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Bakgrund: Venösa bensår uppkommer till följd av venös insufficiens. Tillståndet förväntas öka i takt med en åldrande befolkning. Behandlingen kan vara tidskrävande och följsamheten är låg. Sjuksköterskan spelar en viktig roll vid behandlingen av dessa personer. Genom att belysa personers upplevelser av att leva med venösa bensår kan kunskap genereras som är nödvändig för att sjuksköterskan ska kunna ge god vård. Syfte: Att belysa personers upplevelser av att leva med venösa bensår. Metod: Litteraturöversikt med riktad innehållsanalys. Analysen utgick från de tre centrala komponenterna begriplighet, hanterbarhet och meningsfullhet i Antonovskys teori om känsla av sammanhang (KASAM). Sökningar genomfördes i tre databaser. Sökord för att leva med kombinerades med sökord för venösa bensår. Träffar begränsades till artiklar publicerade mellan 1 januari 2008 och 31 augusti 2018. Elva vetenskapliga artiklar valdes ut för analys. Resultat: Under tre huvudkategorier formulerades åtta underkategorier. Huvudkategorierna var begriplighet, hanterbarhet och meningsfullhet. I kategorin begriplighet beskrevs upplevelser av att drabbas av venösa bensår, betydelsen av kontroll samt betydelsen av information. Under hanterbarhet beskrevs användandet av resurser och strategier för att hantera livet. Under meningsfullhet beskrevs tillståndets inverkan på människors identitet och självbild, sårens plats i livet samt hur livet med bensår upplevdes på ett emotionellt plan. Diskussion: I resultatdiskussionen lyftes aspekter av tid relaterat till omvårdnad och behandling. Sjuksköterskans betydelse för följsamhet till behandling samt vikten av information och kunskap belystes. Resultatet diskuterades i relation till Antonovskys centrala komponenter samt tidigare forskning. / Background: Venous leg ulcers occur as a result of venous insufficiency. The condition is expected to increase in line with an aging population. Treatment may be time consuming and the adherence to treatment is low. The nurse plays an important role in the treatment of these persons. By highlighting people’s experiences of living with venous leg ulcers, knowledge necessary for the nurse to provide good care can be gained. Aim: To highlight people’s experiences of living with venous leg ulcers. Method: A literature review with directed content analysis. The analysis was based on the three key components in Antonovsky's theory of sense of coherence (SOC): comprehensiveness, manageability and meaningfulness. Searches were carried out in three databases. Keywords for to live with were combined with keywords for venous leg ulcers. Searches were limited to articles published between the 1st of January 2008 and the 31st of August 2018. Eleven scientific articles were selected for analysis. Results: Eight subcategories were presented under three main categories. The main categories were comprehensiveness, manageability and meaningfulness. The comprehensiveness category described experiences of suffering from venous leg ulcers, the significance of control and the importance of information. In the manageability category, the use of resources and strategies to handle life were described. In the meaningfulness category, the impact of leg ulcers on identity and self-image were described. The place of the ulcers in patients’ lives and descriptions of how life with leg ulcers was emotionally experienced were also presented. Discussion: Aspects in relation to nursing and treatment were discussed. Time, adherence to treatment, information and knowledge were highlighted. This was discussed in the light of Antonovsky's core components as well as previous research.

Bakgrund: Venösa bensår är vanligt förekommande åkommor och är idag klassat som ett folkhälsoproblem. Det beräknas att upp till 2% av den vuxna befolkning i världen någon gång i livet kommer att drabbas av venösa bensår. Studier har visat att försämrad livskvalitet, dåligt självförtroende, förändrad kroppsuppfattning och psykisk ohälsa ärvanligt bland patienter med venösa bensår. Syfte: Att beskriva patienters erfarenheter av att leva med svårläkta venösa bensår. Metod: En kvalitativ litteraturstudie utfördes. Databassökningar gjordes i Cinahl och PubMed. En resultatanalys av 9 studier utfördes genom en femstegsmodell av Friberg. Resultat: Tre huvudkategorier med tillhörande tio underkategorier skapades utifrån patienternas erfarenheter. Huvudkategorierna som formades var Livet begränsas, Uppleva psykosociala utmaningar och Söka copingstrategier Konklusion: Denna studie har visat att patienter kan uppleva många negativa erfarenheter av att leva med svårläkta venösa bensår. Genom en ökad förståelse för hur patienterna upplever smärta och psykosociala utmaningar kan sjuksköterskans individanpassning av omvårdnaden underlättas. / Background: Venous leg ulcers are common and are today classified as a public health problem. It is estimated that up to 2% of the adult population in the world at some point in their lives will suffer from venous leg ulcers. Studies show that impaired quality of life, low self-confidence, altered body image and mental illness are common among patients with venous leg ulcers. Aim: To describe patients experiences of living with severe venous leg ulcers.Methods: A qualitative literature study was conducted. Database searches were made in Cinahl and PubMed. Analysis of 9 articles results was performed through a five-step model by Friberg. Results: Three main categories with associated ten subcategories emerged from the patients’ experiences. The main categories were Life is limited, Experience psychosocial challenges and Searching coping strategeis. Conclusion: This study has shown that patients can experience many negative experiences of living with hard-to-heal venous leg ulcers. Through an increased understanding of how patients experience pain and psychosocial challenges, the nurse's individual adaptation of nursing can be facilitated.

Bakgrund: Personer med bensår kan man stöta på inom hela hälso- och sjukvårdssystemet och venösa bensår är en av de vanligaste. De kan vara kroniska och svårläkta, också orsaka smärta för personen. Risken att utveckla venösa bensår ökar även med åldern. Det fattas vetenskapligt underlag och riktlinjer för behandling av venösa bensår men kompressionsbehandling är en vanlig och avgörande faktor som kombineras med att man innan rengör såret genom debridering. Kirurgi och fysisk aktivitet är andra faktorer som kan förbättra läkning. Det krävs kunskap och erfarenhet hos sjuksköterskan i valet och utförandet av behandling.Vården av venösa bensår kan vara besvärande för personen och skapa lidande. Syfte: Att beskriva personers upplevelser av vård vid venösa bensår. Metod: En icke-systematisk litteraturöversikt med 15 inkluderade kvalitativa- och kvantitativa artiklar har gjorts. Artiklar som är publicerade mellan 2011-2021 har inhämtats från CINAHL och PubMed. Samtliga artiklar har genomgått en kvalitetsgranskning innan en integrerad dataanalys gjordes. Resultat: Av de insamlade artiklar framkom det att personers förväntningar av vården intemotsvarade verkligheten. De upplevde den mer tidskrävande och begränsande för sitt sociala och privata liv. Personer hade genomgått många misslyckade behandlingar och kände därför en desperation för att hitta en behandling som botade deras venösa bensår. Personer upplevde att de fått förståelse och kunskap om sitt tillstånd och som var en bramotivation för att följa sin behandlingsplan, dock upplevde personer brister i sjuksköterskans bemötande som försvårade följsamheten. Slutsats: I denna litteraturöversikt framkom det att sjuksköterskor generellt behöver mer kunskap och förståelse för hur de venösa bensåren påverkar personernas livssituation. Ökade kunskaper om själva tillståndet och de olika behandlingsalternativ som finns kunde minska lidandet hos de personer som behandlas och hade en tät vårdkontakt. Detta skulle även öka personcentreringen gällande vård hos personer med venösa bensår och därmed ge förutsättningarna för en bättre vård. / Background Persons with leg ulcers can be encountered throughout the health care system and venous leg ulcers are one of the most common, they can be chronic and difficult to heal and even cause pain. The risk of developing venous leg ulcers also increases with age. There is a lack of scientific basis and guidelines for the treatment of venous leg ulcers, but compression therapy is a common and decisive factor that is combined with a cleansing of the wound with debridement. Surgery and physical activity are other factors that can improve healing. Knowledge and experience of healthcare professionals is required in the selection and performance of treatment. The care of venous leg ulcers can be perceived as difficult and cause suffering. Aim To describe persons’ with venous leg ulcers experiences of care. Method A non-systematic literature review with 15 included qualitative and quantitative articles has been made. Articles published between 2011-2021 have been obtained from CINAHL and PubMed. All articles have undergone a quality review before an integrated data analysis was performed. Results From the collected articles, it showed that person’s expectations of care did not match the reality. They found it more time consuming and limiting for their social and private lives. People had undergone many failed treatments and therefore felt a desperation to find a treatment that cured their venous leg ulcer. People felt that they gained understanding and knowledge about their condition, which was a good motivation to follow their treatment plan. However, people experienced lack in the nurse's treatment that made compliance more difficult. Conclusions In this literature review it is evident that nurses need more knowledge and an understanding about how venous leg ulcers impacts a person’s life. An increased knowledge about the condition and the different treatment options that are available could decrease the suffering the persons are experiencing receiving treatment. This could also increase the person centred care aspects of care when it comes to venous leg ulcers, thus making it possible for a better care.

Introduction: Hard-to-heal leg ulcers are common, especially among the elderly. A leg ulcer is not a disease in itself but a symptom of an underlying disease. Venous insufficiency is the most common cause. The quality of life deteriorates for the patient and the treatment time is often long and resource-intensive for healthcare and society. The district nurse has an important role in the meeting with the patient. With knowledge of the patient's experience of living with hard-to-heal leg ulcers, good care can be provided.   Aim: The aim of this literature study was to describe patients' experiences of living with hard-to-heal leg ulcers.   Method: A descriptive design with a general literature study as a method. The study was based on 17 articles with a qualitative method   Results: The results showed 3 main categories and 15 subcategories. The main categories were living with one's body, a changed everyday life and experience of the care situation. Patients described that it was difficult to identify oneself with a body with wounds. The pain was the most prominent symptom that affected sleep, mental state, and led to physical limitation and activities were limited. Smell, exudate and bandage contributed to feelings of shame. Relationships were affected and many isolated themselves. Patients developed different coping strategies and never stopped hoping for healing. The treatment time was long and the care relationship was of great importance.   Conclusion: Living with hard-to-heal leg ulcers was a subjective experience. The results showed that the wound had a negative effect on the quality of life. The care relationship was of great importance and that it was favorable for wound healing and quality of life when the patient felt seen as a person and was involved in the care. Applying person-centered and holistic care was essential for good nursing.

La Ulcera Venosa (UV) es una patología crónica, que afecta aproximadamente a un 1-2% de la población mayor y adulta en los países desarrollados y demanda, importantes costes, en atención a los tratamientos prolongados y variados, inversión de tiempos por parte de profesionales de la salud, consumo de grandes volúmenes de materiales. Se ha constatado que la calidad de vida relacionada con la salud (CVRS) de las personas con UV está afectada negativamente. La medición de CVRS permite, en gran medida, contribuir a mejorar la calidad del cuidado. En España no se dispone de instrumentos de medida específicos CVRS en personas con UV y de medida de la evolución hacia la cicatrización en pacientes con UV, que hayan sido validados mediante la investigación. Disponer de estas herramientas ayudaría a la toma de decisiones y a aumentar la calidad de los cuidados con este tipo de pacientes. / Objetivo General: Determinar CVRS de los pacientes con UV y analizar como la evolución clínica de la herida influye en las distintas dimensiones de la CVRS, mediante la aplicación de instrumentos específicos de medida para tal fin. / Material y Método: El estudio se realizó en tres fases: FASE 1: Revisión bibliográfica y sistemática en las principales bases de datos de ciencias de la salud MEDLINE (a través PubMed y Webspirs), PsycINFO, COCHRANE, CINAHL, LILACS, FECYT, EMBASE y CUIDEN entre 2003 y 2008. Se utilizaron las palabras clave: Leg ulcer, score, quality of life, instrument and tool, con sus correspondientes conectores booleanos. La calidad de las publicaciones fue evaluada mediante CASP Guide (Critical Appraissal Skill Programme y the JBI SUMARI (The Joanna Briggs Institute 2008) herramienta para la evaluación crítica de estudios cualitativos y cuantitativos. / FASE 2: La versión original del cuestionario CCVUQ, que incluye 21 preguntas, se ha adaptado al castellano siguiendo la metodología de traducción y retrotraducción y el establecimiento de equivalencias semánticas culturales. Se efectuaron ajustes considerados menores a partir de los aportes y las sugerencias de expertos y de los pacientes, que no afectó la esencia, de las preguntas originales, pero necesarios para la comprensión de la población local. / FASE 3: estudio de validación, observacional y de medidas repetidas, durante 6 semanas. Se estima una muestra de 105 pacientes. Se calcula consistencia interna mediante alfa de Cronbach, fiabilidad test-retest entre el inicio y la segunda semana, validez concurrente con el SF12.v2 y sensibilidad al cambio mediante ANOVA de medidas repetidas. Para la validez de constructo se realizó un análisis factorial confirmatorio. / Resultados: FASE 1: 22 estudios fueron incluidos, los cuales utilizaron métodos cuantitativos y cualitativos. El dolor se destacó como el hallazgo más prevalerte que afecta la CVRS en los estudios los instrumentos genéricos más utilizados: SF36 y sus adaptaciones, el Nottingham Health Profile y Euroqol-5. En cuanto a los instrumentos específicas de CVRS en UV se encontraron: Hyland, Cardiff Wound Impact Schedule and Charing Cross Venous Leg Ulcer Questionnaire. Dos nuevos instrumentos específicos para UV fueron encontrados Sheffield Preference-Based Venous Leg Ulcer 5D. Se confirma el impacto negativo de las UV en la CVRS, el cual es medido con una variedad de instrumentos específicos, sin embargo por sus valores psicométricos el más adecuado es el Charing Cross Venous Ulcer Questionnaire CCVUQ. / FASE 2: Se obtuvo una versión satisfactoria de la versión española del CCVUQ que es semántica y culturalmente equivalente a la versión original inglesa. En el proceso de adaptación participó un grupo de expertos en heridas crónicas y un grupo de pacientes con úlceras venosas, quienes a partir de los criterios de evaluación de ítems: precisión, claridad y comprensión asignaron resultados de aceptabilidad en el escenario de aplicación del 94% a la totalidad de los ítems como Índice de Validez de Contenido (IVC). / FASE 3: se incluyen 60 pacientes, en su mayoría mujeres (66,7%), con mediana de edad de 78 años. El 75% de las lesiones eran recurrentes con una antigüedad mediana de 2,14 años. La consistencia interna para el CCVUQ-e es alta (alfa>0,80), para el PUSH-e es baja. Ambos instrumentos tienen buena fiabilidad test-retest (CCVUQ-e ICC: 0,71, PUSH-e ICC: 0,97). Se confirma el modelo factorial de 4 dimensiones. Hay buena correlación entre el SF12.v2 y el CCVUQ-e. La sensibilidad al cambio es buena para los dos instrumentos de medida (diferencia de -44,3 puntos para el CCVUQ-e). / Conclusiones: queda confirmada la validez, fiabilidad y sensibilidad al cambio del CCVUQ-e. En el caso del PUSH-e solo se puede confirmar la sensibilidad al cambio a partir de la segunda semana de tratamiento. Además, se confirma que los pacientes con UV tienen mala CVRS cuando esta es medida con el CCVUQ-e y con el SF12 V2 pero que esta mejora cuando mejora el estado de la UV.

No / To assess clinical outcomes and cost-effectiveness of using a two-layer cohesive compression bandage (TLCCB; Coban 2) compared with a two-layer compression system (TLCS; Ktwo) and a four-layer compression system (FLCS; Profore) in treating venous leg ulcers (VLUs) in clinical practice in the UK, from the perspective of the National Health Service (NHS). METHOD: This was a retrospective analysis of the case records of VLU patients, randomly extracted from The Health Improvement Network (THIN) database (a nationally representative database of clinical practice among patients registered with general practitioners in the UK), who were treated with either TLCCB (n=250), TLCS (n=250) or FLCS (n=175). Clinical outcomes and health-care resource use (and costs) over six months after starting treatment with each compression system were estimated. Differences in outcomes and resource use between treatments were adjusted for differences in baseline covariates. RESULTS: Patients' mean age was 75 years old and 57% were female. The mean time with a VLU was 6-7 months and the mean initial wound size was 77-85 cm2. The overall VLU healing rate, irrespective of bandage type, was 44% over the six months' study period. In the TLCCB group, 51% of wounds had healed by six months compared with 40% (p=0.03) and 28% (p=0.001) in the TLCS and FLCS groups, respectively. The mean time to healing was 2.5 months. Patients in the TLCCB group experienced better health-related quality of life (HRQoL) over six months (0.374 quality-adjusted life years (QALYs) per patient), compared with the TLCS (0.368 QALYs per patient) and FLCS (0.353 QALYs per patient). The mean six-monthly NHS management cost was pound2,413, pound2,707 and pound2,648 per patient in the TLCCB, TLCS and FLCS groups, respectively. CONCLUSION: Despite the systems studied reporting similar compression levels when tested in controlled studies, real-world evidence demonstrates that initiating treatment with TLCCB, compared with the other two compression systems, affords a more cost-effective use of NHS-funded resources in clinical practice, since it resulted in an increased healing rate, better HRQoL and a reduction in NHS management cost. The evidence also highlighted the lack of continuity between clinicians managing a wound, the inconsistent nature of the administered treatments and the lack of specialist involvement, all of which may impact on healing. DECLARATION OF INTEREST: This study was supported by an unrestricted research grant from 3M Health Care, UK. 3M Health Care had no influence on the study design, the collection, analysis, and interpretation of data, or on the writing of, and decision to submit for publication, the manuscript.