Beyond hospital walls: patient and nurse perspectives on training and implementing venous leg ulcer care in the community

What is it about?

Aims (1): To implement community-based compression bandaging for venous leg ulcer (VLU) patients using the Implementation Research Logic Model (IRLM) and train community nurses. (2) To evaluate patient and nurse perspectives on satisfaction, confidence and outcomes. Background: In Singapore, compression bandaging for VLUs has been limited to tertiary care due to inadequate community nurse training, therefore a structured program was developed to bridge this gap. Methods: This quasi-experimental study evaluated the implementation outcomes of a structured training program on two and four layer compression bandaging in community settings. Patients were given the choice to receive compression bandaging in either community or tertiary care settings. The program included theoretical training, clinical attachments, and competency-based assessments. Guided by the IRLM, facilitators and barriers to community-based care were identified through multiple channels, including intervention characteristics, settings, processes, the referral system and experience by patients and nurses. Patient outcomes, training effectiveness and experiences were assessed after 12 weeks. Results: 27 out of 47 patients opted for community-based bandaging; 15 completed follow-up, with nine achieving complete ulcer healing (median wound area reduction: −2.272 cm squared, p = 0.003). Patients reported consumable cost saving S$339.50 (median)and time savings to commute to the tertiary care centre. There was mixed confidence in the performance of community nurses. Fifteen community nurses completed the training, with half of them strongly supporting its utility. Discussion: Community-based compression bandaging is feasible and effective in addressing VLU care gaps. It improves access, enhances outcomes and reduces costs through training and collaboration between tertiary and community teams. Conclusion and implications for nursing and/or health policy: This initiative empowers community nurses with advanced skills and offers a scalable, cost-effective model to extend specialised care into the community. Aligning subsidy structures and decentralising healthcare supports equitable, sustainable care delivery and improved patient outcomes.

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