An interview with Alison O’Connor Alison O’Connor

Macmillan Clinical Nurse Manager—Lymphoedema, Gloucestershire Hospitals NHS Foundation Trust 

Email: alison.o’[email protected]

What first brought you into the field of chronic oedema? I was first introduced to chronic oedema while working as a practice nurse. A large part of that role involved wound care and leg ulcer management. In order to enhance this care I was undertaking a leg ulcer module, as part of my degree. One of the sessions was led by Nina Linnitt (now training manager for Medi UK). Attending that session changed my career direction. She was running our local lymphoedema service in Worcester and I was fascinated by the images she shared and inspired by the difference that could be made to patients’ lives. I have to admit that I had never heard of chronic oedema and I often remind myself of this. Due to the present economic climate, health professionals have an everincreasing workload—I am happy to be able to support primary care nurses to manage complex chronic oedema patients. I know from experience how many different aspects of health care these nurses have to be up to date with, and that timely input from specialist services and ongoing education can only benefit our patients and enhance nurse job satisfaction.

What do you think is the most challenging thing about chronic oedema? I think working with patients who are living with longterm conditions is always challenging. We all know

‘After undertaking weeks of bandaging to dry up leaking legs, community nurses need a working knowledge of available hosiery and the appliances available to aid application and removal of this hosiery’. S38

how difficult it is to stay motivated to do something regularly,—I struggle with my Zumba commitment twice weekly! Compression is the mainstay of treatment at present, and all practitioners accept that this is not easy for patients to live with. After undertaking weeks of bandaging to dry up leaking legs, community nurses need a working knowledge of available hosiery and the appliances available to aid application and removal of this hosiery. Teaching and encouraging growth of knowledge in these areas is an essential part of any chronic oedema service (Wounds UK, 2009). As specialists, we are all aware that we cannot assess and treat every patient with chronic oedema. The specialism has to move forward through collaboration of services. Joint working with community nurses is essential and chronic oedema services need to work with these staff to equip and educate them. Nurses need be able to support patients and carers through the challenge of wearing hosiery by encouraging and supporting hosiery concordance. This may take a few visits and encouragement. This in turn can prevent legs from ‘breaking down’ again, which itself presents an enormous saving in cost of dressings and nursing time.

What changes have you seen recently that have improved the experience of people with chronic oedema? Since I first came into the chronic oedema arena in 2004, the main changes I have seen are increased awareness surrounding the condition. As more patients are able to gain access to the internet they become aware of available treatments and actively ask for referral to specialist services. In my own area, Gloucestershire, the ability to accept patients into the service who have non-cancer-related swelling has been a huge step forward. I hope this will encourage early referral and therefore reduce the incidence of severe

Chronic Oedema October 2014

h Journal of Community Nursing. Downloaded from by on January 30, 2016. For personal use only. No other uses without permission. . All rights rese

INTERVIEW swelling and leaky legs (lymphorrhea). The introduction of Velcro compression devices such as Medi’s Juxta-Fit and Haddenham Healthcare’s FarrowWraps has benefitted community nurses. It has eased their workload by reducing the need for bandaging. These devices can also be applied by family members and carers once leaky legs have dried up and are often more acceptable than hosiery to less able patients. This lessens the burden on social care as partners and family members often find these devices more acceptable to apply than hosiery. Within the Gloucestershire service we have introduced health care assistant and staff nurse roles. This has freed up the specialist practitioners to work with more complex patients and has made the service a lot more economically viable.

What are you most disappointed with in terms of current service provision, and why? Ongoing economic difficulties impact on all services and this in turn means pressures on staff to make savings involving difficult decisions. In some areas this has meant cutting back on health professionals’ ability to free up staff to attend training. I believe that education is really important for raising awareness of the necessity of early referrals to chronic oedema services or simple interventions by frontline staff. I am disappointed that, across the country, there are still areas where patients are unable to access the services they need.

What is the most important area for policy development in chronic oedema? It would be beneficial if chronic oedema services across England could work toward proper coordination, as has occurred in Northern Ireland, Wales and Scotland. Working towards a managed clinical network would mean coordination of data and alignment of services and treatments for all areas. Incorporating awareness into educational programmes would lead to earlier referrals and minimise the development of the most severe cases. I think raising awareness of innovative treatment modalities—for example, liposuction—is important. Some patients have limbs that do not respond to conventional treatment of decongestive lymphatic therapy (lymphoedema bandaging and manual lymph drainage) and the only option

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Can you give an example of an area where progress is being made in chronic oedema management? Well, this supplement being in existence and the increasing profile of the condition are great progress in themselves. The Lymphoedema Support Network continues to work towards increasing patient knowledge and the British Lymphology Society promotes collaboration and education of health professionals. Companies continue to strive to bring out innovative products that enable clinicians and patients to have a wider choice of treatments. Collaboration between community services and specialist services continues to improve and promotes the best possible care for the patient.

Looking into the next 10 years of chronic oedema practice, what three things would you hope for? The first thing I would hope for would be national guidance for lymphoedema, including introduction of NICE guidelines and a national dataset implemented in a similar way to that of Northern Ireland (Rankin, 2010). This would increase our knowledge of epidemiology and facilitate effective audit. Secondly, prevention of the condition has to be the key and continued development of effective education locally and nationally would mean patients are seen much earlier in their chronic oedema journey. Thirdly, a few more staff in clinic would be beneficial, enabling continued service development the time to develop educational resources. BJCN Rankin J (2010) Managed clinical networks: future for LE service provision. J Lymphoedema 5(1): 86–90 Wounds UK (2009) Skills for Practice: Management of Chronic Oedema in the Community. (accessed 12 September 2014)

Are you interested in giving your views on lymphoedema management in your area? Do you have some ideas of how the speciality could be developed, locally and nationally? Get in contact with the editor: [email protected]

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Chronic Oedema October 2014


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An interview with Alison O'Connor.

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