Planning exercise interventions as an adjunct treatment in managing venous leg ulcers: A qualitative study of nurses’ perspectives

Objective: To explore clinicians' perspectives regarding strategies to support exercise interventions for people with venous leg ulcers. Design: 1:1 interview was guided by the Behaviour Change Wheel (BCW) to collect thoughts from clinicians with experiences in managing venous leg ulcers. Settings: Clinical nurses in metropolitan/regional Victoria, Australia. Participants: A convenience sample of 21 nurses (mean clinical experience 14 years) was recruited. Methods: We conducted semi-structured remote interviews. Transcripts were coded and analysed using a theory-driven thematic analysis, and interventions to support the implementation of exercise interventions were mapped across the BCW. Results: Strategies related to capability, opportunity and motivation components from the BCW were identified. The strategies reported to be important included: i) education of patients and family members; ii) the provision of consistent and clear exercise advice; iii) setting realistic and meaningful goals in light of challenges encountered by patients; iv) flexibility in how exercise programmes were organised/structured, particularly to facilitate rapid adoption; and v) clinician education. Conclusions: In-depth qualitative interviews of nurses working with people with venous leg ulcers in Australia revealed multifactorial issues that potentially affect prescription of care regarding physical exercise. In order to improve and standardise future clinical practice, a clear focus of future research should address such issues.