Van Hecke Ann, Grypdonck Maria, Beele Hilde, De Bacquer Dirk, Defloor Tom
Department of Public Health-Nursing Science, Faculty of Medicine and Health Sciences, Ghent University, Belgium.
J Adv Nurs. 2009 Feb;65(2):337-47. doi: 10.1111/j.1365-2648.2008.04871.x. Epub 2008 Nov 6.
This paper is a report of a study to describe venous leg ulcer care regarding compression, pain management and lifestyle advice in community settings and to identify factors that predict the provision of lifestyle advice by nurses.
Incongruence between evidence and practice in leg ulcer care has been reported. Little is known about predictive factors related to the provision of lifestyle advice.
Two focus interviews and a Delphi procedure were used to develop a self-administered questionnaire based on the Graham questionnaire. Nurses employed by community healthcare organizations and independent nurses in private practices participated (n = 789). The data were collected in 2006.
Compression was applied in 58.7% of patients with venous ulcers. Pain was present in 82.9%. A third of patients with pain received analgesics, but half of these patients (52.1%) took analgesics as prescribed. Half of the nurses (50.8%) gave lifestyle advice related to the leg ulcer. It was mainly instructions about leg elevation (68.3%), promoting physical activity (39.8%) and optimizing nutrition (16.7%) that were provided. Nurses who perceived themselves to have adequate leg ulcer knowledge and skills were 3.75 times more likely to provide lifestyle advice compared with those lacking such knowledge and skills. Nurses who found leg ulcer care not rewarding, rarely successful or difficult gave statistically significantly less lifestyle advice than those who found it rather rewarding, successful and not difficult.
Patients with leg ulcers receive less than optimum care and patient education. A particular challenge lies in leg ulcer education programmes and pain management.
本文报告一项研究，旨在描述社区环境中腿部静脉溃疡护理在加压治疗、疼痛管理和生活方式建议方面的情况，并确定预测护士提供生活方式建议的因素。
已有报告指出腿部溃疡护理的证据与实践之间存在不一致。关于与提供生活方式建议相关的预测因素知之甚少。
采用两次焦点访谈和德尔菲法，在格雷厄姆问卷的基础上编制一份自填式问卷。社区医疗保健组织雇用的护士和私人诊所的独立护士参与了调查（n = 789）。数据于2006年收集。
58.7%的静脉溃疡患者接受了加压治疗。82.9%的患者存在疼痛。三分之一有疼痛的患者接受了镇痛药治疗，但其中一半患者（52.1%）按规定服用了镇痛药。一半的护士（50.8%）给出了与腿部溃疡相关的生活方式建议。主要提供的是关于抬高腿部（68.3%）、促进体育活动（39.8%）和优化营养（16.7%）的指导。认为自己具备足够腿部溃疡知识和技能的护士提供生活方式建议的可能性是缺乏此类知识和技能的护士的3.75倍。认为腿部溃疡护理没有回报、很少成功或困难的护士，在统计学上提供的生活方式建议明显少于那些认为护理有回报、成功且不困难的护士。
腿部溃疡患者得到的护理和患者教育未达最佳水平。腿部溃疡教育项目和疼痛管理面临特别的挑战。
