Community-dwelling individuals living with chronic wounds: Understanding the complexity to improve nursing care. A descriptive cohort study

Abstract

Background: Chronic disease management is a priority in most healthcare systems. The burden of managing these chronic conditions frequently falls on nurses since the majority of individuals with chronic conditions are treated by nurses in the community or home care setting. Chronic wounds are frequently one of the conditions managed thus were used as an example to illustrate the profile of the population being referred for community care. Fully understanding this population is a first step toward successful chronic disease management and improved care planning for nursing.

Objectives: 1) Describe demographic, circumstance-of-living, clinical and wound characteristics of individuals living with a chronic condition; 2) Determine pain, health-related quality of life (HRQoL), function and health outcomes on admission and along the trajectory to healing; and 3) Identify factors to assist health authorities in gathering planning data for chronic disease populations.

Design: Secondary data analysis of four major studies using a descriptive/exploratory design.

Setting: Care delivered in the community in three Canadian provinces at either a clinic or in home by trained nurses using an evidence-informed protocol.

Participants: 735 cognitively intact adults receiving community wound care for a leg ulcer below the knee of venous or venous-mixed etiology.

Main Outcome Measure(s): Demographic, clinical, circumstance-of-living, ulcer characteristics and interventions, pain, HRQoL and health outcomes, and healthcare utilization.

Main Results: Participants averaged 68 years old, 30% had three or more comorbidities, and many lived alone (37%). Ulcers were present for 11 weeks (median) prior to receiving care and took almost 10 weeks to heal. At baseline 85% reported leg ulcer pain, 53% issues with mobility, 24% issues with washing or dressing, 58% had issues performing usual activities, and one-third reported moderate anxiety or depression.

Conclusion: The data illustrate the complexity surrounding individuals receiving community care for a chronic wound and illuminate the challenges faced in planning an effective chronic disease management approach. Implications from this study are relevant to planners, policy-makers and frontline care providers and a number of specific recommendations are offered.