Clinician's perspectives on the treatment of venous leg ulceration

Abstract

Treatment of venous leg ulcers (VLU) represents a considerable challenge to the health care professional and to the patient alike. Much of the current literature regarding VLU focuses on either wound pathophysiology and treatment of chronic venous insufficiency or the patients' experience of the condition. We present two studies that examine more closely the clinicians' experience of treating VLU and reflect upon how that understanding may further enhance better outcomes for patients in the future. The first of these studies is a qualitative investigation of 49 clinicians treating VLU in the UK and USA. The second is a quantitative, online survey of 304 clinicians' beliefs, attitudes and practices in the UK, Germany and USA. Findings show that the clinicians' experience of treating VLU is often accompanied by frustration and dissatisfaction with treatment challenges and uncertain outcomes. Practices and treatment choices were found to vary widely and differ by countries. We conclude that a key aspect in improving VLU treatment is in listening to the frustrations of the clinician when considering new approaches to therapy.

District nurses’ experiences of caring for leg ulcers in accordance with clinical guidelines: a grounded theory study

“…The study identified challenging collaboration with GPs as an important aspect of complex treatment. Previous studies have found that barriers to following guidelines include lack of routines for cooperation between nurses and GPs (Eskilsson & Carlsson, 2010; Friman et al, 2010) and/or GPs’ lack of access to clinical guidelines and experience treating chronic leg ulcers (Cullen & Phillips, 2009; Graham, Harrison, Shafey, & Keast, 2003). DNs’ strategies for avoiding consequences of this obstacle included proactively informing GPs when it was time to take action, such as when a patient needed a referral to a dermatology clinic.…”

Limits and possibilities experienced by nurses in the treatment of women with chronic venous ulcers

“…This is an emerging theme of a study that portrayed the experiences of health professionals involved in providing care for CVU. In general, they strove to provide effective care to patients, but recognized that there were many factors related to adherence to treatment that transcended the domain of professionals (8) .…”

“…The professionals in that study attributed nonadherence to treatment by people with CVU to factors such as non-cooperation and lack of motivation to follow through with the therapy. Furthermore, there was evidence of limitations of time and/or knowledge on the part of nurses, which prevents them from elaborating on effective strategies for adherence to treatment (8) .…”

“…The professionals in that study attributed nonadherence to treatment by people with CVU to factors such as non-cooperation and lack of motivation to follow through with the therapy. Furthermore, there was evidence of limitations of time and/or knowledge on the part of nurses, which prevents them from elaborating on effective strategies for adherence to treatment (8) .Adherence to the lifestyle required for people with CVU can be influenced by the trusting relationship established between patients and nurses (9)(10) . Therefore, it is assumed that the relationship of care, mediated by trust between the individuals involved, constitutes an important instrument of adherence of women to treatment proposed by nurses.…”

“…This is an emerging theme of a study that portrayed the experiences of health professionals involved in providing care for CVU. In general, they strove to provide effective care to patients, but recognized that there were many factors related to adherence to treatment that transcended the domain of professionals (8) .Knowledge acquired throughout life, added to professional experiences, aids nurses in developing an understanding of issues related to treatment of CVU and elaborating proposals for improvements in treatment.Background knowledge constitutes a frame of reference for understanding the world and planning future activities. The biographical situation comes from the point of view of the subjects in regards to the things of this world.…”