title: Community nurses', home carers' and patients' perceptions of factors affecting venous leg ulcer recurrence and management of services.
abstract: OBJECTIVE
  This study examines the feasibility of utilizing social service home carers (SSHC) to provide a collaborative approach with community nurses for the provision of leg ulcer aftercare in four National Health Service (NHS) Trusts. The purpose of this study was to gain insight into what community nurses and people with healed venous leg ulcers felt influenced leg ulcer recurrence.
  
  
  BACKGROUND
  Studies have demonstrated that provision of community-based leg ulcer clinics has improved healing rates of venous leg ulcers, yet recurrence remains a problem. The reasons for this are far from clear, and further research is required before unequivocal support can be given to one approach to the provision of care for this client group. Collaborative approaches to the provision of leg ulcer aftercare are beginning to receive more attention. It has been recognized that social service health carers could be co-opted to provide essential aftercare once healing has occurred, although the logistics of this approach have not been fully explored.
  
  
  METHODS
  This study was conducted in four NHS Trusts. Stage one used focus groups to explore the perceptions of district nurses (n = 15) and social service health carers (n = 15) of a leg ulcer shared care project and to gain insight into factors that they felt influenced recurrence. The second stage used semistructured interviews (n = 12) to explore the perceptions that people with healed leg ulcers have about factors influencing ulcer recurrence.
  
  
  RESULTS
  Key themes emerging from this study were: health promotion is perceived by community nurses and patients to be ineffective and leg ulcer aftercare services are fragmented. Organizational factors such as time constraints and limited resources were cited by community nurses and home carers as being responsible for high leg ulcer recurrence rates. Community nurses expressed a desire to delegate preventative aspects of leg ulcer care to home carers rather than participate in health promotion strategies to support healing behaviours.
  
  
  CONCLUSIONS
  A strategy aimed at supporting healing behaviour in elderly people has the potential to reduce the recurrence of leg ulceration and improve quality of life. The findings suggest that such a strategy needs to rationalize delivery of leg ulcer aftercare to provide seamless care. It needs to improve carers' and patients' understanding of factors influencing leg ulcer recurrence and facilitate development of a more balanced professional--patient relationship.
authors.affiliation: Principal Lecturer, Post-Registration Nursing, Faculty of Health and Human Sciences, University of Hertfordshire, Stevenage, UK. m.flanagan@herts.ac.uk
authors.forename: M
authors.initials: M
authors.lastname: Flanagan
authors.forename: L
authors.initials: L
authors.lastname: Rotchell
authors.forename: J
authors.initials: J
authors.lastname: Fletcher
authors.forename: J
authors.initials: J
authors.lastname: Schofield
mesh_terms: D000328:Adult; D000359:Aftercare / Q000458:organization & administration*; D003152:Community Health Nursing / Q000458:organization & administration*; D005240:Feasibility Studies; D005260:Female; D017144:Focus Groups; D006699:Home Care Services / Q000458:organization & administration*; D006801:Humans; D007871:Leg Ulcer / Q000451:nursing* / Q000517:prevention & control; D008297:Male; D008875:Middle Aged; D010348:Patient Care Team; D012008:Recurrence; D013222:State Medicine; D006113:United Kingdom