University of York, Department of Health Sciences, University of York, York, YO10 5DD, UK.
Bradford Institute for Health Research, Bradford, BD9 6RJ, UK.
Int J Nurs Stud. 2018 Jan;77:29-38. doi: 10.1016/j.ijnurstu.2017.09.015. Epub 2017 Sep 28.
Most surgical wounds heal by primary intention, that is to say, the edges of the wound are brought together with sutures, staples, adhesive glue or clips. However, some wounds may be left open to heal (if there is a risk of infection, or if there has been significant tissue loss), and are known as 'surgical wounds healing by secondary intention'. They are estimated to comprise approximately 28% of all surgical wounds and are frequently complex to manage. However, they are under researched and little is known of their impact on patients' lives.
To explore patients' views and experiences of living with a surgical wound healing by secondary intention.
A qualitative, descriptive approach.
Participants were recruited from acute and community nursing services in two locations in the North of England characterised by high levels of deprivation and diverse populations.
Participants were aged 18 years or older and had at least one surgical wound healing by secondary intention, which was slow to heal. Purposeful sampling was used to include patients of different gender, age, wound duration and type of surgery (general, vascular and orthopaedic). Twenty people were interviewed between January and July 2012.
Semi-structured interviews were conducted, guided by use of a topic guide developed with input from patient advisors. Data were thematically analysed using steps integral to the 'Framework' approach to analysis, including familiarisation with data; development of a coding scheme; coding, charting and cross comparison of data; interpretation of identified themes.
Alarm, shock and disbelief were frequently expressed initial reactions, particularly to "unexpected" surgical wounds healing by secondary intention. Wound associated factors almost universally had a profound negative impact on daily life, physical and psychosocial functioning, and wellbeing. Feelings of frustration, powerlessness and guilt were common and debilitating. Patients' hopes for healing were often unrealistic, posing challenges for the clinicians caring for them. Participants expressed dissatisfaction with a perceived lack of continuity and consistency of care in relation to wound management.
Surgical wounds healing by secondary intention can have a devastating effect on patients, both physical and psychosocial. Repercussions for patients' family members can also be extremely detrimental, including financial pressures. Health care professionals involved in the care of patients with these wounds face multiple, complex challenges, compounded by the limited evidence base regarding cost-effectiveness of different treatment regimens for these types of wounds.
大多数外科伤口通过一期愈合，也就是说，伤口边缘通过缝合、订书钉、粘合剂或夹子缝合在一起。然而，一些伤口可能会敞开愈合（如果有感染的风险，或者组织大量流失），这种情况被称为“二期愈合的外科伤口”。据估计，它们约占所有外科伤口的 28%，而且通常很难处理。然而，对它们的研究很少，人们对它们对患者生活的影响知之甚少。
探讨患者对二期愈合的外科伤口的生活体验和看法。
定性、描述性方法。
参与者是从英格兰北部两个地点的急性和社区护理服务机构招募的，这些地点的特点是贫困程度高，人口多样化。
年龄在 18 岁或以上，至少有一个二期愈合缓慢的外科伤口。采用目的性抽样方法，纳入不同性别、年龄、伤口持续时间和手术类型（普通外科、血管外科和骨科）的患者。2012 年 1 月至 7 月期间共进行了 20 次访谈。
采用半结构式访谈，访谈指南是在患者顾问的协助下制定的。使用“框架”分析方法中的步骤对数据进行主题分析，包括熟悉数据；制定编码方案；对数据进行编码、图表化和交叉比较；解释确定的主题。
最初，人们通常会感到震惊、震惊和难以置信，特别是对于“意外”的二期愈合的外科伤口。伤口相关因素几乎普遍对日常生活、身体和心理社会功能以及幸福感产生了深远的负面影响。挫败感、无力感和内疚感很常见，而且令人虚弱。患者对愈合的期望往往不切实际，这给照顾他们的临床医生带来了挑战。参与者对伤口管理方面的连续性和一致性表示不满。
二期愈合的外科伤口会对患者的身体和心理造成毁灭性的影响。患者家属也可能受到极其不利的影响，包括经济压力。参与治疗这些伤口的医护人员面临着许多复杂的挑战，而且关于这些类型伤口的不同治疗方案的成本效益的证据有限，这使情况更加复杂。
