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Quality Improvement

Although ageing is a natural physiological process of growing older, it is often accompanied by numerous severe and chronic illnesses. Taking into consideration a predicted increase in the senile population, improvements in health care of the elderly can be identified as one of the most significant medical issues today. Despite the rise of the number of researches on the senile in general, elderly patients with chronic venous leg ulcers suffer from severe or continuous pain, restricted mobility, depression, anxiety, sleep disturbances, and decreased quality of life. A new effective approach to care of such patients is analysed in the publication “A randomised controlled trial of a community nursing intervention: improved quality of life and healing for clients with chronic leg ulcers” (Edwards et al., 2009).

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The title of the publication clearly indicates the content. The specific research question is the effectiveness of a new model of nursing care for patients with chronic venous leg ulcers. The researchers determine correlation between a new community nursing care model and various aspects of life of patients with chronic leg ulcers, such as morale, self-esteem, depression, quality of life, social support, healing, pain, and functional ability. Venous leg ulcers are defects of integuments on a medial anklebone; they are often chronic, difficult to treat, and associated with constant pain, decreased mobility, labor productivity, and quality of life.

Applying methods of quantitative research, Edwards et al. conducted a randomised controlled trial aimed at comprehensive assessment of the effectiveness of the new community nursing model (a Leg Club model) of care of clients with chronic venous leg ulcers. A randomised controlled trial is the most demonstrative and scientifically rigorous tool of evidence-based medicine. “The randomised clinical trials have become identified with valid medical research” (Di Stefano, 2006, p. 147). The study framework was presented clearly and was identified according to the practice guidelines designed by Australian Wound Management Association and Royal College of Nursing. Providing precise findings, theoretical grounding, accurate numerical data, questionnaires, applicable scales, consistent treatment protocols, and statistical tools of their study, the authors testify the effectiveness of this healthcare project, though there has been ‘little evidence available on the effectiveness of differing models of community care for clients with chronic venous leg ulcers before (Edwards et al., 2009, p. 1542). Hence, findings and conclusions of the quantitative research on the new model of health care conducted by Edwards et al. appear to be valid and highly reliable.

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Traditional models of care do not always “provide the social and psychological support necessary to enhance effective chronic disease management and quality of life.” “Based on community involvement and ownership, the Leg Club model provides social activity and peer support for leg ulcer sufferers” (Edwards et al., 2009, p. 1543). 35 patients with venous ulcers below the knee received care at the Leg Club, which they visited weekly. Their treatment included performance of the following procedures: 1) a comprehensive examination; 2) referral for further circulatory assessment; 3) treatment of venous ulcer in conformity with research protocols; 4) advice and assistance; 5) methods of preventive treatment and consistent management. The Leg Club settings and facilities provided participants with opportunities to communicate with each other and share their experiences and feelings. Thus, they were constantly accompanied by “peer support, assistance with goal setting, and social interaction” (Edwards et al., 2009, p. 1543). The project also involved trained volunteers who helped to transport participants who were unable to move independently. 

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 Edwards et al. pointed out several inconsistencies between the results and expected findings due to time limitations of the research. However, the results of the randomised controlled trial conducted by Edwards et al. are objectively and sequentially presented; they are discussed and interpreted within the context of previous studies of improvements in quality of life of patients with chronic leg ulcers. Data and statistics regarding improved outcomes in quality of life, morale, self-esteem, healing, pain, and functional abilities of the senile with venous ulcers demonstrate the potential of the Leg Club model of care to improve conditions and well-being of patients. Thus, the findings of this healthcare project can be generalized and disseminated among administrators of clinical settings and medical professionals of community health organisations involved in the care of patients with chronic leg ulcers. 

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