Haematoma management in community settings presents a clinical challenge because of the absence of standardised national guidance. Haematomas, defined as localised collections of clotted or partially clotted blood within tissues, can result in complications such as skin necrosis, infection and delayed healing if not managed appropriately. This article outlines the assessment and management of closed, open-bleeding and open-clotted haematomas, with emphasis on timely escalation and risk identification, based on the haematoma clinical decision guide designed by the author to address hesitation and poor confidence among nurses in dealing with haematomas in the community. The importance of holistic assessment is highlighted, including comorbidities, coagulation status and recognition of complications such as compartment syndrome. Particular consideration is given to lower limb haematomas, where vascular assessment is essential before initiating compression therapy. Appropriate debridement options for community practice such as autolytic, mechanical and biological are discussed. This approach aims to improve clinical decision making and optimise patient outcomes.
This article explores existing literature for clarity and insights regarding the tissue viability nurse role. This review was prompted by the author's curiosity and questions about clinical development pathways as there is ambiguity about the role and varying opinions about the clinical activities that should be undertaken by tissue viability nurses. The article reviews the role, value and impact of tissue viability nurses on patient outcomes, as well as on national service provision. The review further discusses some of the limitations and issues the specialism faces and potential new opportunities for service development as the NHS fit for the future plan is implemented.
The NHS 10-year plan re-emphasises the long-standing policy aspiration for population and place-based approaches to health improvement. The Fit for the Future: 10 Year Health Plan sets out a neighbourhood health service as the practical mechanism for shifting care from hospital to community and from sickness to prevention. There is a gap between known evidence-based approaches to health improvement in community settings and local adoption in service delivery. One of the most underserved populations in any neighbourhood will be those affected by a lower limb condition, people with these conditions are likely to also experience a range of co-morbidities and health inequalities. The Lindsay Leg Club Model is a long-established evidence-based approach that may be implemented in a neighbourhood setting to deliver positive outcomes. Using methods outlined in recent government guidance, integrated commissioning boards can implement the Model within neighbourhood service pathways as a cost-effective high impact approach that expands patient choice, addresses inequalities and facilitates prevention and self-care.
Background Effective leg ulcer care includes the removal of hyperkeratosis, a thick, adherent layer of dead skin. In the UK, available methods to remove hyperkeratosis include debridement pads, pre-impregnated cloths and tenotomes. However, evidence supporting their efficacy remains limited. Aims This study aimed to explore how expert clinical intuition can inform a protocol to guide less-experienced nurses in selecting appropriate methods for hyperkeratosis debridement. Methods Drawing on Benner's ‘novice to expert’ model, three highly experienced nurses observed each other's practice while debriding hyperkeratosis in leg ulcer patients. Standard of care was maintained throughout. Findings Tenotomes were consistently the most effective, removing adherent scales efficiently. Debridement pads removed only loose debris, while pre-impregnated cloths were ineffective for stubborn scales but useful for rehydration post-tenotome use. Conclusions: A simple protocol recommending tenotomes for hyperkeratosis removal was developed. Further research is needed to evaluate its implementation in clinical practice. Implications for practice: The protocol offers practical guidance for selecting hyperkeratosis debridement methods and may support more consistent leg ulcer care.
The patient, John, is a 94-year-old man with mild mobility issues but is otherwise fit and active. He developed a trauma-related ulcer, likely originating from an insect bite, that is now almost fully closed following treatment with compression hosiery. This case study discusses the symptoms, assessment, diagnosis, treatment plan and the outcomes resulting from timely and appropriate nursing interventions.
This article discusses the government's initiatives to make the NHS more efficient through digitalisation and reducing waiting lists, and explores the unintended barriers to care created by these moves.
Advanced practice roles in primary care have often emerged in response to workforce pressures and service instability, with medical substitution acting as an initial driver. While these origins are important to acknowledge, focusing on substitution alone risks under representing the contributions that advanced primary care nursing makes towards contemporary healthcare challenges. This article argues that advanced primary care nursing has evolved into an integrative, system level form of practice, shaped by population need rather than task equivalence. Drawing on concepts of continuity, relational accountability and longitudinal clinical reasoning, the article explores how advanced nursing practice supports safe and co-ordinated care over time, particularly for populations experiencing complexity, frailty and health inequality. It suggests that the primary value of advanced primary care nursing lies not in role replacement, but in its capacity to hold care together across time, transitions and uncertainty. Recognising and scaling this contribution is essential if primary care is to improve population health outcomes and address deep seated inequality.
Student placements are a key component of healthcare professionals' development as it provides them with real-world experience, knowledge and practical skills. However, while there is a perceived cost to healthcare services when taking on students, there may also be benefits. This commentary critically appraises a systematic review that examines both perspectives - the potential service benefits and the associated staffing requirements.
An ageing population, increasingly frail and affected by multiple chronic conditions and the impact of COVID-19 on overall health, has necessitated the acceleration of international territorial healthcare reorganisation. Responses have been adapted to several care settings highlighting the central role of nurses, both in terms of direct care and in organisational and clinical views. Urgent community response initiatives are based on key principles of multidisciplinarity and interprofessional collaboration, which are significant in the context of European healthcare, and could serve as a model for the potential implementation of care processes in other post-COVID-19 crisis scenarios of assistance.
Before 2014, lymphoedema compression garment provision in Wales was fragmented, with wide variation in access, prescribing routes, product quality and cost, resulting in inequity for patients and inefficiency. Given the chronic nature of lymphoedema and the central role of compression therapy, a more consistent national approach was required. This commentary describes the rationale, development and impact of implementing a single national procurement contract and standardised garment formulary for lymphoedema care in Wales. Between 2014 and 2023, a clinically led, collaborative procurement process was undertaken involving national clinical leadership, procurement services, clinicians, patients and independent laboratory testing to inform garment selection. The resulting contract improved equity of access, strengthened quality assurance, standardised prescribing practice and enabled all-Wales audit and exception monitoring. This model demonstrates how national procurement, grounded in clinical evidence and stakeholder engagement, can reduce unwarranted variation, optimise value-based healthcare and support consistent, person-centred care across community and specialist settings.
Threats of workforce displacement and ethical uncertainty accompany the use of artificial intelligence in palliative care and nursing in general. Diminished human connection is also a major concern for healthcare professionals. However, these technologies also offer opportunities to enhance personalised and equitable care.
Enteral tube feeding provides nutritional stability for individuals unable to meet requirements orally. However, the psychosocial consequences of enteral tube feeding, particularly loneliness arising from disrupted social eating practices, remain under-recognised in community care. Eating is a socially and culturally embedded activity linked to identity, belonging and relational connection. For individuals receiving long-term enteral tube feeding, altered participation in shared mealtimes and social rituals may increase vulnerability to isolation despite physiological stability. This article critically appraises district nursing interventions in enteral tube feeding management and examines the leadership role of the district nurse in addressing loneliness as a determinant of health. A review of contemporary literature highlights a predominance of biomedical focus during routine visits and identifies limited structured assessment of psychosocial wellbeing. The integration of the University of California Los Angeles Loneliness Scale is proposed as a pragmatic service innovation to strengthen holistic review processes and facilitate psychosocial assessment in enteral tube feeding management. It represents a district nurse-led opportunity to align nutritional care with broader wellbeing, reinforcing holistic, person-centred community practice.
Wound care has significant associated challenges in clinical practice, particularly for chronic wounds such as venous leg ulceration, pressure ulceration and diabetic foot ulceration. This article discusses the emerging and current applications of artificial intelligence in wound care, including wound image analysis, infection detection, predictive modelling and decision support systems. The article explores how artificial intelligence technologies are being leveraged to enhance accuracy and efficiency in wound assessment and management. Additionally, the integration of artificial intelligence with mobile health platforms and wearable devices is examined, particularly in the context of telehealth and remote patient monitoring. Consideration is given to the challenges of artificial intelligence including data quality, algorithm bias, ethical concerns and regulatory challenges. Clinicians may be able to apply artificial intelligence safely and effectively to their own clinical practice. Direction for future research is also identified.
Incontinence is a highly stigmatised condition that can significantly impact an individual's quality of life, yet few people seek proper assessment and treatment. Therefore, outreach events aimed at specific or general patient groups can play a crucial role in creating awareness of the condition. This article discusses some of the principles behind health promotion and outreach activities, and the importance of health literacy. It suggests some questions to consider when planning outreach activities and ideas of possible events. Two case studies from the authors’ community service have been included as examples.
Background: Lipoedema is a painful, chronic condition associated with ‘heavy legs’ that are disproportionately larger than the upper body. Compression is known to support tissue, reduce pain and improve mobility. Aims: This study aimed to establish types of compression worn by people with lipoedema, identify satisfaction, problems and reasons why some prescribed garments are never worn. Methods: The team co-developed, evaluated and promoted an online survey. A total of 373 people with lipoedema completed the survey between 15 March 2024 and 14 May 2024. Results: All four compression classes and 15 garment types were prescribed to people with lipoedema. Compression classes were not consistent and one in four people did not wear any or all of their most recently prescribed compression garment(s). The most frequent reason for noncompliance was the garment falling down. Conclusions: Specialist measurement and listening to patients' needs can optimise fit and use of compression. Implications for practice: Selecting the target pressure, rather than class, when ordering compression can yield better results. Additional attention to product development is required to prevent garments from falling down during use.
Climate change is not only resulting in increasing extreme weather events and record temperatures across the globe, it is also having an impact on people's bodies, especially for those living with chronic oedema/lymphoedema. Increased lethargy in affected limbs, a feeling of increased swelling and greater challenges keeping everything under control have been reported by patients. It is important to explore and understand how climatic variations affect lymphoedema. This is the topic of an ongoing PhD study at Flinders University, South Australia. This article will outline the key findings from this project and highlight the planned next steps in understanding this phenomenon. By fully understanding the impact of climate change on the body, healthcare professionals can implement countermeasures to support their patients and minimise the impact of lymphoedema.
The 13th National Lymphoedema Conference was held on 5 February 2026 at the Minster Building in London. Organised by the British Journal of Community Nursing , in association with the British Lymphology Society and Lipoedema UK, the event featured a line-up of expert speakers and a diverse programme of engaging sessions. It brought together clinicians, healthcare professionals, patients and industry partners from all over the globe, fostering insightful discussions and knowledge sharing to advance lymphoedema care and improve patient outcomes.
