Module NHS-3135:
Leg Ulcers

Module Facts

Run by School of Health Sciences

20 Credits or 10 ECTS Credits

Organiser: Mrs Jo Jones

Overall aims and purpose

This module will be of interest to those working in general practice, community settings and other areas where practitioners encounter patients with lower limb venous leg ulceration. Care of individuals with lower limb ulceration is often very complex involving knowledge and application of specialist clinical skill. This module aims to develop your understanding of your role and responsibilities in relation to leg ulcer prevention and the provision of a high quality evidence based service in their management. It is the aim of this module to encourage analytical thinking in relation to linking theory to practice. This module will develop registered practitioners ability to holistically assess, plan, implement and evaluate care utilising specialist clinical skill with a focus on the use of evidence based practice to enhance the care provided to patients with this condition. Practitioners will also develop competency in the skills area of holistic vascular assessment which in part includes handheld Doppler assessment. In addition practitioners will also develop their skills and knowledge relating to the application of compression therapy for the management of venous leg ulceration. In doing so this will enable the practitioner to identify and develop strategies to reform lower limb ulceration management and improve services and practice by focusing on leg health and prevention of lower leg ulceration.

Course content

• Revision of anatomy and pathophysiology of the lower limb • Develop understanding of the aetiology of lower limb ulceration using a holistic vascular assessment approach • Understand the use of the most recent venous leg ulceration pathways and regimes • Develop awareness that Doppler is only one part of a holistic venous leg assessment to include interpretation of results and understand the limitations of this technology. • Develop understanding and competency in compression therapy management of the lower limb for venous lower leg ulceration • Understand and demonstrate the importance of leg health by increasing practitioner awareness of interventions and strategies they can use to engage patients within these strategies to increase leg health promotion.

Assessment Criteria

threshold

Basic understanding of the facts and principles specific to the topics covered in the module. Basic understanding and demonstration of application and process of appropriate holistic venous leg assessment and management and with limited identification of leg health promotion. Written work does not contain a large number of computational errors. Demonstrate an attempt to present relevant links to theory and practice. Referencing in text and reference list in APA style will or may contain some errors. All elements must be passed to be successful in completion of this module.

good

Demonstrates some understanding of the facts and principles specific to the topics covered in the module. Demonstrates some understanding and demonstration of application and process of appropriate holistic venous leg assessment and management and with some identification of leg health promotion. Written work contains limited computational errors. Demonstrates some accurate arguments with some original interpretation and with some relevant links to theory and practice. Referencing in text and reference list in APA style will contain few errors.

excellent

Demonstrates comprehensive understanding of the facts and principles specific to the topics covered in the module. Demonstrates comprehensive understanding and demonstration of application and process of appropriate holistic venous leg assessment and management and with wide evidence of and identification of leg health promotion. Written work contains minor computational errors. Demonstrates accurate and original arguments with comprehensive interpretation and with highly relevant links to theory and practice. Referencing in text and reference list in APA style will not contain errors.

Learning outcomes

  1. Demonstrate systematic knowledge and understanding of venous leg ulceration, its pathology and wound healing in patients

  2. Demonstrate the ability to perform a holistic assessment (including the use Ankle Brachial Pressure Index) of the patient with or at risk of leg ulceration.

  3. Demonstrate analysis through reflection and evaluation of leg ulceration managements with the ability to justify the selection of chosen management modalities for individual patients with venous leg ulcers or at risk of further leg ulceration.

  4. Recognise the psychosocial impact of venous leg ulceration on the individual.

  5. Identify potential improvements to management and delivery of leg ulceration care in relation to their area/scope of practice.

Assessment Methods

Type Name Description Weight
EXAM Multiple Choice Questions relating to Venous Leg Ulceration and its Management

A 20 question mutliple choice examination with questions topics realted to venous leg ulceration and management

25
CASE STUDY Reflective account of the management of a patient with venous leg ulceration 50
LOGBOOK OR PORTFOLIO Clinical portfolio of competencies related to the management of venousl leg ulceration

Clinical portfolio. As two elements: 1. Successful completion of clinical competencies within the clinical practice 2. Selection of care plans of patients that the student has treated accompanied by reflective accounts related to the care

25

Teaching and Learning Strategy

Hours
Lecture

35 hours of lectures 5 x7 hours days

24
Private study

Private Study with online accessible content via blackboard. Online formative reflective blog weekly

106
Fieldwork

Clinical assessment in practice with mentor to develop and demonstrate competency in clinical components such a venous leg ulceration badaging, skin care, patient education and advice.

70

Transferable skills

  • Literacy - Proficiency in reading and writing through a variety of media
  • Numeracy - Proficiency in using numbers at appropriate levels of accuracy
  • Self-Management - Able to work unsupervised in an efficient, punctual and structured manner. To examine the outcomes of tasks and events, and judge levels of quality and importance
  • Exploring - Able to investigate, research and consider alternatives
  • Information retrieval - Able to access different and multiple sources of information
  • Inter-personal - Able to question, actively listen, examine given answers and interact sensitevely with others
  • Critical analysis & Problem Solving - Able to deconstruct and analyse problems or complex situations. To find solutions to problems through analyses and exploration of all possibilities using appropriate methods, rescources and creativity.
  • Safety-Consciousness - Having an awareness of your immediate environment, and confidence in adhering to health and safety regulations
  • Presentation - Able to clearly present information and explanations to an audience. Through the written or oral mode of communication accurately and concisely.
  • Teamwork - Able to constructively cooperate with others on a common task, and/or be part of a day-to-day working team
  • Caring - Showing concern for others; caring for children, people with disabilities and/or the elderly
  • Management - Able to utilise, coordinate and control resources (human, physical and/or financial)
  • Argument - Able to put forward, debate and justify an opinion or a course of action, with an individual or in a wider group setting
  • Self-awareness & Reflectivity - Having an awareness of your own strengths, weaknesses, aims and objectives. Able to regularly review, evaluate and reflect upon the performance of yourself and others
  • Leadership - Able to lead and manage, develop action plans and objectives, offer guidance and direction to others, and cope with the related pressures such authority can result in

Subject specific skills

Competence development in selection and application of venos leg ulcer managements involving compression, through bandaging, hoisery and wrap systems. Development of skills in skin management, daily skin care, management of hyperkeratosis and lymphorrhoea. Clinical identification and recognistion of lipodermatosclerosis and cellulitis and the appropriate management strategy in realtion to the presenting condition.

Resources

Resource implications for students

Time to complete practice competencies Access to and utilisation of personal computer or lap top with the ability to be conversant in IT

Talis Reading list

http://readinglists.bangor.ac.uk/modules/nhs-3135.html

Reading list

References CHAMANGA E.T. ( 2014) Understanding the impact of leg ulcer bandaging on patient quality of life. Journal of community Nursing Vol 28, No 1 : 40 - 47

MADDOX, D (2012). Effects of venous leg ulceration on patients’ quality of life. Nursing Standard. 26, 38, 42-49.

SLONKOVA, V. AND VASKU, V., (2008). Quality of life in patients with chronic leg ulcers: a preliminary report. EWMA Journal 8 (3), 23

WILLIAMS, A.M., (2010). Issues affecting concordance with leg ulcer care and quality of life. Nursing Standard 24 (45), 51-56

Diabetic Issues

DORRESTEIJN, JAN.; KRIEGSMAN, DMW and VALK, GD., (2010). Complex interventions for preventing diabetic foot ulceration. Cochrane Database of Systematic Reviews. Issue 1

DORRESTEIJN, JAN.; KRIEGSMAN, DMW ASSENDELFT WJJ and VALK, GD., (2010). Patient education for preventing diabetic foot ulceration. Cochrane Database of Systematic Reviews. Issue

EDWARDS, J. and STAPELY, S., (2010). Debridement of diabetic foot ulcers. Cochrane Database of Systematic Reviews. Issue 1

Lymphoedema Issues

HAMPTON, S., (2010), Chronic oedema and lymphoedema of the lower limb. British Journal of Community Nursing 15 (10), S4-S12

HONNER, A. (2008), Classification, aetiology and nursing management of lymphoedema. British Journal of Nursing 17(9), 577- 586

LINNITT, N., and DAVIES,R., (2007). Fundamentals of compression in the management of lymphoedema British Journal of Nursing 16(10), 588 – 592

MOFFATT, C. (ed.), (2006). Best practice for the management of lymphoedema: international consensus. London: MEP

Assessment

DOWSETT, C.( 2005). Assessment and management of patients with leg ulcers. Nursing Standard 19 (32), 65-70

MOFFATT, C, MARTIN, R. SMITHDALE R. (2009) Leg ulcer management OXFORD BLACKWELL PUBLISHING

Treatments BENBOW, M. and STEVENS, J., (2010). Exudate infection and patient quality of life. British Journal of Nursing 19 (20), S30-36

BRIGGS M. and NELSON E A.( 2010). Topical agents or dressings for pain in venous leg ulcers. Cochrane Database of Systematic Reviews. Issue 4.

FLANAGAN, M. (2013) Wound healing and skin integrity , Principles and Practice. Malaysia, Wiley- Blackwell .
GARDENER, S. (2013) Using treatment pathways to improve healing of venous leg ulcers. Wound UK 9 (1), 67 – 75

HARDING, K, DOWSETT, C. FIAS, L., JELNES,R., MOSTI, G., ÖEIN,R., PARTSCH, h., REEDER, S., SENET, P., VERDU SORIANO, J. & VANSCHEIDT, W.(2015).Simplifying venous leg ulcer management .Consensus recommendations. Wounds International

JONES J E. and NELSON E A., (2010). Skin grafting for venous leg ulcers. Cochrane Database of Systematic Reviews Issue 1

JULL A B., WATERS J. and ARROLL B., (2011). Pentoxifylline for treating venous leg ulcers. Cochrane Database of Systematic Reviews Issue 1.

PRICE, P., GOTTRUP, F. & ABEL, B. (2014) Study recommendations for clinical investigations in leg ulcers and wound care. Journal of Wound Care ; 23: 5, S1–S36.

NICE (2012) Clinical knowledge summary. Management of venous leg ulceration http://cks.nice.org.uk/leg-ulcer-venous#!topicsummary

VOWDEN, P., (2010). Effective management of venous leg ulceration. Practice Nursing 21 (4), 194-200

SIGN ( 2010) Management of venous leg ulceration . Clinical guideline

YOUNG T. and RODEN A., (2008). Pains-taking care, everyday issues in wound management. In R. WHITE (ed.) Advances in wound care. Aberdeen: Wounds UK. pp166-86

VOWDEN ,P. (2010), Effective management of venous leg ulceration .Practice Nursing. 21 (4), 194 – 200

WHEATLEY C., (2007). Collaborative working to improve leg ulcer outcomes for injecting drug users. British Journal of Nursing 16 (8), 444-454

Internet List: Wound Care Alliance –UK http://www.wcauk.org/ World Wide Wounds – www.smtl.co.uk/world-wide-wounds European Wound Management Association – www.ewma.org Leg Ulcer Forum www.legulcerforum.org http://www.e-academy.wounds-uk.com/index.php