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. 2020 Dec 16:21:e63.
doi: 10.1017/S146342362000064X.

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

Xiaoli Zhu  1 , Ling Jia Goh  1 , Evelyn Chew  2 , Mary Lee  3 , Bernadette Bartlam  4 , Lijuan Dong  1
Affiliations

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

Xiaoli Zhu et al. Prim Health Care Res Dev. .

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.

Keywords: diabetes; interpretative phenomenological analysis; lived experience; lower extremity amputation; normality; post-amputation wound; primary care; qualitative research.

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Figures

Figure 1.
Figure 1.
The essence of ‘struggling for normality’ embodies physical loss, emotional impact, social challenges, and attempt to regain normality
Figure 2.
Figure 2.
Interdisciplinary care model for physical and psychosocial adjustment and normalisation for patients with DLEA and post-amputation wound in primary healthcare
See this image and copyright information in PMC

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