Effects of nurse-led education on pain management, adherence to compression therapy and quality of life for venous leg ulcers

Abstract

In Western countries, venous leg ulcer is experienced by 2% of the population with most of those affected being at age over 60 years. Prevalence is increasing due to rising age population, smoking, obesity, diabetes and sedentary life. Treatment with compression bandages stimulates venous flow and improves oxygen and nutrient transportation to the skin thus reducing oedema, inflammation and pain (Bobridge, Sandison, Paterson, Puckridge & Esplin, 2011). This study is intended to probe into published evidence of whether nurse-led education is substantive in improvement of pain management, adherence to compression bandages and quality of life. To facilitate the search strategy, a PICO question was devised: In patients over 60 years of age (P) suffering from venous leg ulcer, is nurse-led education (I) effective when compared to usual care (C) in improving pain management, adherence to compression therapy and quality of life (O)? Methods The PICO question is based on the population (P) concerned, intervention (I) with comparing actions (C) and the resulting outcomes (O). A systematic literature search strategy was carried out through electronic databases and manually using a set of inclusion and exclusion to include articles published in English concerning males and females aged over 60 with venous leg ulcers and needing compression therapy, while excluding other published data in other languages with no translation provided. Five relevant studies including: one systematic review, two randomized control trials, a quasi-experimental and a mixed qualitative and quantitative study were selected. An intense critical appraisal of the studies using tools such as the critical appraisal skill program adapted by Oxman, Cook & Guyatt (1994), the frameworks of Melnyk & Fineout-Overholt (2011), Polit & Beck (2008) and Ryan Coughlan & Cronin (2007), was carried out to evaluate their potentiality to indicate the best evidence that can lead a pathway to evidence based practice. Results Although there are some gaps in literature due to small size of the studies, there is evidence indicating that nurse-led education is beneficial in mitigating pain, and in improving adherence to therapy and quality of life. Recommendation and Implications Recommendations emanating from these results include educating patients and health professionals to promote awareness that venous leg ulcer is a chronic condition and therefore treatment is lifelong; providing regular sessions and socializing environments for further support and feedback, adherence to compression therapy and pain management as a prerequisite and conducting, further research preferably locally. Implications Improvement of pain may lead to a greater possibility to increase activity, enhance independence and allow patients to feel more satisfied with their life besides reducing readmissions.