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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’.

Urinary tract infections (UTIs) are among the most common bacterial infections managed
in community and primary care, with around half of women experiencing at least one episode during their lifetime (Foxman, 2014). The estimated prevalence of recurrent UTI in women in the UK is approximately 6% (Sanyaolu et al, 2023; 2024).

Foam dressings were among the earliest modern wound dressings introduced in the mid-1970s and represented a significant advancement at a time when limited options were available to  effectively manage the wound environment, particularly exudate control (Sussman, 2010; Hargis et  al, 2024). Today, foam dressings are widely used in clinical practice and are manufactured using  materials such as polyurethane (PU), polyvinyl alcohol (PVA) or silicone-based formulations (Hedger, 2014; Wakefield, 2025).

A venous leg ulcer (VLU) as defined by the National Institute for Health and Care Excellence (NICE) is a perforation in the skin in between the knee and ankle, which has not  resolved within a two-week period with the added complication of venous insufficiency (NICE, 2024).  VLUs are the most common type of leg ulceration with a 60–80% incidence rate (Atkin et al, 2024). The annual prevalence per population  of VLUs in the UK is estimated at 1.08% (Guest et al, 2020).

The Leadership Education and Progress Scheme (LEAP, developed by the clinical
education department at Advancis Medical) involved six specialist clinicians in podiatry and tissue viability from five National Health Service trusts across the Northwest of England. The one-year scheme comprised soft skill modules, including leadership and management.

Sepsis is life threatening and life changing, around 20% of people who develop sepsis do not survive and 40% of those who survive have significant cognitive or functional impairment  (Burki, 2018; Prescott and Angus, 2018). The 2024 National Institute for Health and Care Excellence  (NICE) guideline focused on enabling clinicians to identify those who were sickest and to ensure  that they received prompt treatment. The guideline advised clinicians to take a little more time to  diagnose those who were less acutely ill and to prescribe an appropriate antibiotic rather than a  broad spectrum one (NICE, 2024).

Cancer is more likely to be underdiagnosed and undertreated in people
with disabilities compared to non-disabled people, as shown by the Cancer Patient Experience Survey  (NHS England, 2021). Disabled people are more likely t experience stigma, discrimination and inaccessibility in  healthcare, including inequalities within cancer services such as physical inaccessibility and invalidation.