The palliative management of fungating malignant wounds--generalising from multiple-case study data using a system of reasoning.
The project focused on individual experiences, from 45 participants, of living with a fungating wound and the performance of wound dressings in reducing the impact of the wounds on daily living. A case study design was adopted. This posed a key methodological challenge in the form of the contentious epistemological issue, characterised in the literature as the "nomothetic-idiographic dilemma". This issue concerns the nature of knowledge generated from an individual case and its generalisability. A system of reasoning was adopted as the analytic strategy, within a theory-driven evaluation, to abstract general issues from the case study data to construct explanations of symptom control and dressing performance. The latter were generalised beyond the individual cases with the use of theory. This paper focuses on the methodological issues that are inherent in the use of a case study design and the nature of the evidence generated. The system of reasoning is described and illustrated using data from a single participant with advanced uterine cancer and a fungating nodule in the groin.
Grocott
P
P
Florence Nightingale School of Nursing and Midwifery, King's College London, James Clerk Maxwell Building, 57 Waterloo Road, London SE1 8WA, UK. patricia.grocott@kcl.ac.uk
Cowley
S
S
D000203:Activities of Daily Living; D001458:Bandages / Q000592:standards*; D018450:Disease Progression; D005122:Exudates and Transudates; D005260:Female; D006801:Humans; D019359:Knowledge; D008128:Logic; D009336:Necrosis; D009730:Nursing Assessment; D015403:Nursing Evaluation Research; D015404:Nursing Methodology Research; D009742:Nursing Theory; D010166:Palliative Care / Q000379:methods*; D011788:Quality of Life; D012107:Research Design; D017592:Skin Care / Q000295:instrumentation* / Q000451:nursing* / Q000523:psychology; D012878:Skin Neoplasms / Q000150:complications / Q000451:nursing* / Q000473:pathology / Q000523:psychology / Q000556:secondary*; D012883:Skin Ulcer / Q000209:etiology / Q000451:nursing* / Q000473:pathology / Q000523:psychology; D016896:Treatment Outcome; D014594:Uterine Neoplasms / Q000473:pathology*