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Living with a venous leg ulcer: Lived experiences and the presence of self-care in daily life
Linnaeus University, Faculty of Health and Life Sciences, Department of Health and Caring Sciences.ORCID iD: 0000-0001-7875-0985
2024 (English)Doctoral thesis, comprehensive summary (Other academic)
Sustainable development
SDG 3: Ensure healthy lives and promote well-being for all at all ages
Abstract [en]

Aim: The overall aim of this thesis was to describe the lived experiences of patients with hard-to-heal venous leg ulcers before and after healing, as well as the understanding of the role and presence of self-care activities in ulcer management.

Methods: The thesis is based on four studies, with differing designs. In Studies I and II, a phenomenological approach was used. To describe lived experiences of undergoing ulcer management, 16 persons were interviewed (I), and to describe lived experiences of daily life after healing,15 persons were interviewed (II). Study III was a registry-based, quantitative study. In total, data from 699 patients with venous leg ulcers(VLUs) were analyzed. Logistic regressions were performed to describe associations between advice given on self-care and its impact on ulcer healing. Study IV, which focused on patient experiences of the feasibility of an intervention for self-care, was based on eleven interviews with six patients with VLUs. The data from the interviews underwent qualitative content analysis.

Results: Ulcer management aims at ulcer healing. In the protracted process, patients often experience hopelessness. When healing is slow, patients doubt the professionals’ knowledge. A patient’s trust in professionals and the entire healthcare system may erode if treatment and information vary between different professionals (Study I). Study II revealed that daily life after healing was still strongly affected by the ulcer. Memories from a lost period in life were ever-present. Life after healing was changed – for some, life was not very eventful. The patients’ own knowledge was often limited, and there was a struggle to do what was best for the own body to prevent a new ulcer. Study III revealed that advice on nutrition and physical activity had no impact on healing time. Only 44% of the sample were advised on both nutrition and physical activity. It was common to have an ulcer for a long time before seeking help; about half of the sample had an ulcer for >84 days before registration. Other findings were that the median age among the 699 patients was 77 years, the majority were female, and comorbidity was common. The intervention tested in Study IV offered welcomed information. However, even among those experiencing some sense of recognition, the link to their own situation and life was unclear. The technical solution with videos on a flash drive was difficult for most people to use. The importance of close cooperation with professionals was highlighted.

Conclusion: Venous leg ulcers have a profound impact on patients and their life situations. Ulcer management can, in different ways, impose suffering on patients. Not being listened to or seen as a person is anexperience that leaves its marks on a patient. When healing is slow, and someone has to be blamed, relationships with professionals are damaged. The role of self-care is unclear for most patients, which makes self-care harder. Those who tried a video-based intervention for self-care showed difficulties in relating it to their own life. Enabling a caring relationship can enhance patients’ understanding of information and advice. Patients must be invited to share their own experiences, to create a foundation for self-care. The provision of advice alone is not the solution to the issues related to self-care.

Place, publisher, year, edition, pages
Växjö: Linnaeus University Press, 2024. , p. 96
Series
Linnaeus University Dissertations ; 527
Keywords [en]
caring relationship, intervention, lifeworld, lived experiences, self-care, suffering, ulcer management, venous leg ulcer
National Category
Nursing
Research subject
Health and Caring Sciences, Caring Science; Health and Caring Sciences, Caring Science
Identifiers
URN: urn:nbn:se:lnu:diva-129427DOI: 10.15626/LUD.527.2024ISBN: 9789180821612 (print)ISBN: 9789180821629 (electronic)OAI: oai:DiVA.org:lnu-129427DiVA, id: diva2:1860142
Public defence
2024-06-14, IKEA-salen, hus N, Georg Lückligs väg 3, Växjö, 13:00 (Swedish)
Opponent
Supervisors
Funder
The Kamprad Family Foundation, 20190132Available from: 2024-05-24 Created: 2024-05-23 Last updated: 2024-06-03Bibliographically approved
List of papers
1. Experiences of undergoing venous leg ulcer management: A reflective lifeworld research study
Open this publication in new window or tab >>Experiences of undergoing venous leg ulcer management: A reflective lifeworld research study
2023 (English)In: International Wound Journal, ISSN 1742-4801, E-ISSN 1742-481X, Vol. 20, no 6, p. 1857-1865Article in journal (Refereed) Published
Abstract [en]

Venous leg ulcers have multiple consequences for the patient. Ulcer management can be lengthy and recurrence is common. As the patient is the expert on their experiences and life, the aim of the present study was to describe patients' lived experiences of undergoing management for a venous leg ulcer. The study encompassed 16 phenomenological interviews. The analysis led to a description of the phenomenon's essence, further described by three constituents. The essential meaning of the phenomenon is described as being in an oscillation between hope and despair. Ulcer management is challenging for the patient, who feels unseen and lives with doubts during the management period. This study is considered enriching as it puts words to the patients' suffering during ulcer management and shows that reliable relationships and competence can reduce patient doubts. This knowledge should enable improvement of patient care and treatment during ulcer management.

Place, publisher, year, edition, pages
John Wiley & Sons, 2023
National Category
Nursing
Research subject
Health and Caring Sciences, Nursing
Identifiers
urn:nbn:se:lnu:diva-117730 (URN)10.1111/iwj.14044 (DOI)000914185900001 ()36457152 (PubMedID)2-s2.0-85143762876 (Scopus ID)
Funder
The Kamprad Family Foundation, 20190132
Available from: 2022-12-02 Created: 2022-12-02 Last updated: 2024-05-23Bibliographically approved
2. Daily life after healing of a venous leg ulcer: A lifeworld phenomenological study
Open this publication in new window or tab >>Daily life after healing of a venous leg ulcer: A lifeworld phenomenological study
2022 (English)In: International Journal of Qualitative Studies on Health and Well-being, ISSN 1748-2623, E-ISSN 1748-2631, Vol. 17, no 1, article id 2054080Article in journal (Refereed) Published
Abstract [en]

PURPOSE

Venous leg ulcer is a recognized condition, affecting people globally. Ulcers mainly affect the elderly and recurrences are not uncommon. There is knowledge about life with venous leg ulcers, but the situation after healing is unexplored. This paper explores and describes meanings of experiences of daily life after healing of a hard-to-heal venous leg ulcer.

METHODS

Lived experiences of 15 individuals with healed hard-to-heal venous leg ulcers generated data for this study. Interviews were recorded for analysis using a reflective lifeworld research approach. An essence emerged, further described by its constituents.

RESULTS

Memories of a difficult time with leg ulcer were ever present, in a way becoming part of the self. A striving for control in daily life entailed a struggle to do what was best for the own body. After healing, a new normal emerged in daily life, a reality that encompassed the risk for a new ulcer. The body had changed physically, with marks alongside those from ageing, in a life that still went on.

CONCLUSIONS

For those who had healed from a venous leg ulcer, life had changed. Even if they referred to life as normal, it was not the same normal as before.

Place, publisher, year, edition, pages
Taylor & Francis, 2022
Keywords
life change events, life experiences, qualitative research, varicose ulcer, wound healing
National Category
Nursing
Research subject
Health and Caring Sciences, Caring Science
Identifiers
urn:nbn:se:lnu:diva-110904 (URN)10.1080/17482631.2022.2054080 (DOI)000771405800001 ()35306967 (PubMedID)2-s2.0-85126794673 (Scopus ID)2022 (Local ID)2022 (Archive number)2022 (OAI)
Funder
The Kamprad Family Foundation
Available from: 2022-03-21 Created: 2022-03-21 Last updated: 2024-05-23Bibliographically approved
3. Associations between self-care advice and healing time in patients with venous leg ulcer – a Swedish registry-based study
Open this publication in new window or tab >>Associations between self-care advice and healing time in patients with venous leg ulcer – a Swedish registry-based study
Show others...
2024 (English)In: BMC Geriatrics, E-ISSN 1471-2318, Vol. 24, no 1, article id 124Article in journal (Refereed) Published
Abstract [en]

Background Venous leg ulcers take time to heal. It is advocated that physical activity plays a role in healing, and so does the patient’s nutritional status. Additionally, malnutrition influences the inflammatory processes, which extends the healing time. Therefore, the staff’s advising role is important for patient outcomes. Thus, this study aimed to investigate the associations between given self-care advice and healing time in patients with venous leg ulcers while controlling for demographic and ulcer-related factors.

Methods The sample consisted of patients registered in the Registry of Ulcer Treatment (RUT) which includes patient and ulcer-related and healing variables. The data was analyzed with descriptive statistics. Logistic regression models were performed to investigate the influence of self-care advice on healing time.

Results No associations between shorter healing time (less than 70 days) and the staff´s self-care advice on physical activity was identified, whilst pain (OR 1.90, CI 1.32–2.42, p < 0.001) and giving of nutrition advice (OR 1.55, CI 1.12–2.15, p = 0.009) showed an association with longer healing time.

Conclusions Neither self-care advice on nutrition and/or physical activity indicated to have a positive association with shorter healing time. However, information and counseling might not be enough. We emphasize the importance of continuously and systematically following up given advice throughout ulcer management, not only when having complicated ulcers.

Place, publisher, year, edition, pages
BioMed Central (BMC), 2024
National Category
Nursing
Research subject
Health and Caring Sciences, Nursing
Identifiers
urn:nbn:se:lnu:diva-127439 (URN)10.1186/s12877-024-04660-8 (DOI)001155895500003 ()2-s2.0-85183682041 (Scopus ID)
Funder
Linnaeus University
Available from: 2024-02-02 Created: 2024-02-02 Last updated: 2024-05-23Bibliographically approved

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