Care of elderly lower limb amputees, as described in medical and nursing records

Abstract

This thesis has a caring science perspective (caring in nursing). The general aim was to gain a deeper understanding of important aspects of caring in clinical practice from both the patients' and nurses' perspectives and to illuminate essential aspects of caring for future nursing research. In Study I, aspects of caring important to women (n = 10) suffering from breast cancer and the importance of the outcome of caring for patients' health and wellbeing was illuminated with a descriptive exploratory method. In Study II, caring and its influence on excellent nurses' (n = 5) attitudes, actions and professional growth was studied with a descriptive phenomenological approach. In Study III, caring as described in the medical and nursing records of lower-limb amputees (n = 45) was explored by content analysis. Study IV was conducted to illuminate essential areas in caring for future patient-related nursing research. A three-round Delphi technique was used on 95 nurses within a health care district.The results highlight the need for health care professionals who are competent, compassionate, courageous and concordant in order to develop caring in health care practice. The results also indicate that caring has a positive impact on vulnerable patients' health and wellbeing and on nurses' professional growth. Furthermore, this thesis explores the problem of documenting patients' suffering and caring needs in nursing records and the risk of inadequately prioritizing or of underestimating these needs. When prioritizing important areas for patientrelated nursing research, informed nursing practitioners prioritize research areas that will assure patients' wellbeing and a caring environment. Research areas across the full continuum of care, from wellness to death, are regarded as important. A focus on research aimed at preserving humanistic values and developing collaboration between health care providers across organizational boundaries in the health care system is stressed.This thesis points out the importance of caring encounters in modern health care practice and the need for investigation and research on connections with the creative use of health care resources in the 21 st century. SVENSK SAMMANFATTNINGDenna avhandling belyser några grundläggande aspekter av mänsklig omsorg (caring) inom professionell omvårdnad. Det övergripande syftet var dels att få en djupare förståelse för vilka aspekter av mänsklig omsorg i omvårdnaden (caring in nursing) som är väsentliga för både patienter och sjuksköterskor och dels att klargöra vilka områden inom mänsklig omsorg som sjuksköterskor prioriterar för framtida forskning. Avhandlingen har en vårdvetenskaplig ansats och är en sammanläggning av fyra delarbeten. Delarbete I och II belyser betydelsen av mänsklig omsorg från patienters och sjuksköterskors perspektiv. Delarbete III beskriver hur mänsklig omsorg dokumenteras i medicinska -och omvårdnadsjournaler. Delarbete IV visar på att mänsklig omsorg är ett prioriterat forskningsområde för framtiden. Delarbete I Mänsklig omsor...

The Locomotor Capabilities Index; validity and reliability of the Swedish version in adults with lower limb amputation

“…Walking ability with a prosthesis depends on several factors including patient's physical and mental status [ 8 ], the surgical method used [ 9 ], postoperative care, nutrition and pain relief [ 10 ] as well as the rehabilitation and prosthetic fitting procedures [ 6 ]. Lower limb amputation related to peripheral arterial disease or diabetes is usually performed on elderly patients who have multiple medical disorders, and the rehabilitation may be compromised by other illnesses such as stroke and heart failure or vascular problems involving the contralateral leg.…”

Pendulating—A grounded theory explaining patients’ behavior shortly after having a leg amputated due to vascular disease

“…The majority of major leg amputations performed in the western world is caused by vascular disease (Global Lower Extremity Amputation Study Group, 2000 ) and are often preceded by a long, troublesome period of wounds, diagnostic trajectories (Denmark's National Board of Health, Sundhedsstyrelsen, 2011 ; Ragnarson Tennvall & Apelqvist, 2000 ), vascular surgery, and pain (Schoppen et al, 2003 ). The amputation is often performed sub-acutely with the aim of ensuring survival for patients who have infections or acute embolus as well as to relieve pain and ensure the best possible level of function for patients (Game, 2012 ) as they face remarkable physical challenges while recovering from surgery (Back-Pettersson & Bjorkelund, 2005 ). Patients who have leg amputation due to vascular disease are characterized by high age (Global Lower Extremity Amputation Study Group, 2000 ), multi co-morbidity (Fortington, Rommers, Geertzen, Postema, & Dijkstra, 2012 ; Kristensen, Holm, Kirketerp-Moller, Krasheninnikoff, & Gebuhr, 2012 ), and low survival prognosis (Fortington et al, 2013 ; Kristensen et al, 2012 ).…”

Is occupational therapy practice for older adults with lower limb amputations evidence-based? A systematic review

“…10,11,40,41 Older adults aged 85 and over with amputations may have different rehabilitation goals than those aged between 65 and 88 years. A study by von Faber et al 42 showed that older adults aged 85 and over value well-being and social functioning higher than physical or psychocognitive functioning.…”

“…Frykberg et al’s 9 study of 41 patients over 80 years old showed that the postoperative functional status remained unchanged in 40% and worsened in 55% of the participants, while the residential status was unchanged in 68% and worsened in 32% of participants. A study by Bäck-Pettersson and Björkelund 10 conducted in Sweden showed that the older patients who survived six months after amputation had permanent problems in the area of nutrition, elimination, skin ulceration, sleep, pain and pain alleviation. The patients who died during hospitalization and within six months after amputation (13 out of 45 adults over 60 years of age) had also reported problems in these areas.…”