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When a leg ulcer becomes chronic : a phenomenological study of the older adult’s experience of living with a chronic venous leg ulcer Liebelt, Kathleen S.

Abstract

Chronic venous insufficiency has been recognized as one of the most common health problems experienced by the older adult. Unfortunately, an all too frequent complication of this circulatory disorder is the development of a venous leg ulcer. Chronic venous leg ulcers can have a negative impact on the general well-being of the older adult and costs to the health care system associated with the treatment of chronic venous leg ulcers are substantial. A review of the literature revealed that no qualitative research studies have been conducted in relation to the older adult's experience of living with a chronic venous leg ulcer. Rather, there are a few anecdotes in relation to the venous leg ulcer experience that have been written from a health care professional's perspective. Thus, in the context of chronic venous leg ulcers, the explanatory model of the client has not yet been documented. The purpose of this study was to gain an understanding of the chronic venous leg ulcer experience from the perspective of community-dwelling older adults. The phenomenological approach to qualitative methodology was used for this study. This approach seeks to describe human experience as it is lived. Six individuals, over sixty-five years of age, agreed to participate in this study; they were currently being seen or had been seen on a regular basis by a home care nurse for treatment of their chronic venous leg ulcers. Participants were each interviewed twice and these interviews were guided by open-ended questions. Analysis of the data revealed that participants moved through three sequential phases of a "living with a chronic venous leg ulcer continuum” as they lived with chronic venous insufficiency and chronic venous leg ulcers. In the first phase of the continuum, participants experienced the effects of living with their chronic circulatory disorder. They encountered losses in relation to physical endurance, gratifying activities, companionship, and predictability in their lives. In addition to experiencing loss, the participants encountered a gain as a result of having a chronic venous leg ulcer: the emotional support afforded them by home care nurses and homemakers involved in their care. In the second phase of the continuum, participants evaluated how significantly their chronic venous leg ulcers had affected their lives. In so doing, the participants either appraised their leg ulcer as having been detrimental to their quality of life, or inconsequential with regard to living a satisfying life. The key factor that influenced the appraisal that participants made of their leg ulcers was whether or not their circulatory disorder had impacted on a primary source of satisfaction in their life. In the third and final phase of the continuum, the participants coped with their circulatory disorder in one of two ways. Each participant either "put their life on hold" if they had appraised their leg ulcer as being detrimental to them, or they "got on with life" if they had appraised their leg ulcer as being inconsequential. The implications for nursing practice, education, and research were identified in light of the research findings.

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