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'How do we close the research-practice gap?'

  • Comments (9)

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.

 

  • Comments (9)

Readers' comments (9)

  • michael stone

    '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.'

    That is true in a much more general sense, not just for leg ulcers.

    I'm not entirely sure how to resolve that problem. But it is a problem, especially for the patient.

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  • Anonymous

    "...not all patients have access to specialist services..."


    why do not all patients have access to specialist services? some do not need them and the services of generalists may be adequate but what of those who do? are you saying they don't have access to them? if they don't who does and how do they gain this access and what criteria makes some patients privileged over others? it seems you do not have a modernised and up to date health service in the UK on line with most of the rest of the European countries despite the EU. Could it be because citizens do not pay enough into it to meet demands and needs put upon it?

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  • Anonymous

    "Perhaps it is time for researchers’ success to also be measured by their impact on patient care."

    I would agree. However, as has been demonstrated by some of the reader comments in another NT article citing NNRU research on staff wellbeing, nurses themselves are incredibly ignorant about research. They seem to think that all researchers should just put a halt to their activities, then come join us all on the front line. There is one research unit run by nurses in the whole of the UK. A lot of work required on all sides.

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  • Are you interested in leg ulcer research? Researchers at the Universities of York and Manchester are intending, subject to funding, to establish a James Lind Alliance style leg ulcer research priority setting partnership. Patients, carers and health professionals will be invited to identify and prioritise questions for research into leg ulcer prevention and treatment. Experience shows this type of priority setting process results in the commissioning of randomised controlled trials to answer the most important questions. Visit www.jlapressureulcerpartnership.co.uk for more information or contact richard.morley@york.ac.uk to be kept up to date.

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  • Anonymous

    I couldn't agree more, the problem we are faced with is not the frontline staffs unwillingness to listen, learn or change. It is indeed access to the evidence and filtering its relevance to the specific patient that is missing. And why is there a gap, because, as far as I have witnessed, the brilliant role of the ward or hospital educator is too often used to plug the gaps elsewhere, or keep an eye on staffs mandatory updates or give advice on problem patients/at team meetings. Surely this role should be mainly to access and share the knowledge that has been gained by the hard work of the research teams. Also, staff should be encouraged to read the news on nursing (such as the nursing times) but use their valuable time off to recharge. Companies and hospitals should allocate them paid time to spend with their well informed ward based educators. Simple. Surely?

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  • Anonymous

    As you say you don't know if this man is 'compliant' with his treatment or even if he is motivated to make an effort himself. Its amazing how quickly leg ulcers heal when patients are pro active in their care. Not everything can be landed at the NHS's door. Patients have rights and that is as it should be but they do not always see their responsibilities. Your man is obviously able to get on a bus why do you think he is not able to take some responsibility for his own hygiene? You might be right - he may not have access to the services he needs but it could also be the case that he is unwilling to participate in his own care and thinks that the health service can solve his problems with no help from him - I have seen both situations. If you see he is wearing compression bandages then someone is doing some research based care but maybe with limited resources there is not enough time to see him more often - or maybe he insists on sleeping in a chair and its an impossible job to stop the exudate - is it right that the NHS is expected to do everything? Or maybe he was just on his way to clinic to get the bandages changed. Its all too easy to criticize care but the least you should do is know all the facts before jumping in to suggest that nurses [other than yourself] are not doing a good job.

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  • Anon 6.43
    Well said!
    Eileen Shepherd
    Perhaps get a snatch squad of crack tissue viability nurses to pounce on him at the bus stop and force the dirty bugger to have a bath and wash his clothes. Or open a window. Or get a taxi to the station. Or a clothes peg for the hooter. A smidge of Vicks on the philtrum works wonders.

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  • Anonymous

    You did well to diagnose his ulcers as venous with a quick glance on the bus. In my experience lots of nurses and doctors think all bandages are compression and whip them off telling the patient they are unsuitable when they are only support bandages not compression. Must be great to be such an expert.

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  • eileen shepherd

    This blog is a reflection on an everyday situation that made me think about whether research evidence reaches those in practice. The blog is not intended to be a critique of care which, as I acknowledge, I can't comment on. The question I raise is whether researcher have a responsibility to ensure their findings are disseminated.

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