Need a bit of guidance re community nurses.

[Scruffy]

Hello,
The community nurses have been coming to change a dressing on my mother for about ten months. The sore has been healing and the nurses visits reduced from day and evening to daily and now every other day with dressings left for me to put on if needs be.

Some nurses have been saying the wound is healing and one a few days ago said that she'd heard it was doing well, that she hadn't been for a while so she'd be able to see any difference and said that it was indeed doing a lot better and mentioned one part which she'd remembered which was now healed.

Today another nurse said she didn't think it was healing and wanted to return to daily visits. I was so shocked and it knocked me sick and I didn't remember the comments by the other nurses just days earlier.
Tomorrow we will be having two other nurses coming out and I don't know whether to say anything to them.

The nurses had reduced their visits to every other day as they said changing it every day wasn't good for the surrounding skin.

This nurse today was asking me how often I hoist mum and I said every two hours and she said it might need doing more often.

I just want to know how I can find out who is right and why we are having to follow the decisions made by today's nurse on her opinion.

The odd thing is she said the wound was wet and for the first time ever I had changed the dressing an hour before she called as mum had opened her bowels and it was a bit of a mess. So the dressing the nurse saw was fresh and dry. It gave me the impression that they had made their decision prior to seeing the wound today.

What can I do ?

[bowlingbun]

Not again! I remember your earlier problems. In hospital, they now photograph all sores to record their progress, or lack of it. Maybe you could too?

[Dancedintherain]

Skin breakdowns also get measured......photo no use without measurements, but I expect you know this already Scruffy.
As for your question, I suppose you just have to go along with the. Most recent professional assssment. I too know how long and how much you care.....and how much you worry. Sorry I haven't got much else to offer by way of advice. Hope you are getting enough sleep...it must be stressful for you both.

[christina 17]

You should also have a named community nurse for your mother, it is she/he who writes up the care plan and she can thoroughly reassess and may decide to go back to not changing the dressing so frequently. She is likely to be a qualified nurse. This is what happened when my mother needed dressings for her leg ulcers, Mum would have a health care assistant quite often and sometimes they needed a second opinion as they were not confident enough or trained to the same degree as the qualified nurse.
You can always ask to speak to the named nurse on the phone and ask them to come out and reassess as there have been conflicting opinions of the frequency of redressings.
I would also get annoyed when I wasn't around that a new nurse would put sticky tape to secure a dressing, which had been decided that should never be used, as it would tear off mum's papery thin skin and create another wound - they hadn't read the care plan not the large note put on the front of the care plan!

Good luck

[Scruffy]

Thanks for all the help and advice. They've been taking photos on and off through the year as they've been treating the sore and it's been healing. They ask me each time and I have no objection as I think it helps them monitor the progress and there has been a lot, it's almost completely healed now and one nurse said this sometimes happens nearer the end of it, that it slows down or words to that effect.

The latest is that the nurses are calling every day and I am also fine about that because the nurse who came out the next day explained everything to me and by chance I'd also seen it that day and had seen a white edge to the wound which was explained as a sign that the skin is too wet and I totally understood that and so had more confidence that changing the dressing more often would help with this.

The nurse who came yesterday had a look at it as she'd not been for a while herself and said 'ooh yes it's a lot better now'. I really didn't know if she meant since she'd last seen it or since seeing the photo that was taken the day before. I didn't ask. I am learning to just get on with doing everything I'm supposed to and letting their opinions not affect me too much so I don't get my hopes up too high or get let down too hard.

I've ordered very high protein foods off the internet as these were making a difference earlier on and as the wound healed I moved from them to the usual well known sources of protein in everyday foods, corned beef, mackerel, tuna, eggs etc and continuing with the Marvel milk powder added to food and drinks to boost the protein as mentioned by the dietitian who came out many months back.

So I'm a lot calmer now. I think I panicked and feared the worst after the nurse said it was breaking down and this was then added to by not knowing who to believe when one nurse says that and only days earlier other nurses had said it was healing well.

I didn't know we should have a named nurse, that's interesting.

Thank you again. It's just good to offload and get feedback and other opinions on what is going on.
It's very much appreciated.
Scruffy x

[Henrietta]

Hi Scruffy
I've had daily district nurses in for dressing Dad's legs for well over a year now, occasionaly they get better, the nurses drop down to once every two days , then it gets worse and back to square one. The Skin Tissue Viability nurse has been once and I know the nurses have consulted her since. The nurses will say it is getting better nearly every other visit but this seems to be just part of their bedside manner. The GP was more realistic speaking to me and said at Dad's great age of 90 and with his other health conditions it was unlikely the legs would repair properly and all they can do is to try and keep on top of it and make it as comfortable as possible for him. Sometimes they soak through daily, sometimes he gets infections , swabs are done and Anti Biotics prescribed. I never get involved in redoing the dressings, I always call for help if needed due to soaking through or getting pulled off by Dad once or twice . The nurses have tried a huge variety of dressings etc and I have a room overflowing which looks like a nurses store cupboard sometimes.
I have found a magic phone number for local out of hours nurses , rather than having to go through the 111 rigmarole.
Dad hasn't been eating at all well either , nurses also recommended getting some drinks to build him up. I gave him a Fortisip that I bought from Boots and he just said it was yuk and to tip it down the sink! I've also got some Complan Chicken soup but I havn't tried that with him yet. The nurses are referring him to a dietician. He doesn't like ready meals, he doesn't like my cooking or bread or cakes or vegetables, or pasta or rice, or grapes and many other types of fruit- not much left