There is an old man who occasionally catches the same bus as me to the station. When he arrives at the bus stop there is an odour which in the confined space of the bus gets worse.
It took me a while to work out that the smell was from compression bandages on his legs which are usually heavily stained with exudate. Month after month the smell hasn’t improved and I would assume neither have his ulcers.
How does he feel when people instinctively move away from him, look the other way or fan themselves with a copy of the Metro?
I can’t make a judgement on his care or whether he is compliant but I do wonder whether his wound management is based on the best available evidence.
Management of leg ulcers, unlike other nursing activities, has a fairly robust evidence base. A well-managed venous ulcer can heal and we have a host of products for management of odour and exudate.
Sadly, the evidence has also highlighted the profound psychological effect ulceration has on people’s lives leading to social isolation, depression and anxiety.
So when I look at my fellow bus companions bandages I am left wondering about the research-practice gap.
Who is removing this gentleman bandages and assessing his symptoms?
Is anyone talking to him about how he is managing is hygiene and washing is clothes?
Has anyone talked to him about his shoes that don’t fit comfortably over the bandages?
Has anyone asked him how he feels?
The application of compression bandaging is a specialist skill and the Leg Ulcer Forum is clear that it should be undertaken by nurses with specialist training.
However not all patients have access to specialist services and the net results is on-going, expensive and ineffective care that has a negative impact on patients.
We all have a responsibility to use evidence based practice but practitioners need to have access to it. While practitioners should ensure they are up to date, researchers must ensure that their work is disseminated as widely as possible.
The problem is academic institutions usually measure the value of its researcher by their publications in academic journals with impact factors. This measure is not based on the impact on patient care but on the number of citations to the journal - those with higher impact factors are deemed to be more important than those with lower ones.
Perhaps it is time for researchers’ success to also be measured by their impact on patient care.