Electronic Thesis and Dissertation Repository


Doctor of Philosophy


Health and Rehabilitation Sciences


Polgar, Janice A.


Wound prevention and management best practice guidelines and literature contain recommendations that treatment plans need to consider the client’s lifestyle but offer little guidance about the specific lifestyle factors to be considered, nor how to address these. A post positivist constructivist grounded theory study was used to explore this gap Participants were health care providers with at least 5 years of experience working with community dwelling adults with chronic wounds. Data were transcripts of two semi structured individual interviews, a reflective journal, relevant documents identified by participants and transcripts of focus groups.

A common understanding of lifestyle factors was not found; however, a substantive theory was co-constructed. This work builds on a concept described by Schon (1987, pg 3)where best practices and research studies are described as occupying a high ground overlooking a swamp, where complex clients are managed with limited resources. In this study, three major themes emerged – the high ground, the swamp and co-occupation. The high ground included how the health care provider entered wound prevention and management, and that their initial task was local wound care. Health care providers expected wounds to heal with specific treatments within specific time frames. Practice, however, happens in the “swamp”. Participants described the context of the swamp to include ideas such as; the practicality of treatment, client characteristics, the client’s vocation, etc. Co-occupation occurs when the clinician and client are both engaged, working together on the common goal of identifying and addressing lifestyle factors within the context of the swamp.