Non healing leg ulcers and the nurse–patient relationship. Part 2: the nurse’s perspective
Bibliographic record
Abstract
This paper focuses on the experiences of four community nursing teams responsible for the care of a small group of patients with leg ulcers who they had identified as 'non healing' and 'non concordant' with treatment. Four focus groups were held, one with each community nursing team, to examine the issues underpinning the labelling of these patients as 'non healing' and 'non concordant'. There was an expectation that patients should obey treatment instructions and be positive and participative and there was a strongly felt link between concordance and healing of the ulcer. However, limited non concordance was considered to be acceptable as long as the patient continued to progress. Nurses viewed ulcer healing as the priority even though this was unlikely and differed from the patient's priority of achieving comfort. Patient behaviour was an important determinant of labelling by nurses. Efforts by patients to exert some control over their own care were met with them being viewed as 'difficult', 'uncooperative' and 'non compliant'. There was also a pervasive level of stress, distress and anxiety among the community nurse participants, which led to distancing and blaming that undermined the nurse-patient relationship. At the centre of a successful nurse-patient relationship is a non judgemental partnership that can often be challenging to achieve especially when ulcers fail to heal.
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How this classification was reachedexpand
Full frame distilled prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. Learned from the 10,348 direct Codex labels and 10,348 direct Gemma labels. Candidate is the union of thresholded teacher heads; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels or direct frontier model labels.
Codex and Gemma teacher scores by category
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.002 | 0.001 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.000 | 0.000 |
| Science and technology studies | 0.006 | 0.000 |
| Scholarly communication | 0.000 | 0.001 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.002 |
| Insufficient payload (model declined to judge) | 0.001 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one teacher head, not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".