This article reflects on the measures that can be taken at home to decrease the chances of developing ulcers and to help improve the outcomes of those that do already have venous ulcers.
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Abstract This abstract has a very clear, concise summary of the article. It includes the aim and objectives, background information, design, methods and results. The article (Burns & Grove, 2011) addressed the area of concern being that many patients with venous leg ulcers did not adhere to the recommended guidelines for treatment and prevention.
This research article provided interventions that the patients could reform in their own home on a daily basis and the results were presented in a table. The information for evaluation was gathered at the baseline (one week before the start of intervention), the end of the intervention (within one week after the last visit) and three months after. The sample was a select group of patients with variety of common issues. The results showed that with adherence to the interventions provided did in fact decrease some of the common issues associated with venous leg ulcers. Research Problem and Purpose The problem in this research study is clean and concise, being that patients are often non-compliant with routine care of venous leg ulcers. It was noted that only 52% of patients wore compression stockings daily for the first six months after leg ulcer healing, about 22% had not worn compression stocking at all (Heck et al.
, 2011, p. 430). Some studies examined the adherence to leg elevations and reported that only 22% elevate their legs while sitting and walk for 1. 7 hours a day. The results of physical activity showed that 56% of the 1 50 participants were physically active less than 2. Hours per week (Heck et al.
, 2011, p. 430). Many reasons for non-adherence included difficulties applying the compression stockings, skin problems, uncomfortable footwear, poor cosmetic appearance of compression bandages and financial restrictions (Heck et al.
, 2011, p. 430). The research purpose is to examine the changes associated with the nursing intervention ‘ Adherence to leg ulcer lifestyle advice’ (1) to identify outcomes sensitive to leg ulcer patients’ experience and more specific to the nursing intervention and (2) to explore the quantitative effects of the intervention (Heck et al. 2011, p. 431). Research questions/hypotheses The objectives and aim of the study are to “ examine the experienced changes associated with a nursing intervention to enhance the adherence to leg ulcer lifestyle advice” (Heck et al. , 2011, p.
429). No questions or hypotheses were found in this study. Design The study used has subjects and has a bearing on educational practice for nursing, this makes this particular study an applied research.
This study used a subjective approach to describe life experiences and situations, making it a qualitative evaluation. The design was a pre-posters qualitative evaluation because valuations were done before the study began and again after it was completed. Framework No specific framework was stated to be the basis of this study. This study revolves around the possible outcomes of adhering to the nursing interventions listed, but does not provide mapping of any kind. Variables The independent variables in this study are the interventions. These interventions are education intervention, cognitive intervention and behavioral interventions. An independent variable is a stimulus or activity that is manipulated or varied by the researcher to create an effect on the dependent variable (Burns & Grove, 2011). The educational intervention will focus on educating the patient venous leg ulcers and how they can help themselves by performing certain actions at home such as elevating legs, wearing compression stockings etc.
The cognitive interventions include letting the patient know what to do and why they need to follow the leg ulcer lifestyle advice. An example of this was that some patients knew that they needed to elevate their legs, but when given correct instruction, they realized that the way they were doing things were incorrect. The outcome from this intervention is that once he patient is able to sit down and get detailed information, it can lead to better techniques and healing. The behavioral interventions are seen in “ following and giving lifestyle advice” and “ using creative strategies and use habit formation to incorporate advice in daily life” (Heck et al. , 2011, p. 436).
These interventions focused on the performance of the physical aspects of the leg ulcer lifestyle advice. It involves adhering to leg exercises and compression therapy. The outcome of this intervention was that some patients only performed the routine when it “ crossed heir mind” (Heck et al. , 2011, p. 436) or when they found it was easy to fit it into their daily schedule.
Not all patients were able to adhere to the lifestyle and some patients developed their own versions of the therapies; such as wearing the compression stockings, but not as recommended. Others that previously counted out the number of reps of exercises now do them over the course of a commercial break- not counting and Just doing them. Some patients are even networking with others with the same problems to teach and offer advice on therapies. Review of literature The literature review has many sources of information. There were a total of 69 reference articles and 13 of them were current.
The most recent few being from 2009-2011, but there were very few of them. Several dated back to late sass’s. The data in these articles includes both quantitative and qualitative data and outcomes. Currency includes articles published within the last 5 years. Many of the articles AR current, but the majority is not. All of the articles are relevant to the study. They all offer background information or statistical information, along with recommendation ND outcomes.
The articles do address the problems and variables of the study. I don’t feel that there is any one particular landmark article in this study, but a great compilation of many articles. The Journal for Advanced Nursing provides information for the article about making a plan for patients and doing multiple follow-ups with them. The Journals of Wound Care provided great educational aspects. Sample an setting The sample size is 26 patients that all have the same problem. The sampling method used was purposeful sampling, also referred to as “ Judgmental or selective impaling where the researcher consciously selects certain participants, elements, events or incidents to include in the study’ (Burns & Grove, 2011, p. 313). The inclusion criterion was that the patients needed to have an Ankle Brachia Pressure Index (BPI) between 0.
8-1. 2 (Heck et al. , 2011, p. 432).
They also had to have a prescription of compression garments, speak Dutch, be able to read and write, receive leg ulcer care by community nurses and be non-adherent. Patients were excluded if they had communication impediments, fixed ankle range motion, were totally dependent for mobility, or had underlying pathologies such as uncontrolled diabetes mellitus, epidermal gangrenous, anesthesia gravies or vacuity’s (Heck et al. , 2011, p. 432).
The study setting was in the patients’ homes. Instrument Demographic Data: the researchers used interviews and participant observation to obtain this data. Frequency and duration of wearing compression, performing leg exercises and leg elevation is used. There is not validity or reliability for this because it is not measurable. The patients keep a diary and record exercises and how often compression garments are worn. Activity level-step counts were recorded with Cathartic accelerometer GTRM. The patients were instructed to wear these during their waking hours for seven days.
No information about the validity or reliability. Pain-a visual analog pain intensity scale was used, this is not recommended for old people. The numeric rating scales are easier to use and understand. Ulcer size-the researcher measured the healing rate by acetate tracing and computer-assisted counting the number of squares (CM, squared).
This acetate method is most commonly used for measuring wound and has been demonstrated to have good enter-and integrated reliability (Heck et al. , 2011, p. 435). Demographic and illness- related variables-at baseline a general questionnaire was used to obtain data AIBO age, gender, education level, living circumstances, mobility status, leg ulcer duration and recurrence rate. Data collection took place between September 2008-July 2009 (Heck et al. , 2011, p. 435).
Data Collection Data was collected by observation and interviews. Interviews were conducted using open ended questions where patients self-reported progress. Qualitative an quantitative data were collected. The interviews were held in the patients’ homes.
The interviews took place within a week after the end of the intervention to maximize recollection of experiences. Interviews lasted between 18-81 minutes, being audio- taped and transcribed.