“Wounds Home Alone”—Why and How Venous Leg Ulcer Patients Self-Treat Their Ulcer: A Qualitative Content Study
Abstract
:1. Introduction
2. Materials and Methods
2.1. Design
2.2. Sampling
- Can be useful for identifying and understanding cases that are information-rich;
- can provide an important qualitative component to quantitative data. There are lots of issues in VLU; and
2.3. Data Collection
2.4. Ethical Considerations
2.5. Data Analysis
3. Results
3.1. Theme 1: Current Local VLU Therapy
3.1.1. Subtheme: Conduct of Current Local VLU Therapy
“The nurse came every other day and she changed it. Every other day she came, made it clean and tidy and everything was covered.” (Identification number (ID)4, female (F), wound duration (WD) 6 years)
“The nurse comes to me.... she rinses it with a solution and puts the dressing on.” (ID28, male (M), WD 1.5 years)
3.1.2. Subtheme: Compression Therapy
“Well, it has to do with the sock. It rolls down and you just can’t... And sometimes it pinches a lot. It gets tight, so I have to unwind it because it gets really tight. Once I unwound it in the park... I took the wound dressing off in the park because it had tightened, I couldn’t walk any longer... underneath the sock, when I take it off, it starts itching like hell. And my whole leg starts to itch. Because it’s tight the whole day.” (ID18, F, WD 3 years)
“Well, I wear bandages all the time. When I wear my boots, it gets sweaty in the heat.” (ID16, F, WD 7 years)
“In the beginning, maybe only a couple of times, but ever since, it’s so normal and it’s easy for me to walk in it.” (ID19, F, WD 3 years)
3.1.3. Subtheme: Effective Therapy
“To be honest, I don’t know what will help me. Today they start with this; they start with that, and a week later it is another thing.” (ID19, F, WD 3 years)
“I don’t know. I came here because I had an appointment.” (ID12, M, 15 years)
3.2. Theme 2: VLU Self-Treatment
3.2.1. Subtheme: Performing VLU Self-Treatment
“First, I wash my hands so they’re clean. I have clean gauze and then I clean it [the ulcer]. I can do this professionally, as a nurse does! And then I put on the clean gauze, then a thin bandage, the elastic one, and that’s it!” (ID19, F, WD 3 years)
“The doctor didn’t give me anyone else, no. He gave me an ointment, but he couldn’t get anyone else to do it. I did it, and my husband helped me when he could.” (ID4, F, WD 6 years)
“I can’t stand that [the wound dressing] in a shiny envelope… It’s pinching the whole leg…It was very good when it was with gauze, but the doctor told me to put that…And the wound wasn’t dry anymore, it was just horrible…and it’s not good to keep it covered all the time.” (ID18, F, WD 2 years)
“I’m afraid to take care of it or to touch it.” (ID27, M, WD 6 years)
3.2.2. Subtheme: Changing the Prescribed Treatment
“I don’t know where to go? Where?” (ID19, F, WD 3 years)
“I took that vine cream, which cleaned it.” (ID13, F, WD 10 months)
“I take 40 marigold flowers. I don’t wash them. I just wipe them very well and put in four spoonfuls of pork fat, but pure fat. It mustn’t be buttery. Then I warm up the fat with the flowers in it. And I mix it over a small fire, so the fat becomes yellow. And then I decant it through the gauze and I have the fat. I put it in the refrigerator. I apply it around the cracked part of the wound. I read about it somewhere.” (ID21, F, WD 2 years)
“Then I put on the badger fat and the skunk fat.” (ID26, F, WD 10 months)
“Sometimes I apply some honey on the wound and around it, yeah, that too. And then I heard about the grass as well. The one with sorrel, as they say. That wide leaf. I put it on myself and now I have a very large wound.” (ID24, F, WD 30 years)
“I preheated some water. I put in some salt, that’s what the doctor told me, and I put it on the ulcer. The gauze too, they told me.” (ID24, F, WD 30 years)
3.3. Theme 3: Patient Education
3.3.1. Subtheme: Receiving Information
“The doctor explained it to me and then I remembered it.” (ID20, F, WD 2 years)
“Well yes… sometimes one would read a thing or two [meaning educational leaflet]… you’re scared all the time… why is it yellow, why it hurts.” (ID5, F, WD 5 years)
3.3.2. Subtheme: Following Instructions
“I saw my nurse wrap it for me, and then I did it the same way.” (ID21, F, WD 2 years)
“At first, I wrapped it with the bandage on my own and then I didn’t know how to handle it. I stopped it. But then the doctor... told me about the sock. But nobody showed me how…how to put it on.” (ID27, M, WD 6 years)
3.4. Theme 4: Psychosocial Issues
3.4.1. Subtheme: Role of Informal Caregivers
“My husband helps me. He washes his hands and puts on gloves and then he irrigates the ulcer. And he unwinds it after a day or two, for instance, when my nurse isn’t working or something, and then he does it, as I direct.” (ID5, F, WD 5 years)
“My daughter lives next to me, she’s a nurse and she makes the dressing change.” (ID20, F, WD 2 years)
“No, nobody takes care of my ulcer. Who should take care of it [angrily]? I don’t want that; it’s my ulcer!” (ID22, M, WD 26 years)
3.4.2. Subtheme: Fear of the Future
“I’m frightened if this ulcer will be bigger…if not heal…I’m really scared of it…that I’ll not succeed…I’m really frightened.” (ID24, F, WD 5 years)
“What worries me? You can imagine what…you know what will be if this won’t heal [showing cutting the leg]… [crying] (ID4, F. WD 6 years)
“I was worried about when I got well and took a bath my way. (laughter) To lie in the bath…And to put on anything and everything… (laughter) And you know how I take baths now? Like a stork. I lift one leg in the air like this, and then that’s how I bathe.” (ID6, F, WD 2 years)
4. Discussion
5. Conclusions
Supplementary Materials
Author Contributions
Funding
Acknowledgments
Conflicts of Interest
References
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Characteristics | ||
---|---|---|
Age (y 1) | ||
Mean | 68.2 | |
SD | 7.6 | |
Range | 59–81 | |
Sex (n 2, %) | ||
Male | 12 | 37.5 |
Female | 20 | 62.5 |
Wound duration (n, %) | ||
< 6 months | 6 | 18.8 |
6 months–2 years | 7 | 21.9 |
2–5 years | 6 | 18.8 |
>5 years | 13 | 40.6 |
Wound recurrence | ||
Yes | 11 | 35 |
No | 21 | 65 |
Subthemes | Themes |
---|---|
Conduct of current local VLU therapy Compression therapy Effective therapy | Current local VLU therapy |
Performing VLU self-treatment Changing the prescribed treatment | VLU self-treatment |
Receiving information Following instructions | Patient education |
Role of informal caregivers Fear of the future | Psychosocial issues |
Answer | Frequency | Percent |
---|---|---|
Yes—elastic bandage | 14 | 43.8 |
Yes—compressive sock | 8 | 25.0 |
Yes—multilayer compressive | 5 | 15.6 |
No | 3 | 9.4 |
No, contraindicated | 1 | 3.1 |
No answer | 1 | 3.1 |
Answer | Frequency | Percent |
---|---|---|
Lives alone | 2 | 6.3 |
Daughter | 4 | 12.5 |
Family member (not specified) | 4 | 12.5 |
Sister-in law | 1 | 3.1 |
Spouse | 3 | 9.4 |
Did not want to involve and burden the family | 9 | 28.1 |
None | 7 | 21.9 |
No answer | 2 | 6.3 |
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Žulec, M.; Rotar-Pavlič, D.; Puharić, Z.; Žulec, A. “Wounds Home Alone”—Why and How Venous Leg Ulcer Patients Self-Treat Their Ulcer: A Qualitative Content Study. Int. J. Environ. Res. Public Health 2019, 16, 559. https://doi.org/10.3390/ijerph16040559
Žulec M, Rotar-Pavlič D, Puharić Z, Žulec A. “Wounds Home Alone”—Why and How Venous Leg Ulcer Patients Self-Treat Their Ulcer: A Qualitative Content Study. International Journal of Environmental Research and Public Health. 2019; 16(4):559. https://doi.org/10.3390/ijerph16040559
Chicago/Turabian StyleŽulec, Mirna, Danica Rotar-Pavlič, Zrinka Puharić, and Ana Žulec. 2019. "“Wounds Home Alone”—Why and How Venous Leg Ulcer Patients Self-Treat Their Ulcer: A Qualitative Content Study" International Journal of Environmental Research and Public Health 16, no. 4: 559. https://doi.org/10.3390/ijerph16040559