A community nursing model of care for people with chronic leg ulcers

Chronic leg ulcers affect approximately 1 – 3% of the population aged over 60 years in the U.K., Europe, U.S.A. and Australia (Briggs & Closs, 2003; Margolis et al., 2002). Prevalence increases with age (Margolis et al., 2002), rising from around 0.6% of the general adult population up to 2% - 5.6% of those aged over 65 years (Bergqvist et al., 1999). With today’s ageing societies (Parker, 2005), this condition will become an increasing problem in the future. Leg ulcers often take months or years to heal and frequently recur, becoming a life long chronic condition associated with prolonged ill-health, pain, restricted mobility and decreased quality of life (Chase et al., 2000; Walshe, 1995). When planning care for people with chronic leg ulcers, a health care model is required which not only addresses the need for evidence based wound care, but also pain management, symptom management and quality of life issues associated with the condition. Prevalence of pain associated with leg ulcers is reported as ranging from around 50% (Nemeth et al., 2003) to 80% (Hareendran, 2005) and leg ulcer pain is reported to decrease energy levels (Persoon et al., 2004), interrupt sleep (Edwards et al., 2005a), affect mood (Edwards et al., 2005a) and restrict mobility (Brown, 2005) and ability to manage normal work (Edwards et al., 2005a). Mobility is often further constrained by the need to wear bulky, multilayered bandages, limiting the type of footwear and clothing able to be worn. Reduced mobility impacts on independence in activities of daily living and productivity. For example, Abbade et al. (2005) found 49.2% of patients had a functional disability impacting on daily activities and work and Persoon et al.’s (2004) review of 37 studies found restraints in work and leisure activities were one of the major limitations imposed by leg ulcers. Pain, limited mobility and embarrassment associated with leg ulcers often leads to social isolation (Ebbeskog & Ekman, 2001; Persoon et al., 2004). The combination of pain, restricted mobility and social isolation in turn contributes to a negative impact on psychological health (Ebbeskog & Ekman, 2001; Persoon et al., 2004); such as depression and anxiety (Jones et al., 2006). In addition, the long term nature of the disease can lead to uncertainty, disappointment, loss of hope, or despair (Ebbeskog & Ekman, 2001). Problems with poor understanding of the cause and treatment of the condition have been noted (Chase et al., 2000), leading to feelings of powerlessness, lack of ownership and apathy with regard to management strategies. Not surprisingly, measures of quality of life in people with chronic leg ulcers have generally found significantly lower quality of life scores than in the general population (Franks et al., 2003; Jull et al., 2004).