Resources

As we head into summer, this issue of the JCN will keep you busy. It is packed with informative articles, which aim to both support and prompt you to question your practice and make changes where necessary to enhance patient care. Our ‘Community matters’ piece discusses the increased life expectancy of our population and, due to this, the likelihood of more people living with long-term conditions. It explores the effect that this is currently having on the NHS and possible solutions, focusing on the community nurse’s role and how our holistic approach and knowledge of available local services can improve patient care. It also looks at our own health and the importance of making time to care for ourselves, which is essential if we are to stay well and ultimately enjoy our retirement.

First, let’s celebrate the good news. Medical advances and healthier lifestyles mean that many of us will live to a ripe old age, easily outstripping the life expectancy of previous generations many of whom expected to retire at 60 and have ten or 15 good years in the sun before a sudden heart attack or stroke brought down the curtains.

However, as always with healthcare, there is always a cloud to darken any silver lining, and this one comes in the form of what is euphemistically termed ‘healthy life expectancy’. In simple terms this means that while it is definitely good news that many of us are living longer, the downside is that we are also more likely to develop any number of long-term conditions – heart disease, cancers, dementias, depression and respiratory conditions – which mean that our ‘golden years’ may not be as trouble free as we had hoped

It is no secret that lung health is in crisis in this country. While there has been a dedicated focus on improving cardiovascular and cancer care, respiratory has lagged, and it is the three million people living with chronic obstructive pulmonary disease (COPD) in the UK (Whittaker et al, 2025) who are bearing the brunt of this as they struggle to get a diagnosis and optimum care.

Venous leg ulceration (VLU) remains one of the most common chronic wounds managed in community nursing (Guest, 2020), yet outcomes across the UK continue to vary dramatically. Despite decades of evidence confirming that compression therapy is the cornerstone of treatment, healing rates remain unacceptably poor in many areas (Guest et al, 2018). At the centre of this problem sits a test that was originally designed to support vascular assessment but which in practice has become something far more powerful: the ankle brachial pressure index (ABPI).

Alginates and gelling fibre dressings are fibrous, absorbent and conformable dressings that form a gel on contact with exudate. They are both indicated for similar wound types and create a moist environment that promotes autolytic debridement. However, dressing performance differs significantly with regards to absorbency and physical structure of the dressing. This article discusses the physical properties of each dressing type and how they may fit into clinical practice.

Aim: To evaluate whether switching to a multilayered, bordered, silicone-coated foam dressing (SFD) alongside structured clinical training reduces dressing changes and costs while maintaining or improving wound management in primary and home care settings. Method: Outpatients with hard-to-heal wounds that had been managed with foam dressings (other than the study dressing) were recruited. Data on foam dressing use in the seven days prior to the baseline assessment was recorded. Clinicians received structured training on SFD use and wear time. Eligible patients’ wounds were then dressed with SFDs for up to four weeks alongside standard care. Patient comfort, satisfaction and pain were recorded and clinicians evaluated dressing performance. Results: Thirty-seven patients completed the evaluation. The median number of SFDs changed within the seven days before the final visit was significantly less than that for previously used dressings (1 vs 3; p<0.001), equating to a 44% cost reduction. Despite poor prior healing, an average reduction in wound size of 68.7% from baseline to final visit was observed, with 32.4% of wounds fully healed. Clinicians rated SFDs highly across all assessed attributes. Patients reported less pain and better comfort. No dressing-related adverse events were reported.
Conclusion: Using SFDs with clinician training reduced dressing frequency and costs while improving wound outcomes and satisfaction of both patients and clinicians. However, due to the small sample size, short follow-up, and lack of a randomised comparator, further investigation using robust methods is needed.

Wound care is a complex, under-addressed issue in the UK that places significant and unnecessary burden on patients and the healthcare system. Commonly perceived as a nursing issue, recent years have seen national programmes successfully support a shift in the recognition of wound care as a system issue. Partnership working between providers and national teams, such as the National Wound Care Strategy Programme (NWCSP) and Transforming Wound Care (TWC) programme, has generated the evidence and frameworks to support improvements in leg ulcer management (the largest percentage of all wounds in the UK) via dedicated services. Coupled with new evidence regarding the economic impact of leg ulcers, this makes a compelling case for change. Sustainable change in leg ulcer management will require providers, commissioners and policy makers to recognise the need for fundamental adjustments to the underlying service delivery models of care.

Osteomyelitis is a complex and frequently less recognised complication of pressure ulcers, particularly those associated with deep tissue loss and exposed bone. For community nurses, early recognition is challenging because clinical presentation is often subtle, diagnostic certainty is limited in the early stages, and the evidence base specific to pressure ulcers above the ankle remains underdeveloped. This first article in a two-part series focuses on the clinical foundations required for early identification, integrating epidemiology, pathophysiology, and key risk factors, alongside a structured and holistic approach to history-taking and clinical examination. It emphasises the role of community nurses as first assessors, highlighting the importance of recognising high-risk presentations such as category 4 pressure ulcers, exposed or palpable bone, delayed healing, and recurrent local inflammation. By strengthening clinical suspicion and supporting timely escalation, this article aims to improve early recognition and reduce missed or delayed diagnosis of osteomyelitis in primary and community care.

The first article in this two-part series intr oduced and discussed the importance of movement and gait of the lower extr emity in relation to chronic venous insufficiency and chronic oedema (Campbell and Ritchie, 2025). This second part offers a commentary on the use of foot orthotics and footwear in the management of chronic oedema and venous disease in the lower extremity. It explores how these interventions potentially improve symptoms, and how their use within venous and lymphatic car e can enhance patient-centred care.

This article examines asthma, the relevant national guidelines for its management and the importance of personalised asthma action plans (PAAPs) (Asthma and Lung UK, 2025a). A case study is used to explore factors that can help or hinder patient adherence to PAAPs. District nurses play a vital role in bridging the gap between home and hospital for vulnerable patients post-discharge. Community nurses are in a unique position to assess local population needs working on the frontline and can become involved in commissioning services as well as providing home-based education and environmental assessments vital for improving asthma control.