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.

References

Adderley U (2020) National Wound Care Strategy Programme: looking at the impact of COVID-19. Wounds UK 16(2): 11

Anderson I (2012) Encouraging compliance and concordance in leg ulcer patients. Wounds UK 8(1): S6-8

Atkin L, Tickle J (2016) A new pathway for lower limb ulceration. Wounds UK 12(2): 32-6

Atkin L, Tickle J (2018) Best practice statement leg ulceration pathway: revision required to reflect new evidence. Wounds UK 14(4): 58-62

Barker I, Steventon A, Williamson R et al (2018) Self-management capability in patients with long-term conditions is associated with reduced healthcare utilisation across a whole health economy: cross-sectional analysis of electronic health records. BMJ Qual Saf 27: 989-99

Blackburn J, Ousey K, Parfitt G (2021) Exploring concepts and current evidence of shared and self-care in the management of lower limb wounds. Wounds UK 17(4): 36-44

British Medical Association (2019) Self care: question & answer. Available at: https://www.bma.org.uk/media/1936/bma-plg-selfcare-nov-19.pdf (accessed 14 December 2022)

Carfora L, Foley CM, Hagi-Diakou P et al (2022) Patients’ experiences and perspectives of patient-reported outcome measures in clinical care: A systematic review and qualitative meta-synthesis. PLoS One 17(4): e0267030

Carr AJ, Higginson IJ (2001) Are quality of life measures patient centred? BMJ 322(7298): 1357-60

Darawsheh W, Chard G (2015) Towards culturally competent professional practice: exploring the concepts of independence and interdependence. Research, Policy and Planning 31(1): 3-17

Diabetes UK (2009) Improving supported self-management for people with diabetes. Available at: https://www.diabetes.org.uk/resources-s3/2017-09/Supported_self-management.pdf (accessed 21 November 2022)

Dowsett C (2021) Transforming venous leg ulcer management: opportunities for self-care solutions. Wounds UK 17(1): 49-55

Elwyn G, Frosch D, Thomson R et al (2012) Shared decision making: a model for clinical practice. J Gen Intern Med 27(10): 1361-7

Fletcher J, Atkin L, Murphy N, Murray S, Ousey K, Sandoz H (2021) Lessons learned from COVID-19: Building a ‘new normal’ in tissue viability. Wounds UK 17(4): 99-103

Gao J, Arden M, Hoo ZH et al (2019) Understanding patient activation and adherence to nebuliser treatment in adults with cystic fibrosis: responses to the UK version of PAM-13 and a think aloud study. BMC Health Serv Res 19(420): 1-12

Goh LJ, Zhu X (2018) Exploring patient and caregiver perceptions of primary healthcare sector home care for simple acute wounds. Adv Skin Wound Care 31(8): 348-60

Gray TA, Rhodes S, Atkinson RA et al (2018) Opportunities for better value wound care: a multiservice, cross-sectional survey of complex wounds and their care in a UK community population. BMJ Open 8: e019440

Guest JF, Ayoub N, McIlwraith T (2015) Health economic burden that wounds impose on the National Health Service in the UK. BMJ Open 5(12): e009283

Guest JF, Fuller GW, Vowden P (2020) Cohort study evaluating the burden of wounds to the UK’s National Health Service in 2017/2018: update from 2012/2013. BMJ Open 10(12): e045253

Gwilym BL, Mazumdar E, Naik G et al (2022) Initial reduction in ulcer size as a prognostic indicator for complete wound healing: A systematic review of diabetic foot and venous leg ulcers. Adv Wound Care (New Rochelle)

Hallas-Hoyes L, Williamson S, Kerr A, Andrews T, Calladine L (2021) An advanced self-care delivery model for leg ulcer management: a service evaluation. Journal of Wound Care 30(9); 751-62

Harding K et al (2015) Simplifying venous leg ulcer management. Consensus recommendations. Wounds International

Health Education England (2022) Module: T- GROW. Available at: https://kss.hee.nhs.uk/wp-content/uploads/sites/15/2022/08/Coaching-for-success-TGROW.pdf (accessed 21 November 2022)

House of Lords (2017) NHS: Wound Care. Available at: https://hansard.parliament.uk/lords/2017-11-22/debates/6C57E65A-A04D-449B-82E9-C836F088A696/NHSWoundCare (accessed 21 November 2022)

Hughes M, Balduyck B (2022) Made Easy: Challenges of venous leg ulcer management. Wounds International

International Self-Care Foundation (2022) What is Self-Care? Available at: https://isfglobal.org/what-is-self-care/ (accessed 21 November 2022)

International Wound Infection Institute (2022) Wound Infection in Clinical Practice. Wounds International

Janamian T, Greco M, Cosgriff D, Baker L, Dawda P (2022) Activating people to partner in health and self-care: use of the Patient Activation Measure. Med J Aust 216(Suppl 10): S5-S8

Jonkman NH, Westland H, Groenwold RH et al (2016) Do self-management interventions work in patients with heart failure? An individual patient data meta-analysis. Circulation 133(12): 1189-98

Kapp S, Santamaria N (2017) How and why patients self-treat chronic wounds. Int Wound J 14: 1269-75

Kapp S, Santamaria N (2020) The effect of self-treatment of wounds on quality of life: a qualitative study. J Wound Care 29(5): 260-68

L&R Medical UK (2022) Club Squeeze In. Available at: https://lrselfcare.co.uk/club-squeeze-in (accessed 21 November 2022

Lindsay E (2017) Leg clubs: A cost-effective social prescribing approach to lower limb management. Wounds Central 1(2): 111-2

Lindsay E (2018) Monitoring service quality: Lindsay Leg Club member satisfaction survey. Br J Community Nurs 23(Sup12): S24-S8

Martínez N, Connelly CD, Pérez A, Calero P (2021) Self-care: A concept analysis. Int J Nurs Sci 8(4): 418-25

Mills J, Wand T, Fraser JA (2018) Exploring the meaning and practice of self-care among palliative care nurses and doctors: a qualitative study. BMC Palliat Care 17(1): 63

Moore Z (2016) Patient empowerment in wound management. Wounds Essentials 11(1): 32-5

Moore Z, Coggins T (2021) Clinician attitudes to shared-care and perceptions on the current extend of patient engagement in wound care: Results of a clinician survey. Wounds International 12(1): 48-53

National Wound Care Strategy Programme (2020) Recommendations for Lower Limb Ulcers. Available at: https://www.nationalwoundcarestrategy.net/wp-content/uploads/2021/04/Lower-Limb-Recommendations-WEB-25Feb21.pdf (accessed 21 November 2022)

Nelson EA, Bell-Syer SE (2014) Compression for preventing recurrence of venous ulcers. Cochrane Database Syst Rev (9): CD002303

NHS England (2014) Five Year Forward View. Available at: https://www.england.nhs.uk/wp-content/uploads/2014/10/5yfv-web.pdf (accessed 21 November 2022)

NHS England (2015) Compassion in care campaign hits new milestone. Available at: https://www.england.nhs.uk/2015/02/hellomynameis/ (accessed 24 November 2022)

NHS England (2017) Next steps on the NHS Five Year Forward View. Available at: https://www.england.nhs.uk/wp-content/uploads/2017/03/NEXT-STEPS-ON-THE-NHS-FIVE-YEAR-FORWARD-VIEW.pdf (accessed 21 November 2022)

NHS England (2018a) Module 1: Patient Activation Measure – implementation quick guide. Available at: https://www.england.nhs.uk/wp-content/uploads/2018/04/patient-activation-measure-quick-guide.pdf (accessed 21 November 2022)

NHS England (2018b) Language Matters. Available at: https://www.england.nhs.uk/wp-content/uploads/2018/06/language-matters.pdf (accessed 21 November 2022)

NHS England (2019) The NHS Long Term Plan. Available at: https://www.longtermplan.nhs.uk/wp-content/uploads/2019/08/nhs-long-term-plan-version-1.2.pdf (accessed 21 November 2022)

NHS England (2020a) Supported self-management: Summary guide. Available at: https://www.england.nhs.uk/wp-content/uploads/2020/03/supported-self-management-summary-guide.pdf (accessed 21 November 2022)

NHS England (2020b) COVID-19: Diabetes online self-management courses. Available at: https://www.england.nhs.uk/coronavirus/documents/covid-19-diabetes-online-self-management-courses/ (accessed 21 November 2022)

NHS England (2020c) Health coaching implementation and quality: Summary guide. Available at: https://www.england.nhs.uk/wp-content/uploads/2020/03/health-coaching-implementation-and-quality-summary-guide.pdf (accessed 21 November 2022)

NHS England (2022a) Care and support you can get for free. Available at: https://www.nhs.uk/conditions/social-care-and-support-guide/care-services-equipment-and-care-homes/care-and-support-you-can-get-for-free/ (accessed 21 November 2022)

NHS England (2022b) Social prescribing. Available at: https://www.england.nhs.uk/personalisedcare/social-prescribing/ (accessed 21 November 2022)

NHS England (2022c) Health and wellbeing coaches. Available at: https://www.england.nhs.uk/personalisedcare/supported-self-management/health-and-wellbeing-coaches/ (accessed 21 November 2022)

O’Meara SO, Cullum N, Nelson AE, Dumville JC (2012) Compression for venous leg ulcers. Cochrane Database Syst Rev 11(11): CD000265

Office for Health improvements & Disparities (2022) Social prescribing: applying All Our Health. Available at: https://www.gov.uk/government/publications/social-prescribing-applying-all-our-health/social-prescribing-applying-all-our-health (accessed 21 November 2022)

Ousey K, Atkin L, Conway B et al (2021) Compression therapy for pharmacy teams. Wounds UK

Queen and Harding (2022) COVID-19 consequences in the management of persons with wounds. Int Wound J 19: 237-8

Proprietary Association of Great Britain (2016) Self Care Nation. Available at: https://www.pagb.co.uk/content/uploads/2016/11/PAGB-SELF-CARE-NATION-REPORT-NOVEMBER-2016-1.pdf (accessed 15 December 2022)

Rae B (2021) Obedience to collaboration: compliance, adherence and concordance. Journal of Prescribing Practice 3(6): 235-40

Riegel B, Westland H, Iovino P et al (2021) Characteristics of self-care interventions for patients with a chronic condition: A scoping review. Int J Nurs Stud 116: 103713

Roberts NJ, Kidd L, Dougall N et al (2016) Measuring patient activation: the utility of the patient activation measure within a UK context—results from four exemplar studies and potential future applications. Patient Educ Couns 99: 1739-46

Sandy-Hodgetts K et al (2020) International best practice recommendations for the early Identification and prevention of surgical wound complications. Wounds International

Schultz G, Sibbald G, Falanga V et al (2003) Wound bed preparation: a systematic approach to wound management. Wound Repair Regen 11: 1–28

Self Care Forum (2013) How to implement a self-care aware approach to demand management. Available at: https://www.selfcareforum.org/wp-content/uploads/2013/10/How-To-Guide-PDF-FINAL.pdf (accessed 21 November 2022)

Self Care Forum (2022) What do we mean by self care and why is it good for people? Available at: https://www.selfcareforum.org/about-us/what-do-we-mean-by-self-care-and-why-is-good-for-people/ (accessed 4 November 2022)

Sheridan NF, Kenealy TW, Kidd JD et al (2015) Patients’ engagement in primary care: powerlessness and compounding jeopardy. A qualitative study. Health Expect 18(1): 32-43

Simmons LA, Wolever RQ (2013) Integrative health coaching and motivational interviewing: Synergistic approaches to behavior change in healthcare. Glob Adv Health Med 2(4): 28-35

The King’s Fund (2017) What is social prescribing? Available at: https://www.kingsfund.org.uk/publications/social-prescribing (accessed 21 November 2022)

Vowden P and Vowden K (2016) The economic impact of hard-to-heal wounds: promoting practice change to address passivity in wound management. Wounds International 7(2): 10-15

West Suffolk Clinical Commissioning Group (2020) Self-care during COVID-19: Guidance for patients looking after their wound at home. Available at: https://www.westsuffolkccg.nhs.uk/wp-content/uploads/2020/06/Self-care-for-Wounds-Guidance-WSCCG.pdf (accessed 21 November 2022)

Whitmore J (2004) Coaching for Performance: Growing People, Performance, and Purpose. Nicholas Brealey Publishing, London

White R, Witts S, Hopkins A, Ewart J (2016) The differences in approach and clinical outcomes of venous leg ulcers managed in primary and secondary care. Wounds UK 12(2): 10-19

Wilde K (2020) Patients’ perceptions of self-management of chronic wounds. Wounds International 16(3): 38-44

World Health Organization (2016) Patient Engagement: Technical Series on Safer Primary Care. Available at: https://apps.who.int/iris/bitstream/handle/10665/252269/9789241511629-eng.pdf (accessed 4 November 2022)

World Union of Wound Healing Societies (2020) Optimising wound care through patient engagement. Wounds International

Wounds International (2016) International Best Practice Statement: Optimising patient involvement in wound management. Wounds International

Wounds UK (2016) Best Practice Statement: Holistic management of venous leg ulceration. Wounds UK

Wounds UK (2018) Best Practice Statement: Improving holistic assessment of chronic wounds. Wounds UK

Wounds UK (2019) Best Practice Statement: Addressing complexities in the management of venous leg ulcers. Wounds UK

Wounds UK (2021a) Best Practice Statement: Compression hosiery: A patient-centric approach (3rd edn). Wounds UK

Wounds UK (2021b) Best Practice Statement: Addressing skin tone bias in wound care: assessing signs and symptoms in people with dark skin tones. Wounds UK

Wounds UK (2022) Best Practice Statement: Holistic management of venous leg ulceration (second edition). Wounds UK

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

Primary and secondary prevention in lower leg wounds

Improving offloading for the foot in diabetes: Use of total contact casting in practice

Malignant wounds: Management in practice

Effectively assessing ABPI in leg ulcer patients

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