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Nursing Best Practice Guideline
mobility, over an average of one to three visits to the clinic, and home visits by primary care
nurses. There is also some evidence demonstrating an improvement in the quality of life
resulting from healing of leg ulcers, but again, results are inconclusive.
See Appendix F for a Quality of Life Assessment Tool.
Recommendation • 7
Assess the functional, cognitive and emotional status of the client and family to manage
self-care. (Level of Evidence = C – RNAO Consensus Panel, 2004)
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Communicate with the client, family and caregivers to establish realistic expectations for the
healability of the venous leg ulcers. The basis for a treatment plan begins with the client when
the individual aims of the overall treatment are defined and agreed upon.
The RNAO guideline development panel believes that the presence or absence of a social
support system is important for the treatment and prevention of venous leg ulcers.
Discussion of Evidence:
Pieper, Rossi & Templin (1998) describe how persons with leg ulcers describe interferences
in their functional status and psychological well-being. They experience more pain, less vitality,
more restrictions in physical and social functioning, and poorer general health and limitations
in their physical and emotional roles compared with age-matched cohorts.
Pain and increased sensitivity can serve as a constant reminder of the presence of an ulcer,
and contribute to sleep disturbances and decreased mobility (Liew et al., 2000). In a study where
62 individuals with chronic leg ulcers were interviewed, Phillips et al.
(1994) found the leg ulcer was associated with altered mobility
(81 percent of cases), burdensome care (58 percent), negative
emotional impact on life such as fear, isolation, anger,
depression, and negative depression (60 percent). Pieper et al.
(2000) documented similar findings.