The Experience of Living With Pressure Ulcers on the Elderly Diabetic Patients

Abstract

In recent years, diabetic cases are increasing every day, which has caused pressure to the patients as well as their relatives. To help in solving this problem, there is a need for understanding the experiences of diabetic cases and their impacts on the people. In this paper, the focus will be to address the question that will give a clear understanding in reference to discharging planning of diabetic patients with the use of phenomenology methodological approach.

Introduction

Phenomenology as a research methodology used in nursing focuses on the essence, experience, and gives the interpretation/understanding of these essences and experiences (Freshwater & Holloway, 2007). It gives the definitions of the essence of consciousness and perception. In addition, phenomenology is a philosophy that refers back to the essence into existence without a clear understanding of the illness from the starting point other than the experiences and impacts of the illness (Holland & Rees, 2010). Therefore, phenomenology places the assertions in respect to the situation, attitude, and a better understanding (Holland & Rees, 2007). However, it recognizes the existence of the cause before reflecting on the beginning of the cause. Its efforts concentrate on achieving a solution that is direct and would give a primitive contact between the situation and the cause of the problem (Gernish & Lacey, 2010).

In nursing, the category of phenomenology used is existential. It explicitly gives concern to the issues that relate to the experiences of people and biological life progress (Munhall, 2011). In the context of the paper, the method will give concern to the first-person perspective, their unique reaction towards the situation, and their own life expectations in reference to the experience they have. The feedback or findings of these issues would form the basis for discharge planning. The information gathered would dictate the home care strategies for the patient; giving an understanding of the challenges that are likely to occur when caring for the patient and the prescription of the caring routine (Tappen, 2011). The method gives an emphasis on respect to the people by treating the study participants as co-researchers rather than subjects, in-depth interviews to discover and understand the feelings and perceptions and explicit explanation/interpretation of the data collected from the interview (Tappen, 2011). The method thus requires the nurses to have a strong background in philosophy.

Phenomenology further gives emphasis on the phenomenon of the situation and obtains understanding and interpretation from the experience achieved. This method treats every person, as an originator of the meaning of the problem as well as the outcome treated individually (Kim & Kollak, 2009). The knowledge of the problem or perceived reality lies in the consciousness of the people involved.

Reasons for choosing the method

In this paper, the objective is to have an understanding of the impacts of the experience of living with pressure ulcers on the health of the elderly diabetic patients. The method gives a clear understanding and interpretation through the analysis of the data collected. The method of data collection is in-depth interviews. Phenomenology as a research methodology treats the person interviewed as a co-researcher rather a subject that gives the interviewee confidence. This gives the interviewer an advantage of achieving the required data, as the interviewee will have the confidence while disclosing his/her experiences. The method is also involved with the human science as it is concerned with description, interpretation, and giving meaning of the inner cognitive and spiritual aspects of human beings in social, historical and political contexts (Holloway & Wheeler, 2010).

In addition, the methodology seeks to give a description, understanding and interpret people’s experiences in their daily lives (Kermode & Taylor, 2006). Further, the methodology focuses on the meaning of these experiences. This reasons support the use of this methodology in the paper where the intention is to have a clear description, understanding and meaning of the experiences of living with pressure ulcers on the health of the elderly diabetic patients. The objective is to have the knowledge of these experiences and associate the knowledge with the discharging of patients. The understanding will help in description of home care planning of the patient as well as the medication required. Phenomenology further contains openness, resonance, balanced integration, concreteness and actualization (Munhall, 2011). Openness refers to the systematic and explicit way to account for the decisions made during the study. Resonance involves the effects felt during the study. Balanced integration refers to finding relationship between philosophical methods used in collection of data and the balance of the voices between the study participants and the philosophical explanation. Concreteness on the other hand refers to usefulness of data collection methods and finally actualization encompasses future realization of the resonance of the research or study findings. These concepts further ensure that phenomenology, as a research methodology is valid method in nursing. Adoption of the methodology helps to preserve the legitimacy and integrity of interpretive nursing research (Liamputtong, 2006). The main aim of applying the methodology is to have the interest of the patient’s perspective, understand the experience of their living with the illness that further helps in providing appropriate and holistic care to the patients.

Data collection

The method of data collection in this paper is interview. The objective of the interview is to collect data or information that would help in the analysis of the research question. In the research, the target population or sample for data collection was not patients but rather people with the understanding of the experiences related to living with pressure ulcers on the health of the elderly diabetic patients. During data collection, there was consideration of several principles that helped to ensure that the rights of the interviewee and confidentiality of data prevailed. Phenomenology as the method used in the paper, treats the interviewee as a co-researcher rather than a subject. To ensure that the interviewee felt like a co-researcher and had confidence in disclosing the information, the interviewer had to apply several strategies. First, there was observation of ethical standards. Ethics refer to the concept of good and bad, justice and injustice, and right or wrong (Allen & Wiggins, 2011). The methodology used in this paper aimed at ensuring that justice of the interviewee prevails.

The challenges that researchers face during their research in terms of ethical standard maintenance include disclosure of the information, privacy and confidentiality, participant safety, consent, conflict of interests, and scientific merit (Allen & Wiggins, 2011). The privacy and confidentially was ensured through the assurance of the participants that the data collected was only for use of the research and not other purposes. The interviewer made a written agreement on the consequences that would follow in case of disclosure of the information collected. In addition, they ensured that there was no information that would reveal the participant. This gave the interviewee the confidence to disclose the information as he/she felt safe and that the information he/she gives does not get to third parties. On the issue of participant safety, they ensured the participant that he/she was just a co-researcher. The research conducted was for understanding of the experiences of living with pressure ulcers on the health of the elderly diabetic patients. They informed the participant that the participation in the research had no security impact associated with him or her. In addition, they assured the participant that privacy, confidentiality would hold as agreed, and thus no one would later regret of his/her participation in the research. This ensured that the participant felt secure, which enhanced his/her participation in the interview. On the conflict of interest, our main objective was to have a clear description, understanding and meaning of the experiences of living with pressure ulcers on the health of the elderly diabetic patients. To ensure the achievement of the research objective and conflict of interest challenge does not prevail we asked the interviewee questions that only related to our field as well as the interview questions that were sequentially planned (Allen & Wiggins, 2011). This ensured that the participant felt at ease, and would respond to the questions without fear, stress or could not doubt our motive for the interview.

On scientific merit, the intention of the research was not to understand how well the participant is literate in sciences. The focus was to have a clear understanding of the experiences of living with pressure ulcers to the health of the elderly diabetic patients. With the understanding of the main objective of the interviewee, the participant was relaxed, as he/she understood the main reason for the research. The participant understood objective of the research and thus gained confidence as he/she realized the main reason for his/her participation in the research process. Consent refers to the agreement or approvals provided after a thoughtful consideration. To deal with the participant consent, they agreed to uphold with the national statement on ethical conduct in research involving humans prepared by the National Health and Medical Research Council. This agreement ensured that the participant had the right to ask questions that related to the research. The participant felt that the need to have a consensus of the guidelines and principles to guide them through the interview was important. The agreement upon statements gave them guidelines during the interview and failure to follow the guidelines had consequences as stipulated by the statement. In addition, the participant had a right to agree or disagree on audiotaping. However, since they required a taped source of information they requested the participant to allow them to audiotape the interview. The aim of audio taping agreement was to ensure that there was respect for participant ethical standards.

Data analysis

The analysis methods appropriate with the methodology used in this paper are heuristic and narrative. Heuristic analysis also referred to as phenomenology analysis gives analysis of the emphasis of individual experience (Fresh water & Holloway, 2007). This analysis method emphasizes on the idiosyncratic meaning of individual experiences not shared construction of experiences from different people. After the analysis, the method then generalizes the findings of other people’s perspective and experiences. The method emphasizes on the research experience depending on the research-personal knowledge from the research work (Kermode & Taylor, 2006). On the other hand, narrative analysis gives the study of individual speeches. The method analyzes the story, extracts the required information and gives the perception to the data collected. The analysis focuses on the context-situation, the core plot of the information gathered during the research and the basic action (Freshwater & Holloway, 2007).

These two methods are relevant in the analysis of the data collected in this method as they revolve around the objective of the research. In phenomenology research method, the objective is to achieve an understanding of individual experience and then generalize to the other people’s experiences. This supports the use of heuristic or phenomenology analysis method that gives emphasis on individual experiences. The objective of the research is to gain an understanding of discharging planning on the experiences of living with pressure ulcers on the health of the elderly diabetic patients. The understanding achieved from this research gives the general experience of patients that are associated with such illness. The care given to patients suffering from this illness will depend on the outcomes of the research analysis. Similarly, narrative analysis method is applicable to phenomenology method of research in our paper as it analyzes the individual speeches. The analysis gives concern to the aspect of speech between the interviewee and the interviewer. The analysis method thus seeks to analyze the data from the interview. The method will emphasize on the context of the interview and the core plot of the information collected during the interview.

In the interview, the information collected indicates that the impacts of the experiences of living with pressure ulcers on the health of the elderly diabetic patients range from economic to psychological. The data collected from the interview indicates that majority of the people struggling with this illness face economic challenges. They experience economic challenges due to the medical bills on their treatment. This causes the families associated with these people to struggle as they seek to support the patients. Consequently, the effort of the extended families to support the elderly patients has caused majority of the associated families to have financial challenges that cost the children their education, failure of the families to raise basic needs and sale of properties. In addition, the financial struggles of these families make them unable to deal with minor illnesses that further result to major illnesses. This further affects the family even more as they seek treatment for illnesses at advanced stages.

The other impact of the experiences of living with pressure ulcers on the health of the elderly diabetic patients as revealed during the interview is on psychological effects. According to the data collected from the interview, psychological effects affect several elderly diabetic patients due to stress of the illness. They spend most of their time thinking of their life and the consequences of their illness. They consider and find themselves as burdens to their families and they therefore keep on thinking of the possible outcome of their illness. From the interview, the data indicates that for every ten elderly diabetic patients, five of them live with stress and hope that they may die as soon as possible. This is mainly in the families that struggle financially as even raising enough money to cater for medication is a problem. They spend most of their illness time in pains and to them they find that the solution to their ailments is death. Further, these patients feel uncomfortable in the society due to their illness. They segregate themselves with other people in the society and spend most of their time alone. This has caused a major problem to their health as they spend most of their time meditating. They give less attention to what happens in the society or the country and concentrate on their health aspects. This makes their situation worse as they find themselves sicker than they would have been if they concentrated on other issues. Finally, these physiological effects develop to depression that makes their health worse than it would have been if they spent more time with other people.

Another impact associated with living with pressure ulcers on the health of elderly diabetic people is on the social aspects. In recent years, the society has been responding negatively to the people with various illnesses. They associate most of the illnesses with HIV/AIDS that causes majority to isolate themselves from the patients. They considered the patients to have bad luck that has made them to acquire the illness. The society segregates itself from these people and spends most of their time away from the patients instead of encouraging and consoling them. They spend much of their time on their own activities and rarely visit the sick. According to data collected during the interview among ten patients, only two of them who get attention from the society. This is an indication that the society has less to do with the well-being of the patients. Further, the data indicated that most of the people in the society associate many diseases with curses, which demoralizes majority of the patients. They feel uncomfortable in the society due to being associated with the curses while they understand it is not their wish to be in that situation.

Legibility of the analysis methods used

The choice of the research to use heuristic and narrative analysis methods was due to the research methodology used. The reasons for using these analysis methods were due to their interrelation with the research approaches used. Heuristic analysis as phenomenology method emphasizes on individual experiences (Freshwater & Holloway, 2007). Its focus on the understanding of individual experience supports its use in the analysis of the data as the research data concentrates on individual experience. The analysis method as the research method also gives emphasis on the understanding and essence of the experience from the researcher’s point of view and the interviewee (Kermode & Taylor, 2006). This brings the connection of the two methods to finding the solution of the research question. On the other hand, the use of narrative analysis helps in the analysis of the data with reference to the information gathered from the interview (Freshwater & Holloway, 2007). The method focused on the data context from the speeches made by the interviewee during the interview in response to the questions. The analysis method focused on the understanding of the context of the interview that helped in achieving the main objective (Freshwater & Holloway, 2007). It gave a clear understanding of the proceedings of the interview that consequently helped in understanding the experiences of the researcher on the impact of living with pressure ulcers to the health of the elderly diabetic patients.

Significance of the analysis to discharging planning

The main objective of the research was to answer the research question on the experiences of living with pressure ulcers to the health of the elderly diabetic patients. The understanding of experiences consequently meant to help in discharging planning of the patients with illness. Phenomenology as a research method aims at understanding patient’s perspective; understand their experience and concerns as they live with the illness. In addition, the method aims at helping the nurses with provision of the appropriate and holistic care to the patients (Munhall, 2011).

The analysis from the research paper gives an overview and understanding of the impacts of the experiences of living with pressure ulcers to the health of elderly diabetic patients. The understanding provides the nurses with the knowledge required in discharging patients with this illness. This helps the nurses in their decision making as they prepare the care strategies and routines for the patients. According to analysis of the paper, during discharging of the patients associated with diabetic illnesses it is appropriate to offer psychological advice to the patient on how to live positively with other people in the community without fear, stress or segregation. This will help in reduction of psychological effects to the patient that ensures the patients are able to cope with the illness and focus on other issues. In addition, the analysis has helped in ensuring that the people handling and taking care of the patients at home have the right knowledge and skills required. They give advice to the caretakers on how to help the patient to cope with their illness without stress and the right way of consolation and encouragement. On the society, the nurse with the management of the hospital would organize through the ministry of health on society enlightenment programs through media on the way to live with people with certain illness and the care they deserve from the society. Similarly, on financial basis the nurses in conjunction with the hospital can influence the ministry of health to reduce the cost of medication that will ensure that the patients have the medication even at home. They can also influence the non-government organizations to the patients’ aid through provision of required medication at reduced cost or free of charge. In addition, these organizations can give support to the families associated with these patients through provision of some necessities such as clothing, food and provision of education to fully stressed family. This will help the families to cope with the challenges and cater for their patients.

Limitation of the methods used

Phenomenology as a research method has two major limitations. The method focuses on the experience of a single individual towards a certain problem (Holland & Rees, 2010). Generalization of this experience may not bring the right or expected outcomes of the research. Further, data collection from a small sample may not represent the entire population in the right manner. Secondly, the methods aim at describing rather than explaining. In data collection, the method seeks to describe a certain problem without clearly explaining the problem (Gernish & Lacey, 2010). This limits the level of understanding of the problem, as it does not explain its origin. These drawbacks cause some limitations of method on its application in nursing researches.

Conclusion

Phenomenology as a research methodology that seeks to find the essence, experience, and gives the interpretation/understanding of the essence and experience is valid for use in nursing research. This will help the nurses to have the interests of patient’s perspective, an understanding of their experience and concerns as they live with their illness as well as provision of appropriate and holistic care. The method equips the nurses with knowledge and skills required in making certain decisions.

Interview

This section of the paper illustrates an interview conducted on the impact of experience of living with pressure ulcers on the health of the elderly diabetic patients. The interview started immediately the interviewer arrived, with the interviewer greeting the interviewee. How are you? I am fine thank you. Welcome to this essential session. We will not take long as we want to spend only half an hour in this interview. First, we wish to inform you that we are much glad to have you and we have the ethical standards that guide us in conducting our interviews. We respect your views and your justice prevails under all ethical conditions. Feel free to disclose to us the information we require, as we shall hold the information with privacy and confidentiality. We wish that you would also feel free, as your security in relation to the information that you will provide is not a threat as we consider everything confidential and we treat you as a co-researcher to us. Finally, we wish to request whether you would allow us to audiotape the interview. Yes, you can audiotape if only you will adhere to your promise that this interview is confidential. Once again, the information that you will disclose to us is confidential.

Please tell us what you understand by the phrase “elderly diabetic patients.” The elderly diabetic patients refer to those aged people who suffer from diabetes diseases. What do you know about the disease? The disease result from lack of enough hormones in the body to regulate the amount of insulin. The disease is curable but it might have a great challenge if in advanced stage. What is the rate at which the disease is affecting the people? In the recent years, there has been tremendous increase in the rate at which diabetic patients are admitted in our hospitals. What do you think are the causes of this increase? One, our eating habits have played a major role in the increase of the disease and second lack of enough physical exercises has contributed to the increase. What do you understand by the phrase “living with pressure ulcers on the elderly diabetic patients?” It refers to the elderly patients who suffer from bedsores. What are some of the causes of these pressure ulcers? The causes are reduced blood supply, mobility problems experienced by the elderly people and ageing of the skin. What are the impacts of the experience of living with pressure ulcers on the health of the elderly diabetic pressure? The impacts of living with the pressure ulcers on the health of elderly diabetic patients have several effects on the health of the patients as well to the families associated with the patient. The disease causes financial problems to the families. The cost of medication and hospital bills incurred during the treatment of the disease are many. The disease causes families to sell their properties; sacrifice some needs like children education and other basic needs in order to cater for the hospital bills and medication. In addition, it affects the families more if they spend money on transport to and from the hospital. These financial challenges consequently affect the patient who views himself/herself as a burden to the family thus affecting them psychologically. On the other hand, some of the family’s failure to raise money for the patient medication and medical bills affects the patients, as they do not have the required treatment.

Another impact of these patients is on psychological effects. These patients suffer from stress caused by their illness. They spend most of their time thinking of their health status, which affects them most. They give less attention to the issues that happen in the society or the country and concentrate on their illness status. This causes a great challenge to their health rather than solving the situation. They further segregate themselves from the society that results to their spending most of the time alone. This exposes them to more thoughts of their status that consequently affect their health status. They concentrate much on the impacts of their illness to an extent of wishing that the world might end to set them free. Among the ten elderly diabetic patients, approximately two of them get exposure to psychological effects. This is mostly common to the patients from the families that are not financially stable. They spend much of their time regretting that if it was not for their illness, their families could not be struggling. This over stressing finally results to depression that severely affects the patients.

There is impact on the social aspect where with the increase in the rate of HIV/AIDS infections and disease, most of the people associate several illnesses with AIDS. This has caused majority of the society to segregate themselves from the patients with different illnesses. In addition, the society associates illnesses with bad luck and curses. This further affects the patients who feel that they are associated with bad luck and curses that further put them in more problems that consequently result to psychological effects. The society perception towards these patients causes major problems to their health by exposing them to psychological effects. Instead of the society using their leisure to visit the patients so that they can console and encourage them, they look for other activities to keep them busy. The lack of encouragement and consolation exposes the patients to more psychological effects that further make the patients’ situation bad. The number of patients who receive the attention and care from the society are very few. Finally, according to a research done some months ago, the results indicated that only two out of ten patients receive the society care and attention.

What are some of you views in respect to this impacts and experiences? I feel that much is required to help these patients and overcome all their challenges, as it is not their will to be in such conditions. Please give your final word. I would like to thank you for the time and the opportunity of inviting me for this interview. We are also humbled before you for honoring our invitation and the sacrifice. Thank you for attending the interview.

References

Allen, A., & Wiggins, O. (2011). Clinical ethics and the necessity of stories. New York: Springer Science + Business Media.

Freshwater, D., & Holloway, I. (2007). Narrative research in nursing. Malden: Blackwell Publishing.

Gerrish, C., & Lacey, A. (2010). The research process in nursing (6^th edition). Malden: Blackwell Publishing.

Holland, K., & Rees, C. (2010). Nursing: Evidence-based practice skills. New York: Oxford University Press.

Holloway, I., & Wheeler, S. (2010). Qualitative research in nursing and healthcare (3rd ed.). West Sussex: Wiley-Blackwell.

Kermode, S., & Taylor, B. (2006). Research in nursing and health care: Evidence for practice. Australia: Thomson.

Kim, H., & Kollak, I. (2006). Nursing theories: Conceptual & philosophical foundations. New York: Sheridan Books, Inc.

Liamputtong, P. (2009). Qualitative research methods (3rd ed.). South Melbourne: Oxford University Press.

Munhall, P. (2011). Nursing research: A qualitative perspective (5^th edition). Sudbury: Jones & Bartlett Learning.

Tappen, R. (2011). Advanced nursing research: From theory to practice. Sudbury: Jones & Bartlett Learning.

Appendix

Analytical Notes

Interview program

1. Time scheduled for the interview from 9.35 am to 10.05 am
2. Topic: impact of experience of living with pressure ulcers on the health of elderly diabetic patients
3. The start of the interview: greeting and welcoming the interviewee.
4. Consent with the participants on the ethical standards to be upheld in the interview and after the interview. They should include:

The confidentiality and privacy

• Permission from the participant on audio taping
• Participant security

Critique to Interview Technique

Interviews are generally exposed to risks associated wit manipulation, bias and control. In selection of the interviewee, I would choose someone who would help me in attaining the data I may have expected to arrive at. This causes the research finding to lack some of the information required. In addition, the use of a participant whom I know and has the idea of what am after makes findings to have control by both the interviewer and the interviewee. The participant may also have not involved in the past with search a research or directly living with elderly people suffering from pressure ulcers caused by diabetes disease that means he or she would only give the

Questions for the Interview

• What do you understand by the phrase elderly diabetic patients?
• What do you know about diabetes disease?
• What is the rate at which the disease is affecting the people?
• What causes this disease and the increase in the rate?
• What do you understand by the phrase “living with pressure ulcers on the elderly diabetic patients?”
• What are some of the causes of these pressure ulcers?
• What are some of your views in respect to these impacts and experiences?
• What can be done to ensure we prevent this disease and the effects of the pressure ulcers on elderly people living with diabetes?

1. Final remarks and vote of thanks to the participant.
2. The interview ends at 10.05 am.

Points Highlighted During the Interview knowledge acquired from books or from other sources, which may not necessarily be of help to the objectives of the research.

Similarly, the kind of questions used in this interview are directive that can help the participant in arriving at certain answers to fully fit my mode of questioning and the kind of answers the participant may anticipate were my expectations. This similarly makes the research to yield outcomes that may not be worth generalization.

In the interview, the participant and the interviewer have a high tendency of manipulating the outcomes. As the interviewee, I would focus to only the response that the participant gives that suites my research objective. Similarly, after the participant answers my question I would also question the interviewee rather than having the right information as per the participant perceived. In addition, I may have

Elderly diabetic patients are aged people suffering from diabetes.

The cause of diabetes is lack of enough hormones that regulate the amount of insulin in the body. The disease is controllable and curable if realized at the early stages.

In the recent years there have being tremendous increase in the rate of diabetic patients.

The causes of diabetes are poor eating habits and lack of enough physical exercises.

Elderly diabetic patients living with pressure ulcers are the elderly diabetic people suffering from bedsores due to the advanced level of their diabetic condition.

The causes of this pressure ulcers or bedsores are:

• Reduced blood supply,
• Mobility problems experienced by the elderly people
• Ageing of the skin

influenced the participant in his or her response through the tone I used at some points during the interview. The use of people who understand each other in the interview may lead to such manipulation.

On the other hand, the participant may have manipulated or controlled the interview through his or her response to the questions posed. The participant may have answered the questions in a way that would not be of great importance to the research objective thus spending more time in the interview and yet alive at unexpected or poor outcomes.

The other critique of the interview is on the willingness of the participant to disclose the right information. At first the participant felt save on the ethical standards and especially on.

The categories of the effects of pressure ulcers on the health of elderly diabetic people are:

• Financial effects
• Psychological effects and
• Social effects

On financial effects, the families living with patients experience financial difficulties due to large medical bills and costs of medication incurred by the families. In addition, these families have basic needs, children, and other living factors that they have to cater for that causes more strains financially.

On the psychological effects, the effects of illness cause the patients a high risk to stress and depression. They spend most of their time concentrating with their illness that causes them lack of freedom that eventually affects them due to in-depth thoughts. This also makes them to segregate themselves from the audiotaping that the participant felt unsecure.

Although the participant

finally agreed to disclose the information her/she may have left some of the information that would be of importance to the research due to the his/her security measures as he would not be certain of my upholding of the agreed ethical standards. This further would lead to lack of competent findings of the research and that would affect the objectives.

Rest of the community

On the social effects, the patients have little or no attention from the society that reduces their care level. They are segregated as the society associates them with bad luck and with HIV/AIDs.

Participant final remark: much needs to be done to contain this effects and challenges in the lives of these patients. The patients require support to cope with the situation.