Long-term wounds in the UK are increasing at the rate of 12% per year. The rise in these numbers is partly due to the older population, who tend to have slower healing processes. The majority of wound care is provided by nurses, not all of whom will have received wound care education. Although patient outcomes demonstrate improvement when healthcare professionals receive postgraduate training, it has also been identified that collaborative care and a coordinated team approach can benefit patient care in preventing a wound becoming long term, as has been demonstrated by the Tower Hamlets project. This article explores these issues and the effects that a ‘never healing’ wound can have on a person.
With wound and skin care taking up a considerable part of general practice nursing time, the GPN 'nurse consultation' series follows the therapy chain for the management of patients with venous leg ulcers and looks at the skills needed to ensure safe, competent and professional consultations with patients.
Here, Helen Butterfield, leg ulcer/dermatology specialist nurse, Churchill Hospital, Oxford, looks at the third link, i.e. preventing the recurrence of venous leg ulcers and the importance of lifelong compression therapy to prevent wound breakdown, and the role that patient choice and self-care can play.
Leg ulcers present a common clinical problem for general practice nurses (GPNs). The need for assessment and maintenance can take up a great deal of time and issues such as pain, exudate volume and poorly applied compression bandaging have a serious effect on patients’ quality of life. The ‘gold standard’ treatment for venous leg ulcers has long been multilayer compression therapy (National Institute for Health and Care Excellence [NICE], 2012). However, as with any other technique, expertise can vary, meaning that clinicians sometimes do not apply the necessary sub-bandage pressures. Patients can also find multilayer compression ‘bulky’ and uncomfortable, and thus may not concord with treatment (Wicks, 2015).
Venous leg ulcers make up a large part of a nurse’s caseload, with the application of compression bandaging requiring competent and skilled practitioners. At Central and North West London Foundation Trust (CNWL) Camden Integrated Primary Care (IPC) Service recruiting and retaining community nurses is a challenge, a situation which is shared across all London boroughs. In particular, it is difficult to maintain consistent standards for wound cleansing and compression bandaging, resulting in the responsibility for a large caseload falling to a small number of practitioners. Following a review of innovative products on show at the European Wound Management Association (EWMA) conference in May 2014, an alternative to traditional compression bandaging was identified as a possible solution to this problem; namely, UCSTM for effective debridement and Juxta CURESTM as an alternative to compression bandaging (both medi UK Ltd, Hereford).
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