Identifying the Problems in Leg Ulcer Management in order to develop an Education and Competence Framework

Abstract

This mixed methods study explored the problems in leg ulcer management in order to develop a clear definition of competence and an education framework for leg ulcer management. The views of nurses involved in leg ulcer education and assessing others as competent (Group 1 Assessors), and the views of nurses who have undergone leg ulcer management courses (Group 2 Students) were analysed to identify the problems and potential solutions to establishing effective education and competent practice. Individual interviews and focus groups were held in a staged methodological approach where each stage informed the next. In Stage 1 an initial focus group with specialist nurses led to discussion of the findings at a conference workshop. These qualitative data led in Stages 2 and 3, to an online survey with qualitative and quantitative data from Group 1 and Group 2 participants. Analysis of these data enabled the development of semi-structured interview questions for Groups 1 and 2 comprising individual interviews and a focus group (Group 1) and individual interviews with Group 2 participants. Data were analysed using descriptive statistics for quantitative data and thematic analysis for qualitative data using Braun and Clarke’s (2006, 2013, 2022) framework. There was unanimous agreement that there is a problem in leg ulcer management and the problems are multifactorial and centred predominantly in non-specialist areas and most specifically in general practice with hospital practice presenting challenges too. The perceptions were that there is a lack of investment in supporting staff who are trying to manage high and pressured workloads. There is insufficient support for staff to develop knowledge and skills and no structured approach to education or opportunities to consolidate skills following education. Competence is the most commonly used term in relation to clinical practice but there is no clear agreement of a definition of what this means generally or specifically in relation to leg ulcer management practice. Findings from the data enabled a proposed detailed definition of competence and a framework for measuring this competence. Findings also led to a proposed educational structure for leg ulcer management with recommended content. Recommendations for future research are also made to establish further insights and understanding of the nature of leg ulcer management problems and the nature of competent practice.