As Bess was unable to get herself to the treatment room and her husband was not always available to drive her, an initial assessment visit was organised for her to have a Doppler ultrasound assessment at home.A Doppler assessment is not diagnostic of venous ulceration but is a valuable tool in defining a safe level of compression bandaging. Although helpful in defining when compression bandaging is contraindicated, an ABPI is meaningless when used in isolation. Before the nurse began the assessment with Bess she explained the procedure fully, but in a simple way so as to not confuse her. A Doppler ultrasound is undertaken using a hand-held machine. Bess's ABPI was calculated at 1.0. The calculation of ABPI's greatly enhances the nurse's ability to make the correct decision about treatment. According to Vowden (2001) a patient with an ABPI of 0.8 or greater is generally suitable for full external compression therapy, provided that they are able to tolerate this level of compression.On completing the Doppler ultrasound the district nurse was able to then continue with the assessment using Roper, Logan and Tierney's model of nursing (Roper, et al, 1996). It is vital at this point for the district nurse to have a full understanding of the anatomy and physiology regarding the venous system and wound healing to enable them to give correct treatment and advice. Bess had a venous leg ulcer so a four-layer compression therapy was commenced.There is lots of research on the treatment of venous leg ulcers, but the most effective method is,Compression therapy. If venous ulcers are to heal, they require bandaging. It has been well documented in recent years that sustained graduated external compression therapy is the most effective treatment for venous ulceration, (Fletcher, 1997).For compression bandaging to be effective it must be applied in the correct fashion, which requires a high level of skill, appropriate training and initial supervision of practice, as poor application can be detrimental to the patient, (Nelson, 1996).There are four main types of vessels that f...
