Why patients do not comply with compression bandaging

Abstract

The aim of this study was to explore the perceptions of patients presenting with venous leg ulceration who were labelled as 'non-compliant' with compression bandaging by district nurses. A hermeneutic approach was taken and 14 patients with chronic venous leg ulceration were interviewed. Six themes emerged from the data: (1) lay perceptions of the cause and healing of leg ulceration, (2) concurrent problems of leg ulceration, (3) dilemmas of treatment, (4) perceptions of healthcare professionals, (5) the need for health education, (6) what it is like living with a leg ulcer. Patients did not have a clear understanding of their condition or treatment regimes. Concurrent problems associated with compression bandaging included pain, leakage of exudate and skin irritation, and these symptoms adversely affected patients' lifestyles and contributed to 'non-compliance'. Patients acknowledged that acceptable care was given in the community. However, they said that healthcare professionals misunderstood how their physical and psychological problems affected them, which in turn led to disagreements and disempowerment. Finally, it was apparent that patients were lacking in information relating to their condition and treatment. This study identified that many aspects of patients' perceptions of their condition and treatments influenced their ability to tolerate compression bandages. Non-compliance is a multivariant concept in which both physical and psychological determinants play a key role. Nurses need to gain a clear understanding of patients' concurrent physical problems and perceptions of their health beliefs.

The prevalence, aetiology and management of wounds in a community care area in Ireland

“…There are patient-related factors that should be considered as they can influence the management of care. These factors should also be acknowledged and addressed by the healthcare provider to ensure that the selected dressing enhances the quality of patient care (Edwards, 2003;Finlayson et al, 2010). The findings of this study clearly demonstrate that dressing selection caused some confusion among CRGNs and PHNs regarding the most appropriate dressing to apply to infected wounds and exudating wounds.…”

Physical Activity and Adherence to Compression Therapy in Patients With Venous Leg Ulcers

“…A study by Edwards 27 concluded that many patients do not have a clear understanding of their condition or the treatment regimes prescribed. In addition, Edwards 27 indicated that concurrent problems associated with compression bandaging (eg, pain, leakage of exudates, and skin irritation) contribute to nonadherence. In a study by Kiev et al, 28 socioeconomic factors, cosmetic reasons, concerns about discomfort, and difficulty in putting on the stockings were identified as primary reasons for nonadherence.…”

Painful leg ulcers: community nurses’ knowledge and beliefs, a feasibility study

“…Allodynia is a likely characteristic of neuropathic pain (Wall, 1991); therefore, applying a tight heavily layered bandage can be expected to cause further pain. Others have also reported that patients take off their bandages to reduce discomfort (Edwards, 2003;Herber et al, 2007). Both hyperalgesia and allodynia, if present, would cause a significant amount of pain if a bandage were being applied to the area, regardless of correct or appropriate application.…”