Factors affecting community and district nurses in clinical decision making when managing leg ulcers – a scoping review

Background: Community and district nurses deliver most of the care for patients with venous leg ulcers, positioning them as key healthcare professionals in ensuring quality outcomes for this patient group. Aims: This scoping review explored factors influencing community and district nurses’ decision making in venous leg ulcer management to provide valuable insights that can inform future educational strategies and service development. Methods: The review was conducted using the population–concept–context approach. Multiple databases and grey literature sources were searched for studies published between 2015 and 2025. A total of 50 papers were included and analysed using narrative synthesis, and data were coded thematically across empirical and textual evidence. Results: Five key factors influencing community and district nurses’ clinical decision making in compression therapy were identified: nurse confidence and experience; clinical education and training; systemic and organisational constraints; professional collaboration; and patient-centred considerations. Systemic pressures and patient factors were the most frequently reported influences across the evidence base. Conclusions: The review offered a real-world perspective on the challenges nurses encounter when managing venous leg ulcer, which remains under-researched and under-reported in the literature. Implications for practice: Addressing educational needs, organisational barriers and interdisciplinary working is essential to improve patient outcomes in community settings.