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Case Study. This essay will examine the nursing process involved in managing chronic venous leg ulcers (CVLU).

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This essay will examine the nursing process involved in managing chronic venous leg ulcers (CVLU). The decision to focus on CVLU was made during a community placement where their treatment accounted for more than half of nurse’s workload. According to Posnett et al. (2009), CVLU affect 1-2% of the UK population with over half having an active ulcer for more than one year, costing the National Health Service (NHS) between £266- £314 million. Personal cost to individuals living with CVLU was highlighted by Briggs & Flemming (2007). They report the majority of CVLU sufferers find it incapacitating with physical impacts such as pain & reduced mobility along with psychological impacts of low self-esteem, depression & social isolation. NHS Choices (2012a) define leg ulcers as sores below the knee that are non-healing by six weeks. They advise that different ulcers such as diabetic, traumatic & arterial ulcers can occur however Brown (2011) states around 80% of ulcers are venous. CVLU occur when blood in the lower extremities cannot adequately return to the heart causing hypertension & congestion in the legs. This occurs when calf muscle pump function is reduced, failing to pump blood back towards the heart or if valves in the leg veins that normally prevent blood flowing backwards are damaged. Pressure forces blood and fluid through the capillaries, resulting in irritation to the skin, causing ulceration (Brown, 2011). To illustrate the nursing process, consent was obtained to follow the care of a lady with CVLU, renamed Agnes ensuring confidentiality in line with the Nursing & Midwifery Council (NMC) Code of Conduct (2008). Agnes, a cognitively bright 68 year old widow has been receiving treatment for CVLU for over 10 years. She became housebound in the last 5 years. Hess (2011) advises healing declines with age due to a number of factors such as poorer hydration, reduced circulation, respiratory or immune function or poor nutritional intake. ...read more.


RCN (2006), make patient recommendations such as leg elevation, weight-loss, exercise which have been proven beneficial in the treatment of CVLU. Practitioners also must consider alternative solutions in cases of non-healing ulcers such as referral to MDT where required. With reduced mobility, such as in osteoarthritis, Brown (2012) implies collaboration with physiotherapists & occupational therapists would be beneficial to suggest safe techniques to enhance physical capacity, to improve calf muscle pump function and ankle movement or elevation of feet to reduce oedema to enable individual?s capacity for self-management. Self-management, according to Brown (2010) is defined as increased knowledge of one?s condition, coping strategies, concordance & management of symptoms. For the patient, it may involve managing their condition, maintaining normal daily routines & management of psychological impacts. Some of the earliest trials in self-management were done with arthritis sufferers of various ages (Marks et al., 2005). Through various interventions including support for individual self-management achievements, social persuasion, reinterpretation of symptoms, action-planning & feedback, mastery of new skills & problem-solving strategies, they reported a reduction in physical symptoms & increased psychological wellbeing. Nicholson-Banks (2009) discusses The Expert Patient Program which is a self-management course currently running in the UK. With similar interventions to earlier trials including building self-efficacy, similar positive benefits are being reported. Lorig and Holman (2003) describe self-efficacy, the confidence in one?s self to fulfil behaviours to reach desired goals, as the most essential component in behaviour change. Marks et al. (2005) claim self-efficacy is linked to past experience and predicts future behaviour, suggesting individuals with low self-efficacy less likely to engage in self-management behaviours. As it?s modifiable and impacts wellbeing, motivation & concordance, there is room for interventions to enhance self-management in chronic patients. Before embarking on patient education, professionals require an understanding of health-related behaviour. Using a health education model provides a framework to begin (Marks et al., 2005). Crumley (2011) describes Rosenstock?s Health Belief model as a patient perception model. ...read more.


1, No. 4, pp. 184- 185. Available at: http://www.internurse.com/cgi-bin/go.pl/library/article.cgi?uid=45317;article=jrn_1_4_184_185 [Accessed 26 November 2012]. Palfreyman, S. 2008, ?Assessing the impact of venous ulceration on quality of life?, Nursing Times, Vol.104, No. 41, pp. 34- 37. Available at: http://gcal.summon.serialssolutions.com/search?s.q=Assessing+the+impact+of+venous+ulceration+on+quality+of+life [Accessed 28 November 2012]. Royal College of Nursing 2006, Clinical Practice Guidelines: The nursing management of patients with venous leg ulcers, [online], Available from: http://www.rcn.org.uk/data/assets/pdf_file/0003/107940/003020.pdf [Accessed 28th November 2012]. Scottish Intercollegiate Guidelines Network 2010, Sign Guideline 120: Management of Chronic Venous Leg Ulcers, [online], Available from: http://www.sign.ac.uk/guidelines/fulltext/120/contents.htmlcontents [Accessed 28th November 2012]. Stephen-Haynes, J. 2011, ?Managing exudate and the key requirements of absorbent dressings?, British Journal of Community Nursing, Vol. 16, No. 3, pp. 44-49. Available at: http://gcal.summon.serialssolutions.com/search?s.q=Managing+exudate+and+the+key+requirements+of+absorbent+dressings [Accessed 18 November 2012]. The Scottish Government 2010, The Healthcare Quality Strategy for NHSScotland, [online], Available at: http://www.scotland.gov.uk/Publications/2010/05/10102307/1 [Accessed 23 November 2012]. The Scottish Government 2009, Improving the Health & Wellbeing of People with a Long Term Condition in Scotland: A National Action Plan, [online], Available at: http://www.scotland.gov.uk/Publications/2009/12/03112054/1 [Accessed 28 November 2012]. Todd, M. 2011, ?Venous leg ulcers & the impact of compression bandaging?, British Journal of Nursing, Vol. 20, No. 21, pp. 1360- 1364. Available at: http://gcal.summon.serialssolutions.com/search?s.q=Venous+leg+ulcers+%26+the+impact+of+compression+bandaging [Accessed 20 November 2012]. Van Hecke, A. 2011, ?Missing links in venous leg ulcer management?, British Journal of Nursing, Vol. 20, No. 11, pp. 3. Available at:http://su3pq4eq3l.search.serialssolutions.com/?ctx_ver=Z39.88-2004&ctx_enc=info%3Aofi%2Fenc%3AUTF-8&rfr_id=info:sid/summon.serialssolutions.com&rft_val_fmt=info:ofi/fmt:kev:mtx:journal&rft.genre=article&rft.atitle=%27Missing+links%27+in+venous+leg+ulcer+management&rft.jtitle=British+Journal+of+Nursing&rft.au=Van+Hecke%2C+Ann&rft.date=2011-06-07&rft.pub=MA+Healthcare+Ltd&rft.issn=0966-0461&rft.volume=20&rft.issue=11%20-%20Supplement&rft.spage=3&rft.externalDocID=84388 [Accessed 30 November 2012]. Ward-Smith, P. 2012, "Health literacy" ,Urologic nursing, Vol. 32, No. 3, pp. 168- 70. Available at: http://gcal.summon.serialssolutions.com/search?s.q=Health+literacy [Accessed 28 November 2012]. Whitehurst, F. 2007, ?Assessment & management of venous leg ulcers?, British Journal of Healthcare Assistants, Vol. 1, No. 5, pp. 210- 213 INTERNURSE, viewed 17th November. Available at: http://www.internurse.com/cgi-bin/go.pl/library/article.cgi?uid=27095;article=BJHA_1_5_210_213 [Accessed 14 November 2012]. Wrixon, S. 2010, ?Self-care in the community: moving away from a culture of dependency?, British Journal of Community Nursing, Vol. 15, Vol. 1, pp. 13- 16. Available at: http://www.internurse.com/cgi-bin/go.pl/library/article.cgi?uid=45778;article=BJCN_15_1_13_16 [Accessed 20 November 2012]. Young, T. 2011, ?Wound Care Series Part 3: Doppler Assessment How to undertake a Doppler Ultrasound for Leg Ulceration?, Practice Nursing, Vol. 22, No. 11, pp. 597- 601. Available at: http://www.internurse.com/cgi-bin/go.pl/library/article.cgi?uid=87424;article=PN_22_11_597_601 [Accessed 19 November 2012]. ...read more.

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