Nursing Assignment: Impact of Patient Education on Leg Ulcers

This nursing assignment is a literature review and project proposal focused on the impact of patient education on the prevention and recurrence of leg ulcers. The report begins with a definition of leg ulcers, their prevalence, and the importance of patient education alongside pharmacological interventions. The review synthesizes findings from multiple research studies, including randomized control trials and community-based programs, highlighting the benefits of education programs in improving patient knowledge, adherence to therapies (such as compression therapy), and overall satisfaction. The studies emphasize the role of health literacy and self-management strategies, including foot hygiene and appropriate footwear. The project proposes an education program for patients recovering from leg ulcers, led by nursing professionals. The program will focus on teaching self-management strategies, adherence to interventions like compression stockings, and precautionary measures to prevent recurrence. The effectiveness of the program will be tested in a pilot study before hospital-wide implementation, with progress monitored through follow-up sessions and interviews to assess compliance and patient satisfaction. The report concludes that imparting health literacy helps in disseminating awareness about potential risk factors which could trigger the reoccurrence of leg ulcers in patients, and that a combination of patient education and nursing assistance helped in teaching better self-management strategies to the patients.

Running head: NURSING ASSIGNMENT
NURSING ASSIGNMENT
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Leg ulcers can be defined as unhealed sores or open wounds that occur on the legs
(Lazarus et al. 2014). Research studies suggest that without proper treatment interventions the
ulcers can reoccur frequently (Green et al. 2013). The condition is broadly characterized by poor
blood circulation and a broad range of ailments (Dogra and Sarangal 2014). It should further be
noted in this context that the prevalence of leg ulcers is more common in women, however
affects a major proportion of both the sexes. Research studies further indicate that imparting
health literacy to patients apart from pharmacological intervention could help in effective
management of leg ulcers in patient.
The research question for the literature review can therefore be mentioned as ‘What
impact does patient education play on the prevention and recurrence of leg ulcers?’ In order to
evaluate the research question a thorough search was conducted on the electronic databases that
included Google Scholar, PubMed and MedLine. A specific set of exclusion and inclusion
criteria was used along with relevant key terms to shortlist papers that were relevant with the
research topic. The retrieved papers were then analyzed to study the findings and address the
devised research question.
Literature Review:
Shanley and Moore (2015) conducted a randomized control trail in order to evaluate the
impact of education on patients who had a medical history of leg ulceration. The researchers
made use of specific patient education programs in order to reduce the recurring events of leg
ulceration in patients (Shanley and Moore 2015). The priorities covered in the patient education
program comprised of factors such as increasing patient’s knowledge, changing health related
behaviors and improving adherence to devised therapies and in some cases a combination of two

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or more interventions (Shanley and Moore 2015). The overall findings of the study is supported
by a number of research studies that suggest effective support programs could lead to a decrease
in the incidence and recurrence rate of leg ulcers (Alavi et al. 2014; Dogra and Sarangal 2014).
Also, patients under the education support programs exhibited better adherence to compression
therapy and improved patient satisfaction which suggests that the learning objectives are
practically achievable. According to Weller et al. (2016), community based program such as Leg
Club assisted patients with peer support, goal setting and interaction within home based care.
The researchers conducted 3 randomized control trails which comprised of home-based care,
nurse-led self-management care and another case where education was delivered by means of
video with education delivered by means of text (Weller et al. 2016). Typically the results
reported better adherence to compression therapy in case of the nurse-led self-management care
(Weller et al. 2016). Another research conducted by Bus et al. (2015) supported the findings of
Weller et al. (2016) and suggests that imparting health literacy and instructing patients about
correct foot hygiene can help in acquiring positive patient outcome. As stated by Waaijman et al.
(2013), imparting education and disseminating awareness about adherence to custom made
footwear in Diabetic patients could help in the prevention of Diabetic foot ulcers. The
researchers assessed the adherence level by monitoring the times the shoe was worn using the
ankle worn activity monitor (Waaijman et al. 2013). The research study conducted by Kapp and
Miller (2015) evaluated the experience of older patients to comply with self-management
strategies following a venous leg ulcer healing. The patients were educated through an e-learning
education program while their leg ulcer was active and had not healed (Kapp and Miller 2015).
The participants were interviewed after a period of 6 months and the participants reported better

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adherence with self-management strategies and improved health outcome (Kapp and Miller
2015).
Upon analyzing the findings of the research study it can be mentioned that the research
conducted by Shanley and Moore (2015) critically suggested that imparting education to patients
could effectively help in the prevention of leg ulcers. Also, the studies collectively indicated
better compliance with self-management strategies and compression therapy upon imparting
health literacy (Weller et al. 2016; Bus et al. 2016; Kapp and Miller 2015; Lazarus et al. 2014).
Therefore, overall the outcome of the review could be considered equivalent to the findings of
(Coppola et al. 2016) that emphasized on the fact that imparting patient education could help in
improving patient outcome.
Therefore, to conclude on the basis of the review of literatures it can be mentioned that
imparting health literacy to patients helps in disseminating awareness about potential risk factors
which could trigger the reoccurrence of leg ulcers in patients. Also, a combination of patient
education and nursing assistance helped in teaching better self-management strategies to the
patients.
The purpose of the project is to conduct an education program and empower patients with
a previous medical history of leg ulcers to adhere to interventions and adapt precautionary
measures so as to prevent the recurrence of the leg ulcers. The rationale is to curb the medical
expense related to hospitalization on account of recurrence of leg ulcers and to improve levels of
patient satisfaction.

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The project would start with patients discharging from the hospital after recovery from a
leg ulcer. At discharge, the patients would be enrolled in an education program which would be
headed by nursing professionals who would educate the patient about self-management strategies
so as to empower the patient and ensure adherence with devised interventions such as use o
compression stockings and appropriate footwear.
The program would include the learning objectives which would be taught to the patients
by the nurses at the time of discharge. These would comprise of imparting education about
adherence to compression therapy, maintenance of foot hygiene, consumption and application of
medication at proper timings according to appropriate dose and maintenance of a level of
physical activity and stringently adhering to the precautionary measures that could deteriorate the
ulcer.
The effectiveness of the learning objectives on patient outcome would first be tested in a
pilot study which would be conducted on two patients who are currently admitted at the hospital.
The impact of the education program would be tested by closely monitoring the ability of the
patients to adhere to the devised recommendation. Upon evaluating 75% adherence the program
would be implemented in the hospital setting.
In order to sustain the proposed changes, the level of progress would be monitored by
conducting follow up sessions and personal interviews with the patient. The level of compliance
with the taught strategies would help in evaluating the degree of progress with the treatment
intervention and the level of patient satisfaction acquired.

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References:
Alavi, A., Sibbald, R.G., Mayer, D., Goodman, L., Botros, M., Armstrong, D.G., Woo, K.,
Boeni, T., Ayello, E.A. and Kirsner, R.S., 2014. Diabetic foot ulcers: part II.
Management. Journal of the American Academy of Dermatology, 70(1), pp.21-e1. Retrieved
from: https://www.ncbi.nlm.nih.gov/pubmed/24355275
Bus, S.A., Van Netten, J.J., Lavery, L.A., Monteiro‐Soares, M., Rasmussen, A., Jubiz, Y., Price,
P.E. and International Working Group on the Diabetic Foot (IWGDF), 2016. IWGDF Guidance
on the prevention of foot ulcers in at‐risk patients with diabetes. Diabetes/metabolism research
and reviews, 32, pp.16-24. Retrieved from: https://www.ncbi.nlm.nih.gov/pubmed/26334001
Coppola, A., Sasso, L., Bagnasco, A., Giustina, A. and Gazzaruso, C., 2016. The role of patient
education in the prevention and management of type 2 diabetes: an overview. Endocrine, 53(1),
pp.18-27. Retrieved from: https://www.ncbi.nlm.nih.gov/pubmed/26494579
Dogra, S. and Sarangal, R., 2014. Summary of recommendations for leg ulcers. Indian
dermatology online journal, 5(3), p.400. Retrieved from: http://www.idoj.in/article.asp?
issn=2229-5178;year=2014;volume=5;issue=3;spage=400;epage=407;aulast=Dogra
Green, J., Jester, R., McKinley, R. and Pooler, A., 2013. Patient perspectives of their leg ulcer
journey. journal of wound care, 22(2), pp.58-66. Retrieved from:
https://www.ncbi.nlm.nih.gov/pubmed/23665659
Kapp, S. and Miller, C., 2015. The experience of self‐management following venous leg ulcer
healing. Journal of Clinical Nursing, 24(9-10), pp.1300-1309. Retrieved from:
https://www.ncbi.nlm.nih.gov/pubmed/25422075

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Lazarus, G., Valle, M.F., Malas, M., Qazi, U., Maruthur, N.M., Doggett, D., Fawole, O.A., Bass,
E.B. and Zenilman, J., 2014. Chronic venous leg ulcer treatment: future research needs. Wound
repair and regeneration, 22(1), pp.34-42. Retrieved from:
https://www.ncbi.nlm.nih.gov/pubmed/24134795
Shanley, E. and Moore, Z.E., 2015. Patient education for preventing venous leg
ulceration. Cochrane Database of Systematic Reviews, (5). Retrieved from:
https://www.cochrane.org/CD011696/WOUNDS_patient-education-preventing-venous-leg-
ulceration
Waaijman, R., Keukenkamp, R., de Haart, M., Polomski, W.P., Nollet, F. and Bus, S.A., 2013.
Adherence to wearing prescription custom-made footwear in patients with diabetes at high risk
for plantar foot ulceration. Diabetes care, 36(6), pp.1613-1618. Retrieved from:
https://www.ncbi.nlm.nih.gov/pubmed/23321218
Weller, C.D., Buchbinder, R. and Johnston, R.V., 2016. Interventions for helping people adhere
to compression treatments for venous leg ulceration. Cochrane database of systematic reviews,
(3). Retrieved from: https://www.ncbi.nlm.nih.gov/pubmed/24009097

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Appendix:
Database Search Item Hits Key words Hits Inclusion/exclusion
criteria
Hits Remaining
article notes
Cochrane
Library
database
Patient
education
Leg ulcer
prevention
1116 Patient
education
Leg ulcer
prevention
257 Full text accessible
Published between
2013-2017
English language
193 Found:
Nelson
2012,
Ponsett
2008
Google
scholar
Leg ulcer
recurrence
health
literacy
862 Patient
outcome
patient
education
leg ulcer
450 Full text accessible
Published between
2013-2017
English language
336 Found:
O’Brien
2000
PubMed Patient
outcome
patient
education
leg ulcer
67 Leg ulcer
recurrence
health
literacy
186 Full text accessible
Published between
2013-2017
English language
180 Found:
Internationa
l Working
Group on
Diabetic
Foot 2011
Google
scholar
Self-
management
adherence
patient
education
leg ulcer
1135 leg ulcer
patient
education
patient
outcome
551 Full text accessible
Published between
2013-2017
English language
532 Found:
Clayton et
al. 2009

8NURSING ASSIGNMENT
Cochrane
Library
database
leg ulcer
patient
education
patient
outcome
760 Self-
managemen
t adherence
patient
education
leg ulcer
390 Full text accessible
Published between
2013-2017
English language
112 Found:
Stewart et
al. (2018);
Reflection