Compression bandaging for venous leg ulcers: the essentialness of a willing patient.

AIM: To describe and explore reasons for use or non-use by district nurses of compression bandaging, a best practice component of venous leg ulcer management. BACKGROUND: Leg ulcers are costly to both individuals and communities. The most prevalent of leg ulcers are venous leg ulcers, which are common wounds treated by district nurses. Compression bandaging is the best practice for the treatment of venous leg ulcers with considerable evidence that this aids healing in an effective and timely manner. It is anecdotally known that compression bandaging is not always used by district nurses when treating venous leg ulcers, yet little is known as to why this is so. METHOD: A qualitative descriptive/exploratory study was used; interview data were collected with constant comparative data analysis applied until data saturation was obtained. FINDINGS: As could be anticipated, several basic elements need to be present for a district nurse to use compression bandaging, like knowing that compression bandaging is best practice, knowing how to use compression bandaging and being able to determine that the ulcer is venous in nature. However, the major finding is the essentialness of having a patient willing for compression bandaging to be applied and sustained; the study explored what determines willingness or non-willingness and strategies that can be used to encourage willingness. CONCLUSION: A prime enabler of the use of compression bandaging is having a patient willing to agree to the commencement of this treatment and for this to be sustained. Consequent recommendations are offered. Evidence-based nursing requires not only knowledge of cause and effect evidence but also evidence that provides understanding about human responses and choices when there is a health challenge. RELEVANCE TO CLINICAL PRACTICE: The relevance of the findings for clinical practice is that knowledge is provided about what factors may constrain a patient's willingness for compression bandaging to be applied and sustained as treatment for a venous leg ulcer and about what actions can be tried to facilitate willingness.

A practical guide for nurses in diluent selection for subcutaneous infusion using a syringe driver.

Appropriate diluent selection in continuous subcutaneous infusion optimises symptom management and client well-being. The responsibility of diluent selection is commonly one of the attending nurse. This paper was developed with the intention of providing nurses with practical instruction for diluent selection when preparing medications for administration subcutaneously using a syringe driver. A literature review was undertaken of published journal databases and published guidelines sites. Recommendations regarding diluent choice were reviewed in two iterations by an expert panel of palliative care nurse clinicians. The principles for diluent selection are presented. They are based primarily on expert opinion level of evidence given a lack of primary research evidence in the area of diluent selection. There is a pressing need for manufacturers' guidance on diluent selection and independent research to establish the impact of diluents on drug and drug combinations when using syringe drivers. Until such time that this evidence is available to guide practice, clinicians need to be trained to inspect solutions and assess the effectiveness of the medication in controlling symptoms. The capacity of this paper to provide practical instruction has been limited by the lack of rigorous evidence available, and indeed, the process of developing this guide identified perhaps more questions than answers available at the present time.

Diluent choice for subcutaneous infusion: a survey of the literature and Australian practice.

Continuous subcutaneous infusion is a method frequently used in palliative care to manage patient symptoms. To deliver the dose required and prevent subcutaneous sites from becoming inflamed and painful, the drug is often diluted in a solution, most commonly sterile water for injection or sodium chloride. The use of sterile water for injection has been recommended for cyclizine yet beyond this example there appears to be limited clinical direction regarding diluent selection. Inconsistency or lack of guidelines can be problematic if a diluent that may enhance the effectiveness of a drug compared with an alternate is not used because of lack of knowledge or guidance. This investigation considered existing literature, drug databases and directories, and involved a survey of palliative care services to examine evidence and experience relating to diluent selection. A number of inconsistencies emerged in both the literature and practice. With the exception of five drugs for which only saline was recommended, there appeared to be an inclination to use water unless contraindicated. Given an increasing reliance on this method of symptom management, the absence of formal clinical evidence or recommendations and ambiguity in relation to the use of diluents highlights the need for these deficits to be addressed as quickly as possible.