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Leg ulcer prevention program that works in the home

Involving patients in their own care has been shown to improve wound management, writes Megan Stoyles.

Victoria’s Royal District Nursing Service (RDNS) has successfully trialled and implemented a leg ulcer prevention program for home-based clients, which is centred on client participation in their health care.

While the ‘holy grail’ of wound care continues to elude health care providers, it is known that successfully involving the patient in their own care to treat and prevent leg ulcers is one component of it and this is exactly what nurses seek to achieve with their care and treatment in the community.

Suzanne Kapp, the RDNS clinical nurse consultant wound management and research was involved in the project from the start and is full of praise for those who participated in the action research and who are now benefitting from its rollout into the ongoing RDNS wound care program.

“Venous leg ulceration causes pain and suffering to a small (1-2 per cent) but significant part of the population who are mainly older people. As well as this pain and suffering, leg ulcers are complex and costly to treat, and recur at a rate of around 70 per cent,” she says.

“People require knowledge, understanding and the ability to participate in self management strategies, and in the past client uptake and adherence to compression therapy has not been great.

“We knew that innovative education strategies were needed to improve the immediate and long term outcomes for people with leg ulcers, and this was the basis for developing an e-Learning package, the Leg Ulcer Prevention Program (LUPP).

“LUPP standardises client education and ensures all clients receive timely and evidence-based recommendations for healing and health. This promotes quicker healing, reduces the likelihood of recurrence and can generate savings for the health care systems which support people with leg ulcers.

“With the support and monitoring by our nurses this program empowered clients to take ownership of their peripheral vascular disease and ulcers, clients participated in self management activities whilst receiving formal care.”

Clients engaged in six sessions that covered information about venous ulcers and compression bandage treatment. Management of skin conditions was considered and skin care products were also trialled.

Activities and exercises to promote improved mobility and calf muscle pump function were detailed, along with healthy eating guidelines for nutrition and hydration. Diaries and records for these activities, and diets were established, and there was ongoing reinforcement and encouragement during the program.

During the pilot study from March 2009 to March 2010, 156 clients who were receiving home nursing care of a venous leg ulcer completed LUPP study. Their reaction was positive, with one saying: “This program [LUPP] is an excellent way to help people to understand the problem and help themselves.”

A participating nurse says “the patients loved that whole sitting down with them and looking at the screen and learning, they’ve really been interested. They’d watch a session and then we’d talk about it, and then the next session they actually would have done what was said in the session.”

Kapp says that the results showed statistically significant improvements in client knowledge in:
* ulcer aetiology
* compression bandaging treatment
* activity and exercise
* nutrition
* skin care
* need for compression stockings following healing.

There were also statistically significant improvements in client behaviours regarding:
* four layer compression bandaging
* activity and exercise
* skin care

Overall the LUPP achieved
* Standardised client education in line with evidence based practice
* Improved client knowledge and healthy behaviours and self management practices
* Increased use of best practice compression bandaging
* Client and nurse engagement in health promotion

“The sites which piloted LUPP continue to use the program and in 2011, a refined version (which takes into account the findings of the pilot) will be introduced across the entire organisation,” she says.

“RDNS are also considering ways to share LUPP with the wider wound management community in the future”.

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