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JCN
Supplement 2016
17
COMPRESSION THERAPY
sessions including patient
selection, measuring, fitting and
troubleshooting. The tissue viability
team delivered these sessions with
support from a member of the medi
clinical team.
Nursing skills
The juxtacures product range is
a relatively new innovation and
the concept is very different to
traditional methods of managing
venous leg ulcers. The community
nurses had never used these devices
before and initially struggled to
change their practice, for instance
some would simply revert back to
using bandages if they encountered
any difficulties rather than
reviewing the new system. In the
first few days after application, the
devices often needed to be adjusted
to fit the changing limb size as the
patient’s oedema reduced.
This kind of resistance to change
is not uncommon, however, and
it was important to understand
the nurses’ anxieties and explain
how these could be resolved to
move forward with the project
(Wright, 2010).
Curtis and White (2002)
recommended that ownership
and inclusion are one of the best
methods to overcome resistance to
change and a solution was arrived
at whereby instead of the tissue
viability nurses in the complex
wound clinic measuring and fitting
the adjustable Velcro compression
devices initially, this task would
be given to the community nurses.
It was hoped that involving the
community nurses in the early
stages of the project would help
them recognise the need for change
and lead them to accept the project.
It was also decided to focus on one
community nursing team at a time
— once one team was familiar with
the techniques involved, the project
would move on to another team.
The tissue viability nurses were
charged with acting as change
agents and given the task of
guiding the community nursing
teams through the project, as well
as providing support and advice
(Jones, 2007). The tissue viability
service developed a more in-depth
training schedule and worked
alongside the medi clinical team
to train and support the nurses in
using the product range throughout
the project.
Launch
Once the project launched, the
community nurses were each
accompanied by a member of the
medi clinical team for their initial
visit to measure and fit the device,
as well as on their first follow-up
appointment. After these initial
appointments, the community
nurses continued to manage the
patients independently. During the
project, the nurses were asked to
collect simple information regarding
visit schedules (nurses collected data
on how often they visited patients,
how many times patients called
in for extra visits and how long
the face-to-face contact time was)
and patient comfort. This data was
collected on the initial visit, at week
four, and either upon discharge or
on completion of the treatment.
Patients were asked the following
comfort-related questions:
Whether the garment
was comfortable
Whether the device was
more comfortable than
previous systems
Whether the patient’s mobility
had improved.
Results
Of the 16 patients fitted with
juxtacures, only nine sets of data
were returned and available for
analysis. Two of the nine patients
were subsequently discharged from
the project and the district nursing
caseload completely, as they were
able to manage the adjustable Velcro
compression devices independently.
Before the project, these patients
had been unable to manage
compression hosiery to prevent
reccurrence of venous leg ulcers
and as a result had been managed
in bandages with weekly visits from
the community nursing team.
However, despite the limited
amount of data, the results that
were collected during the project
were very positive. Six of the
nine patients found the devices
comfortable and were keen to
continue with the treatment. Of
the remaining three patients, one
returned to using bandages as they
were not able to wash and care for
the adjustable Velcro compression
device when it became soiled, while
two others asked to be returned
to their previous regimens. One
of these was wearing compression
hosiery before using the adjustable
Velcro compression devices and was
able to manage this independently;
the second was a patient with
dorsum oedema who was unable
to adjust the device and had no
carer to assist and therefore did not
fit the inclusion criteria set out in
Table 1
. These patients should not
have been included in the project
from the beginning — the caseload
holders at the time were under
enormous pressure and at times
the inclusion criteria were not
strictly followed.
During the project there was an
overall reduction in nursing visits
by seven per week across all nine
patients. The average visit time
for a patient with an adjustable
Velcro compression device was
also reduced to 19 minutes from
the average of 40 minutes that
visits had previously taken with
bandages (as documented in
patients’ electronic medical records).
By converting even a small group of
patients from traditional bandaging
methods, an estimated four hours
and 40 minutes of nursing time was
saved per week.
Overall, with the assistance of
carers, patients were able to adjust
the devices independently and
remain in the devices for long-
term management.
DISCUSSION
Issues encountered
during the project
This project was set up to discover
if a therapeutic level of compression
could be applied accurately and
safely by a trained community nurse
using a new system of adjustable
Velcro compression devices. During
the project a number of obstacles
were identified. High workload
and reduced nursing staff meant