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Often people peruse a book with the question ‘Is this for me?’ So what is your purpose in picking up this book? What are you hop-ing to gain or change? You certainly must have an interest in leg ulcers, otherwise you would not have sought out or reached for this book.
Simply because of that interest, the authors are interested in you, in your ambition and in what changes you want to be part of. This book has been written with you in mind. You are likely a community nurse or therapist who wants to manage people with lower limb con-ditions more ef f ectively, and perhaps you would like to place a greater emphasis on partnership working with your patients and colleagues.
With our collaborative experience and clinical expertise, gained in the classroom and in the mentoring of specialists, our aim is to help you increase your knowledge and skill set so that you can improve the lives of your patients and bring about the change the healthcare system and our citizens deserve.
Lower limb management is not just for nurses it needs to involve multidisciplinary teams. There is certainly a groundswell of change being advocated in the world of leg ulcer management and the authors are keen to support this. Improving understanding and developing specialist skills require teamwork, so Accelerate CIC has partnered with key allies in the NHS, King’s College London and the Welsh Wounds Innovation Centre to write this book. This has been an exciting collaboration to be part of.
As I write this preface, I am reminded that this is my 35th year of a focus on improving the lives of people with leg ulcers. It is exciting to see recent developments and the establishment of the National Wound Care Strategy. There is a growing body of evidence about the costs of wound care for both people and the health economy there is a recognition of the drain that unhealed leg ulcers are on our
resources and lives. I do believe we are making national progress.
Yet the story underpinning leg ulcer management can sometimes feel as if nothing has changed since I started my journey in 1989. The health system continues to perpetuate avoidable patient harm through system paralysis and a lack of understanding of the extent of the damage to patients and clinicians.
And this harm is avoidable. The system must focus on develop-ing skilled practitioners, optimising compression therapy, safeguard-ing escalation to specialist practitioners and ensuring that access for biomechanical assessment is addressed. If not, then our patients may well continue to suf f er life- changing events, potentially leading to sepsis and even death. This is completely unnecessary, and we do not need more research to tell us what to do to prevent this or how to improve the lives of our citizens. The resources used to prop up a poor system are costly to all.
Unfortunately we have a narrative that reinforces a negative view of people with leg ulcers. I have witnessed 35 years of a damag-ing story, a powerful and inf l uential narrative that has led to an acceptance of chronicity and to delays in treatment, allowing non- healing wounds to hit crisis point with inadequate resources to man-age them. This false narrative says that leg ulcers are inevitably ‘chronic’, that it is the non- compliance of patients that hinders heal-ing and that nurses should be afraid of doing harm by using compres-sion. Products have been adapted to ref l ect this false narrative there has been a growth in sub- optimal compression devices alongside hundreds of unnecessary wound dressings designed to promote the healing that has so far eluded us.
Meanwhile the prevalence of non- healing persists and grows, using up 50% of community nursing workload. This all- pervasive story hinders the healing of lower limb wounds and is the reason behind the writing of this book. The book aims to bring together the multidisciplinary knowledge and insight required to ef f ectively man-age lower limb conditions, and it aims to support you, the practi-tioner, in developing the courage you need to counter this pervasive narrative. Together we can indeed improve lower limb management by simply using our skills and knowledge.
This level of understanding is necessary to create conf i dence in your growing expertise. It will enable you to have good conversations with your patients and to consider the next steps in partnership with
them. The language this book promotes should give you clarity, con-f i dence and courage alongside professional humility – recognising that we have much to learn from our patients. This book will hope-fully assist in growing your resolution to deliver the expert compas-sionate care required alongside conf i dence to challenge the system.
Your expanding knowledge will enable you to act as an advocate for your patients and your colleagues, and to champion an improved health system.