Profiling the venous leg ulcer population and state of community practice: Designing a nurse-lead leg ulcer service.

Abstract

In order to plan for a new community leg ulcer service, local evidence was required on the regional population with venous leg ulcers and the current state of community practice. There is strong evidence in the literature supporting the assessment and management of venous leg ulcers, but little is known about the local population profile or whether they were receiving the internationally recommended care. This is a manuscript-based thesis that consists of three distinct papers intended for submission for publication. The first two papers detail the planning studies that were undertaken to generate local evidence in order to design a new nurse-led community leg ulcer service. The first paper provides a population profile of the venous leg ulcer population receiving home care in one Ontario region. The second paper provides a critical appraisal of the state of community venous leg ulcer care. In the final paper, an advanced practice nurse (APN) reflects on her role in the design and implementation of the new service. The new leg ulcer service was designed using the evidence from the population profile and to address the gaps and inconsistencies in the provision of "best practice" that were identified in the appraisal of care. In this third paper, a number of barriers to the new evidence-based service were identified on a number of different levels and the multiple strategies tailored to the barriers were described.