Setting up a community nurse-led healed leg ulcer clinic

Abstract

Chronic obstructive pulmonary disease (COPD) is a progressive, smoking-related, chronic disease that eventually impacts on every area of the lives of the patient and his/her family and carers. The nature of the disease - chronic, irreversible airflow obstruction - limits the impact of drug therapy, particularly as the disease progresses. Increasing breathlessness on exertion saps confidence, reduces self-esteem and produces dependence. In addition, frequent exacerbations utilize health service resources. Non-pharmacological approaches, such as pulmonary rehabilitation, together with lifestyle advice that enables patients to help themselves manage exacerbations, maintain independence and quality of life and make the most of life with COPD can benefit both patients and the health service.

Relationships between preventive activities, psychosocial factors and recurrence of venous leg ulcers: a prospective study

“…Only 66% of participants reported wearing compression hosiery regularly in this first year after healing – confirming many reports in the literature on poor rates of adherence with compression (Anand et al. 2003, Flaherty 2005, Seppanen 2007); and the need to identify physical and psychosocial factors which may influence adherence to compression therapy (Nelson 2005).…”

“…There was no statistically significant difference in risk of recurrence between participants not wearing any compression and participants wearing Class 1 hosiery; however, again only small numbers (n = 7) of participants wore Class 1 hosiery. Only 66% of participants reported wearing compression hosiery regularly in this first year after healing -confirming many reports in the literature on poor rates of adherence with compression (Anand et al 2003, Flaherty 2005, Seppanen 2007); and the need to identify physical and psychosocial factors which may influence adherence to compression therapy (Nelson 2005). Levels of adherence to leg elevation are not reported as frequently as those of wearing compression hosiery.…”

“…Current advice provided to patients on prevention thus tends to concentrate on conservative strategies to improve the impaired venous return, such as compression therapy, leg elevation, keeping mobile and exercise (Registered Nurses' Association of Ontario 2004, Royal College of Nursing 2006. Wearing compression hosiery, however, presents several problems itself as a prevention strategy, with reports of difficulties with application, comfort, appearance and cost (Anand et al 2003, Flaherty 2005; and the lack of evidence for alternative strategies such as leg elevation and exercise creates difficulties in planning alternative preventive care. In addition, it is suggested that the low levels of adherence to compression therapy may be influenced by a variety of physical and psychosocial factors (Nelson 2005).…”

Preventing venous ulcer recurrence: a review

“…They also found that patients not treated with superficial venous surgery were at increased risk of leg ulcer recurrence. Flaherty (61) emphasises that 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 and favours the use of a collaborative approach.…”

Predicting the likelihood of venous leg ulcer recurrence: The diagnostic accuracy of a newly developed risk assessment tool

“…A review of the literature has not identified any screening tools to assist clinicians to detect patients at high risk of recurrence after healing in order to guide appropriate prevention strategies. Yet, not only would the quality of life of patients be optimised by reducing venous leg ulcer recurrences but estimates of 8% of cost savings to community nursing time would be achieved for every 1 month that the healed state was maintained …”