Presence and Attributes of Diabetic Foot Ulcer Pain - Coursework Example

Critical Research Paper Name Tutor Date Critical Research Paper The Hidden Burden: Part One and Part two Aim The aim of the research in part 1 study was to explore the presence and attributes of diabetic foot ulcer pain while the aim of part 2 research study was to find out the effect of specific diabetic foot ulcer on life quality from the perspective of the patient. Hypothesis In part 1, the hypothesis was that diabetic foot ulcers generate pain and this pain greatly affects the quality of life while in part 2 the hypothesis was that diabetic foot ulcer pain has an effect on the quality of life. The different in hypothesis was because part 1 aimed at studying two aspects; diabetic foot ulcer pain and its effect on the quality of life while part 2 aimed at only studying the effect of diabetic ulcer pain. Dependent Variables & Independent Variables According to Bradbury (2011), in part 1, the dependent variables are the measure of diabetic foot ulcer pain and the effect of this pain on the quality of life. The independent variables include the characteristics of the pain, the relationship of ulcer pain, etiology, complications associated with diabetic foot ulcer pain, pressure from footwear and dressing changes on the ulcer. On the other hand, the dependent variable in part 2 is the diabetic foot ulcer pain. The independent variables include, pressure from footwear, dressing changes ulcer. Research Design From Bradbury 2011, part 1 employed quantitative design. Quantitative design was used in quantification of relationships between variables. It was used in quantifying the relationship of diabetic ulcer pain and the pain and the effect of this pain on the quality of life. However in part 2, exploratory research was used in order to establish the best research design, the best method of collecting data in addition to choice of research subjects. This research relied on secondary research, i.e. qualitative approach, for example an interview schedule was established in order to guide the conversation onto applicable topics, basing on the aim of the research. As Bradbury (2011) explains, the available literature was also reviewed whereby the main focus was on the DFU pain. Afterwards, a more formal approach was used which included, a pilot study whereby the initial interview was used as the pilot study to establish the validity of the questions and if the questions were comprehensible. Additionally, through in-depth interviews were conducted where they were recorded and physically copied out and also reflective not were taken after the interview ended. According to Asghar et.al. (2007), the importance of using secondary data analysis was because it functioned as the tool for constructing identifying diabetic foot ulcer pain as well as for better understanding of the aim of the research. Data Collection Bradbury (2011) notes that part 1 employed only one method of data collection. Only questionnaires were used in collecting clinical history, diagnosis in addition to the status of the wound. Data regarding the pain was collected using a questionnaire. Interviewing was also used in collecting data where three patients identified through purposive sampling were interviewed regarding the effect of diabetic foot pain on their quality of life. Alternatively, part 2 employed two methods of data collection, namely; interviewing and recording. Purposive sampling was used in selecting the patient samples. Interviews were used in collection of qualitative data regarding the effect of diabetic foot ulcer pain on daily life. Recording was also used in collection of data whereby taped conversations were recorded by the researcher and after that verification was done by the second researcher who had not participated in the interview. Data Analysis The data collected in part 1 through interviewing was analyzed through thematic content analysis while in part 2 exploratory data analysis was used to analyze the collected data and as Choudrie and Dwivedi (2005) explains, this was meant to summarize the main characteristic in the collected data within an easily understandable form. Ethical Considerations According to Bradbury (2011), in the research diabetic foot ulcer part 2, the study protocol was granted by the Local Research Ethics Committee. Confidentiality and anonymity were maintained throughout the research process. Additionally, written informed consent was taken from the interviewees. On the other hand, in the research article, diabetic foot ulcer part 1, verbal informed consent was obtained from all patients before completing the SF-MPQ. Since the information being collected was for meant for auditing and was within the sphere of usual clinical practice, formal ethical approval was not sought. Reliability and Validity Sufficient data was collected in research in diabetic foot ulcer part 2 to help support the findings within the subject scale. However, explains that the size of the data was small because the intended number of five participants reduced to three because some refused to take part while some patients had been discharged by the time the research was approved. In research in diabetic foot ulcer part 1, even though the sample size was relatively adequate, the data collected was not enough. Part 1 is lacking in regard to data collection process where only questionnaires were used in taking the data while part 2 involved questionnaires, interviewing and recording while collecting the data from the participants. Greater elaboration of the research process was provided in part 2. In the absence of sufficient data in part 1 and adequate sample size in part 2, it is very hard to examine the validity and reliability of the research findings in both articles. Pilot Study In the research article, part 2, pilot study was carried out to check that the methodology had been properly thought through. The researcher had a chance of identifying any shortcomings before conducting the main study. However, in research article, part 1, a pilot study was not carried out. Findings Bradbury (2011) points out that in part 1, out of the twenty eight participants, 18 had one or more complications allied to diabetic foot ulcer which include, infection, osteomyelitis along with Charcot arthropathy. 16 participants were on regular oral analgesia, even through not constantly for solely diabetic foot ulcer pain. 68% of the patients stated some level of diabetic foot ulcer pain. Ache was the most frequent sensory pain by 14 of the participants, hot burning pain by eleven participants, tender pain by eleven participants, sharp pain by ten participants and tiring by ten participants. According to Fox (2005), inadequate physical mobility experienced by people suffering from diabetic foot ulcers is among the outstanding challenges faced by the participants. For the findings for the second phase; 4 themes surfaced from qualitative data: experience data, physical effects of pain, coping support & social impact and also psychological impact of the pain. In Bradbury (2011), results showed diabetic foot pain had an effect on the physical and psychology of the participants, more so regarding sleep, mobility in addition to social roles. The participants also expressed feelings of being depressed, isolation and being dependant. Ulcer pressure from footwear and also the changing of the dressing led to DFU or aggravated pain. Most of the participants used analgesia in managing the pain but with changeable effectiveness. Basically, the results are that Diabetic foot ulcer pain can have a negative effect on the quality of life. The result findings in part 2 were as follows: Experience of Pain The description of the pain by the participants was either; sharp, unanticipated, unprompted but with severe intensity, sporadic, constant or implacable. Bradbury (2011), provides that the participants mainly indicated that the aspects that increased or worsened the pain were when pressure was applied on the wound, in particular when dressing was being changed and also from footwear. All the participants described pain while in bed because of pressure from bedclothes or the movements. The article written by Fox (2005) mentions that parts of the treatment regimen for people suffering from diabetic foot ulcer was to have one’s feet up in the air for a considerable hours of the day to avoid bearing the weight. Physical Effects of Pain According to Bradbury (2011), all the participants expressed difficulties with mobility because of the pain and this led to feelings of loss of independence. One of the participants was feeling that his pain was reducing when his ulcer started healing and said that his feelings of loss of control lessened with the improvement in his mobility. Difficulties in footwear also led to poor effects. Still, another participant acknowledged walking as a central element in escalating the ulcer pain, necessitating an electric scooter outside the house and also rendered him not being in a position to drive. Diabetic foot ulcer pain also affected one’s sleep, more so with one patient. Coping, Support and Social Impact As Bradbury (2011) explains, the ulcer pain was seen to be affecting the relationship the participant had with the family, friends as well as the medical practitioners and this included the support the got and the strategies to cope they took up. All the participants in this study were not able to carry out all their every day activities and hence they were not live independently. Other participants recognized the feeling of being a burden to their family members as one of the main aspect resulting from diabetic foot ulcer pain. Psychological Impact From the information provided in Bradbury (2011), the diabetic ulcer pain affected the emotions of the patient and this included, being depressed, isolated as well as loss of independence and this significantly extended beyond other aspects because of the broad effect of the pain generally. The ulcer pains also caused the participants to be less motivated and were predominantly depressed a finding that has been emphasized by Fox (Fox). The results are that Diabetic foot ulcer pain can have a negative effect on the quality of life. The Quality of Findings In research article part 2, all the participants indicated that DFU impacted their psychological and physical domains. Even though considerable results cannot be drawn from the findings, the quality of the findings is excellent since the findings confirmed that diabetic foot ulcer pain can have negative physical and psychological impacts which corresponds earlier studies, Ribu et.al where results were that the patients with DFU pain has constantly low scores in physical and psychological domains. According to Bradbury (2011), research article part 1, 86% of the participants reported some level of DFU pain on the SF-MPQ. The study findings here highlighted previous studies that illustrated that patients normally experience DFU pain. The second phase in part 1 also generated similar findings as in part 2. Basically, the quality of the research findings in both part 1 and 2 is outstanding since these findings support results of previous similar studies including Ribu et al., and Bengtsson et al., that DFU pain is a problem and also supports qualitative work qualitative work on HRQoL of patients with DFU, where pain was frequently raised as a an issue. Fox (2005) points out that the speed upon which ulcers progressed from a simple and minor injury to a threatening condition emphasizes the need adequate prevention measures. Conclusion In both studies, obtaining informed consent enabled the researchers to obtain important information especially in part 2 through in-depth interviews. Additionally, in both studies there were notable limitations like, poor external validity, small sample size and hence similar findings may not be obtained in bigger and less complex population. However, the aim of both studies was meaningful in that establishing the effect on DFU pain on the quality of life. Recommendations Both studies lack external validity to generalize the study findings beyond the sample. The studies should be repeated using a more representative samples and with adequate sample size. The studies findings form a basis for future research and hence more research studies should be carried out in this area. References Bradbury, S. (2011). Diabetic foot ulcer pain: The hidden burden part one. EWMA Journal. 11(1): 11-22. Bradbury, S. (2011). Diabetic foot ulcer pain: The hidden burden part two. EWMA Journal. 11 (2): 25-36. Choudrie, J., & Dwivedi, Y. (2005). Investigating the research approaches for examining technology adoption issues. Journal of Research Practice. Issue1 (1): 1-12. Asghar, A. et.al. (2007). Effects of vacuum-compression therapy on healing of diabetic foot ulcers: Randomized controlled trial. Journal of Rehabilitation Research & Development. Vol. 44 (5): 631-636. Fox, A. (2005). Innocent Beginning, Uncertain Futures: Exploring the Challenges of Living with Diabetic Foot Ulcers. Canadian Journal of Diabetes. 29 (2): 105-110. Read More