Difficult Clinical Encounters in Chronic Wound Care: An Interview Study of Nurses' Experiences and Approaches

Although difficult social interaction patterns are scientifically addressed in other medical fields, it is an under-researched topic in wound care. A knowledge gap exists pertaining to what kind of interpersonal problems occur between patients with chronic wounds, their relatives and nurses. In an exploratory interview study, we analyzed 37 interviews with nurses from different settings to explore how they perceive and approach difficult encounters with patients with chronic wounds. A content analysis conducted with MAXQDA revealed three broad themes of difficult nurse-patient interactions. First, conflicts included aggression, violence, insults, arguments, unrealistic demands, discrimination, lying, complaints, and general unfriendly behaviour. Often, nurses function as a kind of outlet for patients' annoyance. Second, non-adherence was associated with perceiving treatment as difficult. Third, difficult but non-conflictual situations were also common, that is, various and multilayered issues which complicate treatment. In addition, an overview of what respondents considered an ideal wound care practitioner is provided. Interventions could target self-care, nonviolent communication, and health literacy.