A study of patient and nurse factors influencing sub-bandage pressure
This thesis describes an investigation of sub-bandage pressure (SSP). It examines the characteristics of the Strathclyde Pressure Monitor, which incorporates a fluid-filled sensor and a piezo-electric transducer. The sensor volume was minimised, the variation in output with change in sensor position eliminated, and the time response of the system reduced. The impact of changes in foot position on SSP was investigated using two compression bandages. The pressure at a site depended upon the interaction between the type of bandage (elastomeric or non-elastomeric) and the position of the foot. The impact of changes in subject posture on SSP was studied. The SSP increased as the subject stood, from sitting. There was no consistent pattern in pressure change as the subject sat up from lying supine. The sub-bandage pressures of patients with active venous ulcers were monitored at two sites on the leg for seven days. There was a decrease in SSP upon standing, in contrast to normal volunteer studies. Three series of experiments investigated the impact of training in bandaging on SSP. A pilot study of 18 nurses assessed SSP on normal legs before and after training, as well as using a bandage printed with an extension guide. After training, significantly more nurses achieved acceptable pressure profiles. An additional 48 nurses were trained using three bandages (two elastomeric and one non-elastomeric). Training improved bandaging technique but more nurses applied satisfactory bandages with the elastomeric bandages than with the non-elastomeric bandage. In the final investigation, 224 community nurses were trained applying a two-layer and a 4-layer compression system. After training, a higher proportion of nurses applied the 4-layer in a satisfactory manner. This research highlights the different response to posture between patients and normal subjects, and the variable impact of training on nurses depending on the bandage system.