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The chaos of hospitalisation for patients with critical limb ischaemia approaching major amputation

Susan Monaro1,2, Sandra West2, Jana Pinkova3

  • 1Concord Repatriation General Hospital, Concord, NSW, Australia.

Journal of Clinical Nursing
|May 19, 2018
PubMed

Insights

Patients and families face chaos during hospitalization for critical limb ischaemia (CLI) and amputation. Improved communication, coordinated care, and peer support are vital for mindful decision-making and a sense of safety.

Area of Science:

  • Medical Sociology
  • Patient Experience Research
  • Qualitative Health Research

Background:

  • Critical limb ischaemia (CLI) presents a significant health burden, often leading to major amputation due to limb deterioration, pain, and infection.
  • While clinical outcomes of CLI and amputation are documented, the patient and family experience during hospitalization remains underexplored.
  • Understanding this experience is crucial for person-centered care and effective planning.

Purpose of the Study:

  • To explore the hospital experience of patients and families facing major amputation for critical limb ischaemia (CLI).
  • To identify challenges and needs influencing patient and family decision-making and adjustment.
  • To inform the development of patient-centered care strategies.

Main Methods:

  • Longitudinal qualitative study employing Heideggerian phenomenology.
  • Semi-structured interviews were conducted with 14 patients and 13 family carers post-advice for amputation, with follow-up interviews at 6 months for a subset.
  • Hermeneutic phenomenological analysis was applied to 42 transcribed interviews.

Main Results:

  • Hospitalization for CLI and amputation induced a sense of chaos, characterized by fragility (physical and mental), nurse busyness, and carer hypervigilance.
  • Participants felt adrift in uncontrollable environments, citing issues with noise, space, accommodation, and scheduling.
  • Confusion arose from missed/mixed messages due to multiple stakeholders, information overload, and cultural/linguistic diversity.

Conclusions:

  • Patients and families require strategies to navigate the chaotic process of amputation decision-making and hospitalization.
  • Cognitive deficits can exacerbate care complexity and the burden of family advocacy.
  • A coordinated interprofessional approach, including improved communication, engagement, scheduling, discharge planning, and peer support, is essential to foster safety and adjustment.
Abstract

Keywords:
communicationcritical limb ischaemiafrailtymajor amputationphenomenologyqualitative research

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