Chronic venous leg ulcer care: Putting the patient at the heart of leg ulcer care Part 2: Development and evaluation of the consultation template

The (dis)organization of leg ulcer care: A realist synthesis

BACKGROUND

Venous leg ulcers affect 1.5% of the UK adult population. Leg ulcers are painful, can be malodourous and are associated with poor quality of life. Leg ulcers are predominantly cared for by nurses in the community. Frequently, patients receive suboptimal treatment through unwanted variations in care and simple ulcers deteriorate to become hard-to-heal wounds. It is important to understand the current UK system of care and how nurses and patients navigate through it.

AIM

The aim of this paper was to understand how, when, for whom and in what context leg ulcers are cared for in the United Kingdom and specifically, the current system of care, the nurses' role and the patients' experience in this system of care.

DESIGN

A realist synthesis of the literature was undertaken, reported following the RAMESES publication standards: Realist syntheses.

DATA SOURCES

An iterative literature search was conducted across three recognized health collections from January 2010 to January 2022 that included descriptive studies as well as primary research.

RESULTS

73 papers were included.

CONCLUSION

In the absence of UK national guidance that recommends how leg ulcer care is organized and delivered, care is commissioned locally, with variable outcomes. Patients with venous leg ulcers would like to be looked after by knowledgeable, skilled and confident nurses, in well-equipped and staffed clinics; nurses who have the ability to make clinical judgements to alter their treatment when necessary and are empowered to refer to specialist centres when further support is required.

IMPLICATIONS FOR THE PROFESSION AND/OR PATIENT CARE

This synthesis offers guidance to commissioners and providers to change how leg ulcer care is organized.

PATIENT OR PUBLIC CONTRIBUTION

The views of a patient and public group was sought at each stage of the synthesis.

Nursing outcomes in wound care management: A mixed method study

AIM

The aim of the study was to analyse the management of chronic wound outcomes and the experience of patients with chronic ulcers.

DESIGN

Explanatory mixed method.

METHODS

This study consisted in a sequential explanatory mixed method with a quantitative and a qualitative phase. In the first phase, quantitative data were collected during a longitudinal study, in a convenience sample of 44 patients presenting at a nursing outpatients' clinic. Linear regression was conducted to evaluate the associations between variables. In phase two, 14 patients from the initial sample were interviewed, and the data were analysed using Giorgi's descriptive phenomenological method.

RESULTS

The participants, mostly males, in conditions of comorbidity and polypharmacotherapy, were mainly affected by venous leg ulcers. An association between the quality of life of patients (both physical and mental) and some socio-demographic and clinical factors has been confirmed. I Variance analysis showed a significant wound improvement across all the measurement times. The themes identified through the qualitative analysis were: "Cared by self," "Cared by Healthcare Providers" and "Quality of life".