Resources

As lymphoedema prevalence continues to rise causing increasing demand for services, optimising patient self-management is vital. In the UK, lymphoedema treatment models have traditionally followed the ‘four cornerstones’ approach, including skin care, compression therapy, physical activity, and lymphatic drainage massage. These address the physical manifestations of lymphoedema yet neglect the psychological and emotional impact. Since the establishment of the psychology service within the Lymphoedema Wales Clinical Network (LWCN) in 2023, a more holistic model of care has been introduced into clinical practice. This development reflects a growing recognition of the psychological burden associated with lymphoedema and the need for integrated support services. The introduction of the lymphoedema COMPASS treatment model represents a significant advancement in routine care delivery, combining physical and psychological interventions to support patients to live as well as possible with lymphoedema. The COMPASS model is designed to place individuals at the centre of their care, promoting active engagement and self-management. It supports and encourages patients to take ownership of their condition, including the emotional and psychological challenges that often accompany lymphoedema.

The trial without catheter (TWOC) procedure aims to assess an individual’s ability to void effectively without the use of an indwelling urinary catheter. Prolonged catheterisation increases the risk of catheter-associated urinary tract infections (CAUTIs), sepsis, and hospital readmissions. Traditionally, TWOC procedures have been conducted in hospital settings, which can be costly, resourceintensive, and inconvenient for patients, particularly those with mobility issues or chronic conditions. This article evaluates the implementation of a commercial clinical nurse specialist (CNS)-led community-based TWOC service, highlighting its cost-effectiveness, improved patient outcomes, and positive patient experience. It aligns with national healthcare priorities, such as the NHS Long Term Plan, by promoting care closer to home, reducing hospital admissions, and optimising NHS resources. The findings support the case for expanding community-based urology services to enhance patientcentred care and achieve better health outcomes.

There continues to exist within society a taboo on discussing death and dying, an omission of which can lead to severe distress and anxiety, that can leave terminally ill patients fearful of dying. This paper extols the importance of nurses providing psychological, social and spiritual support at a time when patients may understandably be at their most vulnerable. While modern medicine clearly has a place in helping to reduce pain and anxiety, such interventions are not the only answer. Mindfulness-based interventions (MBIs) may also have a part to play. This paper also encourages nurses to seek an understanding of the concept of death cafés and how they can help people come together in a meaningful and supportive way. It concludes by encouraging nurses to develop a greater insight into such interventions, so that they are more able at least to discuss these with their patients.

Glaucoma is a serious eye condition, comprising a group of eye diseases, and is a leading cause of sight loss around the world. It has several forms, with primary open angle glaucoma (POAG) the most common. Glaucoma can affect people of all ages but is more prevalent among older adults. It is a progressive condition and has a huge impact on quality of life, affecting the person’s ability to continue to lead a normal life. This article focuses on glaucoma in adults, and provides information on symptoms, risk factors, diagnosis and treatment. The aim is to help nurses and non-medical prescribers to recognise and refer suspected cases, improving outcomes and quality of life for all those affected by this devastating disease.

In the last 80 years, the number of people in the UK with diabetes has risen from 200,000 to over four million (Nazarko, 2023). People with diabetes have at least double the risk of heart failure than the general population (Kenny and Abel, 2019), with American research indicating that 22% of people who have diabetes have heart failure (Pop-Busui et al, 2022). Most cases of heart failure are diagnosed in hospital, although 40% of people with heart failure have symptoms that the British Heart Foundation (BHF, 2025) comment ‘should have triggered an earlier assessment’. This article examines the link between diabetes and heart failure to update nurses working in primary care on who is at risk, when to suspect heart failure, as well as how it is diagnosed and treated.

Here, Allison Whitehorn tells her story of having cauda equina syndrome (CES) and the challenges and impact that the condition has had on her life. As a result, together with her husband, she has founded Cauda Equina Spinal Cord Injury (CESCI), a not for profit organisation to help provide education and support to others coming to terms with this devastating condition.

Welcome to our June/July issue, although as I am writing I am wondering just how we have arrived at June already! As always, there are lots of informative and interesting features, all of which we hope will support your learning and practice, leading to enhanced patient care. The ‘Community matters’ piece focuses on the delays our patients are encountering for dermatological services. Please take some time to read this article, which will give you an oversight into why the delays exist and the potential physical and mental effects these are causing. With the summer months upon us, it is particularly relevant that skin cancer is a focus — information is given around the rising rates and possible reasons for this. The feature discusses a variety of skin conditions and offers strategies and advice to support your patients — an interesting and informative read.

Somebody once said that good things come to those who wait, a neat little piece of advice but one that seems over-ambitious given the parlous state of our health services, as anyone who has recently tried to book a GP appointment or find an NHS dentist willing to see them in the next decade will tell you.

But, it’s not just GPs and dentists who are in short supply. A recent BBC report highlighted how pressure on dermatology services is causing long delays for people with inflammatory skin conditions such as severe eczema, psoriasis and acne, with waiting times for NHS dermatology clinics in England even longer than before the Covid-19 pandemic (‘Living hell for “forgotten” skin patients’ — www.bbc.co.uk).

But what is driving these delays and how might it affect your patients?

The QICN has raised serious concerns about the recent government announcement about the apprenticeship scheme. At the heart of the issue is the proposed discontinuation of level 7 apprenticeships, which currently fund specialist postgraduate training for nurses, including district nursing, adult social care nursing, inclusion health nursing, community children’s nursing, and general practice nursing. These programmes are considered essential for delivering complex care in community settings.

Leg ulcers are a common, painful debilitating condition, characterised by long periods of ulceration and a high incidence of recurrence. Despite this, little attention tends to be given to prevention and education regarding the wide-ranging effects that leg ulceration has on a person’s quality of life.

In the past decade, radical changes have occurred within the provider healthcare setting. GPs are looking into the cost-effectiveness of treatments for their patients and the provision of services available for purchase from an NHS provider organisation. The restructuring of clinical services and a new pattern of provision organised around the concept of lower limb care could result in service provision being further fragmented within the category of long-term conditions that require specialist management by an appropriately trained clinician.