Observations of nurses' treatment of leg and foot ulcers in community health care

Abstract

Objective The aim of the study was to obtain knowledge about leg and foot ulcer care performed by nurses in community health care. Design This is a descriptive observational study. Setting and subjects The sample consisted of Norwegian home care nurses (n = 31), student nurses (n = 30), and patients with leg and foot ulcers (n = 32). Thirty-five ulcer treatments were observed in the patients' homes. Methods A structured observation form with space for additional notes and assessments was used. Photographs were taken of the ulcers. Information on background variables for patients and nurses was collected, and descriptive and interpretive analyses were performed. Nursing students made the observations. Results In 16 situations the patients had no ulcer diagnosis, and most of the patients (79.9%) had other serious chronic diseases. The home care nurses were uncertain about their assessment of the ulcers, and the treatment principles were not always current; for example, dry dressings and normal saline were used for cleansing. Twenty-eight different dressing combinations were used on the 35 ulcers. Compression was used on undiagnosed ulcers, sometimes incorrectly. Hand-washing routines were poor, and the treatment was often poorly documented. Poor working conditions were also observed, such as bad lighting in the room. The majority of the ulcer treatments lasted 20 to 30 minutes. Conclusion The study identifies areas where leg and foot ulcer treatment by home care nurses can be improved with respect to technique and documentation.