Patricia Shuter

A randomised controlled trial of a community nursing intervention: improved quality of life and healing for clients with chronic leg ulcers

AIMS AND OBJECTIVE The negative impact of chronic leg ulcers on quality of life is well documented. The aim of this study was to determine the effectiveness of a new community nursing model of care on quality of life, morale, depression, self-esteem, social support, healing, pain and functional ability of clients with chronic venous leg ulcers. BACKGROUND Venous leg ulcers are slow to heal, frequently recur and are associated with pain, restricted mobility and decreased quality of life. Although chronic wound care consumes a large proportion of community nursing time and health care resources, there is little evidence available on the effectiveness of differing models of community care for this population. DESIGN Randomised controlled trial. METHODS We recruited a sample of 67 participants with venous leg ulcers referred for care to a community nursing organisation in Queensland, Australia after obtaining informed consent. Participants were randomised to either the Lindsay Leg Club model of care (n = 34), emphasising socialisation and peer support; or the traditional community nursing model (n = 33) consisting of individual home visits by a registered nurse. Participants in both groups were treated by a core team of nurses using identical research protocols based on short-stretch compression bandage treatment. Data were collected at baseline, 12 and 24 weeks from commencement. RESULTS Participants who received care under the Leg Club model demonstrated significantly improved outcomes in quality of life (p = 0.014), morale (p < 0.001), self-esteem (p = 0.006), healing (p = 0.004), pain (p = 0.003) and functional ability (p = 0.044). CONCLUSION In this sample, the evaluation of the Leg Club model of care shows potential to improve the health and well-being of clients who have chronic leg ulcers. RELEVANCE TO CLINICAL PRACTICE These results suggest further evaluation and implementation of this model is warranted by community health organisations involved in the care of this population.

An Exploratory Study of Grief and Health-Related Quality of Life for Caregivers of People With Dementia

The aim of this qualitative study was to explore key positive and negative factors that impact on grief resolution and health outcomes of caregivers who were caring, or had cared, for a family member with dementia who had died. The study was a scoping study and involved face-to-face interviews with these family caregivers (N = 13). Results indicated a complex interaction of issues (many unique to dementia caregiving) which in different combinations acted as protective or risk factors for caregiver outcomes. Interaction of individual characteristics, role appraisal, value of intrinsic and extrinsic resources, and experiences with health professionals during the caregiving period and around the death of their relative were shown to have the most influence on caregiver outcomes. Psychological resilience and satisfaction with caregiving were protective against negative outcomes while unresolved grief was a risk factor. These findings highlight the potential benefits of multicomponent, holistic dementia caregiver interventions.

Risk factors for delayed healing in venous leg ulcers: a review of the literature

To the Editor: We read, with great interest, the recent article of Parker et al. (1) on the risk factors for the delayed healing in venous ulcers; article is interesting and it is very well done. The review has been extensive and report important researches about physiological risk factors in venous ulcer formation (2). We would like to make a comment reporting the role of lower limb lymphatic system in the onset and the healing of chronic venous ulcers (3). In fact, venous and lymphatic systems work together to drain blood and interstitial fluids from the limb and, in case of post-thrombotic syndrome we were able to demonstrate, using lymphoscintigraphy, that the formation of venous ulcer is related to an impairment of the lymph flow and that, on the contrary the healing of the ulceration is related with and improvement of the lower limb lymphatic flow (3). Elastic compression therapy, anticoagulation and mobilization enhance lymphatic drainage and improve healing rates (3–5). Psychosocial and physiological risk factors could include together with venous abnormalities, decreased mobility, fixed ankle joint, nutrition, ulcer duration, location and dimensions, wound exudation, wound infection and compression treatment (1) also the role of lymphatic drainage (3, 4). In fact, a reduction in the lymphatic flow of the affected limb at lymphoscintigraphy is a negative predictive factor for wound healing, on the contrary an improvement of the lymph flow at lymphoscintigraphy is a positive predictive factor for wound closure (3,4). In conclusion, lymphoscintigraphy could be an additive method of investigation to understand the mechanism of formation and healing of venous ulcers and it could be used, during the follow-up of these patients, to identify the progresses of a determinate treatment of the venous ulcers because when ulcer start to heal the lymph flow improves.

Protective and risk factors for health outcomes in family caregivers of people with dementia following bereavement

Background: The vital role of family caregivers of people with dementia is increasingly recognized, and the need to support them, especially in the terminal stages of the disease, is crucial. Some factors associated with the role are known to contribute to risk of negative outcomes including complicated grief following bereavement. This PhD research project aims to determine the risk and protective factors for post-bereavement health outcomes in primary family caregivers to inform development of effective interventions. Methods: The research project consists of two studies: a scoping study involving semistructured interviews with 13 family caregivers, the results of which were used to inform data collection for the second prospective cohort follow-up study. This study includes baseline surveys administered before the death of the relative with dementia and/ or 6 weeks after death. The surveys will then be repeated for all participants 6 months following the death, at which time a measure of complicated grief will also be carried out. Results: The findings indicate that key issues associated with bereavement outcomes for family caregivers appear to be an interaction of individual characteristics and coping strategies, gender, death sequelae, and the existence of a spiritual dimension in their lives. Conclusions: Interventions developed to support this group should remain mindful of these issues to facilitate progress toward developing early, dementia-specific preventive and therapeutic interventions for both family caregivers and their relatives with dementia.