Resources

This case report explores the community management of a patient with a medical history of heart failure (HF) and oedema. Gold standard guidelines recommend targeting clinical congestion and oedema with increased loop diuretics alongside multilayer compression bandages for effective limb decongestion, reduction of swelling and limb shape restoration. Without early identification and intervention, oedema can worsen, leading to skin changes such as lymphorrhoea (wet or leaky legs), and having a detrimental physical, functional, and psycho-emotional impact on patients. Yet, HF and oedema continue to be mismanaged because healthcare workers have reservations about the use of compression therapy and concerns about overloading the circulatory system in patients with HF. This case report demonstrates appropriate treatment and management of oedema in patients with HF within a community district team setting, highlighting best guidance on diuretics, compression therapy, exercise, and skin care.

Hypercholesterolaemia, typically characterised by elevated levels of low-density lipoprotein cholesterol, remains a significant modifiable risk factor for cardiovascular disease. Before pharmacological intervention, UK guidelines emphasise the importance of making lifestyle changes — especially dietary modification — which can yield clinically meaningful reductions in cholesterol levels. This article equips community nurses with practical, evidence-based nutritional strategies to support patients in managing hypercholesterolaemia. Key areas include increasing dietary fibre intake and striving towards a Mediterranean-style diet. Controversies around saturated fat, seed oils, and dietary cholesterol are addressed through a nuanced, food-matrix lens. The article also explores the roles of phytosterols, cooking oils, coffee, and body weight in lipid management. With appropriate support, nurses can help patients implement simple, sustainable changes to lower cholesterol levels and reduce their risk of cardiovascular disease.

As the UK population ages, the number of people with multiple long-term conditions and multimorbidity will increase. Hospitalbased staff tend to specialise and will usually provide care for a single condition such as heart failure. This focus is not helpful for people with multimorbidity, as their conditions interact and medication prescribed to treat one condition may worsen another. People with multimorbidity require skilful holistic care to enable them to have the best possible quality of life. Nurses working in primary care are in a unique position to provide this care. This article examines how reduced fluid intake caused by dysphagia can affect renal function and offers advice on holistic management and treatment of both conditions.

Sundowning, a change in the behaviour of a person with dementia that appears in the evening or during the night, is a well-recognised occurrence in dementia care. The behaviours observed can be agitation, aggression, anxiety or those associated with delirium. This article uses case studies to illustrate the ways in which sundowning may present, and explores possible rationales, approaches and interventions that might be useful in supporting the person, family carers and caregivers.

Psychological safety aims to reduce patient-related harm by creating high performing teams, which are open and transparent, functioning in the absence of retribution. Models for delivering nursing care, along with matrices designed to monitor their impact, can negatively affect the adoption of psychological safety in practice. Strategies have been designed at national level to ensure the adoption of psychological safety, while, at a local level, individual organisations can implement processes to improve psychological safety from floor to board.

Here, Amanda Young, director of nursing programmes (innovation and policy), Queen’s Institute of Community Nursing, looks at the opportunities that a career in community nursing can offer, from specialist practice qualifications to master’s degrees. She also emphasises the importance of ensuring that student nurses can undertake community-based placements to support them in becoming the community nurses of the future.

I hope you are enjoying the summer months and have managed to take some time away from work for yourselves. As always, this issue is filled with information to support your learning and development, challenge your practice and keep you up-to-date with current issues. Our ‘Community matters’ piece discusses how vitally important it is to support patients to take responsibility for their own health and to self-care. By educating, advising and working in partnership with patients, we can support them to make informed decisions and choices about their own health and promote self-care, ultimately enhancing health outcomes and reducing NHS pressures.

Self-care or self- management of health has become essential for sustainability of health and social care services but can be challenging to engage with for several reasons. Frustration can arise when people are unable to self-manage, perhaps through lack of confidence, willingness, outside influences (such as family members), lack of knowledge about a particular condition or procedure, disease symptoms, or even issues with digital inclusion. It can become difficult to work with people where there are barriers to self-management due to lack of time or resources to fully explore and address these alongside the person, or lack of access to professional training for skills such as coaching, which are essential to achieving effective self-management.