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Nursing Best Practice Guideline
Zink et al. (2000) recommend a guided interview to obtain the history most pertinent to the
cause of the ulcer, explaining that while the client may be able to relate important symptoms,
living with a chronic disease often blunts the ability to be discriminatory. Zink et al. (2000)
further adds that the initial encounter with the client is critical to establishing a positive,
therapeutic relationship. Establishing trust is instrumental for successful client outcomes,
particularly as venous leg ulcers often involve a lengthy healing time.
Misdiagnosis of ulcers can cause harm or lead to long periods of inappropriate treatment. It
is therefore important to have an accurate diagnosis of ulcer etiology (NZGG, 1999). Despite this,
there is only one population study that has systematically investigated and published data
on the etiology of identified ulcers.
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Recommendation • 3
Information relating to ulcer history should be documented in a structured format.
(Level of Evidence = C – RNAO Consensus Panel, 2004)
An ulcer history should include:
The year first ulcer occurred.
Site of ulcer and of any previous ulcers.
Number of previous episodes of ulceration.
Length of time taken to heal in previous episodes.
Length of time with no recurrence of ulcers.
Past treatment methods (both successful and unsuccessful).
Previous operations on venous system.
Previous and current use of compression hosiery.
Discussion of Evidence:
Although no specific evidence was cited, the Royal College of Nursing (1998) supports the
theory that collection of data in a structured format will enable consideration of clinical factors
that may have an impact on treatment and healing progress, as well as provide baseline
information on ulcer history. They cautioned, however, that a diagnosis of ulcer type should
not be made solely on this information.