Resources

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.

Following the Covid-19 pandemic and the cost of living crisis, the authors have seen an increase in the number of patients attending their continence clinics with issues with the bowel or bladder and/ or pelvic floor dysfunction that were reporting a history of abuse, sexual violence and/or trauma. The authors recognised the need to adopt a more trauma-informed approach to care, and so reached out to Visible, a project which wants to improve health and wellbeing outcomes for adult survivors of childhood sexual abuse (CSA). They had been approached by Visible to support statutory and voluntary bodies by working together to develop effective policies and best practices. The authors’ understanding of the links between trauma and bowel, bladder, pelvic floor, mental health, and gynaecological issues has grown, highlighting how these experiences may present in diverse and complex ways. They have also recognised that trauma can contribute to inequalities in healthcare and that individuals may find it difficult to know how or where to seek help. Therefore, it is important to raise awareness among healthcare professionals about the specific inequalities faced by those who have experienced CSA, and to recognise that services need to work together to improve outcomes for both patients and healthcare professionals.

In January 2023 I began my career as a registered adult nurse. My first staff nurse position was on a 53-bed acute medical unit – a busy patient environment with fast-paced working. I had the opportunity to develop my nursing fundamentals further by consolidating my learning of the management of acute illnesses and long-term conditions. Throughout my time on the acute medical unit, I used and expanded my skillset, including building competence and confidence in completing A to E clinical assessment and how this would enable me as a clinician to detect a deteriorating patient, and then how I escalated that information and assessment to the appropriate clinician to support high quality patient care.

Welcome to our spring issue of the JCN. I am sure that many of you are looking forward to the longer and warmer days. In this issue, our ‘Community matters’ feature focuses on the new cancer plan and it is certainly worth taking some time to read. It examines concerns relating to our cancer services, including performance targets, and draws comparisons with neighbouring countries. The ambition of the plan is discussed and, due to there being so many recommendations, themes are highlighted to support your awareness and understanding. While innovations specifically for the community are considered, the challenges associated with delivering these in practice are also acknowledged.

When it comes to health, nobody likes to hear the worst, but in your role as a community nurse you’ve probably grown used to delivering bad news. However, in the long list of conditions and diagnoses that you might have discussed with your patients, few engender
as much anxiety than what is often euphemistically referred to as the ‘C word’.