Compression bandaging for venous leg ulcers: the essentialness of a willing patient.
OBJECTIVE
To describe and explore reasons for use or non-use by district nurses of compression bandaging, a best practice component of venous leg ulcer management.


BACKGROUND
Leg ulcers are costly to both individuals and communities. The most prevalent of leg ulcers are venous leg ulcers, which are common wounds treated by district nurses. Compression bandaging is the best practice for the treatment of venous leg ulcers with considerable evidence that this aids healing in an effective and timely manner. It is anecdotally known that compression bandaging is not always used by district nurses when treating venous leg ulcers, yet little is known as to why this is so.


METHODS
A qualitative descriptive/exploratory study was used; interview data were collected with constant comparative data analysis applied until data saturation was obtained.


RESULTS
As could be anticipated, several basic elements need to be present for a district nurse to use compression bandaging, like knowing that compression bandaging is best practice, knowing how to use compression bandaging and being able to determine that the ulcer is venous in nature. However, the major finding is the essentialness of having a patient willing for compression bandaging to be applied and sustained; the study explored what determines willingness or non-willingness and strategies that can be used to encourage willingness.


CONCLUSIONS
A prime enabler of the use of compression bandaging is having a patient willing to agree to the commencement of this treatment and for this to be sustained. Consequent recommendations are offered. Evidence-based nursing requires not only knowledge of cause and effect evidence but also evidence that provides understanding about human responses and choices when there is a health challenge.


CONCLUSIONS
The relevance of the findings for clinical practice is that knowledge is provided about what factors may constrain a patient's willingness for compression bandaging to be applied and sustained as treatment for a venous leg ulcer and about what actions can be tried to facilitate willingness.
Annells
Merilyn
M
Royal District Nursing Service, Helen Macpherson Smith Institute of Community Health & La Trobe University, St Kilda, Victoria, 3182, Australia. m.annells@latrobe.edu.au
O'Neill
Janine
J
Flowers
Charne
C
D000328:Adult; D001291:Attitude of Health Personnel; D019985:Benchmarking; D002755:Choice Behavior; D002983:Clinical Competence / Q000592:standards; D003299:Cooperative Behavior; D019317:Evidence-Based Medicine; D005260:Female; D017144:Focus Groups; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D008297:Male; D008875:Middle Aged; D009042:Motivation; D015404:Nursing Methodology Research; D009740:Nursing Staff / Q000193:education / Q000458:organization & administration / Q000523:psychology*; D010349:Patient Compliance / Q000523:psychology*; D018579:Patient Selection; D011637:Public Health Nursing / Q000193:education / Q000458:organization & administration*; D036301:Qualitative Research; D053828:Stockings, Compression / Q000009:adverse effects / Q000706:statistics & numerical data; D011795:Surveys and Questionnaires; D014647:Varicose Ulcer / Q000517:prevention & control / Q000523:psychology; D014739:Victoria