Self-management to prevent recurrence in venous leg ulcers: A concept analysis

The recurrence of venous leg ulcers (VLUs) is of concern to both patients and health care systems, with large amounts of resources being consumed by this chronic condition. Self-management has been recommended to decrease the recurrence of VLUs. However, this concept has not been clearly defined in VLU recurrence prevention. The aim of this concept analysis was to describe self-management in VLU recurrence prevention, and explore the terms used and their application in preventing VLU recurrence. Using Walker and Avant's method of concept analysis, 19 articles were systematically reviewed. The primary term used was that of self-care. The defining attributes included (a) completing preventative tasks of compression, elevation and exercise; (b) lifelong compliance with preventative tasks by patients; (c) internal factors of understanding why tasks are needed, and motivation/belief they will help prevent recurrence, hence changing routines/lifestyles; (d) environmental support through local health care systems and support systems, while avoiding risk. Inconsistent terminology use can cause communication issues within wound management as well as multidisciplinary teams. Although self-management is evolving, its development may have been constrained by the medical model, which emphasises compliance with direct preventative tasks for this chronic condition. There is minimal focus on external or environmental factors that support behaviour change. The use of the term self-management may be more beneficial to communication between professions as it aligns with the chronic disease research. Presently the concept focuses on concordance of the patient with completing the preventative tasks of lifelong compression, elevation and exercise/mobility. The person's beliefs and understanding that compliance with these tasks will reduce the risk of recurrence, and hence, lifelong changes to routines, habits and lifestyles must be made by the person.