Journal of Community Nursing

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Community nursing is challenging at the
moment. We, as practitioners, need to ensure
that our patients have access to the right care
at the right time. NHS England’s (2017)‘Betty’s
story’highlighted differences within care
delivery. However, the‘Leading Change, Adding
Value’framework aims to reduce variations in
practice, thus improving patient outcomes as
well as enabling financial advantages (NHS
England, 2016).
Guest et al (2015) highlighted that chronic wounds impose a
significant burden on the NHS. The study identified that there were
approximately 2.2 million patients living with a chronic wound in the
UK, at an estimated total cost of £4.5–5.1 billion. The majority of these
patients were treated in the community. Furthermore, less than 50% of
chronic wounds healed within the study year — the common linking
factor being inadequate assessment and lack of diagnosis.
The Scottish Intercollegiate Guidelines Network (SIGN, 2010)
outlined that assessment, which should take place within four weeks
of presentation (and three monthly thereafter), should include clinical
history and ankle brachial pressure index (ABPI) measurement to
exclude arterial insufficiency. However, clinicians frequently cite that
they are unable to meet the guidance to obtain and performABPI
readings due to skill mix and time. Clare Mechen’s article discusses
why holistic assessment is so important and looks at the MESI ABPI
MD device (medi UK), which can calculate an accurate ABPI in under
a minute with no resting time, and how this can help clinicians in their
day-to-day practice and enable patients to be started on the correct
treatment pathway in a timely fashion (pp. 4–9).
This supplement also looks at the importance of wound
debridement as an essential element of wound bed preparation and
why this should be performed on an ongoing basis (pp. 10–15), as well
as the management of chronic oedema (pp. 17–22).
I hope that you enjoy this supplement, which provides useful
education on complex and challenging conditions.
Bernadette McGlynn, tissue viability nurse,
Birmingham Community Healthcare NHS Foundation Trust
Guest JF, Ayoub N, McIlwraith T, Uchegbu I, Gerrish A,Weidlich D,Vowden K,
Vowden P (2015) Health economic burden that wounds impose on the National
Health Service in the UK. BMJ Open 5(12): e009283
NHS England (2016) Leading Change, AddingValue. A framework for nursing,
midwifery and care staff. Available online:
uploads/2016/05/nursing-framework.pdf
NHS England (2017) NHS RightCare scenario: the variations between sub-optimal and
optimal pathways. Betty’s story — leg ulcer. Available online:
uk/rightcare/wp-content/uploads/sites/40/2017/01/nhs-rightcare-bettys-story-
narrative-full.pdf
Scottish Intercollegiate Guidelines Network (2010) Management of venous leg ulcers.
Clinical guideline no.120. SIGN, Edinburgh. Available online:
Meeting the challenges of
community nursing
i Contents
JCN supplement 2018,Vol 32, No 4 3
EDITORIAL
Managing director
Alec O’Dare
07535 282827
Publisher/editor
Binkie Mais
Sales manager
Sam Ciotkowski
©Wound Care People Limited 2018
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Journal of Community Nursing