I recently heard about a patient who removed her compression bandages so she could put on her shoes in order to go to church. The nurse was surprised that the patient put church before her medical treatment.
In this issue of Chronic Wound Care Brenda King (p40) reports on the results of an audit that identified that many patients with leg bandages found it difficult to move around their homes or go outside because they could not wear their shoes. It is a concern that many have to adapt their shoes by, for example, cutting them, which has financial implications, or tying them on with elastic, which has implications for safety. The audit also identified patients who had to wear slippers and shoes that were soaked with exudates even after fresh dressings were applied because they were unable to wash their footwear.
Many patients with leg ulceration experience social isolation as they are unable to go outside due to the problems they experience with their footwear, yet a simple measure - providing footwear that fits and can be washed - could significantly improve their quality of life. Suitable products are available free of charge to patients in secondary care but they cannot be prescribed for those living in the community - where the majority of these patients are cared for.
This audit provides an insight into how patients manage their health problems. It challenges us to stop and look beyond the task of dressing a wound and think about the effect the wound is having on our patient's life and the products that should be available.
It is clear that the patient's priority may be different to that of the health professional but if care is to be truly evidence-based we need to not only identify how our interventions, however well intentioned, actually affect the patient, but also consider whether there are treatment alternatives that better suit the patient's needs. Critical to this is access to equipment, medicines and adaptations that can help patients and nurses achieve shared goals.
Gaining insight into the patient's lived experience of their condition must lie at the heart of nursing; understanding that there may be a mismatch between the outcomes anticipated by the health professional and patient is fundamental to achieving effective care. It is this understanding and the subsequent negotiation with the patient about the plan of care that really tests nurses' skills.