Many government and healthcare strategies now advocate supporting self-care in the management of long-term conditions (LTCs). This approach has been driven by the increasing number of poly-morbid, obese and elderly people in the UK, which is putting an immense strain on already stretched health and social care resources. The emphasis on promoting self-care throughout the illness trajectory has been a pivotal aspect of nursing care for more than 50 years and this approach in the management of chronic oedema has always been a key aspect of treatment plans by specialists in this field. Practitioners need to be skilled in assessing the self-care needs of patients and to be ready to adopt this approach and provide appropriate support. This article gives an overview of self-care for people with chronic oedema and focuses on how nurses can encourage and support patients to do this. A case study demonstrates the importance of thorough and accurate assessment to encourage self-care and health behaviour change.
This paper looks at an audit which compared the clinical outcomes of patients with lower limb oedema, who were either treated in a designated leg ulcer clinic or in their own homes. From exploring the findings, the author identified areas for service improvement such as staff training, staff allocation for clinics/home visits and completion and documentation of leg assessments. The piece of work forms part of a wider review of lower limb management within the author’s locality. The findings have facilitated greater discussion with senior management within the organisation around service provision for this patient group and gained valuable support for service and staff development.
In each issue of JCN we ask a clinical expert to take a look at a therapy area and examine some everyday problems that community nurses may experience. In this issue, we look at venous leg ulceration and associated oedema and ask the question...
How do I reduce foot oedema while healing a leg ulcer?
Leg ulcers and chronic oedema can be complicated to treat, particularly when oedema is present in the the foot and you are trying to apply compression bandaging. We asked Winnie Furlong, the clinical lead for the leg ulcer service, The Princess Alexandra Hospital and West Essex Leg Ulcer Service, to explain the best way to treat venous leg ulceration with associated foot oedema, in response to the implementation of local guidelines.
By reading the article, you can learn all about the key principles of subjects that are vital to your role as a community nurse. Once you have read the article, visit www.jcn.co.uk/learning-zone/ to evaluate your knowledge on this topic by answering the 10 questions in the e-learning unit; all answers can be found in the article. If you answer the questions correctly, you can download your certificate, which can be used in your continuing professional development (CPD) portfolio as evidence of your continued learning.
Compression therapy can play a vital role in improving the quality of life for those with chronic venous insufficiency, chronic oedema and lymphoedema (Lymphoedema Framework, 2006; World Union of Wound Healing Societies [WUWHS], 2008). In particular, compression bandaging can facilitate wound healing and oedema reduction in the treatment phase of management, before further healing and maintenance with compression hosiery.
In patients with venous and lymphovenous disease, skin changes to the lower limb(s) occur gradually, and become more serious over time if left untreated. The CHRonic Oedema Signs and Symptoms (CHROSS) Checker is a tool kit consisting of an assessment chart and key cards that have been developed to help clinicians easily identify the skin changes that occur as a result of underlying venous and lymphovenous disease, when carrying out holistic patient assessment. It also provides clear guidance on which compression products can be used to manage the disease type and severity of skin change. For clinicians unfamiliar with some or all of the signs and symptoms listed on the CHROSS Checker chart, the key cards contain further information in the form of a photograph, definition and cause of each sign and symptom listed. This article will describe the theory behind the development of the CHROSS Checker tools and explain how to use them in clinical practice.
Janice Bianchi, Independent Medical Education Specialist and Honorary Lecturer, Glasgow University
Anne Williams & Gillian Craig consider some of the possible challenges for community nurses as they establish a role in the management of chronic oedema
Anne F Williams is a Cancer Nursing Research Fellow/Specialist Lymphoedema Nurse at Napier University/NHS Lothian.
Gillian Craig is a Specialist Lymphoedema Physiotherapist at NHS Grampian Chronic Oedema Service
Article accepted for publication: August 2007
Irene Speding gives a brief overview of a case study involving a lady with chronic oedema
Irene Speding, RGN, NDNcert, BSc (Hons), Dip Diabetic Care/Stoma Care is a Tissue Viability Nurse Specialist, South of Tyne and Wear NHS Trust serving Sunderland & Gateshead PCT
Article accepted for publication: September 2007
