Leg and foot ulcer patients: Epidemiology and nursing care in an urban population in South Stockholm, Sweden

Ebbeskog, Britt; Lindholm, Christina; Öhman, Susanne Georgsson

doi:10.3109/02813439608997091

Cited by 49 publications

(36 citation statements)

References 11 publications

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“…It is fair to expect that the quality of wound management depends highly on the level of knowledge of those who diagnose and treat patients. Nurses often inspect, investigate, diagnose and treat patients with wounds, and evidence from previous studies suggests that many physicians rely heavily on their opinions, evaluations and guidance (16,17). Accordingly, it may be hypothesised that treatment outcome is influenced by nurses' knowledge and practice of wound care.…”

mentioning

confidence: 97%

Significant Differences in Nurses’ Knowledge of Basic Wound Management – Implications for Treatment

Zarchi¹,

Latif²,

Haugaard³

et al. 2014

Acta Derm Venerol

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Wounds represent a growing healthcare problem due to an aging population. Nurses play a key role in wound management and their theoretical understanding of basic wound management may be expected to influence the quality of wound therapy fundamentally. In this study, we evaluated the level of knowledge of wound management in 136 Danish nurses working in 3 different settings: advanced wound care clinics, home care and general hospital departments. We found that hospital nurses had less theoretical knowledge than home care nurses and nurses working at advanced wound care clinics. We also found that the length of experience (adjusted for workplace and education) did not have any impact on nurses' knowledge. Nurses' knowledge of clinical investigations was consistently lower than their knowledge of therapy and clinical symptoms. This study provides benchmarking information about the current status of wound management in Denmark and suggests how improvements might be achieved.

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mentioning

confidence: 97%

Significant Differences in Nurses’ Knowledge of Basic Wound Management – Implications for Treatment

Zarchi¹,

Latif²,

Haugaard³

et al. 2014

Acta Derm Venerol

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“…[53][54][55][56][57][58][59][60][61][62][63][64] However, it was not always possible to determine from reports of leg ulcer studies if people with ulcers confined to the foot were excluded. A total of 16 studies investigated either (people with) foot ulcers (diabetic foot ulcers n = 6, 65-70 non-diabetic foot ulcers n = 2 71,72 ) or pressure ulcers (n = 8).…”

Section: Types Of Complex Woundsmentioning

confidence: 99%

“…3,[26][27][28]31,32,[36][37][38][39][40][41][42][43][44][48][49][50][51]53,54,[56][57][58][59][60][61][62][63]73,74 The choice of denominator for the remainder of the studies included the total current caseload 29,30,64,69,[75][76][77][78]82 of health-care professionals or the provider organisation, the sample surveyed (not clear if these were representative samples of geographical populations) [45][46][47]55,62,[65][66][67][68]70 and respondents to the survey. …”

Section: Denominator Datamentioning

confidence: 99%

Wounds research for patient benefit: a 5-year programme of research

Cullum

Buckley

Dumville

et al. 2016

Programme Grants Appl Res

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BackgroundComplex wounds are those that heal by secondary intention and include lower-limb ulcers, pressure ulcers and some surgical wounds. The care of people with complex wounds is costly, with care mainly being delivered by community nurses. There is a lack of current, high-quality data regarding the numbers and types of people affected, care received and outcomes achieved.ObjectivesTo (1) assess how high-quality data about complex wounds can be captured effectively for use in both service planning and research while ensuring integration with current clinical data collection systems and minimal impact on staff time; (2) investigate whether or not a clinical register of people with complex wounds could give valid estimates of treatment effects, thus reducing dependence on large-scale randomised controlled trials (RCTs); (3) identify the most important research questions and outcomes for people with complex wounds from the perspectives of patients, carers and health-care professionals; (4) evaluate the potential contributions to decision-making of individual patient data meta-analysis and mixed treatment comparison meta-analysis; and (5) complete and update systematic reviews in topic areas of high priority.MethodsTo meet objectives 1 and 2 we conducted a prevalence survey and developed and piloted a longitudinal disease register. A consultative, deliberative method and in-depth interviews were undertaken to address objective 3. To address objectives 4 and 5 we conducted systematic reviews including mixed treatment comparison meta-analysis.ResultsFrom the prevalence survey we estimated the point prevalence of all complex wounds to be 1.47 per 1000 people (95% confidence interval 1.38 to 1.56 per 1000 people). Pressure ulcers and venous leg ulcers were the most common type of complex wound. A total of 195 people with a complex wound were recruited to a complex wounds register pilot. We established the feasibility of correctly identifying, extracting and transferring routine NHS data into the register; however, participant recruitment, data collection and tracking individual wounds in people with multiple wounds were challenging. Most patients and health professionals regarded healing of the wound as the primary treatment goal. Patients were greatly troubled by the social consequences of having a complex wound. Complex wounds are frequently a consequence of, and are themselves, a long-term condition but treatment is usually focused on healing the wound. Consultative, deliberative research agenda setting on pressure ulcer prevention and treatment with patients, carers and clinicians yielded 960 treatment uncertainties and a top 12 list of research priorities. Of 167 RCTs of complex wound treatments in a systematic review of study quality, 41% did not specify a primary outcome and the overall quality of the conduct and reporting of the research was poor. Mixed-treatment comparison meta-analysis in areas of high priority identified that matrix hydrocolloid dressings had the highest probability (70%) of being the most effective dressing for diabetic foot ulcers, whereas a hyaluronan fleece dressing had the highest probability (35%) of being the most effective dressing for venous ulcers; however, the quality of this evidence was low and uncertainty is high.ConclusionsComplex wounds are common and costly with a poor evidence base for many frequent clinical decisions. There is little routine clinical data collection in community nursing. A prospective complex wounds register has the potential to both assist clinical decision-making and provide important research evidence but would be challenging to implement without investment in information technology in NHS community services. Future work should focus on developing insights into typical wound healing trajectories, identifying factors that are prognostic for healing and assessing the cost-effectiveness of selected wound treatments.FundingThe National Institute for Health Research Programme Grants for Applied Research programme.

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“…In this descriptive study, the wound registration form and the questionnaire were constructed by the authors according to the validated questionnaires by Ebbeskog et al (1996) and Lindholm et al (1999). These were modified to suit the aim of the study.…”

Section: Methodsmentioning

confidence: 99%

“…The initial assessment of wounds is often made by a district nurse, and in topical treatment of wounds, she/he often works independently (Hickie et al, 1998). Several studies reveal that the wide variety of dressings causes uncertainty (Ebbeskog et al, 1996;Lindholm et al, 1999), while guidelines for wound treatment have an important function (Ebbeskog, 2003;Ubbink et al, 2006). Guidelines are essential to guarantee appropriate treatment of patients (Ehrenberg & Birgersson, 2003;Harrison et al, 2005).…”

Section: Introductionmentioning

confidence: 98%

Wound care in primary health care: District nurses' needs for co-operation and well-functioning organization

Friman¹,

Klang²,

Ebbeskog³

2009

Journal of Interprofessional Care

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Most patients with leg- and foot ulcers are managed within non-institutional care. The aim of this study was to investigate the district nurses' wound management, including wound appearance, assignment of responsibility, guidelines for wound treatment and co-operation with other professional groups. The study has a descriptive quantitative approach. Data was collected using a wound registration form and a questionnaire. The selection of participants was made by random sampling. District nurses (n = 26) in five health-care centers situated in central Stockholm and two of its suburbs, participated in the study. The results show that the wound appearance is dominated by traumatic wounds. Approximately 40% of the wounds were not medically diagnosed. The area of responsibility of different professional groups was not defined and guidelines for wound treatment were mostly lacking. The decision about wound management was generally made by the district nurse. Co-operation with the general practitioner was lacking and when a consultation with dermatologist was required, the routines concerning referral were undefined. Co-operation with the assistant nurses consisted of redressing the wounds in home care. Interprofessional co-operation was regarded as important for wound healing. The paper provides insights into the district nurses' wound management and co-operation in wound care.

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Leg and foot ulcer patients: Epidemiology and nursing care in an urban population in South Stockholm, Sweden

Cited by 49 publications

References 11 publications

Significant Differences in Nurses’ Knowledge of Basic Wound Management – Implications for Treatment

Significant Differences in Nurses’ Knowledge of Basic Wound Management – Implications for Treatment

Wounds research for patient benefit: a 5-year programme of research

Wound care in primary health care: District nurses' needs for co-operation and well-functioning organization

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