Implementing evidence-based leg ulcer management (original) (raw)
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Nursing Interventions in Prevention and Healing of Leg Ulcers: Systematic Review of the Literature
Journal of Palliative Care & Medicine, 2015
Aim: To identify nursing interventions aimed at persons with venous, arterial or mixed leg ulcers. Methodology: Carried out research in the EBSCO search engine: CINAHL Plus with Full Text, MEDLINE with Full Text, MedicLatina, Academic Search Complete, sought full text articles, published between 2008/01/01 and 2015/01/31, with the following keywords [(MM "leg ulcer") OR (wound care) OR (wound healing)] AND [(nursing) OR (nursing assessment) OR (nursing intervention)], filtered through initial question in PI[C]O format. Results: The different etiologies of leg ulcer require a specific therapeutic and prophylactic approach. Factors that promote healing were identified: individualization of care, interpersonal relationship, pain control, control of the exudate, education for health self-management, self-care, therapeutic adherence, implementation of guidelines of good practice and auditing and feedback of the practices. Conclusion: Person-centred care and practices based on evidence improves health results in prevention and treatment of leg ulcers.
Journal of Clinical Nursing, 2011
Aim and objectives. Examining the (experienced) changes associated with a nursing intervention to enhance adherence to leg ulcer lifestyle advice. Background. Few interventions to enhance adherence to leg ulcer treatment are developed and tested. Design. Qualitative evaluation approach and pre-post-test design were used. Method. Twenty-six patients with venous ulcers in a community care setting participated. Data were collected by means of interviews and participant observation. Frequency and duration of wearing compression, leg exercising and leg elevation, activity level, pain and ulcer size were registered at baseline, after the end of the intervention and three months later. Inductive content analysis and Wilcoxon signed-rank test were used. Results. Knowledge about leg ulcer advice increased. The education contributed to more consciously following of the advice. The rationale of the advice and its association with healing or recurrence remained often unclear. More patients performed exercises after the intervention and at follow-up. Patients often looked out onto a 'new' perspective where enhancement of quality of life and even healing might be attainable. Some patients regained independence after learning how to apply and remove compression garments themselves. The frequency of exercising and the duration of exercises increased significantly. Step counts had not altered significantly. Patients not elevating the legs at baseline elevated the legs more and for a longer period of time after the intervention. This effect on leg elevation decreased after three months. No significant changes were reported on hours wearing compression. Conclusions. The perceived changes suggest that the intervention holds a promise for current home care. Combining qualitative and quantitative research assisted to determine the possible effects of the intervention, increasing the potential for a meaningful randomised trial in the future. Relevance to clinical practice. Education about leg ulcer advice should be incorporated in nursing practice. Further testing of the intervention is recommended.
Phlebology: The Journal of Venous Disease, 1998
Objective: To illustrate the benefit of the factorial design in randomized controlled trials of leg ulcers. Design: A 2 × 2 × 2 factorial design. Setting: Hospital leg ulcer clinics in Edinburgh and Falkirk. Patients: Adults with at least one unhealed leg ulcer of determined origin, present for at least 2 months and greater than 1 cm in diameter. Interventions: Pentoxifylline (Trental) 400 mg, three times daily, versus placebo Main outcome measure: Complete healing of all ulcers within 24 weeks. Results: Of 525 patients screened, 200 pure venous ulcers were randomized (58.5% healed by 24 weeks), 45 complex venous ulcers were randomized (57.8% healed) and 41 arterial patients were randomized (excluding bandaging comparisons) (19.5% healed). There were no interactions between treatments. Conclusion: The factorial design was feasible to administer and allowed three therapeutic questions to be investigated using the same resources as would have been needed to answer a single question.
Wound Repair and Regeneration, 2016
The present status of clinical leg ulcer healing research was reviewed by 25 experts over 2 days on September 28 and 29, 2015. Multiple clinical effectiveness reviews were presented suggesting that published clinical wound healing research often does not meet present (2015) evidence based standards. Specific areas requiring remediation were highlighted and approaches to overcoming existing challenges were proposed. Participants using anonymous voting technology developed an action plan to resolve perceived deficiencies. Statements were accepted if 75% of participants agreed. Older patients with a high frequency of comorbid conditions posed particular difficulties in designing clinical research protocols and better diagnostic categorization is necessary A standardized model template for collecting information about diagnosis and evaluation of the effect of interventions on healing of all types of leg ulcers was considered a high priority. Such a model template could be modified depen...
Community leg ulcer bandaging study: lessons learned in a pilot, randomized controlled trial
Ostomy/wound management, 2010
Compression is the cornerstone of venous leg ulcer (VLU) care but comparative effectiveness evidence is limited, especially regarding home care. In preparation for a large, community-based randomized controlled clinical trial (RCT), the "Canadian Bandaging Trial" (CBT), a pilot study was conducted to assess the practicality of the CBT study protocol. Nurses who provided home care also performed the research intervention and outcome measurements. All trial procedures were implemented to examine the following aspects of the study protocol: 1) eligibility screening, recruitment, enrollment, and randomization procedures; 2) integration of intervention protocol with usual clinical routines; 3) data collection and management and outcome measures; and 4) database creation and testing. Guided by a Pilot Research Process Framework (PReP), this 6-month pilot RCT was conducted at two community-based sites in Ontario, Canada. Participants included 12 persons with VLUs, 40 nurs...
Journal of Advanced Nursing, 2010
Aims. To describe and discuss of the added value of systematic development and validation of nursing interventions in nursing care. Background. An adherence-promoting intervention for leg ulcer patients was developed in 2008, based on the model of van Meijel. This model requires a systematic development using an analysis of patients' (lived) experiences and professionals' views on (good) care. It employs a cyclical process of trying out, evaluating, revising and reassessing the adapted intervention in patients. The intervention consists of information and counselling sessions carried out by tissue viability nurses and focuses on wearing compression hosiery, practising leg elevation, physical activity and performing leg exercises. Discussion. Exploring patients' and nurses' perspectives during the development of intervention increases the likelihood that the resultant intervention is both feasible and attuned to patients' needs. Various implementation issues were identified during the developmental process. Validation of the intervention through its use in nursing care aids in refining the intervention and in linking the techniques most successful in effecting behavioural change to theoretical constructs. It contributes to the refinement of concepts of behavioural theories by clarifying the processes underlying the intervention's effectiveness. Direct involvement of the researcher in the validation phase has great added value. Implications for nursing. Patient involvement in intervention development is essential, as is the researcher's direct involvement in practical situations in which the intervention is tested. Qualitative (evaluation) approaches are recommended. Conclusion. Although the systematic development of nursing interventions is timeconsuming, the contribution to the development of nursing practice and nursing science makes it worthwhile.
The Canadian Bandaging Trial: Evidence-informed Leg Ulcer Care and the
Background: Objective: To determine the relative effectiveness of evidence-informed practice using two high compression systems: four-layer (4LB) and short-stretch bandaging (SSB) in community care of venous leg ulcers. Design and Setting: Pragmatic, multi-centre, parallelgroup, open-label, randomized controlled trial conducted in 10 centres. Cognitively intact adults (≥18 years) referred for community care (home or clinic) with a venous ulceration measuring ≥0.7cm and present for ≥1 week, with an ankle brachial pressure index (ABPI) ≥0.8, without medication-controlled Diabetes Mellitus or a previous failure to improve with either system, were eligible to participate.
Leg-ulcer care in the community, before and after implementation of an evidence-based service
Canadian Medical Association Journal, 2005
Background: Leg ulcers usually occur in older patients, a growing population for which increasing health care resources are required. Treatment is mainly provided in patients' homes; however, patients often receive poorly integrated services in multiple settings. We report the results of a prospective study of a community-based care strategy for leg ulcers.
A systematic review on the impact of leg ulceration on patients' quality of life
Health and Quality of Life Outcomes, 2007
Background: A systematic review was conducted to analyse journal articles that describe or measure the impact of leg ulceration on patients' quality of life (QoL) in order to improve the content of an educational programme that aims to enhance self-care agency in leg ulcer patients.