Struggling for normality: experiences of patients with diabetic lower extremity amputations and post-amputation wounds in primary care

Abstract

Aim: To explore the experiences of patients living with diabetic lower extremity amputation (DLEA) and its post-amputation wound in primary care. Background: DLEA, including both minor and major amputation, is a life-altering condition that brings numerous challenges to an individual’s life. Post-amputation physical wound healing is complicated and challenging because of wound dehiscence and prolonged healing times. Understanding patients’ experiences after DLEA with a post-amputation wound will enable healthcare professionals to develop interventions to assist patients in physical healing and psychosocial recovery. Methods: This study employs a qualitative design using interpretative phenomenological analysis (IPA). A purposive maximum variation sample of nine patients who had had lower extremity amputations and post-amputation wound attributed to diabetes in the previous 12 months was recruited from a primary care setting in Singapore. Semi-structured audio recorded one-to-one interviews with a duration of 45–60 min each were conducted between September 2018 and January 2019. The interviews were transcribed verbatim and analysed using IPA. Findings: The essential meaning of the phenomenon ‘the lived experiences for patients with DLEA and post-amputated wound’ can be interpreted as ‘struggling for “normality”’ which encompasses four domains of sense making: physical loss disrupted normality, emotional impact aggravated the disrupted normality, social challenges further provoked the disrupted normality, and attempt to regain normality. The study highlights the complex physical and psychosocial transition facing patients after DLEA before post-amputation wound closure. In primary care, an amputation, whether minor or major, is a life-altering experience that requires physical healing, emotional recovery, and social adaptation to regain normality. Patients living with DLEA and a post-amputation wound may benefit from an interdisciplinary team care model to assist them with physical and psychosocial adjustment and resume normality.

Psychological Consequences in Patients With Amputation of a Limb. An Interpretative-Phenomenological Analysis

“…In such circumstances, the new reality might be less alienated, less disconnected from past experience thus facilitating psychological health and enabling the person to access available internal and external resources. These findings are supported by previous results (Murray, 2010;Dunne et al, 2014;Zhu et al, 2020) showing that the desire to connect with previous interests and activities was a way to recover a feeling of normality. From our theoretical viewpoint, involving the amputee in a process of reality negotiation (Carpenter, 1994) and the gradual accommodation of a new self-representation is crucial.…”

“…For example, one participant had modifications done to his vehicle in order to be able to drive, while another found hope in the idea of having prosthesis and resuming physical activities in the future. Previous studies (Hall et al, 2005;Zhu et al, 2020) have had similar findings regarding the rehabilitation process. They found that the ability to self-manage and make adjustments influenced how easily one could regain a sense of normality and balance in their lives.…”

“When nothing happens, nobody is afraid!” beliefs and perceptions around self‐care and health‐seeking behaviours: Voices of patients living with diabetic lower extremity amputation in primary care

“…Previous work reported that the level of knowledge underpins a person's beliefs about health and illness and thus determines health‐related behaviours. 12 , 45 , 46 Levels of knowledge and awareness of diabetes and diabetes‐related foot diseases shape patients' beliefs and perceptions regarding their susceptibility to the disease and are key factors in health care‐seeking practices. 47 In the present study, participants' low perceived susceptibility and severity attributed to low perceived threats to the consequences of diabetes that shaped their passive health‐related attitudes, which was in contrast with the findings from recent studies from Singapore researchers.…”

“…DFU is a common precursor to diabetic lower extremity amputation (DLEA). 9 , 10 DFU and DLEA result in physical dysfunction, emotional distress, and diminished quality of life 1 , 11 , 12 and increase the risk of early death. 1 DLEA is a life‐altering experience that requires physical healing, emotional recovery, and social adaptation to regain normality.…”

“…1 DLEA is a life‐altering experience that requires physical healing, emotional recovery, and social adaptation to regain normality. 12 Pivotal to good self‐care is patient education. 13 , 14 , 15 However, despite provision of appropriate information and guidance, patients' self‐care is often suboptimal, and adherence to foot self‐care recommendations and compliance to medication remains low.…”