Nurses lack confidence in applying full compression and need to improve their skills, says Irene Anderson
Effective compression therapy is key to healing venous leg ulcers. However, practitioners must be properly trained and assessed as competent in applying compression bandages to ensure the treatment is effective and safe.
The term “evidence-based practice” is widely used and should be a goal for all treatments and methods of managing patients. Evidence should underpin all interventions, but for this to happen practitioners need to know what that evidence is and how to apply it.
When I talk to specialist nurse colleagues and to non-specialists attending study days, workshops and courses, it becomes apparent that there is sometimes a lack of confidence about applying full compression therapy. This may be due to lack of assessment data such as Doppler assessment of the ankle brachial pressure index, or a lack of confidence when applying compression therapy. The explanation given is that it “feels safer” to apply reduced compression just in case damage is caused to a patient’s leg, or because damage has occurred.
In some acute trusts, guidelines may indicate that compression therapy is suspended for inpatients. This pragmatic stance is based on the difficulties of ward staff gaining and maintaining bandaging competencies when there may be few opportunities to practise such skills.
Often patients are in hospital for a short time, their acute condition may impact on their vascular system and they are on bedrest or able to maintain leg elevation for longer periods than they would at home, which helps to control oedema. If oedema increases, the need for compression therapy to be resumed should be revisited.
Most people with leg ulcers are treated in the community and this is where the focus of staff education and training should be, although some acute trusts have extremely effective systems for managing inpatients.
Evidence-based practice should be optimum practice (based on the best knowledge at the time). To withhold treatment, such as by not applying full compression, means patients may have their leg ulcer and the unpleasant symptoms associated with it for longer than necessary. This delay also adds to service costs.
If full treatment is withheld because damage has been caused to the patient’s skin, assessment, diagnosis and application skills must be revisited.
‘It is unacceptable to reduce compression as a matter of course for patients because staff are not adequately trained and supported to deliver safe and effective treatment.’
Of course nurses should be concerned about patient safety but it is wrong to deprive patients of the best chance of healing. Compression levels may be reduced in response to patient pain or discomfort, and certainly in a concordant relationship there must be negotiation and understanding of each patient’s individual perspective.
Reduced compression is indicated in mixed aetiology ulceration, particularly in the presence of significant arterial disease, to ensure that arterial flow is not unduly compromised. Some patients may have reduced compression if there is some doubt about ulcer aetiology and further advice is being sought, but this reduction must not become a final solution unless the decision is based on sound clinical criteria.
There are many compression systems available, which gives scope for patients to choose the one that suits them best. It is, however, unacceptable to reduce compression as a matter of course for patients because staff are not adequately trained and supported to deliver safe and effective treatment.
IRENE ANDERSON is programme tutor, tissue viability, School of Nursing and Midwifery, University of Hertfordshire.