ABSTRACT
OBJECTIVES: To investigate factors that promote and prevent the use of compression therapy in people with venous leg ulcers. DESIGN: Qualitative interview study with nurses using the Theoretical Domains Framework (TDF). SETTING: Three National Health Service Trusts in England. PARTICIPANTS: Purposive sample of 15 nurses delivering wound care. RESULTS: Nurses described factors which made provision of compression therapy challenging. Organisational barriers (TDF domains environmental context and resources/knowledge, skills/behavioural regulation) included heavy/increasing caseloads; lack of knowledge/skills and the provision of training; and prescribing issues (variations in bandaging systems/whether nurses could prescribe). Absence of specialist leg ulcer services to refer patients into was perceived as a barrier to providing optimal care by some community-based nurses. Compression use was perceived to be facilitated by clinics for timely initial assessment; continuity of staff and good liaison between vascular/leg ulcer clinics and community teams; clear local policies and care pathways; and opportunities for training such as 'shadowing' in vascular/leg ulcer clinics. Patient engagement barriers (TDF domains goals/beliefs about consequences) focused on getting patients 'on board' with compression, and supporting them in using it. Clear explanations were seen as key in promoting compression use. CONCLUSIONS: Rising workload pressures present significant challenges to enhancing leg ulcer services. There may be opportunities to develop facilitated approaches to enable community nursing teams to make changes to practice, enhancing quality of patient care. The majority of venous leg ulcers could be managed in the community without referral to specialist community services if issues relating to workloads/skills/training are addressed. Barriers to promoting compression use could also be targeted, for example, through the development of clear patient information leaflets. While the patient engagement barriers may be easier/quicker to address than organisational barriers, unless organisational barriers are addressed it seems unlikely that all people who would benefit from compression therapy will receive it.
Subject(s)
Leg Ulcer , Varicose Ulcer , England , Humans , Leg Ulcer/therapy , Qualitative Research , State Medicine , Varicose Ulcer/therapyABSTRACT
Background: The COVID-19 pandemic caused unprecedented changes to the lives of many. The aim of this paper was to understand how the COVID-19 pandemic impacted behavioral inflexibility (BI) and anxiety among autistic children and how autistic children and their families have adapted to COVID-19-related routine changes. Methods: This sequential mixed-method study included two phases. During the first phase, parents of autistic children (N = 48) completed an online survey consisting of the Behavioral Inflexibility Scale (BIS) and the Parent-Rated Anxiety Scale – Autism Spectrum Disorder (PRAS-ASD). During the second phase, a subset of parents (parents of adolescents, N = 11) was invited to participate in a virtual focus-group. Results: The parents reported a wide range of BI during the pandemic (BIS M = 2.03, SD = 1.02, range = 0.21 – 3.86). Child BI was a significant predictor of anxiety (t[40] = 5.56, p < .0001). From the focus groups, 155 codes were organized into four themes, two of which are discussed in this paper: child client factors that have changed during the pandemic and changes to family routines. Conclusions: In this preliminary study, the parents identified problematic BI and anxiety among their autistic children. The outcomes of this small-scale study indicate that some of the changes to routines brought about by the pandemic may be helpful for autistic children after the pandemic restrictions have ended. We provide a unique perspective on how to leverage occupational changes that resulted from the COVID-19 pandemic to aid autistics during non-pandemic times.