How Nurses Communicate About Amputation and Death in Specialised Outpatient Wound Clinics-A Qualitative Study

To explore how nurses communicate with patients at risk of amputation due to chronic leg wounds, with a specific focus on discussions regarding amputation and death and to explore the perceived barriers that nurses face when engaging in conversations about prognosis, treatment options and end-of-life care.

An exploratory qualitative design was employed, utilising non-participant observations and focus group interviews conducted in specialist wound clinics across four hospitals in Denmark. The observations included 85 consultations involving 84 patients with chronic leg wounds, and four focus group interviews were conducted with 13 registered nurses. Data analysis followed a qualitative content analysis procedure and is reported according to the COREQ guidelines.

The study revealed that the primary goal of nurses is to achieve wound healing, which often overshadows the need for discussions about amputation and death. Five key themes emerged: 'Professional responsibility shaped by emotional involvement'; 'Meeting patients with honesty rather than compassion'; 'Avoiding conversations about amputation and death'; 'Timing dilemmas in conversations about amputation and death'; and 'Biomedical confidence and psychosocial uncertainty'. Nurses expressed a desire for deeper conversations but felt constrained by institutional practices and personal beliefs.

This study highlights the critical need for a systematic approach to communication about amputation and end-of-life care in chronic wound management. By identifying barriers and emphasising the importance of holistic, patient-centred care, the findings contribute to the ongoing discourse on improving palliative care practices for patients with chronic wounds. The insights gained can inform training and guidelines to enhance nurses' competencies and foster more open discussions about difficult topics, ultimately improving patient outcomes and quality of life.

Several barriers hinder nurses from discussing amputation and death with patients, including perceived incompetence, time constraints, lack of systematic approaches, unclear roles among healthcare professionals, and personal beliefs. The strong emphasis on achieving wound healing can overshadow the need for compassionate discussions about potential amputation, the broader implications of living with chronic wounds, and the risk of dying. Nurses often prioritise the practical tasks around wound healing over holistic patient care, which can lead to neglecting important conversations about prognosis and end-of-life care.