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Associations between self-care advice and healing time in patients with venous leg ulcer – a Swedish registry-based study
Linnaeus University, Faculty of Health and Life Sciences, Department of Health and Caring Sciences. Halmstad University, Sweden.ORCID iD: 0000-0001-7875-0985
Linnaeus University, Faculty of Health and Life Sciences, Department of Health and Caring Sciences.ORCID iD: 0000-0003-1020-5141
Linnaeus University, Faculty of Health and Life Sciences, Department of Health and Caring Sciences.ORCID iD: 0000-0003-4630-7385
Region Kalmar, Sweden;Linköping University, Sweden.ORCID iD: 0000-0002-6278-1362
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2024 (English)In: BMC Geriatrics, E-ISSN 1471-2318, Vol. 24, no 1, article id 124Article in journal (Refereed) Published
Sustainable development
SDG 3: Ensure healthy lives and promote well-being for all at all ages
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. Vol. 24, no 1, article id 124
National Category
Nursing
Research subject
Health and Caring Sciences, Nursing
Identifiers
URN: urn:nbn:se:lnu:diva-127439DOI: 10.1186/s12877-024-04660-8ISI: 001155895500003Scopus ID: 2-s2.0-85183682041OAI: oai:DiVA.org:lnu-127439DiVA, id: diva2:1834040
Funder
Linnaeus UniversityAvailable from: 2024-02-02 Created: 2024-02-02 Last updated: 2024-07-04Bibliographically approved
In thesis
1. Living with a venous leg ulcer: Lived experiences and the presence of self-care in daily life
Open this publication in new window or tab >>Living with a venous leg ulcer: Lived experiences and the presence of self-care in daily life
2024 (English)Doctoral thesis, comprehensive summary (Other academic)
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
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:nbn:se:lnu:diva-129427 (URN)10.15626/LUD.527.2024 (DOI)9789180821612 (ISBN)9789180821629 (ISBN)
Public defence
2024-06-14, IKEA-salen, hus N, Georg Lückligs väg 3, Växjö, 13:00 (Swedish)
Opponent
Supervisors
Funder
The Kamprad Family Foundation, 20190132
Available from: 2024-05-24 Created: 2024-05-23 Last updated: 2024-06-03Bibliographically approved

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Rosenburg, MarcusTuvesson, HannaLindqvist, GunillaFagerström, Cecilia

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