Health promotion in leg ulcer management in the community

This article acknowledges the substantial progress that has been made in leg ulcer management in recent years. However, there needs to be greater emphasis on health promotion, quality of life, general patient well being and promoting health within illness. Incorporating health promotion activities within venous leg ulcer management strategies may serve to empower patients to participate more fully in their care. Nurses' awareness needs to be raised to ensure that the assessment process is used as a tool to promote holistic care and not merely as a checklist to provide baseline information on the patient's health status. A series of factors highlighted during assessment are explored to demonstrate the potential for health promotion.     

Cost effectiveness in leg ulcer management in the community

Wound care and leg ulcer management account for the largest part of district nurses' workload. This has major implications on prescribing budgets of primary care groups (PCGs). Ineffective care results in an expensive waste of financial resources and poor quality care for the patients involved. Two case studies of patients with venous leg ulcers are used as an example of how practice can vary within one PCG. Continuing support and training is needed for all community nurses to enable them to meet national and local standards and guidelines.     

A comparison of the management of venous leg ulceration by specialist and generalist community nurses: A judgement analysis

BackgroundVenous leg ulcer management in the UK varies significantly. Judgements made by nurses contribute to this variability and it is often assumed that specialist nurses make better judgements than non-specialist nurses. This paper compares the judgements of community tissue viability specialist nurses and community generalist nurses; specifically, the ways they use clinical information and their levels of accuracy.ObjectivesTo compare specialist and non-specialist UK community nurses’ clinical information use when managing venous leg ulceration and their levels of accuracy when making diagnoses and judging the need for treatment.DesignJudgement analysis.SettingUK community and primary care nursing services.Participants18 community generalist nurses working in district (home) nursing teams and general practitioner services and 18 community tissue viability specialist nurses.MethodsData were collected in 2011 and 2012. 18 community generalist nurses and 18 community tissue viability specialist nurses made diagnostic and treatment judgements on 110 clinical scenarios and indicated their confidence in each of their judgements. Scenarios were generated from real patient cases and presented online using text and photographs. An expert panel made judgements, and reached consensus on the same scenarios. These judgements were used as a standard against which to compare the participants. Logistic regression models and correlational statistics were used to generate various indices of judgement “performance”: accuracy, consistency, confidence calibration and information use. Differences between groups of nurses with different levels of characteristics linked to expertise were explored using analysis of variance.ResultsSpecialist nurses had similar cue usage to the generalist nurses but were more accurate when making diagnostic and treatment judgements.ConclusionIt is not obvious why the tissue viability specialist nurses were more accurate. One possible reason might be the greater opportunities for ‘deliberate practice’ afforded to specialists. However, restricting aspects of practice only to specialist nurses is likely to hinder the judgement performance of generalists.     

Wound management for 287 patients with chronic leg ulcers demands 12 full-time nurses Leg ulcer epidemiology and care in a well-defined population in southern Sweden

Objective. To investigate quality of life, measured by the SF-36 scales, in a population-based sample of women who have survived cancer at any site and, specifically, breast cancer. Design. A representative cohort of women was observed over 24 years with regard to cancer prevalence, incidence, and quality of life. Setting. Gothenburg, Sweden. Subjects. A total of 1462 women aged 38–60 years at baseline. Main outcome measures. Differences in quality of life between cancer survivors and cancer-free controls measured by the SF-36 Short Form Health Survey, with adjustment for age and additionally for social status, and history of major disease (diabetes, stroke, and myocardial infarction) at follow-up in 1992–93. Results. In women who had survived cancer, a lower feeling of general health was the only score found to be significantly associated with having had cancer. Similar analysis was conducted separately for breast cancer cases. Survivors of breast cancer reported lower vitality and when controlled for major disease also lower general health compared with women who had not had cancer. All other results were independent when adjusted for social status, and also for history of major disease. Conclusions. Women who have survived cancer report lowered general health, and breast cancer cases lowered vitality, but considering the non-significant results for the other scores and summary scales it can be concluded that the well-being of women who have survived a cancer on the whole did not differ profoundly from that of other women.     

Strategies and approaches towards evidence-based practice in the management of chronic leg ulcers by nurses working in the community in Kronoberg County, Sweden and the East Riding & Hull, UK

Aim: This paper reports one aspect of a study concerning management of chronic leg ulcers by nurses working in the community in Kronoberg County, Sweden (KC) and the East Riding & Hull, UK (ER). Our study focus was to describe reported evidence-based practice in leg ulcer care in two samples of nurses from two countries. The paper describes the overall utilisation of clinical guidelines and their use in clinical assessment, documentation and resource utilisation.Method: A semi-structured self-administered questionnaire was used. The questionnaire was sent to practising community nurses, nurses working in primary health care and nurses working in nursing homes. A total of 222 nurses working in KC, Sweden and 124 nurses in ER, UK (response rate 55% vs 50%) returned the questionnaire.Results: The results provide a rather mixed picture in relation to evidence-based practice. Whilst 60.3% of nurses in KC and 87.1% in ER use guidelines, the reported use of guidance on diagnostic investigations is much more variable both in terms of frequency and indication (P=0.000). The widest difference was found in the use of cleansing agents: in KC 83.7% of nurses used tap water against 92.8% of nurses in ER who used a sodium chloride preparation (P=0.000).Conclusion: This study provides information on the reported use of guidelines by the nurses in two different countries. It raises questions about the relationship between evidence and practice. Comparison between the two countries helps to expose the taken for granted expectations of practice.     

Actico: a short-stretch bandage in venous leg ulcer management

Actico compression bandage system (Activa Healthcare) completes the prevention and treatment regime of venous leg ulcer management. Actico gives the patient comfort by being a simple two-layer compression bandage system that is also effective and which stays in place because of its cohesive nature. This product focus looks at the impact of venous leg ulcers, the use of compression and focuses on short-stretch bandages and the Actico bandage system.     

Wound management for 287 patients with chronic leg ulcers demands 12 full-time nurses. Leg ulcer epidemiology and care in a well-defined population in southern Sweden

OBJECTIVE: To study the prevalence, aetiology and treatment of chronic leg and foot ulcers, and to estimate the nurse's time in wound management. DESIGN: A structured questionnaire with 19 questions about chronic ulcers and wound management was sent to all district and community nurses in the county during 1 week in March 1998. A similar questionnaire has been administered regularly since 1986. SETTING: Primary and community care in the county of Blekinge, Sweden, with a population of 1,51,610. PATIENTS: 287 patients with chronic leg and foot ulcers were identified during the week studied. MAIN OUTCOME MEASURES: Prevalence of leg and foot ulcers, ulcer aetiology, treatment of ulcers and wound management time. RESULTS: The estimated prevalence of chronic leg and foot ulcers was 0.19%. Venous ulcers were the most common (38%), of which 87% were treated with some form of compression therapy. Seven percent of the nurse's workload was devoted to ulcer care. During the period 1986 to 1998, ulcers with missing or unknown aetiology decreased from 31% to 6% and ulcers with a duration of more than 2 years from 44% to 27%, while treatment time per ulcer decreased from 2.1 to 1.7 hours/week. CONCLUSION: Monitoring standards for ulcer aetiology through repeated questionnaires seems to ensure more accurate diagnoses. Thorough and detailed information about treatment time documents the workload for wound management.     

Compression therapy in leg ulcer management

Leg ulcer management is an important consideration for all nurses involved in the care of older people. Non-specialists in tissue viability might not always be aware of the evidence base for best practice. The authors examine the effectiveness of multilayer and single-layer long- or short-stretch bandage systems in leg ulcer management.     

Setting up a community nurse-led healed leg ulcer clinic

The success of compression therapy and emphasis on healing rates of venous ulcers in studies has shifted the emphasis from prevention to cure. Venous insufficiency is, in the majority of cases, a chronic condition. From a patient's perspective, unless they are suitable for corrective surgery, he/she will never be rewarded with a cure. Patients often need to make permanent life-style changes to reduce the risk of ulceration or re-ulceration and may require differing levels of support to achieve this. The implementation of a designated clinic for patients with healed leg ulcers in a primary care trust in the east end of London is the first step in promoting a collaborative approach to prevention of leg ulcer recurrence.     

The management of the client with a leg ulcer: precarious nursing practice

The management of clients who present at the doctor's surgery with leg ulcers follows an accepted but often perilous course It is generally accepted custom and practice that the overall care of this client group is delegated to nurses without the medical practitioner first determining the nature of the underlying pathology The usual arrangement of care for patients with leg ulcers is such that the development of chronic wounds is almost inevitable The author, drawing on the medical and nursing literature and on the findings of her ongoing doctoral research, suggests that nurses in primary care should re-examine this area of practice and consider alternative approaches that would emphasize the unique contribution professional nursing practice could bring to this patient group     

The provision of leg ulcer services by practice nurses

As part of their implementation programme of leg ulcer guidelines, the group conducted a study of the caseload and attitudes and training of practice nurses with relation to leg ulcer management. They begin by outlining the prevalence and treatment methods of leg ulcers, then outline their study and put forward their resulting recommendations.     

Use of a hydrogel dressing for management of a painful leg ulcer

This case study is of an 82-year-old lady who was widowed and lives alone in a council house. A left lateral leg ulcer had developed over the gaiter area, and the community team were asked to assess in 2004. The main issues were her inability to tolerate compression (even when reduced) because of the pain. Nevertheless, the community nurses had tried very hard with compression, using different compression techniques at different times to try to encourage her to persevere. The nurses felt they were running out of ideas and therefore the tissue viability nurse (TVN) was asked to assess the wound. The TVN recommended ActiFormCool dressing. This article will examine the background for wound healing, provide the rational for the recommendation and describe the progress of the patient.     

The Lindsay Leg Club Model: a model for evidence-based leg ulcer management

Leg Club is a unique model of community-based leg ulcer care. By providing nursing care in a non-medical, social environment, the model has several benefits: it removes the stigma associated with leg ulcers and helps isolated older people reintegrate into their communities, which in turn improves concordance and has a positive impact on healing and recurrence rates. In an atmosphere of de-stigmatisation, empathy and peer support, positive health beliefs are promoted and patients take ownership of their treatment. The Leg Club model creates a framework in which nurses, patients and local community can collaborate as partners in the provision of holistic care. The model also provides an environment for appropriate supportive education, advice and information.     

Attitudinal patterns determining decision-making in the treatment of the elderly: a comparison between physicians and nurses in Germany and Sweden

OBJECTIVE: Do-not-resuscitate orders (DNR orders) and advance directives (AD) have been developed and their use by patients is increasing. The objective of the study was to evaluate the compliance with patient's wishes and doctors' and nurses' agreement on decision-making in the treatment of elderly patients from a cross-cultural perspective. DESIGN AND PARTICIPANTS: One hundred and four Swedish physicians and 122 nurses as well as 192 German physicians and 182 nurses from teaching and university hospitals were surveyed by a questionnaire based on a case-vignette with three scenarios of available information about patient's wishes for treatment. RESULTS: A relationship between the perceived level of help and the chosen treatment option was established for all four samples, especially for the scenario in which an AD was available. Two patterns of closely related determinants appeared: (a) 'patient's wishes', 'ethical concerns', and 'family wishes'; and (b) 'patient's age', 'level of dementia', and 'hospital costs'. CONCLUSIONS: An intensive and continuous education of physicians and nurses in medical ethics is required to promote patient autonomy in clinical practice. The ethical implications of patient's age and level of dementia in relation to hospital costs should constitute important topics of these educational programs.