Resources

Chronic oedema of the lower limb arises when the balance between capillary filtration, venous return, and lymphatic drainage is disrupted. Venous hypertension, most often resulting from venous reflux or obstruction, increases capillary pressure and fluid extravasation into the interstitial space (Eberhardt and Raffetto, 2014). Sustained oedema impairs oxygen and nutrient diffusion, promotes inflammation, and contributes to skin changes such as lipodermatosclerosis, hyperpigmentation, and ultimately ulceration (Moffatt et al, 2017). The development of venous leg ulcers is therefore closely linked to the chronic cycle of venous hypertension, oedema, and tissue breakdown, with healing often delayed by persistent swelling and recurrent episodes of cellulitis (Guest et al, 2020).

Individuals experiencing homelessness and substance use disorders often present with complex, chronic wounds exacerbated by compromised immune systems and poor nutrition. Traditional healthcare models frequently fail to address their unique needs, leading to fragmented care and suboptimal outcomes. This paper advocates for the integration of wound care services into familiar, community-based settings, emphasising the role of traumainformed, nurse-led initiatives in improving engagement and health outcomes for this vulnerable population.

Recruitment and retention challenges in community nursing have exacerbated disparities in wound care outcomes, particularly among housebound patients. In response, University Hospitals Coventry and Warwickshire NHS Trust Wound Healing Integrated and Community Care Services developed the Coventry community wound healing team (CWHT) in 2022 to improve healing outcomes and relieve pressure on district nursing services. This paper outlines the development, structure and outcomes of the Coventry CWHT, which delivers specialist wound care in patients’ homes through a skill-mixed team led by a wound healing clinical nurse specialist (CNS). Findings indicate significant benefits in terms of patient outcomes, workforce effciency and staff wellbeing. The model presents a scalable solution to current challenges in community wound care delivery.

Moisture-associated skin damage (MASD) affects people of all ages and patient groups (Voegeli, 2019). It describes a range of inflammatory conditions that occur in response to prolonged exposure of a person’s skin to moisture, i.e. perspiration, urine, faeces, wound exudate and ostomy effluent (Gray et al, 2011). Prolonged exposure to these irritants damages the natural barrier function of the skin and, if not managed effectively, can lead to tissue damage and subsequent breakdown (Dykes and Bradbury, 2016).

Lymphoedema is a chronic, progressive condition caused by impaired lymphatic drainage, leading to swelling, skin changes and increased risk of infection. Although specialist services provide targeted treatment, many patients are first seen in community settings where generalist practitioners may have limited knowledge or training in lymphatic care. This article offers a practical overview to support non-specialist healthcare professionals in recognising and managing lymphoedema. It outlines prevalence, risk factors and common presentations, highlights key assessment and differential diagnosis points, and reviews core management principles, including compression therapy, skin care, exercise and patient education. The psychosocial impact of lymphoedema and the importance of timely referral to specialist services are also discussed. Early recognition, consistent advice and person-centred support can improve outcomes and quality of life, while collaborative working ensures safe longterm care.

Dementia is a syndrome occurring as a result of brain disease, which is usually chronic or progressive in nature and ultimately a life-limiting condition. As discussed in the first article in this twopart series, in addition to cognitive decline, people diagnosed with dementia will also experience a gradual loss of function with a growing inability to perform basic activities of daily living, such as feeding, toileting and dressing (Kilroy-Findley and Harrison Dening, 2025). Dementia is often synonymous with ageing so people will also experience other comorbid conditions related to age, such as the effects of ageing skin and increased risk of frailty. In the advanced stages of dementia, the person may also experience immobility and poor nutrition and hydration, all of which are significant risk factors for developing pressure ulcers. This paper considers pressure ulcers in the context of a fictionalised case study based on clinical practice of a person with dementia, and explores patient assessment and care as well as treatment of pressure ulcers, reflecting on the literature.

As violence against nursing staff becomes more commonplace and the abuse suffered continues to increase, our ‘Community matters’ piece looks at whether violence specifically against community nurses is increasing. It discusses potential reasons for the rise in violence and abuse and the vulnerability of nurses working alone. Measures and processes that have been and are still taken to protect staff are explored, alongside their effectiveness. Remember to always report any instances of abuse, no matter how small and no matter how busy you are. Perhaps the most important section is the one headed ‘Relying on number one’ — please ensure that you read this and the advice offered. Take on board the recommended actions to support your safety at work and take all the precautions available to stay safe.

It is an unfortunate fact of nursing life that much like below-inflation pay rises and other people’s bodily functions, occasional incidents of abuse come with the job.

A recent report from the Royal College of Nursing (RCN) shed light on the issue with some shocking statistics showing that incidents of abuse and violence against staff in A&E departments had doubled since 2019, with nurses being punched, spat on and even threatened with guns and acid attacks (‘Nurses too scared to even go into work — as violence against A+E staff almost doubles in five years’ — www.rcn. org.uk)

As we approach National Self-Care Week (17–23 November 2025), new findings from the Living Self-Care Survey Study (www.selfcareforum.org/self-care-forum-research/) — conducted by the Self-Care Forum in partnership with Imperial College London’s Self-Care Academic Research Unit (SCARU) — reveal a pressing need to rethink how we support self-care across the UK. Led by my colleague, Dr Peter Smith, president of the Self-Care Forum, the study is one of the largest of its kind and highlights a clear disconnect between public willingness to self-care and the professional systems meant to support it.

Night-time care is one of the most complex challenges in adult social care. For decades, routine hourly checks have been the default approach to keeping residents safe. Yet this practice, although well-intentioned, often disturbs rest, reduces recovery, and increases risks such as falls and hospital admissions. In North Central London (NCL), we asked a simple but powerful question: could technology protect residents while also preserving their sleep?