No

Bakgrund: Förekomsten av venösa bensår hos den vuxna befolkningen i EU-länderna uppskattas vara mellan 490 000 upp till 1,3 miljoner personer. Den viktigaste behandlingen för att förebygga recidiverande bensår är kompressionsstrumpor. Hos de patienter som inte använder kompressionsstrumpor har risken att få recidiv beräknats vara 100% och hos de som använder strumporna 16%. Patientens livskvalitet påverkas av att det oftast krävs lång vårdtid och behandling av bensåret och att det vanligtvis är ett återkommande problem. Syfte: Att beskriva faktorer som påverkar patientens följsamhet till kompressionsbehandling för att förebygga och behandla venösa bensår. Metod: Studien har genomförts som en litteraturöversikt. Datainsamling har skett genom sökningar i databaserna CINAHL och PubMed. Resultat: Sammanfattningsvis så visar resultatet att det finns flera faktorer som påverkade patientens följsamhet. Patienternas följsamhet minskade till följd av smärtan som orsakades av kompressionsbandaget eller vid såromläggningen. Hos nya oerfarna sjuksköterskor fanns bristande kunskap i hur kompressionsbandaget ska appliceras, hos ett flertal patienter fanns bristande kunskap och förståelse varför kompressionsbehandling var viktigt för att förhindra nya venösa bensår. Appliceringssvårigheter med att ta av och på kompressionsstrumporna, tillit till sjuksköterskan och utseendet på kompressionsstrumporna/bandaget var andra faktorer som påverkade följsamheten. Slutsats: Patientens följsamhet till kompressionsbehandling påverkas av både hämmande och främjande faktorer. Det som sjuksköterskan bland annat kan göra för att påverka patientens följsamhet till kompressionsbehandling är att informera om hur kompressionsbehandling hjälper till med läkningen och egenvårdsråd för att förhindra recidiv. / Background: The incidence of venous leg ulcers in the adult population in the EU countries are estimated to be between 490,000 and 1.3 million. The main treatment for the prevention of recurrent leg ulcers is compression stockings. For those patients who don´t use compression stockings, the recurrence has been calculated to be 100% and for those who used the socks 16%. Patient's quality of life is affected by the fact that it is usually required long care and treatment of the leg and that it is usually a recurring problem. Aim : To describe factors that affect patient compliance with compression therapy to prevent and treat venous leg ulcers. Methods: The study has been carried out as a litterature review. Data collection has been done through searches in the CINAHL and PubMed databases. Results: In summary, the result shows that there are several factors that affected the patient's compliance. Patient compliance decreased as a result of the pain caused by the compression bandage or by the wound dressing. At new inexperienced nurses were lacking in knowledge of how the compression bandage should be applied, in several patients there was a lack of knowledge and understanding why compression treatment was important to prevent new venous leg ulcers. Difficulty in applying and removing the compression socks, trust in the nurse and the appearance of the compression socks / bandage were other factors that affected compliance. Conclusion: The patient's adherence to compression treatment is affected by both inhibitory and promotional factors. What the nurse can do, among other things to influence the patient's adherence to compression therapy is to inform about how compression treatment helps with the healing and self-care advice to prevent recurrence.

Introduction This thesis describes a research study designed to examine the consequences of disability arising out of spinal cord compression secondary to cancer, and to examine the rehabilitation services available to patients. Research aims and questions The study was intended to achieve the following: 1. To ascertain what might constitute effective rehabilitation interventions for patients with metastatic spinal cord compression. 2. To identify the conditions in which these intervention might be delivered. 3. To ground proposals in spinal cord compression patients’ experience of disability. The following research questions were posed: 1. What are the consequences of disability for patients with metastatic spinal cord compression? 2. What strategies do patients themselves use to manage disability? 3. What do health care staff, particularly rehabilitation professionals, understand to be the consequences of disability for this patient group, and correspondingly, what are their views on the significance and provision of rehabilitation? 4. To what extent is rehabilitation being provided to these patients, and with what effect? 5. Where rehabilitation is not being provided, why is this the case? Study design The study had two components: • A series of nine in-depth interview-based case studies, which involved talking to patients about their experiences of living with spinal cord compression, as well as gaining the perspectives of family members and the health professionals who provided care and services. • A retrospective audit of the medical records of 73 spinal cord compression patients admitted to a radiotherapy in-patient unit (the Frank Ellis Unit at the Churchill Hospital in Oxford) over a two year period (July 2003 – June 2005), identifying disability-related problems and the measures taken to address them. This was a Phase I modelling study in terms of the Medical Research Council’s framework for evaluating complex interventions, with Pawson and Tilley’s (1997) Context-Mechanism-Outcome configuration adopted as a conceptual basis for data collection. Within-case analysis was informed by George and Bennett’s (2004) account of process tracing, and between-case analysis was modelled on the constant comparative method of Glaser and Strauss (1967) with an analysis of narrative as a variation on that theme. Results Disability is a serious problem for patients with spinal cord compression, but it is one problem among many others, not the least of which are the physical and emotional consequences of life-threatening illness. In response to disability, patients ‘twin-track’ their attitudes to it, acknowledging but also resisting the idea of themselves as disabled, and adopting a series of psychological devices to manage the tension. In effect, patients recognise that something significant has changed and that, as a consequence, new self-management skills must be learned, functional boundaries must be explored, useful information must be sought. At the same time, they display a determination to hold on to an established identity, associated with a sense of normality. This identity embraces the idea of competence and resourcefulness, the events, activities and pleasures that one looks forward to, and the wish to avoid burdening others. It is not a ‘disabled’ identity. To some extent, these two attitudes are in tension, as one acknowledges disability while the other, implicitly or explicitly, resists it. Consequently, patients try to find ways of resolving this tension, by ‘revising downwards’ their expectations, by constantly deferring the anticipated pleasures, and by avoiding situations in which their abilities might be put to the test, or the sense of normality be disconfirmed. Health care professionals are likely to construe the patient’s response as indicative of a certain type of character – ‘realistic’ on one hand, and ‘unrealistic’ on the other. They do not see ‘acknowledging / not acknowledging’ as twin facets of a complex response to circumstances, or as something which every patient engages in to one degree or another. Patients are motivated not to recognise rehabilitation as something they need, a view which is confirmed by the cursory form of rehabilitation experienced in hospital, and by the marginal significance attributed to it by nursing and medical staff. On discharge, hospital staff assume that rehabilitation needs will be identified in the community, although the way in which community rehabilitation services are organised virtually guarantees that this will not happen, unless a specific referral is made (as it is in only 5% of cases). The patient, meanwhile, remains unaware of the potential value of rehabilitation, and has no incentive to request rehabilitation if no-one offers it. They are consequently unprepared for life post-discharge, and assume that they (and their families) must manage on their own. Conclusions Like the patients, health care professionals may have to ‘twin-track’ if they are to provide rehabilitation in a way that is acceptable to patients with metastatic spinal cord compression. Instead of categorising patients as ‘realistic’ or ‘unrealistic’, they should work towards sustaining patients’ ‘positive illusions’, while at the same time taking whatever opportunities arise to enhance the patient’s day-to-day ability to function in a ‘safe’ space. This entails revising some deeply entrenched ideas about working with patients who have a disability: patient-centredness, the importance of goal setting, and the need for adjustment.