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Assessing the value of Leg ulcer education to influence change in practice

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Assessing the value in Leg Ulcer education to inform recommendations for change in practice 

Aby Mitchell BA (Hons), PGCAP, RGN, FHEA, TCH (NMC) 


Venous leg ulceration (VLU) is a significant financial implication for the NHS. It is estimated the cost of treating one ulcer was to be between £1,298 and £1,526 per year based on 2001 prices and in the context of specialist leg ulcer clinic trial. (SIGN 2010)

The estimated cost of chronic venous insufficiency (CVI) is between 600 – 900 million across Western Europe (Rabe and Pannier 2010). However; early diagnosis of CVI using CEAP classification and proactive management in primary care services can significantly reduce the prevalence of leg ulceration (Rabe and Pannier 2010). 

Why is leg ulcer education needed?

•Venous leg ulceration currently effects 1% of the population and 3% of those over 80 years old (EWMA 2016)
•Accounts for 83% of the community caseload (SIGN 2010).
•However, despite the recognised impact VLU has on the NHS there are currently no national competencies or standards for leg ulcer management, although the SIGN (2010) guidelines offer a framework for the attributes of leg ulcer care.
•Results from the RCN survey (2006) demonstrated that approximately a quarter of community nurses had not received leg ulcer training in the past 3 years.
•SIGN (2010) study reviewing the effectiveness of training found that a large number of nurses perform compression bandaging inadequately. In two studies it was identified that technique improved following appropriate training and was sustained for 2-4 weeks subsequently but standards declined to near baseline levels within 6-10 weeks (SIGN 2010). 

What is the education?

Level 6 module at a London university

The module is rich in theoretical content pertaining to leg ulceration in conjunction with practical sessions surrounding assessment, ABPI Doppler and compression bandages in a simulated learning environment supported by case studies and scenarios.

Knowledge is assessed through completion of a practice-based audit, assignment on theoretical aspects to leg ulceration and an OSCE in a simulated environment. 

The students

11 Primary care nurses took part in the study, although 4 withdrew prior to the post module interview.

All 11 completed the pre course questionnaire and 7 the post course interview. 7 of the nurses had over 20 years’ experience and primary care experience ranged from 1 year to 38 years.

Of the 11 nurses all but 1 reported that they had attended some kind of short tissue viability of leg ulcer course previously.

Two claimed they had no previous experience with managing leg ulcers and 9 were already carrying out treatment of ulcers to some capacity. Mostly the years of experience were concurrent with those already managing leg ulcer patients. 


•5 of the 7 nurses interviewed were satisfied that their expectations for the module had been met.
•1 commented she was expecting a one day course and not 6 weeks.
•1 nurse would have preferred a wider range of compression bandages to practice with.
•7 nurses interviewed commented that the module had changed and influenced their practice in some way.
•All of the nurses stated that they felt more confident in carrying out Doppler ABPI assessment and application of compression bandages and cited improvements in reflection and decision making skills.
•Of the 7 nurses all commented that they had an increase in knowledge in classification of venous disease and now considered prevention of chronic venous disease and early detection a high priority.
•Nurses found peer sharing of protocols, practice documents and experiences to be of great benefit with some practices previously struggling to implement robust guidelines. 


Continuous education is a prerequisite in nursing to ensure standards are met, maintained and patients are placed at the centre of their care. Results from this evaluative study indicate an improvement in patient and service outcomes, increased skills, knowledge and competence of primary care staff and recognition of areas for improvement. 


Kirkpatrick, D. L. (1994). Evaluating training programs: the four levels. San Francisco: Berrett-Koehler.

Royal College of Nursing (2006) Clinical Practice Guidelines: The Nursing Management of Patients with Venous Leg Ulcers. London: RCN Institute.

Scottish Intercollegiate Guidelines Network (SIGN) (2010) Management of chronic venous leg ulcers  http://www.sign.ac.uk/guidelines/fulltext/120/index.html

EWMA (2016) Management of patients with venous leg ulcers. Challenges and current practice. MA Healthcare Limited.

Rabe, E. Pannier, F. (2010) Societal costs of chronic venous disease in CEAP C4, C5, C6 disease. Phlebology, 25 suppl 1:64-67




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