Nurses’ ethical reflections on caring for people with malodorous exuding ulcers

Abstract

The aim of this study was to illuminate nurses' reflections on obstacles to and possibilities for providing care as desired by people with malodorous exuding ulcers. Six nurses who took part in a previous study were interviewed. The participants were shown an illustration with findings from a study that elucidated the meaning of living with malodorous exuding ulcers. They were asked to reflect on the obstacles to and possibilities of providing the care desired by the patients. Twelve audio-recorded transcribed interviews were analysed using qualitative content analysis. Our interpretations of participants' reflections on the obstacles and possibilities while caring for such patients revealed one theme: striving to 'do good' and 'be good'. The obstacles were formulated as subthemes: experiencing clinical competence constraints, experiencing organizational constraints, experiencing ineffective communication, fearing failure, and experiencing powerlessness. The possibilities were formulated by the subthemes: spreading knowledge about ulcer treatments, considering wholeness, and creating clear channels of communication. A multiprofessional team could overcome the identified obstacles and provide structure, competencies, commitment and support to 'do good' for patients and 'be good' nurses.

Exploring psychology and nursing students perceptions of disgust

“…The notion of contagion and purity is explored by Lindhal, Gilje, Norberg and Soderberg [13] who interviewed retired nurses in Sweden and found that nurses strove for purity by preserving cleanliness, order and a clear conscience when caring for individuals with malodorous exuding wounds. This would suggest that sensitivity to disgust does not diminish over time; whereas the findings from the study reported here on a larger population of students would refute this.…”

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

“…Nursing students new to clinical areas are often shocked at odours that emanate from wounds and have to develop coping mechanisms to manage these situations. The participants in this study confided that nursing students must become sensitized to the needs of patients whose only choice is living with malodorous exuding ulcers [21]. The participants suggested there was a need for clear communication in establishing trust and effective co-operation around patients, as health care professionals encountering patients often communicate with body language.…”

“…A total of 163 papers were retrieved. Following review of the abstracts 7 papers were included for the review [18,19,5,20,21,22,23]. One hundred and fifty six papers were excluded as they were single case studies reporting on the experience of a single patient; were opinion papers or were literature reviews.…”

“…Non healing wounds can impact on professionals and can evoke feelings of helplessness and being emotionally overwhelmed (European Wound Management Association [EWMA], [25] indeed Lindahl et al [21] surmise that when health care professionals come within close physical proximity to an exudating malodourous wound, it could become stressful for nurses to remain close to patients. In an earlier study they concluded that caring for people with malodorous exuding ulcers not only meant struggling to shield patients' vulnerability but also nurses' defencelessness [18].…”

“…In a qualitative study consisting of a convenience sample of six nurses participating in conversational interviews, Lindahl et al [21] investigated ethical reflections of caring for patients with maldourous, exudating wounds. Striving to do good for patients and to be good nurses was seen as a major concern throughout the participants' reflections with effective management of malodourous wound care often causing dilemmas when attempting to 'do good' and 'be a good nurse'.…”