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- Ebbeskog, Britt
(author)
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Elderly patients with slow-healing leg ulcers : an embodied suffering
- 2003
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Doctoral thesis (other academic/artistic)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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- Friman, Anne, et al.
(author)
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District nurses' knowledge development in wound management : ongoing learning without organizational support
- 2014
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In: Primary Health Care Research and Development. - 1463-4236 .- 1477-1128. ; 15:4, s. 386-95
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Journal article (peer-reviewed)abstract
- AIM: The aim of this study was to describe district nurses' (DNs') experiences of their knowledge development in wound management when treating patients with different types of wounds at healthcare centers.BACKGROUND: In primary healthcare, DNs are mainly responsible for wound management. Previous research has focused on DNs' level of expertise regarding wound management, mostly based on quantitative studies. An unanswered question concerns DNs' knowledge development in wound management. The present study therefore intends to broaden understanding and to provide deeper knowledge in regard to the DNs' experiences of their knowledge development when treating patients with wounds.METHODS: A qualitative descriptive design was used. Subjects were a purposeful sample of 16 DNs from eight healthcare centers in a metropolitan area in Stockholm, Sweden. The study was conducted with qualitative interviews and qualitative content analysis was used to analyze the data.RESULTS: The content analysis resulted in three categories and 11 sub-categories. The first category, 'ongoing learning by experience,' was based on experiences of learning alongside clinical practice. The second category 'searching for information,' consisted of various channels for obtaining information. The third category, 'lacking organizational support,' consisted of experiences related to the DNs' work organization, which hindered their development in wound care knowledge.CONCLUSIONS: The DNs experienced that they were in a constant state of learning and obtained their wound care knowledge to a great extent through practical work, from their colleagues as well as from various companies. A lack of organizational structures and support from staff management made it difficult for DNs to develop their knowledge and skills in wound management, which can lead to inadequate wound management.
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- Friman, Anne, et al.
(author)
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General practitioners' knowledge of leg ulcer treatment in primary healthcare : an interview study
- 2020
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In: Primary Health Care Research and Development. - : Cambridge University Press. - 1463-4236 .- 1477-1128. ; 21
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Journal article (peer-reviewed)abstract
- AIM: To describe general practitioners' (GPs') knowledge and the development of their knowledge regarding leg ulcer treatment when treating patients with leg ulceration at primary healthcare centers.BACKGROUND: Earlier research regarding GPs' knowledge of leg ulcer treatment in a primary healthcare context has focused primarily on the assessment of wounds and knowledge of wound care products. Less is known about GPs' understandings of their own knowledge and knowledge development regarding leg ulceration in the everyday clinical context. This study, therefore, sets out to highlight these aspects from the GPs' perspective.METHODS: Semi-structured interviews were conducted with 16 individual GPs working at both private and county council run healthcare centers. The data were analyzed inductively using a thematic analysis.RESULTS: Four themes were identified. 'Education and training' describe the GPs' views regarding their knowledge and knowledge development in relation to leg ulcer treatment. 'Experience' refers to GPs' thoughts about the importance of clinical experience when treating leg ulcers. 'Prioritization' describes the issues GPs raised around managing the different knowledge areas in their clinical work. 'Time constraints' explore the relationship between GPs' sense of time pressure and their opportunities to participate in professional development courses.CONCLUSIONS: The study shows that the GPs working in primary healthcare are aware of the need for ongoing competence development concerning leg ulceration. They describe their current knowledge of leg ulcer treatment as insufficient and point to the lack of relevant courses that are adapted for their level of knowledge and the limited opportunities for clinical training.
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- Grundberg, Åke, et al.
(author)
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How community-dwelling seniors with multimorbidity conceive the concept of mental health and factors that may influence it : A phenomenographic study
- 2012
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In: International Journal of Qualitative Studies on Health and Well-being. - : Informa UK Limited. - 1748-2623 .- 1748-2631. ; 7, s. 19716-
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Journal article (peer-reviewed)abstract
- Multimorbidity, that is, the coexistence of chronic diseases, is associated with mental health issues among elderly people. In Sweden, seniors with multimorbidity often live at home and receive care from nursing aides and district nurses. The aim of this study was to describe the variation in how community-dwelling seniors with multimorbidity perceive the concept of mental health and what may influence it. Thirteen semi-structured interviews were analysed using a phenomenographic approach. Six qualitatively different ways of understanding the concept of mental health and factors that may influence it, reflecting key variations of meaning, were identified. The discerned categories were: mental health is dependent on desirable feelings and social contacts, mental health is dependent on undesirable feelings and social isolation, mental health is dependent on power of the mind and ability to control thoughts, mental health is dependent on powerlessness of the mind and inability to control thoughts, mental health is dependent on active behaviour and a healthy lifestyle, and mental health is dependent on passive behaviour and physical inactivity. According to the respondents' view, the concept of mental health can be defined as how an individual feels, thinks, and acts and also includes a positive as well as a negative aspect. Social contacts, physical activity, and optimism may improve mental health while social isolation, ageing, and chronic pain may worsen it. Findings highlight the importance of individually definitions of mental health and that community-dwelling seniors with multimorbidity may describe how multiple chronic conditions can affect their life situation. It is essential to organize the health care system to provide individual health promotion dialogues, and future research should address the prerequisites for conducting mental health promotion dialogues.
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- Grundberg, Åke, et al.
(author)
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Mental health-promoting dialogues from the perspective of community-dwelling seniors with multimorbidity.
- 2014
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In: Journal of Multidisciplinary Healthcare. - : DOVE Medical Press Ltd.. - 1178-2390. ; 7, s. 189-199
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Journal article (peer-reviewed)abstract
- Mental health promotion needs to be studied more deeply within the context of primary care, because persons with multiple chronic conditions are at risk of developing poor mental health. In order to make progress in the understanding of mental health promotion, the aim of this study was to describe the experiences of health-promoting dialogues from the perspective of community-dwelling seniors with multimorbidity - what these seniors believe is important for achieving a dialogue that may promote their mental health. Seven interviews with six women and one man, aged 83-96 years, were analyzed using qualitative content analysis. The results were summarized into nine subcategories and three categories. The underlying meaning of the text was formulated into an overarching theme that embraced every category, "perceived and well-managed as a unique individual". These seniors with multimorbidity missed someone to talk to about their mental health, and needed partners that were accessible for health dialogues that could promote mental health. The participants missed friends and relatives to talk to and they (crucially) lacked health care or social service providers for health-promoting dialogues that may promote mental health. An optimal level of care can be achieved through involvement, continuity, and by providing a health-promoting dialogue based on seniors' needs and wishes, with the remembrance that general health promotion also may promote mental health. Implications for clinical practice and further research are discussed.
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