LEARNING ZONE
d
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as evidence of your continued learning.
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For all these reasons, the
assessment and management of
venous leg ulceration is a priority for
community nursing, and knowledge
of this area is vital for best practice
(Nic Philibin et al, 2010).
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Leg ulcers can result in a great deal
of disability, which can last for years if
not managed appropriately (Moffatt
et al, 2009). They can have a serious
impact on quality of life, causing pain,
sleep disturbance, reduced energy,
anxiety, depression and poor selfesteem, as well as disrupting social
and work life (Jones et al, 2006a;
Moffatt et al, 2009; Upton, 2013).
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Venous leg ulceration not only has
an impact on patients’ wellbeing, but
also incurs significant financial costs.
Posnett and Franks (2007) estimated
that in the UK there are between
70–190,000 individuals with an open
ulcer at any time and that 100,000
new ulcers develop annually. The cost
of these ulcers is at least £168–198m
annually, with most of the cost borne
in primary care and community
nursing services (Posnett and Franks,
2008). As leg ulcer prevalence
increases with age, these costs are
also set to increase in accordance
with the growing elderly population.
88 JCN
2013, Vol 27, No 5
muscle pumps during walking and
movement, and a series of one-way
valves within the veins stop the blood
from flowing back downwards and
pooling in the leg.
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In reality, many venous leg ulcers
fail to heal over long periods of
time because their diagnosis and
subsequent treatment choices are
inadequate (Posnett and Franks, 2009).
For patients who do achieve healing,
recurrence is common, with many
experiencing alternating periods
of healing and skin breakdown
(Brown, 2013).
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T
he assessment and
management of venous
leg ulceration is both an
expanding and challenging element
of community nursing (Martin and
Duffy, 2011). Venous leg ulceration
is a widespread condition affecting
up to 1% of the population (Callam,
1992; O’Meara et al, 2009), increasing
to 3–5% in those over 65 years of age
(Mekkes et al, 2003). Furthermore,
one in every 50 patients over the age
of 80 years will have a venous ulcer
(Martin and Duffy, 2011).
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Management of venous leg ulcers:
assess, dress and compress
This article will help community
nurses to understand the cause of
venous leg ulceration, how to identify
it by carrying out a full holistic patient
assessment and, according to findings,
place the patient on the correct
management pathway (Royal College
of Nursing [RCN], 2006; Scottish
Intercollegiate Guidelines Network
[SIGN], 2010; White et al, 2011). In
short, the importance of assessment
(Assess), appropriate selection of
dressings (Dress) and compression
therapy (Compress).
PATHOPHYSIOLOGY
The venous system, which transports
blood from the lower legs back
towards the heart, includes deep
veins, superficial veins and capillaries,
which provide the skin with oxygen
and nutrients. Blood is partly pushed
up the leg by the foot and the calf
However, problems occur if
the valves stop working properly,
e.g. after deep vein thrombosis/
venous thromboembolism (DVT/
VTE), or trauma, such as surgery
or bone fracture. This can be worse
if the foot and calf muscle pumps
are also not working properly, as in
those who are elderly or immobile.
This can cause varicose veins on the
surface of the leg, or damage in the
deep veins hidden from view — a
condition known as chronic venous
insufficiency (CVI).
The constant high blood pressure
in the legs causes fluid to leak out
of the veins, resulting in swelling
and skin damage, which may lead
to venous ulceration. Healing
will be difficult to achieve if this
underlying cause is not recognised
and managed.
Failure to identify and manage the
cause of venous leg ulceration can
have many negative effects, including:
 Prolonged duration of the wound
 Loss of limb
 Further deterioration in the
patient’s condition and
quality of life
 Increased morbidity and mortality
 A greater cost to the patient and
society (Heinrichs et al, 2005; Best
Practice Statement [BPS], 2008).
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the journey has
just got easier...
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...for you and
your patients
This NEW kit has a low profile skin-friendly
comfort layer, plus an effective cohesive
compression layer ~ giving your patient the
freedom to wear their own footwear
~ while delivering therapeutic pressure
for treating their leg ulcer (1, 2)
1. Knowles, A. et al, 2013. Evaluation of a new two component inelastic compression bandage kit. Journal of Community Nursing, Vol.27 (3): 10-13.
2. Mazzei S et al, 2012. First results of an observational study in 80 leg ulcer patients with a new Two-Component-System (TCS).
Poster presentation Wounds UK 2012 Wound Care Conference 12-14th November 2012.
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ADV106 V1.2
LEARNING ZONE
Physical assessment
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The patient’s general health should
also be assessed, including baseline
blood pressure, heart rate, and body
mass index (BMI) measurements
(RCN, 2006). Physical examination
should also include:
 Wound assessment
 Skin and lower limb assessment
 Vascular assessment.
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However, before wound and skin
assessment is carried out, any dead,
non-viable/devitalised tissue, infected
or foreign material from the wound
bed and surrounding skin should
be removed if possible. Debrisoft®
(Activa Healthcare) a monofilament
debriding pad, can help to do
this, making it easier to assess the
condition of the wound bed (StephenHaynes and Callaghan, 2012; Wound
Care Today, 2013).
Wound assessment
Wound and skin assessment are
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2013, Vol 27, No 5
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Wound edge
The appearance of the wound edge,
including any areas of swelling,
may help to identify the wound’s
aetiology when considered alongside
the history of the patient and their
wound. Arterial ulcers, for example,
often appear to be punched out,
while rolled edges or a nodular
wound bed can indicate malignancy
(Hayes and Dodds, 2003; Grey et al,
2006;Eagle, 2009).
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Wound size
Wound size should be measured
at first presentation, then regularly
thereafter to monitor the progress/
deterioration of the wound.
Measurements of the wound’s
depth, width and length should
be accurately recorded using a
reproducible method to allow
monitoring over time (Grey et al,
2006; Eagle, 2009; Fletcher, 2010).
presence of necrotic tissue and
fungating lesions.
 Wound-associated pain: the
patient’s experience of pain
should be taken seriously and
assessed using a recognised pain
assessment tool, commonly a
visual analogue scale (VAS).
This will also provide a benchmark
for the success/failure of
wound and pain management.
Assessment should record:
 site of pain
 frequency and severity
 whether it is present all the time or intermittently.
A sudden worsening or change in
the nature of pain can also indicate
the presence of wound infection, or
deterioration of general health.
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Wound type
The wound should be identified as
being acute or chronic, and whether
healing by primary or secondary
intention (Eagle, 2009).
Anatomical location of the wound
Wound location will give clues to
its cause. A venous leg ulcer usually
occurs in the medial malleolar area
or gaiter area of the leg (Hayes and
Dodds, 2003).
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Assessment should begin with a
clinical history, which will help
to determine if the patient has
underlying venous disease which
may be responsible for the ulcer.
Consider:
 Any family history of
venous problems
 Patient’s previous thrombogenic
events such as post surgical
swollen legs, pregnancy or a
period of enforced bed rest
 Varicose veins
 History of DVT/VTE, phlebitis, leg
or foot fracture
 Occupation (jobs involving
standing/sitting for long
periods of time)
 Obesity or multiple pregnancies,
which may cause pressure on the
venous system.
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Patient history
Baseline assessment of the
wound’s type, size, and location
should be carried out. Tissue types
present on the wound bed, along
with the volume of exudate, and
symptoms, such as malodour and
pain, should be recorded.
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A full patient assessment should
include clinical history, physical
examination and holistic assessment
and should always be undertaken on
patients presenting with a suspected
venous leg ulcer. Continuous
assessment is important thereafter to
ascertain if the ulcer is progressing or
deteriorating (RCN, 2006; Newton,
2011).
key components in effective wound
management — for diagnosis,
dressing selection and the monitoring
of the wound’s progress or
deterioration (RCN, 2006).
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ASSESSMENT
Tissue types present in the wound bed
The tissue types present in the
wound bed show the wound’s status,
e.g. healthy granulation tissue is
pink in colour and indicates healing,
while the presence of slough can
provide a barrier to wound progress.
The percentage of slough, necrotic,
granulation and epithelial tissue on
the wound bed should be recorded
at each assessment to enable the
progress/deterioration of the wound
to be monitored (Grey et al, 2006;
Eagle, 2009; Fletcher, 2010).
Wound symptoms
Assessment should consider:
 Exudate: volume, colour
and viscosity of exudate
 Malodour: odour from a wound
can have a huge impact on the
patient’s quality of life. Causes
of malodour include infection,
Skin and lower limb assessment
Assessment of the condition of the
skin surrounding the wound should
help to determine the extent of tissue
damage and offer clues to underlying
pathology. It can also provide signs
as to the ability of a chosen dressing
to successfully manage wound
symptoms such as exudate. Venous
disease results in a number of skin
changes and assessment should look
for the presence of these, including:
 Dry, flaky skin: increasing venous
pressure in the legs starves the skin
of oxygen and nutrients and it can
become dry and flaky. The skin also
cracks and is prone to irritation,
itch and allergy. It is important to
document any allergies/sensitivities
that the patient may have, for
example, to soaps or moisturisers.
 Maceration: this occurs when
the epidermis is over-hydrated
and becomes white and soggy.
Wound exudate, especially from
chronic wounds such as venous
leg ulcers can cause maceration, as
can the mismanagement of large
LEARNING ZONE
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Vascular assessment
It is important to assess the blood
supply to the legs in patients with
ulceration before any compression
is applied. If compression, the gold
standard of treatment for venous
leg ulcers (Cullum et al, 2006), was
applied to legs in patients with arterial
insufficiency, pressure damage, limb
ischaemia and even amputation
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Leg ulceration can negatively
impact on patients’ quality of life
and wellbeing (Franks and Moffatt,
2001; Gray et al, 2011). Alongside
diagnosing and treating the ulcer,
clinicians should always explore
how the patient is feeling and offer
empathy and compassion. Areas to
consider include:
 Feelings of depression (Jones et al,
2006a)
 Immobility
 Lack of social life and/or social
isolation (Stephen-Haynes, 2010)
 Pain (Briggs and Nelson, 2010;
Price et al, 2008)
 Loss of independence
 Poor sleep pattern
 Mood disorders (Upton et al, 2012)
 Wound symptoms, such as exudate
leakage and odour (Snyder, 2006).
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If the systolic readings are the
same, or just slightly different, there
is unlikely to be significant arterial
disease in the legs. However, if the
ratio between the two readings is
significant, the arterial flow in the
lower limb may be compromised to
a degree that compression therapy
would be risky. For example:
 Pressures of 0.5–0.8 indicate
significant arterial impairment
(0.5 = 50% reduction in arterial
blood flow)
 Pressures of 0.6–0.7 can have
compression, provided an
experienced clinician is involved
in the assessment and applies
the compression. Inelastic
bandage systems, for example
Actico®, can be used due to the
lower resting pressure
 Pressures of 0.8–1.3 are suitable for
compression (people with venous
ulcers tend to have an ABPI of 0.8
or greater, [RCN, 2006]).
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
Measurement of ABPI is a simple,
non-invasive vascular assessment
technique that assesses the presence
and degree of arterial disease by
comparing the ankle and brachial
systolic blood pressures (Marshall,
2004).
ABPI measurements may not be
accurate for patients with diabetes,
atherosclerosis or oedema, as these
conditions can produce very high
readings, or be difficult to locate.
Thus, an alternative method of arterial
screening such as pulse oximetry, may
be needed.
Holistic assessment
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Measurement of the ABPI
Measuring the patient’s ankle
brachial pressure index (ABPI) with
a handheld Doppler can help to
confirm or exclude the presence of
arterial disease, and is included in
national guidelines as part of leg
ulcer assessment (Clinical Resource
Efficiency Support Team [CREST],
1998; RCN, 2006; SIGN, 2010). It
is a fundamental part of leg ulcer
assessment and should always be
performed by a competently trained
clinician (Beldon, 2010).
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could result (RCN, 2006; SIGN, 2010).
Nurses should be trained in the use of
Doppler, with evidence suggesting that
competency results in the effective use
of compression (Ruston, 2002).
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volumes of exudate (Hampton and
Stephen-Haynes, 2006).
Excoriation: this is inflammation
of the epidermis caused by an
irritant, such as a chemical or
exudate (Hampton and StephenHaynes,2006).
Discolouration, including
haemosiderin staining: these red
pigment stains, which can be seen
in the lower legs of patients with
venous leg ulcers, occur because
venous congestion causes the
capillaries to swell and leak.
Varicose veins, varicosities:
ankle flare describes the tiny
purple veins on the medial aspect
of the foot, which are caused by
venous congestion and chronic
venous hypertension. Ankle
flare is an early warning sign of
leg ulcer development. Varicose
veins are the larger veins that
swell as blood pressure builds up.
Symptoms include discomfort and
pain, especially after standing for
extended periods. The location
and severity of any varicose veins
should be noted.
Chronic oedema: this is classed
as swelling of the limb that has
lasted longer than three months.
It is often caused by venous failure
and lymphatic overload. The
accumulation of fluid and proteins
leads to swelling, skin changes
and fibrosclerosis. Baseline
measurements of the ankle
circumference are important and
should be repeated at a consistent
time of day (preferably first thing
in the morning) and on the same
point on the limb.
Lipodermatosclerosis: this
refers to dry, hard, red skin
that develops in patients with
venous insufficiency due to lack
of nutrients and reduced oxygen
exchange. It can make the leg
take on the shape of an ‘inverted
champagne bottle’.
ABPI forms part of overall patient
assessment and should not be used
in isolation. If the results do not
tally with those from other findings,
further investigations will be needed
and an appropriate referral should
be made.
It is important to discuss with
patients how their quality of life
is affected by venous leg ulcers, as
this can have an impact on their
concordance with treatment. Building
a good rapport will reassure patients
that they can openly discuss any
anxieties that they may have about
treatment or outcomes (Foster and
Hawkins, 2005; Palfreyman, 2008).
MANAGEMENT
Having confirmed the cause of an
ulcer, a management plan should be
decided upon, in agreement with the
patient and their family/carers. The
priorities are:
 To address the underlying cause of
the ulcer
 To improve the wound bed
 To improve factors that could delay
healing, such as malnutrition, poor
mobility, lack of belief in treatment
 To prevent complications such as
infection or contact dermatitis
 To maintain good skin
care regimens
 To maintain healing once achieved
and prevent ulcer recurrence.
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These results are best obtained
through the use of graduated
compression therapy. This means
the highest pressure is delivered at
the ankle, gradually reducing at the
knee. Short working pressure peaks
of >60mmHg result in short duration,
intermittent closure of the deep veins
which, in much the same way as the
valves of the vein normally work, are
thought to reduce venous reflux and
lower venous hypertension (World
Union of Wound Healing Societies
[WUWHS], 2008).
The amount of pressure applied is
determined by La Place’s law (Figure
1). This dictates that the firmer the
92 JCN
2013, Vol 27, No 5
Laplace’s law
In brief, this law explains how the
sub-bandage pressure will ‘rise with
increasing bandage tension and
the number of bandages applied,
but decrease with increasing limb
circumference and bandage width’
(Moffatt, 2007). The following
calculation shows the pressure
exerted by the bandage:
T x N x constant
CW
d
P=
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P= sub-bandage pressure;
T = tension;
N = number of layers;
C = circumference;
W = width of bandage
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Figure 1.
Laplace’s law of sub-bandage pressure.
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High compression, multilayer
bandaging is the most suitable
treatment for venous ulcers (SIGN,
2010). Once the ulcer has healed,
compression should still be applied
as the underlying aetiology is
still present. If oedema is present,
bandaging can be used to reshape or
reduce the volume of the limb, so that
the patients can be fitted for hosiery to
maintain the condition of the limb and
prevent deterioration (Linnitt, 2012).
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Compression therapy using bandages
or hosiery controls oedema and
reverses venous hypertension by:
 Supporting the veins, reducing
distension, thus improving
blood flow, and thereby freeing
congestion in the capillaries and
veins and in turn reducing oedema
 Increasing blood flow, which
results in improved skin condition
as more nutrients are delivered to
the tissue
 Facilitating the action of the calf
muscle pump
 Relieving symptoms and
improving the healing rates of
venous ulcers (Moffatt et al, 2007).
Empowering patients/concordance
Clinicians should always consider
patients’ lifestyles and activity levels, as
well as cultural/religious factors. They
should also allow patients to choose
the type of compression product they
would like to use. This will encourage
concordance with treatment
(WUWHS, 2008).
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Compression therapy
Practitioners applying compression should have an in depth
knowledge of the variety of bandages
and hosiery available, their individual
properties, as well as the effects of the
patient’s limb size and mobility on the
amount of compression delivered.
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Management should focus on selfcare and empowering patients to lead
as normal a life as possible (Brown,
2013). While healing is realistic for
many patients, recurrence is likely if
compression is discontinued following
ulcer healing. It is important that
patients understand this, otherwise
they may refuse to wear hosiery once
their ulcer has healed (Brown, 2013).
Encouraging self-care, such as wearing
compression hosiery, leg elevation,
ankle exercises and moderate exercise
such as walking, will help reduce
recurrence. A good skin care regimen
will also help to maintain skin integrity.
bandage, the higher the pressure, the
larger the limb, the lower the pressure
and the smaller the limb, the greater
the pressure.
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When it has been established
that the ulcer is venous in origin (i.e.
ABPI of more than 0.8–1.3), it should
be treated with a combination of
compression therapy, exercise and
elevation of the limb, all of which help
to aid venous return to the heart.
Compression products include:
 Elastic/long-stretch bandages
 Inelastic/short-stretch bandages
~ cohesive
~ non-cohesive
 Compression hosiery, including leg
ulcer hosiery kits
 Intermittent pneumatic
compression (IPC) therapy.
Elastic/long-stretch bandages
Elastic or long-stretch bandages
are usually applied at 50% stretch
to ensure a determined amount of
compression. To achieve accurate
pressures, the bandage needs
to be applied correctly as per
the manufacturer’s instructions
and should consider the ankle
circumference. Bandages provide
similar levels of compression,
regardless of patient activity. Elastic
systems thus deliver constant pressure
to the limb as there is little difference
between their working and resting
pressures (Figure 2).
Inelastic/short-stretch bandages
Inelastic/short-stretch bandages are
designed with little or no elasticity
to form a relatively rigid covering
over the limb. When the calf muscle
changes shape on walking it presses
against the non-stretch bandaging,
thereby increasing the efficacy of the
calf muscle pump. Inelastic bandages
can provide pressure peaks
even during small ankle flexions
(WUWHS, 2008), making them
suitable for many immobile patients
(Charles et al, 2009). These bandages
have therapeutic working and lower
resting pressures, which provide
effective ulcer healing
and oedema control (Franks et al,
2004), as the pressure adapts around
the patient’s everyday movements.
They are thus more comfortable to
wear, especially at night. Cohesive
short-stretch bandages provide up to
seven days’ wear.
Compression hosiery
Compression hosiery, which must be
worn daily, is used as maintenance
therapy once ulceration has healed,
Resting pressure: the pressure on
the limb from the bandage itself,
while the patient is at rest or supine
Working pressure: the pressure
created when the limb is moving
and muscles contract against
the bandage
Figure 2.
Resting and working pressures.
LEARNING ZONE
18–21mmHg
Class 2
18–24mmHg
23–32mmHg
Class 3
25–35mmHg
34–46mmHg
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Exercise and elevation
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Frequency of application
The frequency of bandage changes
will need to fit in with the patient’s
lifestyle and work. Hosiery may
be more appropriate for younger
patients who are unable to attend
frequent appointments. Clinicians
should also be competent in
performing different bandaging
techniques (Mear and Moffatt, 2002),
and in measuring and fitting for
compression hosiery. New, online
resources such as a Hosiery Sizer
app (Activa Healthcare) can help to
ensure that the correct size is chosen.
Patients can be offered hosiery
made of various textiles and with
different elastic properties, depending
on the patient’s lifestyle and the
required level of compression.
Intermittent pneumatic compression
(IPC) therapy
This boot-like system is attached to
the leg and connected to a pump,
Wound management
Although most ulcers heal after the
application of compression, some fail
to progress. In this case, wound bed
preparation can identify factors in the
wound bed that are delaying healing.
The clinician can then aim to stimulate
the healing process (Falanga, 2004).
Dressings that perform well under
compression, while also managing
the wound’s symptoms should be
chosen. For example, if a large amount
of exudate is present, the dressing
should be able to absorb and retain
fluid under compression to prevent
maceration of the surrounding skin.
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which applies pressure to inflate and
deflate the boot from the ankle to
the knee. These varying pressures
help to speed up venous return and
reduce oedema. Between treatments,
compression hosiery or bandaging
is necessary, otherwise oedema will
return and venous pressure increase
(Moffatt, 2004).
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As well as compression therapy,
patients should perform exercises
facilitating ankle movement and
flexing the calf muscle pump (SIGN,
2010). They should also be encouraged
to elevate the legs above hip level
whenever possible, reducing pressure
and draining oedema from the veins
(Dix et al, 2004).
Skin care
Managing the peri-ulcer skin is an
important part of any leg ulcer care
plan. Common skin problems with
venous ulcers include:
 Eczema
 Allergic contact dermatitis
 Irritant contact dermatitis
 Hyperkeratosis.
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Hosiery kits are also available.
These comprise two stockings,
one worn on top of the other. The
combined compression allows leg
ulcer healing without the bulk
of bandages.
European Class
14–17mmHg
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British Standard hosiery is suitable
for patients with venous problems
without oedema.
British Standard
Class 1
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Hosiery is available as thigh-high
stockings, below-knee stockings
and unisex socks. British Standard
and European Class hosiery are
available in three classes. The level
of compression applied is expressed
in millimetres of mercury (mmHg)
(Table 1).
Table 1: British Standard and European Class hosiery compression classes
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and where oedema is present, to
maintain limb volume reductions
achieved by bandaging. Hosiery
can also be used as an alternative
to compression bandaging if
concordance becomes an issue,
perhaps because of difficulty in
wearing normal footwear, However,
this is only possible if the ulcer
is producing low to moderate
volumes of exudate. Alternatively,
made-to-measure garments can be
considered. Hosiery is often more
cosmetically acceptable, particularly
to younger patients.
Regular washing of the legs
is important as patients often
develop thick layers of dry skin, or
hyperkeratosis (SIGN, 2010). This
dead tissue should be safely and
atraumatically removed after cleansing
(Whitaker, 2012). A safe and easy
method to do this is with Debrisoft,
which gently and effectively removes
hyperkeratosis. These debridement
pads can also be used by patients
themselves as part of their skin care
regimen (Pidcock and Jones, 2013).
Dry skin is a particularly common
sign of venous ulceration and the use
of emollients may be needed. It is
important to apply any substance to
the leg in the direction of hair growth
to avoid inflaming hair follicles. Skin
care should be continued once healed
to maintain skin integrity, but beware
of use of products that affect hosiery.
Pain
Pain can be particularly intense at
dressing changes (European Wound
Management Association [EWMA],
2002; Price et al, 2008). Leg ulcer pain
ranges from the acute pain caused by
ischaemia or infection, to the aching
caused by oedema (Jones et al, 2006b).
It is vital that dressings are carefully
selected and that the limb is treated
gently. In some cases, compression
can help to relieve pain by reducing
oedema and supporting the limb.
Analgesia should be prescribed
where appropriate.
Psychosocial considerations
Leg ulcers can result in social isolation,
due to pain or the odour of leaking
wounds. The emergence of Leg Clubs
and leg ulcer clinics has gone some
way to address this problem, as they
offer a friendly environment with the
opportunity to have legs washed and
dressed (RCN, 2006).
Preventing recurrence
Healing leg ulcers can take time and
recurrence rates are high. Rippon et
al (2007) found in a literature review
that after two years of treatment
with compression bandaging,
approximately 20% of venous leg
ulcers were still unhealed.
Recent developments in
technology have led to greater
JCN
2013, Vol 27, No 5
93
LEARNING ZONE
What’s your next step?
To use the knowledge you have gained from this article to inform your
continuing professional development (CPD), take the following steps before
logging onto the website (www.jcn.co.uk/learning-zone/) to complete the
learning zone test:
op
le
Lt
d
Reflect
How common is this condition?
What are the symptoms?
What are the causes?
What are the management options?
Pe
Evaluate
Would you be confident in carrying out skin assessment, or understanding the
symptoms of venous ulceration? Would you be confident in choosing a dressing or
selecting compression bandage therapy, or the correct hosiery?
W
ou
nd
C
ar
e
Act
Read the article when you have a spare few minutes in the day.
Make some notes on what you have learned, then visit the online test (www.jcn.
co.uk/learning-zone/) to complete this subject.
The whole test, which involves reading this article and answering the online
questions, should take you 45 minutes to complete.
Finally, download your certificate to show that you have completed the JCN
e-learning unit on venous leg ulcers as part of your CPD portfolio.
20
13
choice in compression hosiery,
with more fabrics, sizes and colours
being available. This has led to an
improvement in patient concordance
(Dowsett, 2011), which helps to
prevent recurrence.
©
Ongoing assessment and
attendance at leg ulcer clinics
and patient education are vital to
maintain healthy legs.
CONCLUSION
Venous leg ulcers are a common
problem in the community, with
which nurses should be familiar if they
are to combat the pain, social isolation
and depression that accompany this
debilitating condition.
It is important that community
nurses know how to assess, diagnose
94 JCN
2013, Vol 27, No 5
and treat leg ulcers, as well as being
familiar with the different types of
compression available.
e-learning resources, visit: http://www.
activahealthcare.co.uk/e-learning-zone/
If community nurses apply the
information contained in this article,
as well as completing the online test
(www.jcn.co.uk/learning-zone/), they
will be better equipped to provide
evidence-based care and advice
for patients living with venous
leg ulceration.
JCN
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Acknowledgements
This learning zone
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of venous leg ulcers. For further
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