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TVS Leg Ulcer Study Days
34 Journal of Tissue Viability Vol 5 No 1
TVS LEG ULCER STUDY DAYS John Young Consultant Geriatrician, St Luke's Hospital, Bradford A report on the Society's First Leg Ulcer Study Day held at Halifax A beginning always appears to be a longtime coming. So it has been with the TVS leg ulcer study days. It has had a longish gestation being deliberated upon for many a month. But the deliberation has been worthwhile judging by the recent pilot day held in Halifax on the 20th October. The notion has been to draw upon the format of the well established, highly regarded and successful pressure sore study days. The success of the pressure sore educational venture can be judged partly by its survival (now running for 8 years) and partly by demand (there is a waiting list for potential host districts). They have been supported and organised by a small band of enthusiasts within the structure of the TVS. Last year, the Society proposed to use its experience with the pressure sore 'road shows' and develop a similar format for leg ulcers. The recent research into leg ulcer disease has also been a success story. Important gains have been made in our understanding of the pathology of leg ulcers and corresponding advances in our management of the condition with routine use of Doppler as a valuable and practical assessment tool, and the effectiveness of compression bandaging: up to 80% three month healing rates in good centres. For a chronic disease and one which, in contemporary parlance, is "not sexy", these are dramatic advances and run counter to the pervading nihilism which has tended to surround the condition. However, it leaves us with a problem: how to now translate these research outputs into routine clinical practice. Few health professionals can have escaped coming across the term research and development ('Rand D') which has become a widely promoted phrase in our 'reformed' National Health Service. For leg ulcer disease the research findings have become crystallised and well accepted. Logic suggests that the next stage, the stage of clinical development, with the application of research knowledge in to the wider clinical setting, should now follow. Traditionally, we have generally attended only poorly to the development phase of' Rand D' in our Health Service. The task for leg ulcer disease is particularly daunting. The prevalence of the condition is high: 20% of the over 80's, the largest growing demographic group in our society. It forms a major component of the workload of most community nurses - up to 50% in some studies. It is therefore necessary to reach out to most community nurses and certain hospital nurses, and something needs to be done with doctors ( !): especially general practitioners and geriatricians. For some people it is important only for the new knowledge to become appreciated but for others, and particularly community nurses, it is not just about a knowledge update - it is about the acquisition of new skills and a different clinical practice.
The purpose of the TVS leg ulcer study days is to contribute to this development process. A steering committee has been formed to plan the content and process of the study day. The resulting format is a locally based meeting in which a group of experts in leg ulcer management come together to present a morning programme which is then repeated (to a fresh audience) in the afternoon. The programme has two set piece lecture style presentations but the core of the half day is based around three 'hands on' workshops: 1. Use of Doppler 2. Four layer bandaging 3. Sub-bandage pressure monitoring
Experience with the pilot study day proved that this format is successful. People particularly enjoyed the hands on experience with doppler and bandaging techniques. The learning appeared relaxed, fun and informal. Purists might be concerned that the participants would go away full of confidence and that, after a mere half an hour bandaging practice, they would feel 'fully trained' and ready to afflict patients with their new found skill. Some reassurance may therefore be necessary. This was not the purpose of the day and this was made clear many times by the several speakers. But every great journey begins with a single step. The study day fulfills the role of the first step - to create an awareness of the new practices which are needed. It will need to be followed up by local people to maintain the momentum. However, if a sufficient critical mass of interested nurses are created in a district, there is a greater likelihood that a climate is produced in which new practices are catalysed. Formal feedback from the day was encouraging with high delegate assessment gradings for the lecturers and workshops. These leg ulcer study days represent a new venture for the TVS. It fulfils the spirit of the Society: to promote good practice through education. Thanks are due to those who developed the programme: Dr Nicky Cullum, Dr Kate Springett, Mrs Helen Orchard, and special thanks must be given toMs Jaqui Fletcher who organised and hosted the first meeting in Halifax. The practical support of representatives with equipment from HNE Healthcare and Talley for the Doppler and Bandage Pressure Monitoring Workshops respectively was vital for the success of the day. The delegates had an enlightening half day - and so did I! (Details of the next Leg Ulcer Study Days are shown on Page 37.)
TVS LEG ULCER STUDY DAYS John Young Consultant Geriatrician, St Luke's Hospital, Bradford A report on the Society's First Leg Ulcer Study Day held at Halifax A beginning always appears to be a longtime coming. So it has been with the TVS leg ulcer study days. It has had a longish gestation being deliberated upon for many a month. But the deliberation has been worthwhile judging by the recent pilot day held in Halifax on the 20th October. The notion has been to draw upon the format of the well established, highly regarded and successful pressure sore study days. The success of the pressure sore educational venture can be judged partly by its survival (now running for 8 years) and partly by demand (there is a waiting list for potential host districts). They have been supported and organised by a small band of enthusiasts within the structure of the TVS. Last year, the Society proposed to use its experience with the pressure sore 'road shows' and develop a similar format for leg ulcers. The recent research into leg ulcer disease has also been a success story. Important gains have been made in our understanding of the pathology of leg ulcers and corresponding advances in our management of the condition with routine use of Doppler as a valuable and practical assessment tool, and the effectiveness of compression bandaging: up to 80% three month healing rates in good centres. For a chronic disease and one which, in contemporary parlance, is "not sexy", these are dramatic advances and run counter to the pervading nihilism which has tended to surround the condition. However, it leaves us with a problem: how to now translate these research outputs into routine clinical practice. Few health professionals can have escaped coming across the term research and development ('Rand D') which has become a widely promoted phrase in our 'reformed' National Health Service. For leg ulcer disease the research findings have become crystallised and well accepted. Logic suggests that the next stage, the stage of clinical development, with the application of research knowledge in to the wider clinical setting, should now follow. Traditionally, we have generally attended only poorly to the development phase of' Rand D' in our Health Service. The task for leg ulcer disease is particularly daunting. The prevalence of the condition is high: 20% of the over 80's, the largest growing demographic group in our society. It forms a major component of the workload of most community nurses - up to 50% in some studies. It is therefore necessary to reach out to most community nurses and certain hospital nurses, and something needs to be done with doctors ( !): especially general practitioners and geriatricians. For some people it is important only for the new knowledge to become appreciated but for others, and particularly community nurses, it is not just about a knowledge update - it is about the acquisition of new skills and a different clinical practice.
The purpose of the TVS leg ulcer study days is to contribute to this development process. A steering committee has been formed to plan the content and process of the study day. The resulting format is a locally based meeting in which a group of experts in leg ulcer management come together to present a morning programme which is then repeated (to a fresh audience) in the afternoon. The programme has two set piece lecture style presentations but the core of the half day is based around three 'hands on' workshops: 1. Use of Doppler 2. Four layer bandaging 3. Sub-bandage pressure monitoring
Experience with the pilot study day proved that this format is successful. People particularly enjoyed the hands on experience with doppler and bandaging techniques. The learning appeared relaxed, fun and informal. Purists might be concerned that the participants would go away full of confidence and that, after a mere half an hour bandaging practice, they would feel 'fully trained' and ready to afflict patients with their new found skill. Some reassurance may therefore be necessary. This was not the purpose of the day and this was made clear many times by the several speakers. But every great journey begins with a single step. The study day fulfills the role of the first step - to create an awareness of the new practices which are needed. It will need to be followed up by local people to maintain the momentum. However, if a sufficient critical mass of interested nurses are created in a district, there is a greater likelihood that a climate is produced in which new practices are catalysed. Formal feedback from the day was encouraging with high delegate assessment gradings for the lecturers and workshops. These leg ulcer study days represent a new venture for the TVS. It fulfils the spirit of the Society: to promote good practice through education. Thanks are due to those who developed the programme: Dr Nicky Cullum, Dr Kate Springett, Mrs Helen Orchard, and special thanks must be given toMs Jaqui Fletcher who organised and hosted the first meeting in Halifax. The practical support of representatives with equipment from HNE Healthcare and Talley for the Doppler and Bandage Pressure Monitoring Workshops respectively was vital for the success of the day. The delegates had an enlightening half day - and so did I! (Details of the next Leg Ulcer Study Days are shown on Page 37.)