Personalised self-care for people with venous leg ulcers: a toolkit for change

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Editor's Pick, Self-care, venous leg ulcer

Personalised self-care for people with venous leg ulcers: a toolkit for change

Supported by L&R

Andrew Kerr, Beth Kelly, Karen Ousey, Laura Hallas Hoyes, Leanne Atkin, Rhian Last, Stephanie Lowen, Zoe Chouliara

8 September 2023

The guidance in this document aims to empower patients and improve outcomes, by equipping clinicians with a toolkit to effectively advocate for the inclusion of self-care, while potentially helping healthcare services to reduce the burden of wounds.

Self-care is the ability of individuals to care for themselves, allowing them to take an active role to achieve, maintain or optimise their health and wellbeing. It refers to the collaborative partnership between clinicians and patients to support individuals to manage their ongoing health conditions themselves (Blackburn et al, 2021; Martínez et al, 2021). An increasing drive towards greater patient engagement and self-care has potential to benefit patients with wounds, especially in the case of chronic lower limb ulcers, where demand for care is growing due to the rising prevalence of wounds, reduction in available trained staff, increasing healthcare costs and unwarranted variation in the use of evidence-based care (Moore, 2016; Gray et al, 2018).

In 2017/2018, 560,000 people were diagnosed with a venous leg ulcer (VLU), and around two-thirds of wound care is delivered in the community, equating to 50% of the community nursing workload (Guest et al, 2020). However, these values may be an underestimate, as an estimated 25% of all wounds being managed within the National Health Service (NHS) lacked a recorded differential diagnosis in the patient’s record.

The psychological, emotional and social impacts of coping and living with a VLU are wide-ranging, including pain, low self-esteem, social isolation, anxiety and depression (Hughes and Balduyck, 2022). It is evident that a change to the model of care provision for people with VLUs is needed, and self-care needs to be encouraged and promoted as early in the treatment journey as possible. Moreover, compression therapy (leg ulcer hosiery kits and adjustable compression wraps) is considered the gold standard for treatment of VLUs, and can be supplied to patients to self-care for their own wounds (Ousey et al, 2021).

A multidisciplinary group of experts convened for an online meeting in October 2022 to develop this Best Practice Statement, focusing on self-care for people with VLUs to improve patient outcomes. The group included experts within tissue viability, wound and vascular care, leaders within education and self-care, a health psychologist, and an expert in self-care within diabetes. The aim of this meeting and the resulting document was to learn from shared experiences and provide guidance on patient suitability and best practice, to reduce the pressure on all clinicians and healthcare providers working with VLUs, and ensure that all patients receive the appropriate level of support.

Following on from the Best Practice Statement on Holistic management of venous leg ulceration (second edition; Wounds UK, 2022), this document aims to:

Outline self-care and its associated concepts
Describe the potential benefits and potential challenges of self-care for patients and clinicians, the barriers to its widespread adoption and approaches to overcome these
Clarify individual patient considerations and guide clinicians on assessing patient suitability, capacity and willingness to be involved in self-care
Emphasise the importance of effective communication to optimise self-care, and provide a Dialogue Tool to support clinicians to promote self-care in the clinical setting
Focus on self-care in the context of VLUs and compression therapy.

Karen Ousey (Chair)

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Disclaimer: This publication was coordinated by Wounds UK with the Expert Working Group and Review Panel. The views presented in this document are the work of the authors and do not necessarily reflect the views of L&R Medical.

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Resources

Personalised self-care for people with venous leg ulcers: a toolkit for change

Personalised self-care for people with venous leg ulcers: a toolkit for change

Principles of wound management in paediatric patients (Second Edition)

Quick Guide: Improving offloading for the foot in diabetes – Use of Total Contact Casting in practice

Demystifying infection in the diabetic foot

Prevention and early identification of lower limb skin injuries: The role of the podiatrist

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