4 / 24
HOLISTIC ASSESSMENT
With over 700,000 people in the UK
estimated as having leg ulceration
and the documented annual cost of
its management being a staggering
£1.94 billion (Guest et al, 2015;
2018), its impact on NHS resources is
significant. As leg ulcer management
is currently estimated to account for
at least 1.3% of the healthcare budget
in the UK, it is essential that clinicians
adhere to best practice to achieve
optimal outcomes. As wound care is
predominantly a nurse-led discipline
and the majority of wounds are
managed in the community setting
(Guest et al, 2015), it is essential
that nurses take the lead as patient
advocates in securing adequate
provision for patients with leg
ulceration to ensure that they receive
evidenced-based, cost-effective
clinical care.
However, in practice, there
are many challenges and barriers
which impact on the delivery of
best practice. Recent wound care
statistics have identified that 420,000
of the 730,000 leg ulcers treated by
the NHS in the UK each year were
classified as‘unspecified’(Guest et
al, 2015). This suggests that the root
cause of the problem is not being
identified (Vowden andVowden,
2016). Indeed, Guest et al (2015)
suggested that approximately 30% of
wounds lack a differential diagnosis.
Without being able to understand
the underlying cause, decisions
cannot be made on the best course of
treatment for patients. The absence
of a clear decision on care can lead
to a delay in patients receiving the
correct treatment, thereby prolonging
discomfort and ultimately increasing
costs to the NHS (Ritchie and
Taylor, 2018). Also, without fully
understanding the underlying cause
of any health problem, there is
increased risk of recurrence, leading
to a further burden on NHS resources
and negative outcomes for patients.
There is a clear link between leg
ulceration and its detrimental impact
on a person’s health (European
Wound Management Association
[EWMA], 2017). Research links
chronic leg ulcers closely to social
isolation and low mood (Nogueira
et al, 2012). It has also been
demonstrated that lonely people:
`
Are more likely to visit their GP
`
Have higher use of medication
`
Have higher incidence of falls
`
Have increased risk factors for
long-term care (Cohen, 2006).
This adds greater demands on
healthcare services.
WHY ASSESSMENT
IS IMPORTANT
The nursing process is a scientific
method of care delivery, which
enables nurses to deliver patient-
focused holistic care (Huckabay,
2009). This process can be broken
down into five separate steps,
including assessment, diagnosis,
planning, implementation and
evaluation (Royal Marsden NHS
Foundation Trust, 2015).
This article will focus on
assessment, which is the first phase of
the process, influencing subsequent
steps and enabling nurses to gather
data, and make relevant observations
and judgements to determine the
care and treatment needed (Royal
Marsden NHS Foundation Trust,
2015). Comprehensive assessment of
a patient with a leg ulcer is possibly
the single most important factor
when deciding upon an effective
care plan (Wounds UK, 2016). It is
recommended that this involves
general holistic assessment of the
patient, their leg, as well as the wound
and surrounding skin (Scottish
Intercollegiate Guidelines Network
[SIGN], 2010; Wounds UK, 2016).
HOLISTIC ASSESSMENT OF A
PATIENT WITH A LEG ULCER
As highlighted, wounds to the lower
limb require a focused approach to
assessment, which should include
Clare Mechen, nurse manager/advanced nurse
practitioner, Adam Practice, Dorset; Leg Club
clinical development nurse,The Lindsay Leg Club
Foundation; Queen’s Nurse
Holistic assessment
IN BRIEF
3UHYDOHQFH RI OHJ XOFHUV PHDQV WKDW WKH\ SUHVHQW D VLJQLÀFDQW
challenge both in terms of management and NHS resources.
Holistic assessment and accurate diagnosis are key for leg
ulcer management.
Measuring a patient’s ankle brachial pressure index (ABPI) is a
vital part of wound assessment to identify or exclude peripheral
arterial disease (PAD).
KEYWORDS:
Holistic assessment
Vascular assessment
Ankle brachial
pressure index (ABPI)
Reassessments
Clare Mechen
4 JCN supplement
2018,Vol 32, No 4