Disrupted lives: investigating coping strategies for non-healing leg ulcers

Abstract

The aim of this study was to explore the lived experience of people who have non-healing venous ulcers using hermeneutic phenomenology. Unstructured interviews were carried out with five people who also completed a diary. Interpretative phenomenological analysis was utilized to identify themes and patterns. The core themes identified through analysis were biographical disruption, ways of coping, social implications and therapeutic relationships. The emergent themes reveal the impact of chronicity in participants' experience of chronic leg ulcers, their various emotional and problem-focused coping strategies and the positive role the district nurse plays in their lives. This study places leg ulceration within the body of literature on chronicity, linking nursing theory with the insights offered from health psychology.

The impact of chronic venous leg ulcers: a systematic review

“…7,44,45 Pain was overwhelming, incessant and unrelenting; it had profound effects on the patient, impacting on their sleep, mobility and day-to-day functioning and was exacerbated by both dressings and treatment regimens. 10,[47][48] Pain, for some, was a 'constant companion', it persistently reminded them of the unremitting nature of their ulceration, [47][48][49] controlling their existence and making them angry, sad and 'to cry in despair'. 50,p.239 The control of pain was also problematic; 45,47,48,51 respondents often under-reported pain 47,48 and were reluctant to take analgesia which was deemed ineffective.…”

“…Eight of the eleven studies referred to issues due to leakage from the wound and the associated malodour 10,11,45,[47][48][49][50][51] Exudate was unbearable and devastating, 11 with the unpredictability of dressing leakage causing distress and shame. 51 There were reports of wet shoes, wet bedding and concerns of what people might think.…”

“…10,40,49,50 Some participants reflected on a desire to avoid subjecting those close to them to the effects of the exudate and voluntarily excluding themselves from engaging in social activity due to their fear of how people might react to them. 49,50 A feeling that private things had been moved into the public domain was the response of participants 49 Hyde et al 10 reported a self-inflicted social isolation as an attempt to limit further damage to legs and to prevent ulcer recurrence. Patients spoke of looking forward to an end of ulceration so that they could initiate social interaction again; their time with ulcers was referred to as 'wasted days'.…”

Disrupted lives and threats to identity: The experiences of people with colorectal cancer within the first year following diagnosis

“…In a similar vein, the concept may not be applicable to those who have always lived with general adversity and material deprivation or who anticipate ill health because of their circumstances, perceived life expectancy or life stage expectation and age. For these individuals, the onset of chronic illness is just another facet of a 'hard life' which may even be biographically anticipated and therefore not amounting to a fundamental and profound biographical disruption but rather one of continuity and normality (Faircloth et al, 2004;Hopkins, 2004;Leveälahti, Tishelman, and Ohlén, 2007;Pound, Gompertz, and Ebrahim, 1998;Richardson, Ong, and Sim, 2006). A study of older women diagnosed with cancer, however, cautions against assuming that those with hard and long lives do not experience cancer as biographical disruption (Sinding and Wiernikowski, 2008).…”

Exploring nurses' and patients' feelings of disgust associated with malodorous wounds: a rapid review

“…The psychological stress that can be associated with malodorous wounds and negative effect on wound healing has been identified [3,4], with some tentative links established between exudate, and associated odour with depression and anxiety [5]. Malodorous leg ulcers have been reported to have a negative effect on patients' social lives [6,7] leading to higher anxiety and depression scores, lower life satisfaction and altered body image [8]. Bland [9] reported that patients were often embarrassed about the smell of their leg ulcer and thus did not leave the house with this being aggravated by the fact that bandaging on the leg prevented regular showers being taken.…”