Many recommend use of minimally invasive techniques including SEPS to treat and address problems related to chronic venous insufficiency (Kalra & Glovisczki, 2002). Multiple studies confirm the safety and efficacy of SEPS when used early, especially resulting from its low complication rates compared with other procedures including the formerly popular Linton procedures (Kalra & Gloiscki, 2002; Lee, et al. 2003; Tenbrook, et al., 2004; Bianchi, et al. 2003).
More randomized clinical trials are necessary however to answer additional questions related to the efficacy of new procedures including SEPS, though this procedures remains important for patients with advanced CVI secondary to PVI or with patients who do not demonstrate other complications including DVT (Kalra & Gloiscki, 2002; Bianchi, et al. 2003).
Wagner-Cox (2005) also notes that it is important for nurses to be considerate, knowledgeable and compassionate toward patients with acute and chronic illnesses, especially when caring for patients in the home. This sentiment emphasizes research suggesting nurse case managers and other critical staff takes into consideration patient's assessment of their pain and discomfort (Hiser, et al. 2006). Pieper et al. (2006) note that WOCN nurses also have a responsibility to patients to adequately address their self-care concerns prior to preparing patients for discharge after surgery, SEPS or treatment for venous ulcers. This education should include discussion of wound care, incision care, symptom management and pain management and also education regarding the patient's quality of life and prevention of new problems (Pieper, et al. 2006). Education is vital to the long-term success and positive patient outcomes, as unmet discharge needs may contribute "to poor patient outcomes and readmission" (Pieper, et al. 2006: 290).
Summary of Literature
The best treatment for any disease whether acute or chronic is prevention. The literature points to the importance of identifying at risk populations. WOC nurses have a responsibility to screen all patients at risk for developing venous stasis ulcers early and recommending appropriate treatment plans taking into consideration their future risk for developing acute or chronic conditions. While it is impossible to prevent all cases of ulcers, much can be done in the way of prevention.
It is vital nurses receive education in new treatments and techniques for diagnosing, assessing and caring for ulcers. The latest research suggests new surgical interventions including use of the SEPS is ideal for treating patients especially those with long-term or long-standing venous ulcers. Thus far all research related to this area of treatment proves promising. The goals of treatment should include not only treating the immediate problem or ulcers but also working with the patient to identify their specific risk factors and educating patients about ways they can prevent future complications.
As researchers uncover newer technology, so too will newer methods of treating venous stasis ulcers arise to help treat patients more effectively. The role of WOCN nurses will also change. However, their role of educator and caregiver for patients is likely to remain the same. The literature does make a final point noting that discharge is one of the most critical aspects of treatment for venous ulcers and related conditions. It is absolutely essential patients are prepared with the information they need to prevent further illness and treat their current illness in the best manner possible. In that respect, hospitals and other health agencies might consider offering WOCN nurses and other key staff members involved in patient recovery and discharge continuing education to ensure they are abreast of the latest techniques and methods for educating patients prior to discharge from the hospital or other health provider's location.
Areas For Future Research
Much of the current literature available on venous stasis ulcers focuses on new surgical interventions including use of SEPS to treat venous ulcers successfully. The future of research will continue to concentrate on new surgical interventions with an emphasis on non-invasive treatment approaches to help patients with venous stasis ulcers and associated problems (Baranoski & Thimsen, 2003; Doughte et al., 2006; Hiser et al. 2006). New techniques will also target prevention more closely enabling nurses and other staff members to better assess patient risk factors for developing venous stasis ulcers and related conditions.
The future of research may also concentrate more on treating the underlying causes of ulcers including chronic venous insufficiency, long standing varicose veins and more (Doughty et al., 2006; Hiser et al. 2006). It is important caregivers always focus on treating illness to the best of their ability, while at the same time looking into new and innovative ways to prevent disease from impacting the quality of lives of those affected as much as possible. Future research should include deciding the best possible ways to educate staff and nurses working with patients on wound care so they are consistently armed with up-to-date information and data to disseminate to patients before, during and after care. This will help promote a more streamlined health care delivery process and ensure the greater good of all involved in treating venous related problems in the young and old alike.
WOC/ET nurse professionals face many challenges when assisting patients with venous stasis ulcers. Fortunately new technologies have afforded patients better care and treatment alternatives. It is vital that nursing staff embark on continuous education plans to ensure they are armed with the information they need to provide optimal patient care in all situations and settings.
Baranoski, S. & Thimsen, K. (2003, Aug). "Oasis Skin and Wound Integumentary
Assessment Items: Applying the WOCN Guidance Document." Home Healthcare Nurse, 21(8): Supplement 3-13.