Elderly patients with slow-healing leg ulcers : An embodied suffering

University dissertation from Stockholm : Karolinska Institutet, Department of Clinical Neuroscience, Occupational Therapy and Elderly Care Research (NEUROTEC)

Abstract: The overall aim of this thesis was to investigate leg and foot ulcer patients, from the perspective of a population in a specific urban area, and to illuminate these individual patients' lived experience of living with slow-healing venous leg ulcers. Study (I) was a survey of chronic leg and foot ulcers and study (II) was a follow-up study of the wound healing rate and an intervention study. A structured questionnaire (I) was used, that included; prevalence, level of care, aetiology and wound treatment. In study (II) a questionnaire was distributed, 18 months after the survey. The questionnaire included; wound healing rate, recurrence, amputation and mortality. A further objective was an intervention study of wound healing, with the use of a triple- layer treatment. Descriptive statistics were used to analyse the collected data in these studies (I-II). Data in study (III) and (IV) was collected by interviews with 15 persons suffering from slow- healing venous leg ulcers. Data was analysed by means of the phenomenological-hermeneutic method (III- IV). In the survey (I) 294 patients with leg and foot ulcers were identified, this represents a prevalence of 0.12%. The majority of the patients (92%) were older than 65 years. More than half of the patients were treated in primary health care. Different local wound dressings were used (N=51). Pain was reported from 56% of patients with venous ulcers. After 18 months, 174 patients remained and in 61% of these cases, leg ulcers had healed (II). Twenty- one patients with a non-healed wound had venous insufficiency. The intervention study (II) indicated that slow-healing ulcers could be improved with modem technology and knowledge about the patients' specific risk factors. Risk factors that contributed to a delay in healing were identified as; impaired mobility, pain, pathological skin changes and the impact of arterial aetiology. The results from study III show that living with venous leg ulcers can be understood as a strain between, on the one hand, the feeling of being imprisoned in the body, the bandage and the home, and on the other hand, the hope of freedom from a burdensome body. The elderly people try to find ways to manage pain, uncomfortable bandages, and a disobedient body, but all of these factors influence their activities in everyday life and their social lives. They believe that the wound will heal, even those who suffer from a slow-healing wound. In study (IV) two main themes were identified: a dignified individual and a vulnerable individual under pressure. This study points to the importance of seeing the unique human being, not only a patient with a wound, requiring medical treatment. Care, based on solid evidence, should include assessments of the illness experience and actions to restore trust and confidence among persons involved in wound healing before the wound becomes manifest. The findings of this thesis show that more knowledge is necessary. Partly, in relation to the prevalence and treatment of leg ulcers and partly, by reaching an understanding about the embodied suffering among people with painful and slow-healing leg ulcers. Understanding the patients as human beings, in their everyday lives, in accordance with illness as a lived experience, provided the opportunity for care providers to perform skilful wound care, with mutual understanding, that is: an intersubjective communion.

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