| Abstract: | ABSTRACT
Theoretical Background: Venous leg ulcer (VLU) is a chronic wound on the lower leg, primarily caused by chronic venous insufficiency and venous hypertension. It presents with pain, swelling, itching, discharge, and varicose veins, and significantly reduces quality of life. Diagnosis is based on medical history, assessment of risk factors, and duplex Doppler ultrasound; classification is performed using the Widmer and CEAP (Clinical – Etiology – Anatomy – Pathophysiology) systems, while pain is assessed using the VAS (Visual Analogue Scale) and NRS (Numeric Rating Scale). It results from damage to venous valves, reflux or obstruction, and weakened muscle pump, leading to venous hypertension, inflammation, and tissue changes. Nursing care follows the phases of wound healing (hemostasis, inflammation, proliferation, remodeling) and the T.I.M.E. concept (tissue – infection/inflammation – moisture – epithelialization): tissue preparation, infection control, moisture balance, and promotion of epithelialization, while simultaneously protecting the surrounding skin and ensuring proper hygiene. The cornerstone of treatment is compression therapy (long-/short-stretch bandages, systems, stockings), taking contraindications into account. If necessary, venoactive drugs, pentoxifylline, analgesics, and antibiotics in case of infection are added. Pain, which is common and affects quality of life, is treated multimodally with medications and non-pharmacological measures. The choice of dressings is individualized according to the wound phase and exudate level, with emphasis on multidisciplinary cooperation and continuous monitoring for successful treatment. The aim of the research was to examine the nursing care of a patient with a venous leg ulcer.
Method: The study was conducted using a quantitative research approach and a descriptive work method. The research sample was convenient, including 113 nursing care providers working in various areas of healthcare. Data collection was carried out through an online survey. The invitation to participate was posted on a Facebook profile and shared via other social networks (Instagram). The collected data were processed using Microsoft Office Excel, and presented graphically in tables and charts.
Results: The results showed that the most represented age groups among respondents were 18–24 years (30%) and 25–34 years (27%), with women predominating (90%) and men representing 10%. Most respondents had a secondary school (42%), higher vocational (27%), or university/postgraduate education (31%). They most often worked in specialist outpatient clinics (35%) or hospitals/clinical centers (24%). According to healthcare workers, most patients with venous leg ulcers experience pain occasionally (35%) or several times a week (35%). In pain relief, healthcare workers most often recommend lighter bandaging (46%) and the use of analgesics (28%), and less frequently refer patients to a pain management clinic (4%). The most commonly used dressings were alginates (x̄ = 3,8) and polyurethane foams (x̄ = 2,7), while among compression aids, long-stretch bandages (x̄ = 3,8) were the most common. Compression stockings (x̄ = 2,7) and short-stretch bandages (x̄ = 2,7) were used occasionally, with 61% of respondents not using any compression aids. The greatest challenges in caring for patients with venous leg ulcers were reported to be workload pressure (x̄ = 4,2) and lack of time (x̄ = 4,1).
Discussion: We found that patients with venous leg ulcers most often experience pain several times a week or occasionally, whereas research shows a much higher frequency, including daily pain. This suggests that healthcare workers may underestimate patients’ pain, which could be related to so-called silent pain in the elderly and cognitively impaired. We also found that standardized tools for pain assessment, such as VAS and NRS, are rarely used, making it difficult to monitor treatment effectiveness. In treatment, alginate dressings and polyurethane foams were most commonly used, while compression systems (SYS), recommended by guidelines, were rarely used, mainly due to discomfort when worn and insufficient patient education. |
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