Resources

Necrotising fasciitis (NF) is a life-threatening condition, consisting of a soft-tissue infection with rapidly progressive, widespread fascial necrosis and sepsis. Prompt diagnosis and  treatment are essential, but in the early stages, it is difficult to differentiate from other skin conditions such as cellulitis. A high level of suspicion and a low threshold for surgical referral are essential to avoid significant mortality. Following often lengthy hospital treatment, patients will be discharged for management in the community — usually with extensive wound care needs. As part of recovery, supported self-care is an option for some patients and the benefits may help improve outcomes.

The vast majority of wound care is undertaken by community nurses (Dhoonmoon, 2023), with £941 million attributed to venous leg ulcer care and a further £836 million spent on unspecified leg ulcer management (Guest et al, 2017). If signs and symptoms can be 
recognised and a diagnosis made, a plan of care can be drawn up and treatment implemented quickly and efficiently to reduce costs escalating further. More important though, the patient’s condition will improve quickly and deterioration in quality of life can be avoided. Nursing staff are currently encouraging patients to take a more active role in their own care, guiding them in how to look after their own long-term conditions, which can promote long lasting healing and independence.

This article provides an update on the dietary management of type 2 diabetes mellitus (T2DM) for community nurses. Dietary change can greatly modify the trajectory of T2DM. Weight changes are a key factor, as significant weight loss can put the condition into remission, and even less dramatic weight loss can have positive effects on glycaemic control and cardiovascular risk factors in individuals with T2DM. Protein intake supports various aspects of glycaemic management and is an especially important nutrient for older adults, who are more prone to T2DM. Carbohydrate restriction is widely advised in clinical practice, although current guidelines do not support this as the sole dietary management strategy for T2DM; it is simply one of various potentially effective measures. Carbohydrate quality is important and high fibre carbohydrates are the preferred source. Excessive alcohol intake can exacerbate T2DM via its damaging effects on the liver. Knowledge of the dietary management of T2DM is vital for community nurses, as it allows them to offer advanced and comprehensive care to their patients.

As part of the ‘Whatever It Takes — Cancer Care for Everyone’ programme (Wessex Cancer Alliance [WCA], 2023), the ‘What I would like to say...’ project involved two disabled researchers carrying out creative and engaging workshops and interviews with 45 disabled and neurodivergent people, with the support of Bournemouth University’s
Public Involvement in Education and Research [PIER] team. These individuals were from various community groups in the Wessex region, including Autism Hampshire’s Fareham Serendipity group; the Dorset Blind Association [DBA]; the Multiple Sclerosis [MS] Centre
Dorset; the Royal National Institute of Blind People [RNIB]; and the Bournemouth and Poole Lymphoedema and Lipoedema Support group. This article reflects on the deep and rich insights shared by attendees, which were facilitated by the PIER community researcher model, and which have already begun to impact practice. It is hoped that the outcomes of this project will contribute to improving disabled people’s experiences of accessing cancer services.

Rectal cancer is a common diagnosis which is often treated by surgical resection of the cancer. However, cancer treatment can result in changes in bowel function. Faecal incontinence can occur because of cancer treatment, as well as increased defecation. Although these symptoms will improve with time over a few months, making changes, such as dietary ones with nursing support, can help. Having a greater understanding of issues that can occur and ways in which to resolve them can improve both healthcare professional confidence and circumstances for patients with bowel dysfunction.

For many nurses working in primary care, chronic obstructive pulmonary disease (COPD) is a familiar condition. From carrying out annual reviews to supporting people living with the symptoms of cough, phlegm, breathlessness and managing their effect on day-to- 
day living, most community nurses will have some experience of supporting people living with COPD. Increasingly, though, community nurses are having to consider comorbidities as part of the review, as for many people living with COPD, this will be just one of the long-term conditions they have already been diagnosed with or of which they will be at risk. In this article, the relationship between COPD and other long-term conditions will be highlighted, along with recommendations about how to identify and manage comorbidities in order to holistically optimise outcomes.

Community hospitals bridge the gap between primary and secondary care. They are geographically diverse local assets that offer a range of services, although inpatient services often focus on rehabilitation, most commonly for stroke and older people. Community hospitals are person-centred in their approach, nurse-led and work in a multidisciplinary way to support people to achieve their goals, maintain independence,  and improve health and wellbeing assets. The model of care, including medical support, has evolved over the 150 years they have been in place, in response to local and systems’
needs, including the development of enhanced and advanced roles. Covid-19 demonstrated flexibility, innovation and resilience to support local communities and the wider health and care system. Community hospitals are valued by the people and  communities they serve and have a part to play in the future health and care landscape, improving the care of older people.

A virtual cow’s milk allergy group has been helping families in Kent get faster access to advice and support. As parents and carers can be seen together, rather than waiting for individual appointments, the initiative has reduced waiting times, meaning quicker access to vital feeding and weaning advice during a baby’s first few months. This also means that parents spend less time worrying. As well as increasing capacity in the clinical nutrition and dietetics team at Kent Community Health NHS Foundation Trust (KCHFT), the virtual group has won national recognition — winning the sustainability award in the Clinical Nutrition Magazine Awards 2023, as families do not have to travel for appointments and fewer letters need to be sent out, making healthcare more sustainable and reducing its impact on the environment. Here, highly specialist paediatric dietitian and team leader, Elaine Greenman, shares how and why the group was set up, what the group sessions involve, and the challenges the team has found along the way.

s we are nearing the end of 2023, could I please take this opportunity to wish everyone
the very best for 2024. I cannot believe how quickly this year has passed — each year seems to go more quickly than the last. Before we leave 2023 and move into the new year, I would like you all to take some time to reflect on everything you have done this year — the many patients you have seen, the improvements you have made to care and your services, the challenges you may have encountered, the ‘thank you’ messages you have received and the enhancements you have made to so many people’s lives. It is always beneficial to reflect, as all too often we continue in our everyday work without having time to really think about everything we have achieved and the very real difference we have made. Please celebrate your work — you are appreciated so much.

It’s been a tough few years for the NHS in general, and for community nurses in  particular. First came Covid-19 and the trials of trying to maintain patient care in the teeth of an unprecedented pandemic, with lockdowns, cumbersome personal protective equipment (PPE) and endless vaccination programmes adding to the burden on an already stressed and under-resourced workforce.