Generating: Quality of life in patients with leg ulcers.Chronic leg ulcer (CLU) also known as chronic lower limb ulcer, this is a wound of the leg that does not heal within 8-12 weeks of appropriate treatment. CLU has a major impact on patients’ physical, functional and psychological status. Pain, exudate, mobility limitation, and long-term treatment affect daily activities (Persoon et al,2004; Herber et al,2007; Green and Jester,2009,2010; Green et al, 2014).
Quality of life in patients with leg ulcers have been extensively explored in both qualitative and quantitative studies (Chamange et al, 2014). In the UK about 400,000 patients with leg ulcer and the coast is about £600 million in a year (BMJ Journals, 2017).According to Maddox (2012) leg ulceration make up about half of community nurses’ workload and an estimated £200 million is spent annually on the care of patients with the CLU condition. Department of Health (1993) stated that health care providers should aim to reduce or minimise the adverse effects of illness and disability, in order that their patients live for more years free from ill health.Evidence show that leg ulcer management had become task oriented rather than person centered (Persoon, et al, 2004; Parkinson,2006; Morgan and Moffutt, 2008).Nursing can be a physically and emotionally demanding profession, but it can have its benefits as well. To care for patients on daily basis, nurses can help teach local communities, help improve the quality of patient care, act as patient advocates, help provide counseling (Royal College of Nursing (RCN), 2017).
Nurses can make meaningful contributions in the lives of patients and their families every day. Health promotion by the nurses can lead to many positive health outcomes including devotion, quality of life, patients and their family’s knowledge of illness and self-management (Bosch-Capblance et al., 2009; Keleher et al., 2009).
Retrieve:Databases are an organized collection of electronic, digitized information that can be searched in a variety of ways. Database collect information from magazines, journals, newspapers, and electronic books. Articles and other types of information are collected, organized and make available by the database provider. Searching for database information by putting keywords, subject heading, author, title and more. Database provided by the libraries are available 24/7 (Margaret, R. 2017).Information on the web pages is not collected and organized in any significant way. Search engine is a software program or script.
It is available through the internet that search documents and files for keywords and returns the results of any files containing those keywords. There are many different types of search engines are available on the internet, each with their own abilities and features. Different research designs and methods can be used within the research approach, which can be presented as either qualitative or quantitative. Searching for the literature can be hard process but there are some simple steps which can help to plan and manage the process by choosing research question, planning the search (sources, keywords), evaluating and recording the results, reviewing the search plan (Moule,2015). Start searching of the topic with a broad idea, reading some general text or doing browsing on the internet can be helpful way of clarifying at this stage.
There are many types of source to get information. Books are often a good starting point for research, but sometimes books are not up-to-date to use. Journal articles are the key resource for a literature. The best way to find a journal articles is to use database. Some database will provide reference to trace the article; others allow accessing the full text straight away.Picking search terms carefully by using either library catalogues or database is important, because search engines and library database are not intellectual will make up words without considering their meaning.
Words or phrases that describe the topic as simple and individually as possible can make searching much easier. If the search topic has a single meaning, then search can be straightforward process.The best way to find the journal articles is to use the database found in the subject resources page under the library catalogue.
To find the subject resources page, first go to the learning centers page, click on ‘SUBJECT RESOURCES’. There is a link to library catalogue and a google scholar. On subject resources page click where it says, ‘select a subject’ then see a long list of possible subjects, select ‘Health’. There will be a list of the databases that have a significant health content, scroll down the page there will be some useful web pages.
There are many databases to choose from e.g. using CINAHL (Cumulative Index to Nursing and Allied Health Literature) is one of the main database for health. Once the initial search has been done start narrowing down the results. It is recommended to only use articles from the last five years, so the first to narrow down the result is by date.
If an article is not present as full text, clicking on the ‘360 link’ icon will search other databases that subscribe to (University of Wolverhampton, 2017). Appraise:Critical appraisal is a systematic process used to identify the strengths and weakness of a research article to assess the usefulness and validity of research findings (Young & Solomon, 2009). Here are two articles to appraise.
Quality of life in patients with leg ulcers or skin lesions-a pilot study 2, and Lived experiences of life with a leg ulcer-a life in hell 1. The aim of this research was to investigate how patients suffering from arterial or mixed leg ulcers experience their everyday life. Researcher conducted six qualitative life interviews, one focus group interview and five semi structured interviews. They used Pia Dreyer’s Paul Ricoeur- inspired method to analyse the data. They follow three steps: naïve reading, structural analysis and critical analysis and discussion. This research took place at The Wound Care Centre (WCC), a specialist patient facility within the Department of Dermatology a Venereology of Aarhus University Hospital in Denmark.
The centre treats about 65 patients per weeks with leg ulcers. Two nurses from the WCC choose 11 patients out of 65 for the research, then the same nurses phoned all patients, informed them about the study, and invited them to participate. Out of 11 only seven patients gave their consent. The first author contacted the patients, and they were given oral and written information about the project.
At the end, out of seven only six patients were enrolled in this study. This is very small number of participation and there were only two females out if six participants.Patients living with an arterial or mixed leg ulcer as living a life in hell.
The findings from this study give a deeper understanding how this condition affects the everyday life of the patients. These patients are in great pain, feel guilt or self-reproach in relation to how they got their wound, and they are fighting to keep their leg and to maintain hope. According to this article patients experience an existential crisis and would rather die than live the rest of their lives with a leg ulcer. This is qualitative study, qualitative research is described as part of an interpretivist approach that can be viewed as constructivist (Guba and Lincoin, 1982).
Qualitative research is designed to reveal a target audience, it aims to explore perceptions and experience to understand and explain behavior. Some common methods to collect qualitative data are focus groups (group discussions), individual interviews and participation/ observations (Moule,2015).1.http://web.b.ebscohost.com/ehost/pdfviewer/pdfviewer?vid=7&sid=744b702b-30c9-4543-a81e-69f03e21849e%40sessionmgr120 In this study the researchers attempted to determine the quality of life are valuable in patients with ulcers as the group affected with this problem is relatively high.
Aim of this research was to compare the quality of life of patients with leg ulcers of venous and arterial ethology and those with lower limb skin lesions due to chronic venous failure. This research was designed as a questionnaire survey and included the Skindex-29 instrument for the assessment of the quality of life of patients with dermatological conditions.Skindex-29 is a refined theoretical framework for the effects of skin disease on the quality of life of affected patients. It enquires about how often (Never, Rarely, Sometimes, Often, All the time) during the previous four weeks the patient experienced the effects described in each item (Mary, 2011). This is a quantitative research as this shows numerical data and statistics.
The questionnaire was completed by participants at the clinic during routine visits.Result of this study shows a significant relationship between the quality of level and type of skin lesion. Patients with ulcers of arterial ethology represented the lowest level of the quality of life, compared to patient with venous leg ulcers who represented the moderate level and individuals with trophic disorders without the discontinuity of skin, whose quality of life was the highest, as suggested by lower values of the Skindex-29 score. They were interpreted as follows: 29 to 58 points indicated high quality of life (25%), 59 to 87 points corresponded to moderate quality of life (26-50%) and 87 points corresponded to low quality of life (above 50%).After detailed analysing of the Skindex-29 subscales shows that the analysed group did not differ significantly in terms of mean levels of the quality of life regarding emotional domain and psychosocial functioning.
According to this article literature data suggest that dermatological conditions can be deteriorate one’s quality of life, by changing patient’s outward appearance, depressing the mood, enhancing sensitivity of the skin, and limiting professional, social, and familial relationships.Skindex-29 questionnaire previously used in the determination of quality of life in dermatological patients. In 2007 first time this instrument was used to evaluate the quality of life of British ulcer patients. Their findings were also compared to another study that employed a different instrument to compare the quality of life leg ulcer patients and ulcer-free patients.This is a quantitative research, quantitative research is described as part of a positivist or scientific approach, this research quantifies the problem by way of generating numerical data or data that can be transformed into usable statistics. Methods to collect quantitative data is much more structured than qualitative data, online and paper surveys, face-to-face and telephonic interviews, website interceptors, online polls, and systematic observations (Moule,2015).
2.http://web.b.ebscohost.com/ehost/pdfviewer/pdfviewer?vid=13&sid=4f074383-aaa5-427f-aa03-dfaf79617719%40pdc-v-sessmgr01Do it:According to article 1 the implications for clinical practice, the healthcare systems need to apply a holistic need orienting nurse intervention for these patients. Help patients live with the pain, for instance through therapy, instead of promising total absence of pain during the ulcer period. Healthcare professionals should discuss the possibility of amputation sooner, educate the patient about their conditions and prepare for the amputation if needed.
The NICE (National Institute for Health and care Excellence) guidelines educate about leg ulcers, the rationale for treatment, and lifestyle strategies should be given whenever possible, and should be appropriate to the person’s stage of treatment. Advise the patient about the following self-care strategies, when they have an active ulcer and after it has healed, to reduce the risk of reappearance. Keep mobile with regular walking, elevate the legs when immobile.
Avoid trauma and wear appropriate(well-fitting) footwear (NICE,2016). There are many interventions have been developed to help these patients (e.g. pain management and specialised wound dressing), but article 1indicates that there is more to be done. The study that could look at the special needs of the patients and work closely with them. These patients have problems with footwear, work with shoe manufactures to develop new shoe design.
Examine the leg regularly for broken skin, blisters, swelling, or redness, advise the patients to adopt a healthy lifestyle to promote healing prevent ulcer reappearance. Provide information and advice on wearing compressions bandages/stockings (NICE, 2016).Evaluate:Personal Development Planning (PDP) is establishing aims and adjectives what I want to achieve. It is a development goal, actions and processes compiled by learner it uses in systematic management and periodic reviews of learning (Chartered Management Institute, 2017).Weakness is something that everyone knows about themselves, what you can or cannot do? By participating in a group work I gained more confidence. In this module, I learnt how to find a research article and, what is difference between a research article and a normal article. A good research article contains abstract, introduction, methodology, results, discussion, conclusion, acknowledgements and references.
Difference between qualitative and quantitative articles and what is difference between database and search engine. Workshops in learning centre helped me how to use database and find article in database, learnt about different types of databases (CINAHL, MEDLINE, Nursing and Allied Health Source etc) are some of the databases I used for this module. Harvard references and academic writing was my biggest weakness before starting this assignment, but I think I learnt about them by going to supports sessions and using University’s Harvard references guidelines when I was struggling with reference. I had lots of opportunities to achieve all my weakness, by gaining support from teachers going to tutorial and other students, asking for feedback of my work and work with others. If I was not sure about anything or did not understand I asked support tutor by email or tutorial.
Assist the chat line and learning centre where there if I needed additional supports. I still need to work on my leadership skills and improve my academic writing. I will gain more knowledge by reading books from recommended list provided in module guides.