The traditional care pathway is one where patients are treated in their homes by district nurses or in GP clinics. Evidence shows that this is costly with slow healing rates and a high incidence of recurrence.
The Leg Club is a social model that emphasises wellness and maintenance of health, placing equal emphasis on social health, i.e. communication, prevention of isolation and depression, plus the creation of a community within the social clinic, the objective of which is to maintain the individual’s social position in the surrounding community. The primary aim is to integrate members (patients) into an environment where they can socialise with others who are experiencing similar problems.
Leg Clubs encourage shared decision making and ensure that people are fully involved in their treatment. This provides real motivation to individuals who are living with chronic wounds. The experience of visiting the Leg Club is wholly positive, as many members who rarely venture out of their houses have made new friends and relationships have blossomed. The model developed by the founder of the Lindsay Leg Club Foundation has been shown to improve healing and reduce recurrence within a highly cost-effective framework that delivers genuine patient empowerment, public health education and social outreach. The ethos of the model is to encourage wellness rather than treat illness in all age groups and is a proven alternative to the traditional management of leg conditions.
Collaborative working is the bedrock of each Leg Club. Members (patients) and nurses work together in an open environment (members can be treated in private if they wish) where interactive learning is paramount. Clubs are run once or twice a week depending on local need and resources, with up to forty members attending each session, and treatment is undertaken in an area where two or three people can have their legs washed and dressed in the same room, giving them the opportunity to compare healing and treatments. Members are encouraged openly to discuss treatment issues with the care team, carers and other members, and this offers them control over their own leg ulcer. Treatment is undertaken with, rather than on, the members.
Leg Clubs are not owned by the healthcare provider but by the local community. Established and run by volunteers in partnership with nurses, they are self-funding, with patients and the community finding various ways of raising money for the rent, equipment and so on. The cost to the NHS is in nursing time and dressings. International research shows that they are extremely cost-effective in the use of nursing resources, saving travel costs, reducing need for the duplication of equipment, simplifying planning and administration, and eliminating wasted home visits.
Leg Clubs are supported by The Lindsay Leg Club Foundation which provides guidance and training during the setting up phase. Health and safety and infection control are primary considerations for Leg Clubs, clearly covered by documented guidelines and risk assessment. During the embryonic stage of each Leg Club, nursing teams are encouraged to meet and liaise with their Tissue Viability Nurse, Lymphoedema Nurse, Consultant Vascular Surgeon/ Nurse Specialist, Infection Control Nurse and the Director of Provider Services.
For further information about the Leg Club Foundation look at their website
The four core principles of a Leg Club:
- Non-medical setting – e.g. community/church/village hall. This avoids the stigma or fear of attending a medical setting and reinforces the community ownership of the Club.
- Informal, open access, no appointment required. This encourages opportunistic attendance for information and advice, providing greatly increased opportunities for early diagnosis and leg ulcer prevention and helps isolated older people reintegrate into their community.
- Collective treatment. People share their experience, gaining peer support, and encouraging them to take ownership of their treatment.
- Integrated ‘well leg’ regime, supporting maintenance of healthy legs, positive health beliefs and broad health promotion.
Pressure ulcer prevalence data was collected on 1196 patients within orthopaedic and community care settings between 2007 and 2008. 13.9% (n=81) in orthopaedic units and 26.7% (n=162) in community care units had pressure uclers. The most common were grade 1 and grade2. 78 patients had severe (grade 3 or grade 4) pressure ulcers across all untis. Surveyed patients tended to be elderly with 38% in orthopaedic units and 65% in community care aged at least 80 years old. Based on the Braden score, patients in the orthopaedic units tended to be slightly more vulnerable to pressure ulcer development than in community care.
This is an important study as it uses similar methodology to other prevalence studies, thus making comparisons more meaningful. However, the continued high prevalence of pressure ulcers means that efforts to prevent their onset must remain to the fore.
The EWMA patient outcomes group launched an important wound management document at the conference in Geneva this year. This document identifies criteria for producing rigorous outcomes in both randomised controlled trials and clinical studies and describes how to ensure studies are consistent and reproducible. The document represents a substantial piece of work which brings together much of the evidence base in wound management. It makes recommendations for those proposing to undertake reserach and also recommends changing the term 'chronic' wound to that of 'non-healing'. The document has generated much debate and in the July issue of Journal of Wound Care, the Wounds Research group from the University of York and Prof. Richard White provide commentary and discussion on the document.
110 delegates attended a one day conference held in the Clayton Hotel in Galway on 9th september. This conference which was sponsored by Smith and Nephew was organised by Department of Podiatry in NUI galway and the western branch of the WMAI. During the course of the day delegate attended workshops and listened to presentation related to microbiology, prevalence, infection control, assessment and wound bed preparation.
A four week Evening Course in Wound Care was held in St Vincent's University Hospital in April/May 2010. There was attendance of 50/60 participants. This course was be repeated every Tuesday. The course covers all aspects of wound care including General Wound Care, leg ulcers, pressure ulcers and the diabetic foot. The course consists of talk on given subject then related workshop.
Interest to all disciplines involved in wound care and there is a multi-disciplinary team involved in running the course. The course has approval from A.B.A and E.W.M.A. Refreshments are served each evening.
A big Thank You to SVUH for the use of there lecture rooms.
We are planning a study evening in November 2010 on Demystifying Dressing Selection.
Congratulation to one of our committee members Pauline on the birth of her beautiful baby boy.
Writing for the newsletter
Would you like to write a short paper for the WMAI newsletter or share your experiences or expertise with others? We would like to invite short papers for inclusion in future issues of the newsletter. Please send your submissions via email or post to the Office.
Bursary 2011 We are now accepting applications for the WMAI bursary 2011, for application information go to www.wmai.ie, application must be made by 1st October 2011.