Patients' Experience of Advanced Wound Treatment
This qualitative design study was part of a randomized clinical trial of NPWT. Fifteen patients kept diaries throughout their treatment, 8 who were treated with NPWT, and 7 who were treated with AMWT (control group). Outcome parameters included wound healing, cost effectiveness, and impact on quality of life. Patients had to meet the following criteria for inclusion: the wound had to be acute with duration < 6 weeks, and the participant had to be cognitively adequate and able to speak and write the Swedish language. Data were collected from the written patient diaries and analyzed with content analysis.
All patients who completed their diaries during the first year of recruitment were consecutively selected and included in this study. The in-depth analysis was conducted with diaries written by 7 patients treated with AMWT and by 8 patients treated with NPWT. All patients had wounds in the lower extremities, and their ages ranged from 41 to 91 years.
The dressing used in the control group featured hydrofiber technology (Aquacel, ConvaTec Inc, Minneapolis, MN) with a transparent film dressing attached on top. The dressing was changed 3 times a week. The NPWT system used was a portable vacuum-assisted closure (VAC) device (ActiV.A.C., KCI Inc, San Antonio, TX). The dressings were changed 2 times a week. The health care personnel performing the wound treatment were registered nurses and nurse's aides at Stockholm South General Hospital, Södersjukhuset, Stockholm, Sweden. The hospital had no formal requirement that personnel should have specialized education in wound care, so knowledge and competence varied and was dependent on the individual's experience and interest.
Data were collected as patients completed their wound treatment throughout 2011, from pre-printed diaries with 14 spreads, 1 for each day of treatment. The patients were asked to write, by hand, about their experience of the treatment, starting on the first day of treatment and then every day for 2 weeks, or less if the wound treatment was terminated earlier. The final material of the combined diaries consisted of 173 days of diary entries, ranging from 2 to 89 words each.
The text of the diaries was extracted and transcribed into a computerized document to get an overview of the material.
In this study, a technique inspired by Graneheim and Lundman was used to analyse the content. Initially, the text of the diaries was read repeatedly to obtain a sense of the whole. The diaries written by the patients treated with NPWT were analysed separately from the control group. Each time the material was read, a deeper understanding of the content was reached, and the analysis was transferred into a more latent approach. In both manifest and latent analysis, an interpretation is made, but in the latent analysis the interpretation is deeper and at another level of abstraction. The timeframe of the analysis was subjectively determined and completed by agreement within the research group. When a good sense of the content of the material was reached, units of meaning emerged and were labelled with codes. The research group organized the codes into 3 categories that reflected the central message of the text from both groups, and the underlying meaning of the categories was formulated into 1 main theme.
To achieve trustworthiness as defined by Graneheim and Lundman, the analytical process was performed in close collaboration with all members of the research group, and the results discussed among wound experts from the Swedish Society for Tissue Viability Nurses, as well as with hospital coworkers who were not involved in the care of study participants. Diaries by 12 patients (6 AMWT and 6 NPWT) had been gathered in a pilot study, and these were the first to be analysed. During 2011, 3 additional patients were included in the larger study, and the research group also chose to include their diaries in the analysis.
These additional diaries did not add new information to the analysis, but confirmed a sense of saturation of the material. All participants were given verbal and written information, and their written consent was obtained. Ethical approval was obtained by the local Ethics Committee of the Stockholm County Council (2008/2023–31).
Method
This qualitative design study was part of a randomized clinical trial of NPWT. Fifteen patients kept diaries throughout their treatment, 8 who were treated with NPWT, and 7 who were treated with AMWT (control group). Outcome parameters included wound healing, cost effectiveness, and impact on quality of life. Patients had to meet the following criteria for inclusion: the wound had to be acute with duration < 6 weeks, and the participant had to be cognitively adequate and able to speak and write the Swedish language. Data were collected from the written patient diaries and analyzed with content analysis.
All patients who completed their diaries during the first year of recruitment were consecutively selected and included in this study. The in-depth analysis was conducted with diaries written by 7 patients treated with AMWT and by 8 patients treated with NPWT. All patients had wounds in the lower extremities, and their ages ranged from 41 to 91 years.
Treatment
The dressing used in the control group featured hydrofiber technology (Aquacel, ConvaTec Inc, Minneapolis, MN) with a transparent film dressing attached on top. The dressing was changed 3 times a week. The NPWT system used was a portable vacuum-assisted closure (VAC) device (ActiV.A.C., KCI Inc, San Antonio, TX). The dressings were changed 2 times a week. The health care personnel performing the wound treatment were registered nurses and nurse's aides at Stockholm South General Hospital, Södersjukhuset, Stockholm, Sweden. The hospital had no formal requirement that personnel should have specialized education in wound care, so knowledge and competence varied and was dependent on the individual's experience and interest.
Data Collection and Analysis
Data were collected as patients completed their wound treatment throughout 2011, from pre-printed diaries with 14 spreads, 1 for each day of treatment. The patients were asked to write, by hand, about their experience of the treatment, starting on the first day of treatment and then every day for 2 weeks, or less if the wound treatment was terminated earlier. The final material of the combined diaries consisted of 173 days of diary entries, ranging from 2 to 89 words each.
The text of the diaries was extracted and transcribed into a computerized document to get an overview of the material.
In this study, a technique inspired by Graneheim and Lundman was used to analyse the content. Initially, the text of the diaries was read repeatedly to obtain a sense of the whole. The diaries written by the patients treated with NPWT were analysed separately from the control group. Each time the material was read, a deeper understanding of the content was reached, and the analysis was transferred into a more latent approach. In both manifest and latent analysis, an interpretation is made, but in the latent analysis the interpretation is deeper and at another level of abstraction. The timeframe of the analysis was subjectively determined and completed by agreement within the research group. When a good sense of the content of the material was reached, units of meaning emerged and were labelled with codes. The research group organized the codes into 3 categories that reflected the central message of the text from both groups, and the underlying meaning of the categories was formulated into 1 main theme.
Ethical Considerations
To achieve trustworthiness as defined by Graneheim and Lundman, the analytical process was performed in close collaboration with all members of the research group, and the results discussed among wound experts from the Swedish Society for Tissue Viability Nurses, as well as with hospital coworkers who were not involved in the care of study participants. Diaries by 12 patients (6 AMWT and 6 NPWT) had been gathered in a pilot study, and these were the first to be analysed. During 2011, 3 additional patients were included in the larger study, and the research group also chose to include their diaries in the analysis.
These additional diaries did not add new information to the analysis, but confirmed a sense of saturation of the material. All participants were given verbal and written information, and their written consent was obtained. Ethical approval was obtained by the local Ethics Committee of the Stockholm County Council (2008/2023–31).