Venous leg ulcers (VLU) are a common, chronic recurring long term condition and affect three people per thousand within the United Kingdom (SIGN 2010).  Petherick et al (2013) has identified that the prevalence of VLU increases with age, therefore considering the current demographic climate VLU will have a significant impact within contemporary healthcare.  This will prove challenging for Community nursing services given that up to 80% of VLU are primarily assessed and treated within the community (Martin 2014).

The impact upon quality of life for patients living with aVLU however is extremely negative, with patients suffering physical symptoms such as pain, psychological distress and social difficulties (Todd 2016).  The annual cost on the treatment and management of leg ulceration is estimated at £400 million (NHS Choices2014).  The average healing time of VLU can be anything from five to nine months with up to 69% recurrence rates within twelve months.

VLU is a preventable condition however there is evidence to suggest that less than 20% of people diagnosed with a VLU receive appropriate treatment (Todd 2016).  This results in long term cyclical healing and recurrence placing further burden on patients, community nursing services and NHS funds. Various studies within the UK have highlighted that adherence to evidence based assessment and the provision of compression therapy are low, with less than 16% of patients within the community receiving the recommended diagnostic and treatment options (Petherick et al 2013).

Evidence suggests that perhaps some community nurses lack appropriate knowledge or have not been given relevant education opportunitieson tissue viability tailored to the context of VLU (Haram et al 2003; Adderley2013; Trevena 2008).  Martin and Duffy(2011) have also highlighted that the management of VLU can be challenging to healthcare professionals in general, but especially for community nurses due to the autonomous nature of the role.  The incidence and cost of treating VLU is likely to increase, due to an ageing population, multi-morbidity and poor lifestyle choices.  Community nurses have a significant role to play and need to have the knowledge and skills to provide appropriate, evidence based care to manage and ultimately prevent VLU.

There is no doubt that managing VLU presents significant challenges within the community.

Possible questions to consider:

Do current statistics reflect what is happening within your own areas in relation to VLU?

Do you feel you have the knowledge and skills to manage VLU within the community?

What models do you use for assessment, diagnosis and treatment of VLU?

What evidence/ guidelines/protocols do you use to underpin your assessment, diagnosis and treatment of VLU?

How do you manage the complications caused by VLU: Pain and the negative impacts on the person?

When would you refer on to secondary care?

What services are available to Healthcare professionals and patients with VLU within your area?

Given that obesity and immobility are the most significant risk factors, what health promotion opportunities/ strategies could you take toreduce the risk of VLU?

What other lifestyle advice is needed for patients with VLU?

What systems do you have in place for follow up and prevention of recurrence?

References:

ADDERLEY, U., 2015. Prescribing for the management of venous leg ulceration. Nurse Prescribing. 13(8), pp. 380-383. Available from: DOI10.12968/npre.2015.13.8.380.

HARAM, R., RIBU, E. and RUSTØEN, T., 2003. The views of district nurses on their level of knowledge about the treatment of leg and foot ulcers. Journal of WOCN: Wound, Ostomy and Continence Nursing. 30(1), pp.25-32. Available from: DOI 10.1067/mjw.2003.4.

MARTIN, F., 2014. Educational challenges and requirements for managing leg ulcers in the community. British Journal of Community Nursing.19 (Sup6), pp. S32-S36. Available from: DOI 10.12968/bjcn.2014.19.Sup6.S32.

MARTIN, F. and DUFFY, A., 2011. Assessing and managing venous leg ulcers in the community: a review. British Journal of Community Nursing.16(Sup12), pp. S6-S14. Available from: DOI 10.12968/bjcn.2011.16.Sup12.S6.

NHS Choices, 2014. Venous Leg Ulcers:  Introduction Available from:http://tinyurl.com/nmjf4mp.

PETHERICK, E.S., CULLUM, N.A. and PICKETT, K.E., 2013. Investigation of the Effect of Deprivation on the Burden and Management of Venous Leg Ulcers: A Cohort Study Using the THIN Database: e58948. PLoS One.8(3), Available from: DOI 10.1371/journal.pone.0058948.

SCOTTISH INTERCOLLEGIATE GUIDELINE NETWORK (2010) SIGN120:  Management of Chronic Venous Leg Ulcers.  [Online] Available at:http://www.sign.ac.uk/guidelines/fulltext/120/index.html

TODD, M., 2016. Managing venous leg ulcers. Independent Nurse. 2016(5), pp. 26-29. Available from: DOI 10.12968/indn.2016.5.26.

TREVENA, L., 2008. Tissue viability specialist module: venousleg ulcers. British Journal of Healthcare Assistants. 2(7), pp. 349-353.Available from: DOI 10.12968/bjha.2008.2.7.30579.