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Chronic leg ulcers influence the daily lives of patients. Besides the burden of therapy, research results in the field of quality of life indicate constraints in the psychological, physiological, occupational and social parts of life. In order to take an active role in coping with the chronic disease, patients need knowledge and information that account for individual needs. Therefore our study had the objective to describe the lived experience of patients with leg ulcer and their corresponding needs for patient education. We used a qualitative study design. In a first step we made five narrative interviews. In a second step we made seven interviews using an interview guide that was based on results of the narrative interviews. Participants were recruited in two regions in Germany via two specialist practices and a hospital. We used a purposeful sampling strategy in order to account for the heterogenity of the patient group. Data was analysed using the content analysis approach by Mayring. Our analysis identified 4 interconnected main categories: living with the illness, experiences of wound care, being an expert, and educational needs. Patients are trying to integrate their illness into daily life and maximize their independence. They prefer individual counselling during regulartreatment to group counselling or meetings with other leg ulcer patients. Overall the described problems and solutions illustrate the complexities of the disease and its care.

Patient-centred information is orientated on the needs. The main objective of such information is coping with every-day life and learning to live with the chronic disease. Regarding the current knowledge, such information does not exist in German speaking countries for people suffering from venous leg ulceration. In order to generate the subject matter of such information, a literature search and a secondary analysis of 27 transcripts of interviews, given by people living with chronic leg ulceration, were conducted. Both analyses show the complex impact of leg ulceration on every-day live. The dimensions competences in every-day live, knowledge, techniques and skills and the meaning of family were generated. The secondary analysis points out that family members are an important part of the supporting system and are concerned by effects of chronic disease as well. After long-lasting disease-experience people consider themselves as experts. They obtain special competences in dealing with their disease and judge their experience-based knowledge higher than the knowledge of healthcare professionals. The participants describe individual concepts about their disease. Medical knowledge constitutes just one source of knowledge among others. People know about alternative medicine and use it. They feel that the healthcare professionals do not take them seriously in most cases. Patient-centred information can be a guide to people suffering from venous leg ulceration and their family members, but also a support for healthcare professionals to reflect their professional behaviour and understanding.

In the wound documentation of pressure sore and leg ulcer the most important tasks and objectives are the presentation of the outcomes of the diagnostic inspection, planning of therapy and evaluation of wound healing. The aim of the systematic literature review covering the period of time between 2001 and 2006 was to look for valid, reliable and feasible methods to the size, appearance, edge, grade, and healing of wounds. Due to their heterogeneity the studies that were found can hardly be compared; some of them show methodological weaknesses. Measurements of an elliptical area based on the perpendicular method using a ruler are the most reliable within the linear methods; however, they only allow an estimation of the size. Together with mechanical or digital planimetry tracings can measure the wound's size reliably. Photographs do not assess large or circular wounds reliably, nor do they adequately document the wound's colour. There are no valid and reliable standardized procedures for the documentation of the wound's colour, exudate, odour; margins and maceration. To describe the pressure sore's degree of severity there are twenty different systems of classification. The data, however, confirm the difficulty to classify pressure ulcers reliably. Wound healing can also be assessed by a number of standardized tools: PSST, PUSH, SWHT, SS, PUHP, CODED and DESIGN (pressure sore) and LUMT (leg ulcer). These tools have not been translated into German and have not been adequately researched. No data exists to allow generalization concerning the practicability of these methods. For all methods of measurement, it can be concluded that training and experience in the use of the method is required and that the validity and reliability are higher when measurements are conducted by an experienced person.

Poor rates of healing and high rates of re-ulceration are characteristic of venous leg ulcer. The performing of special health-deviation self-care is important for the successful treatment and prevention of this chronic disease. This study aimed to validate a newly designed instrument for the measurement of specific self-care. The "Wittener Aktivitätenkatalog der Selbstpflege bei venös bedingten offenen Beinen" (WAS-VOB) (a catalogue containing self-care activities for venous leg ulcer) was conceptualized on the basis of Orem's theory and on pathophysiological processes. The items were created by using patient interviews (n = 20) and a literature review. An analysis of the reliability was used to reduce the raw scale. The quality of the WAS-VOB was assessed for face-validity (n = 6), feasibility (n = 8), test-retest-reliability (n = 60) and the internal consistency (n = 234). The involvement of patients was based on an informed consent. The WAS-VOB is a self-describing instrument, includes 59 self-care activities and describes those in eight scales which deal with "general compression", "wearing compression bandages", "wearing compression hosiery", "mobility", "temperature", "overload of the venous system", "prevention of skin damage" and "wound healing". The WAS-VOB is practicable and has good psycho-metric characteristics. The test-retest-coefficient (Kendall's tau b) is 0.58, Cronbach's alpha 0.72. The instrument WAS-VOB is suitable for the assessment of self-care deficits.

The aim of this study was to provide reliable data on prevalence of leg ulcers in home-care setting. A descriptive explorative cross-sectional design was used. In March 2000, a randomised sample of 520 community home nursing services in North-Rhine Westphalia was sent a standardised questionnaire. Apart from questions about the type of service provider and its geographical population, demographic patient data and information about duration and cause of ulcer was collected. The findings based on the data gathered from 161 nursing home-care services caring for a total 12,156 patients. The overall prevalence was 2.68% (+/- 0.29%) for leg ulcers in home-care setting. The median age of the 326 affected patients was 77.5 years. Women are more than twice as often affected as men, which could be due to the longer life-expectancy for women. A major problem for home nursing services, however, is the large number of leg ulcers of unknown origin. This was the case in almost a quarter of the sample. Depending on the causal factors, compression therapy is of paramount importance and crucial to the successful outcome of the treatment of the leg ulcer. The markedly chronic nature of leg ulcers is again confirmed by this study. Currently, leg ulcers have an average duration of ten months. However, it is not unusual for affected patients to suffer for years or even decades. Almost 80% of patients had their ulcer dressed once a day by the nursing home-care service.