Healthcare Professionals' Perceptions of Person‐Centred Care in Wound Management in Swedish Primary Care Services: A Qualitative Study

ABSTRACT

Background

Hard‐to‐heal wounds pose a significant challenge to healthcare systems globally. While person‐centred care (PCC) has been proposed as a means to improve wound management, there is a scarcity of research examining its practical application in healthcare. An increased understanding of healthcare professionals' perceptions of PCC in wound management and the challenges associated with its application is thus warranted. Such an understanding can facilitate the implementation of PCC and, consequently, enhance the quality of care.

Aim

To explore healthcare professionals' perceptions of PCC in wound management in primary care services.

Method

The study had an explorative abductive design involving semi‐structured interviews with 23 healthcare professionals in primary care working with wound management. An abductive qualitative content analysis was conducted using the PCC framework, incorporating three routines related to, respectively, initiation, working, and safeguarding the partnership.

Results

The findings illustrated healthcare professionals' perceptions regarding initiating, practising, and safeguarding PCC in wound management. Initiating such care entailed having a holistic perspective, considering both the patient and the underlying causes of the wound, using the patient's goals and preferences to establish wound management, and motivating them to commit to the care. Practising PCC in wound management involved establishing a relationship of trust with the patient, tailoring wound management to her/his needs and circumstances, and minimising symptoms that had a negative impact on everyday life. Safeguarding PCC in wound management involved documenting continuously, keeping updated on patient medical records, and facilitating the exchange of information between healthcare professionals.

Conclusion

Healthcare professionals acknowledge the significance of PCC in wound management. The findings also highlight challenges, particularly in practising shared decision‐making, ensuring closeness and continuity of wound management, and documenting person‐centred care. These findings offer insights into key factors that support the implementation of PCC.

1. Background

Hard‐to‐heal wounds pose a significant challenge to healthcare systems globally, requiring significant resources and costs for effective management [1, 2, 3]. The impact on patients is severe, encompassing both pain and reduced health‐related quality of life [2, 4]. Approximately 1% of the population of developed countries will experience a hard‐to‐heal wound during their lifetime [5, 6, 7]. With a demographic shift towards an ageing trajectory, the incidence of hard‐to‐heal wounds is expected to escalate; wound healing in ageing communities is consequently an urgent priority [8, 9]. The term ‘silent epidemic’ [10] aptly describes the increased prevalence of hard‐to‐heal wounds hidden in the midst of other public health imperatives.

Hard‐to‐heal wounds, characterised as stubborn ulcers that resist healing within standard timelines, manifest diversely as pressure ulcers, leg ulcers, or diabetic foot ulcers [7, 11]. These wounds often result from underlying health conditions or factors that impede the natural healing process, such as diabetes or vascular disease [12]. Beyond the physiological consequences, hard‐to‐heal wounds influence the mental and social health of the individual [2, 4]. The negative impact extends to everyday life, causing disruptions in sleep patterns and raising concerns about the wound, which may hinder social interaction and physical activity and lead to stigmatisation [12, 13, 14, 15]. Patients suffering from hard‐to‐heal wounds may also experience emotional distress, complications related to their healing, and disruptions to their everyday activities, which can negatively impact the management outcomes [16]. Additionally, wound management procedures, including frequent and painful dressing changes, contribute to patients' perceptions of a loss of control [14, 17].

The traditional approach to wound management, primarily focused on rigorous dressing changes, has evolved significantly. Modern perspectives emphasise the importance of healthcare professionals integrating biomedical expertise with expertise grounded in a holistic view of the patient. This transformation to a more holistic approach goes beyond the superficiality of changing dressings, necessitating a thorough understanding of the intricate aspects of wound management [18, 19, 20]. It involves actively engaging and seeing each patient as a person, which entails considering individual circumstances, resources, nuanced reactions to pain, discomfort, burden, resignation, and medical history. In addressing challenges in wound management, healthcare professionals employ a diverse range of strategies, including motivational and encouragement approaches, establishing a trustful relationship with the patient, and involving the patient's family in addressing the situation [13, 18]. An illustrative example of this evolution is represented by the community‐based Lindsay Leg Clubs in the United Kingdom. These clubs address the social dimensions of wound management through an integrative and holistic care approach [21, 22, 23].

The need for transition to a more holistic approach in wound management is in line with the person‐centred care (PCC) approach, in which the patient is seen as a whole person within their unique social and cultural context [24, 25, 26, 27, 28]. A person‐centred care approach to wound management recognises the patient's beliefs, perceptions, and autonomy [29]. While research on PCC in wound management is limited, some existing studies indicate improved outcomes in pressure ulcer prevention and improved patient satisfaction, knowledge, and quality of life [4]. Evidence from other clinical areas indicates the advantages of PCC, such as enhanced quality of care and patient quality of life, together with cost savings [30, 31, 32].

However, multiple challenges have been identified in integrating PCC into healthcare services, including time constraints, lack of continuity in care, inadequate documentation systems, difficulties in interdisciplinary communication, and unclear responsibilities among healthcare professionals [28, 33, 34, 35]. Similarly, these obstacles are often amplified in the complex and multidisciplinary context of wound management. For example, several professionals frequently treat patients across different care settings, which can hinder the continuity and person‐centredness of care.

A deeper understanding of healthcare professionals' perceptions of person‐centredness in wound management, including challenges and strategies to handle them, could potentially facilitate the introduction of PCC. This may subsequently lead to quality improvement in wound management similar to that observed in other clinical areas [30, 31, 32].

This study focuses on the healthcare professionals' perceptions of PCC in wound management in Swedish primary care services. PCC is an established approach in Sweden's healthcare system, mandated by the Health and Medical Services Act (SFS 2017:30), which emphasises equality, dignity, continuity, safety, and patient participation. As a core nursing competency, PCC is embedded in nursing education and highlighted in national clinical guidelines, including the National Care Programme for Hard‐to‐Heal Wounds, where it is identified as essential to coherent care delivery.

Since primary care is the most common setting for treating hard‐to‐heal wounds, both in Sweden [36] and worldwide [37, 38, 39], understanding the perceptions of primary care professionals is essential to address challenges and develop effective strategies for integrating PCC in wound management.

1.1. Aim

The aim of this study was to explore healthcare professionals' perceptions of PCC in wound management in primary care services.

2. Methods

2.1. Study Design

The study had an explorative abductive design and applied a qualitative content analysis [40, 41]. An abductive design was used to operationalise the Person‐Centred Care (PCC) framework from Ekman et al. [21] in the data analysis. The study adhered to the Consolidated Criteria for Reporting Qualitative Research (COREQ) 32‐item checklist [42] for reporting.

2.2. Theoretical Framework

The PCC framework described by Ekman et al. [29] used in this study aims to facilitate the systematic application of PCC in healthcare by seeing the patient as a person and active partner in the care [28, 29, 33, 43]. The framework is based on three specific practices (also called ‘routines’): (a) initiating the partnership with patients, by actively listening to and eliciting their narratives, (b) working the partnership through co‐creating health plans, and (c) safeguarding the partnership, by documenting the health plan agreed upon by both parties [29, 43]. The practices involve: (a) eliciting the patient's narrative, that is, obtaining the patient's account of their illness, including its impact on everyday life, emotions, beliefs, coping mechanisms, and available resources, by using open‐ended questions and active listening [29, 34], (b) encouraging shared decision‐making involving the healthcare professional, patient, and often family members, by collaboratively discussing and formulating care plans and objectives based on a shared understanding of the patient's illness experience [29], and (c) maintaining the existing collaboration by documenting the patient's narrative, including their feelings, beliefs, needs, and participation in decision making regarding their treatment and the creation of a care plan to ensure PCC [29, 32, 33].

2.3. Setting

The study was conducted within publicly funded primary care and home healthcare services in two municipalities in the south of Sweden. All units providing such services in the selected area were included, comprising two primary care units and three home healthcare areas. The primary care services were managed by the regional healthcare authority, while the home healthcare services were operated by the municipal organisations. No private providers were involved.

In the Swedish healthcare system, person‐centred care is a guiding principle, supported by national legislation and professional frameworks. According to the Health and Medical Services Act [44], care must be provided with respect for each person's dignity and individual needs. Patients shall be given the opportunity to participate in planning and decisions regarding their care, and their need for continuity and safety must be considered.

Person‐centred care is described as a core competency within the nursing profession [45] and is supported by national policy documents and clinical guidelines. According to national guidelines for wound care, person‐centred and coherent care are emphasised as central principles for assessment and treatment planning [46]. This care approach is expected to guide practice in both regional primary healthcare and in‐home healthcare services provided by the municipalities, and forms part of the broader national system for knowledge‐based and equitable care.

2.4. Participants

Purposeful sampling techniques were employed to ensure variation in the healthcare professionals' perceptions [47]; a diverse group of participants with a range of ages, genders, work experience, and professional roles was included. The eligibility criteria were: (a) working as a district nurse, registered nurse, or assistant nurse, and (b) experience working with patients with acute or hard‐to‐heal wounds. The researcher (IL) informed the managers at the five sites of the aim and structure of the study. The managers then informed the healthcare professionals and asked about their interest in participating in the study. A total of 23 healthcare professionals agreed to participate in the study, with the majority being female, district or registered nurses who worked in homecare services and engaged in wound management on a daily or weekly basis. Two district nurses were managers with extensive experience in wound management but were not currently practising clinically. See Table 1 for more data on participants.

TABLE 1.

Participants' characteristics (n = 23).

Variables	Participants
Gender
Women (n)	22
Men (n)	1
Age, median (range) years	48 (24–64)
Type of Healthcare Professional
District nurse (n)	10
Registered nurse (n)	10
Assistant nurse (n)	3
Workplace
Outpatient clinic (n)	7
Homecare service Provider (n)	16
Professional experience, years, median (range)	17 (0.2–38)
Healthcare Professionals currently working with wound management, frequency
Daily (n)	10
Every week (n)	9
Every month (n)	2
Sporadically (n)	0
Never (n)	2
Healthcare Professionals' experience of working with wound management, median (range) years	15 (0.2–45)
Higher education course in wound management of at least 7.5 ECTS credit points
Yes (n)	3
No (n)	20

2.5. Data Collection

Individual interviews were conducted between January and October 2023. A semi‐structured interview guide [48] inspired by Ekman et al.'s PCC framework [29] was used, with questions related to PCC and wound management. It included two primary questions: [1] ‘What does PCC mean to you?’ and [2] ‘How could you incorporate a person‐centred approach in wound management?’ Follow‐up questions focused on the initiation, practicing and safeguarding of PCC, and potential associated challenges and how to address them. Prompts were used to follow up on interview questions (e.g., ‘Could you tell me more about that?’). All interviews were conducted on‐site at the participant's workplace by two interviewers, S.K., a district nurse and Ph.D. student, and D.T., an experienced researcher with extensive expertise in qualitative methods. The interviews lasted between 51 and 117 min, with a mean duration of 71 min. The interviews were audio recorded and transcribed verbatim.

2.6. Data Analysis

The interviews were analysed using qualitative content analysis with an abductive approach, involving an interchange between inductive and deductive analytical procedures [40, 41]. The PCC framework [29] was used to sort inductively generated codes into three categories related to, respectively, initiating, practising, and safeguarding PCC. In the first step, the first author (A.I.) familiarised herself with the interview data, inductively extracting and coding units of meaning related to the study aim. Secondly, the codes were deductively sorted into three categories—initiating, practising, and safeguarding PCC—based on their similarities and differences. All inductive codes fitted into these categories. Thirdly, the codes in each category were grouped into sub‐categories through inductive analysis. The primary analysis (steps 1–3) was repeatedly discussed with the second and last authors (D.T. and E.S.) until consensus categories and sub‐categories were established. The entire author team, with expertise in wound management, nursing, primary care, PCC, and qualitative methods, collectively ensured the trustworthiness and rigour of the analysis. For an overview of the analytical process, see Table 2.

TABLE 2.

Overview of the analytical process.

	Step	Analytical approach	Analytical procedure	Outcome	Author (s) responsible for analytical procedures
Iterative process, moving back and forth between the different steps	1	Inductive	Reading through the interview material	Familiarity with the data material	A.I.
	2	Inductive	Extracting, condensing, and coding meaning units	Condensed meaning units (e.g., for a wound to heal properly, convincing the patient to treat properly is critical) Codes (e.g., difficulties involving the patient)	A.I.
	3	Deductive	Grouping codes and categories	Categories (e.g., initiating person‐centred care)	A.I., E.S., D.T.
	4	Inductive	Grouping codes within categories into sub‐categories	Sub‐categories (e.g., motivating the person to commit to the care)	A.I., E.S., D.T.
	5	Inductive/deductive	Refining and finalising the analysis	Final report	A.I., E.S., D.T., P.S., I.L.

3. Findings

The healthcare professionals acknowledged the significance of PCC in wound management but also identified challenges in incorporating PCC in their daily work in outpatient clinics and homecare services in primary care. The following sections present their perceptions of initiating, practising, and safeguarding PCC in wound management. Table 3 provides a breakdown of the analysis by category and sub‐category.

TABLE 3.

Overview of the categories and sub‐categories illustrating the healthcare professionals' perceptions of PCC in wound management in primary care services.

Categories	Initiating person‐centred wound management	Practising person‐centred wound management	Safeguarding person‐centred wound management
Sub‐categories	Seeing the whole patient and the underlying causes of the wound	Building and maintaining a relationship of trust with the patient	Documenting and updating patient medical records continuously
	Beginning with the patient's goals and preferences as starting points for care	Adapting healthcare to the patient's needs and circumstances	Keeping updated on patient medical records
	Motivating the patient to commit to the care	Minimising symptoms that negatively impact the patient's everyday life	Sharing information on patients' care between healthcare professionals

3.1. Initiating Person‐Centred Wound Management

The healthcare professionals' perceptions of initiating PCC include the first steps towards a person‐centred approach to wound management. These steps entail seeing the patient as a person, understanding their situation and the underlying causes of their wound, and using this knowledge as a basis for initiating wound management and care. Additionally, motivating patients to commit to the wound management process is perceived as an essential aspect of the first steps towards PCC. These actions are seen as crucial to centring the care around the person and initiating shared decision‐making, but are also associated with challenges linked to the latter.

3.1.1. Seeing the Whole Person and the Underlying Causes of the Wound

As an initial step towards practicing PCC in the wound management setting, the healthcare professionals emphasised the importance of gaining a holistic understanding of the patients' situations, to understand and identify factors that could hinder or facilitate wound healing. This process involved viewing the patient as a person by diligently exploring their narrative and the historical account of their wound, encompassing parameters such as underlying or chronic conditions, social factors, habits,

If the patient doesn't eat, the wound won't heal and if it is very painful it won't heal either. Then we need analgesics. You cannot only look at the wound. (Participant 6)

Notably, the healthcare professionals often found it more feasible to gain a comprehensive and holistic understanding of the patient's situation during homecare visits than during outpatient clinic visits, as it enabled a closer connection with the patient:

When visiting a patient at home, you observe more than you do in a clinic. You witness their movements, notice if the house is clean, and observe their clothing if you tend to them in bed. You also check out the kitchen, to get an idea of how they function at home. Creating a safe environment allows patients to feel comfortable and open up about any concerns they may have, which they might not mention in the clinical setting. (Participant 22)

3.1.2. Beginning With the Patients' Goals and Preferences as Starting Points for Care

Acknowledging the patient's individual goals and preferences at the initiation of wound management was perceived as essential to a person‐centred approach, as well as to the success of any treatment that is dependent on patient concordance:

You focus on each individual, putting them at the centre and working based on their circumstances, which are very different; but I think it's about the patient and their wishes. (Participant 19)

Engageing patients in the decision‐making process concerning wound management was deemed to be fundamental but posed challenges for the healthcare professionals. The healthcare professionals had to balance the need to establish a care plan promoting wound healing while considering the patient's individual goals and preferences. This balance might involve accepting slower wound healing and suboptimal wound management options, which posed a challenge and they tried to anticipate certain issues before they arose:

The patient's own will is sometimes a challenge. So you try to find different methods. For example, nutritional drinks and things like that, and the patient doesn't want to take them, or they don't want to eat to improve the absorption of nutrients. There's a lot of that you have to deal with […] So then you have to try to take steps to prevent problems before they happen. (Participant 9)

3.1.3. Motivating the Patient to Commit to the Care

Once wound management based on the patients' goals and preferences was initiated, as in line with PCC, the healthcare professionals described how they sometimes needed to motivate patients to commit to the proposed care. This became particularly prominent in wound management involving procedures such as leg compression:

The patient sees the wound and you say, ‘This is how it looks today’. ‘Now, I'll put this on, and we'll see how it looks next time’. So, the patient is aware of the process and knows what's going on. I believe that makes the patient motivated. (Participant 16)

To manage such situations and to encourage the patient to commit to the care, the healthcare professionals emphasised the crucial role of continuous and transparent communication with the patient:

You need to have a dialogue about what's best for the wound […] Not all patients want their wounds to be dressed, even though, as a district nurse, I think it necessary. So you will have to motivate the patient and discuss the reasons why a certain dressing is important. Sometimes, we may be hesitant or not persuasive enough in motivating patients to follow through with treatment. It may take some effort to get them on board, but it's all part of the process. (Participant 8)

When motivating concordance with a wound management plan, it was important to inform patients of the advantages of specific wound treatments and offer them comparable treatment options. The information and discussions of options were crucial to promoting shared decision‐making. This involved, for instance, collaborating with the patient to try out various wound treatment materials and carefully monitoring their responses. Furthermore, facilitating patient decision‐making regarding treatment alternatives also involved simplifying patients' wound management processes, by avoiding burdening them with unnecessary visits to the outpatient clinic.

3.2. Practising Person‐Centred Wound Management

The healthcare professionals' perceptions of practising PCC illustrate how to work together with the patient to realise PCC in wound management. This involved building and maintaining a relationship of trust with patients, adapting wound management to the unique patient and their specific situation, and minimising symptoms that had a negative impact on everyday activities. This work was essential to establishing and maintaining both shared decision‐making and wound management that would be aligned with the patient's goals and preferences. However, there were numerous difficulties caused by a lack of care continuity.

3.2.1. Building and Maintaining a Relationship of Trust With the Patient

To provide PCC in wound management, the healthcare professionals emphasised the importance of building and maintaining a trusting relationship with patients:

You feel safe when you meet the same person…. You know the person is going to shower, take their painkiller, then I come in, we're doing the treatment in the chair or they're in bed, I give the anaesthetic first, then I wait…. It becomes routine. It becomes safe. And you also have that little moment to talk to one another. (Participant 16)

This type of relationship encouraged patients to openly express their thoughts and feelings and actively participate in the care process. This trusting relationship was cultivated by way of a safe and welcoming atmosphere, time dedicated to attentively listen to patients, engaging patients in dialogue, and providing comprehensive information about procedures in wound management. Maintaining continuity with the same patient over an extended period was perceived as a prerequisite for establishing this type of trusting relationship:

You really have to build up trust so that the patient really believes what you say and you try to convince them to do something and it may take a few times to create that trust if you haven't met each other before. (Participant 21)

Achieving this type of care continuity was often easier at smaller primary care centres with fewer patients than at larger healthcare centres serving a larger patient population.

3.2.2. Adapting Healthcare to the Patients' Needs and Circumstances

The healthcare professionals described the importance of tailoring wound management to the patients' unique needs and circumstances, as part of practising PCC. They emphasised the diversity of patient needs related to wound management structure, information, and options, highlighting that what might be effective for one patient might not be optimal for another. For instance, one patient may require advanced bandages, while another may require a simple stocking:

The challenge is helping our Agda, who has dementia, understand not to remove her bandages. Maybe just a stocking will do the trick. Her skin is paper‐thin and fragile, so adhesive bandages aren't a good choice. You can still make the best of the situation with a cheap plaster and stocking. (Participant 18)

This required the healthcare professionals to be flexible in how they delivered care. For instance, the intensity at which a patient's wound was treated, whether they provided information on wound management in written or oral form, or how they cleaned and dressed the wound:

You let them express themselves and understand their preferences, giving them a chance to choose. They might not always be able to choose, but you should ask about their preferences for how often they wish to get treated, inform them of the options available to them, and explain your actions and reasons. I think that is important […] Ensuring the patient is included and has confidence in the wound management. (Participant 1)

The healthcare professionals' ability to tailor wound management to the patient's unique needs and circumstances was sometimes hindered by factors such as the involvement of multiple healthcare professionals in treating a single patient, insufficient cooperation between different professions, and a lack of care continuity.

3.2.3. Minimising Symptoms That Negatively Impact the Patient's Everyday Life

The healthcare professionals emphasised the critical importance of minimising symptoms from the patients' wounds in order to align with their needs and wishes for everyday life. This was a pivotal aspect of PCC in wound management. For instance, symptoms such as a bad smell could severely limit patients' everyday life:

It definitely impacts their everyday life, causing unpleasant smells and fluid to seep out. It may also be so painful that it hinders their movement. However, I believe the odour is the worst part. If you have a wound with a foul smell, you might avoid socializing in public places or bringing people to your home, because of the stench. (Participant 7)

Enabling patients to take part in social activities included helping patients maintain good wound hygiene and adapting the dressing of the patient's wound to minimise foul smells. Minimising symptoms involved modifying the wound dressing to manage pain or leakage and enabling patients to put on their own clothes. However, this approach was sometimes associated with severe pain, which required additional management. To make wound management tolerable to the patient, pain relief might have to be administered:

If the patient is in pain or if it hurts to do the wound dressing, it might be necessary for them to be anaesthetized beforehand or to take paracetamol or sedatives. If it hurts, you might not be able to care for the wound. (Participant 20)

This occasionally required a medication prescription from a doctor, thereby leading to an increased workload for healthcare professionals. Practicing PCC thus required coordination among healthcare professionals.

3.3. Safeguarding Person‐Centred Wound Management

The healthcare professionals' perceptions of safeguarding PCC included their views on the importance of documenting patients' wound management to ensure person‐centred care. This included documenting any changes and progress in patients' wound management, staying updated on patient medical records, and sharing wound management information with relevant healthcare professionals. These actions were crucial for tracking patients' progress, maintaining care continuity, and facilitating effective communication about patient care. Although vital for tracking progress and ensuring care continuity, documenting wound management in the medical records posed challenges due to its time‐consuming nature, varying requirements across different healthcare settings, and challenges associated with sharing information cross‐sectoral in healthcare.

3.3.1. Documenting and Updating Patient Medical Records Continuously

Documenting patient care was deemed significant in ensuring continuity of care and, thus, a critical aspect of PCC. The healthcare professionals emphasised the importance of documenting any changes in patients' conditions and wound management, such as pain or a deterioration in health:

I frequently document based on this T.I.M.E. framework, which I have learned and which is now used to guide the assessment of Tissue, Infection, Moisturize, and Edge. We also utilize a checklist. (Participant 15)

This enabled both healthcare professionals and patients to track the progress of the wound management plan. To communicate progress with patients, the healthcare professionals sometimes supplemented their documentation with written clarifications or images, to ensure that patients were well informed:

Sometimes, I take a photo to show the patient if their healing is not noticeable to them. This way, they can see their progress. Later, we can compare the photos to see if there is improvement or not. We may say, This is how it looked two weeks ago, and this is how it looks now. Do you notice the change? (Participant 3)

The documentation requirements varied across various healthcare settings, making using images challenging for some healthcare professionals. The healthcare professionals regarded documentation as a time‐consuming task, which made it hard to maintain the quality documentation practices necessary to ensure PCC.

3.3.2. Keeping Updated on Patient Medical Records

The healthcare professionals emphasised the importance of patient medical records as an essential tool for collecting and maintaining comprehensive information about patients as a person, considering their physical health:

I usually receive verbal instructions, but I also review the notes to gain insight into how they prescribed the wound dressing, what may have changed, and what was used last time. (Participant 11)

Furthermore, the medical records also played a crucial role in keeping updated on patients' wound management, enabling thorough preparation before meeting and treating patients:

I always check the previous notes, whether it's me who wrote them or… With so many patients, it's difficult to remember all the details, so I check to see how things were done last time and when it was. ‘Did something happen? How severe was it? What type of material did I use?’ I always make sure to have this information. (Participant 4)

However, challenges arose due to inconsistent documentation practices among healthcare professionals, leading to difficulties accessing and interpreting wound management and care details. These documentation discrepancies led to extra time spent cross‐checking medical records with colleagues, especially for homecare services staff.

3.3.3. Sharing Patient Care Information Between Healthcare Professionals

The healthcare professionals recognised the significance of sharing patient information across diverse healthcare settings as a fundamental element of PCC in wound management. Despite this acknowledgment, persistent barriers hindered the seamless exchange of patient information due to unsynchronised systems in different settings, such as hospitals, outpatient care, and homecare services. These discrepancies and incorrect assumptions regarding the accessibility of patient information were obstacles to the effective sharing of crucial healthcare data:

Sharing information between hospitals and home healthcare can be difficult. Sometimes, hospital staff may not know that we have access to medical records where they write every day about the patient ‘having a nutritional drink’, but at the same time, we cannot read their plan for a specific pressure sore, and as a result, they assume that we have complete awareness of the situation… (Participant 13)

The healthcare professionals attempted to tackle the challenges of sharing healthcare data by employing various methods, such as retrieving information on wound management from hospital medical records. However, their efforts were hindered by their inability to interpret or document information via external patient medical record systems. This situation posed difficulties for health professionals in tracking and contributing to patient documentation:

Sometimes you have to wait for them to get back to you…and often you get a message saying, ‘This patient was unwell’ and you see it the next day and you think, ‘But why didn't you call?’. Because nobody called, they just wrote a message and sometimes they just wrote to me. And I mean, what if I'm not there for three days. So that's where communication can get tricky. (Participant 14)

4. Discussion

This study explores healthcare professionals' perceptions of PCC in wound management in outpatient clinics and homecare services in primary care in Sweden. It outlines key insights into initiating, practising, and ensuring person‐centred wound management, highlighting associated challenges and strategies. Firstly, initiating person‐centred wound management emphasises a holistic view of the patient and their situation, with a focus on motivating patients to commit to wound management. However, challenges are acknowledged. Secondly, practising person‐centred wound management involves collaborative efforts with patients, focusing on building trust, tailoring care to unique situations, and alleviating symptoms that restrict everyday life. Challenges in maintaining care continuity are recognised. Lastly, safeguarding person‐centred wound management underscores the importance of documenting care, tracking changes in wound management, keeping updated on patient medical records, and sharing information for effective communication between healthcare professionals. Challenges in documenting care include time constraints, different requirements across healthcare settings, and difficulties in information sharing between organisations. Throughout these practices, the overarching goal is shared decision‐making and care aligned with the patient's goals and preferences.

Regarding the initiation of person‐centred wound management, healthcare professionals emphasised the importance of comprehensively addressing the whole person and the underlying causes of wounds as essential factors in providing care centred around the patient. Previous wound management research [49] has highlighted similar insights. Our results showed that compiling patient narratives was easier during home visits, because the setting allowed for a more holistic view of the patient. The healthcare professionals gained this view through a closer connection with the patient, but also by observing the patient in their everyday environment. Consistent with previous research, this underscores the impact of wound management locations on social outcomes [50]. Moreover, the findings demonstrate how wound management narrative acquisition can encompass methods beyond verbal expression. In accordance with previous research, it emphasises the importance of a more relational view of personhood, where the narrative is shaped not only by dyadic relationships, but also by a range of practices and settings [28, 51]. Additionally, this emphasises the importance of healthcare professionals possessing appropriate skills and strategies, such as interpreting non‐verbal cues and being dynamic and creative in gathering the patient's narrative, so that they can effectively implement the standardised set of PCC practices in Ekman et al.'s framework [28, 51].

The results of the current study highlighted the importance of considering patients' goals and preferences and motivating them to engage in wound management. Healthcare professionals must balance advocating for effective wound management with aligning with patient preferences, which poses significant challenges. This tension between patient advocacy and adherence to rules, regulations, and evidence‐based guidelines is a core aspect of PCC, and can be understood as competing norms and values within healthcare settings [30]. Our research underscores the need to better understand how healthcare professionals navigate different norms and values through their daily practices [52, 53]. This type of analysis may enhance our understanding of the effective implementation of PCC in wound management and other clinical contexts.

In person‐centred wound management, a close and continuous relationship between healthcare professionals and patients was perceived as essential. This connection was more achievable in smaller primary care centres with fewer patients, where it was easier to establish trust, an informal yet vital part of the healthcare professional‐patient partnership. Informal factors promote communication, cooperation, and participation, which are central to building the formal aspects of the partnership that are essential to realising PCC [35]. Furthermore, the scope to provide adaptable care based on patients' needs was limited when multiple healthcare professionals were involved in wound management and could lead to care discontinuity. Previous research has highlighted the importance to successful PCC of closeness between patients and healthcare professionals and continuity of care [35, 54]. Our findings suggest that these are also key factors in promoting PCC in wound management.

A further motivation to practice person‐centred wound management was to support patients in achieving their goals and preferences, by addressing hard‐to‐heal, wound‐related symptoms that restricted everyday life. This intersects with the concept of stigma in wound management [12, 13, 14, 15]. Current research acknowledges the psychological impact on patients coping with stigma, which is characterised by shame and societal non‐acceptance of wounds [55, 56]. Furthermore, it underscores the significance of social models of care in the mitigation of stigma, such as the Lindsay Leg Club. This community‐based model for wound management prioritises a supportive, club‐like environment where individuals receive care, education, and peer support [22, 50, 57]. The proposed ‘advocacy partnerships’ enable patients to actively engage in their own wound management and become advocates in the process of combatting stigma [15, 58], which aligns with the fundamental tenets of PCC. Understanding and addressing stigma could foster a more comprehensive approach to PCC, ensuring the inclusion of both patients' and healthcare professionals' perceptions of mitigating stigma and enhancing holistic wound management practices [29]. Regarding safeguarding person‐centred wound management, our study demonstrates numerous challenges to achieving person‐centred documentation in wound management. Documentation is an important aspect of PCC that facilitates continuity of care and legitimises patient perspectives [29, 33]. For example, documented care plans may provide patients with opportunities to revisit decisions in written form and maintain a sense of confidence and trust in their wound management [35]. Challenges in maintaining continuous documentation, keeping updated on wound management, and sharing information with other healthcare professionals, are primarily attributed to established norms in healthcare documentation and the presence of unsynchronized systems [33, 34, 59]. These obstacles collectively act as barriers to achieving person‐centred documentation in healthcare.

5. Methodological Considerations

Trustworthiness in qualitative research is commonly evaluated based on the following criteria: credibility, dependability, confirmability, transferability, and authenticity [40, 41]. The participants were predominantly engaged in regular wound management and exhibited diverse characteristics, which strengthened the study's credibility [40]. Purposeful sampling was employed to ensure variation in age, gender, work experience, professional role, and workplace setting. This contributed to capturing a broad range of perspectives and supports the transferability of findings to similar healthcare contexts. It is important to acknowledge the gender‐based limitation: only one participant identified as male, which reflects the gender distribution among nurses in Sweden [60].

Confirmability was supported by detailed reporting of all steps of the analysis, the interview process, the use of a semi‐structured interview guide grounded in an established theoretical framework [29], and the researchers' pre‐understanding. Participants' experiences are described in rich detail, with illustrative quotations that clarify and deepen the findings. Dependability was ensured through the consistent use of the interview guide and follow‐up prompts for all participants [40, 48]. The analysis followed a structured abductive approach [40, 41], involving an iterative process that combined inductive coding with theory‐informed categorisation. Multiple researchers were involved in all key steps of the analysis, and analytical decisions were discussed repeatedly within the research team to ensure triangulation and reduce individual bias.

The findings are illustrated with rich, direct participant quotations to enhance authenticity [40], and allow readers to assess the connection between data and interpretations. These methodological strategies collectively support the credibility and trustworthiness of the study and strengthen the basis for transferability to comparable healthcare systems where primary care is central to wound management.

6. Conclusion and Clinical Implications

In conclusion, this study explores healthcare professionals' perceptions regarding initiating, practising, and safeguarding person‐centred wound management in Swedish primary care services. While healthcare professionals acknowledge the significance of PCC in wound management, the study reveals challenges, primarily centred around practising shared decision‐making, ensuring closeness and continuity of wound management, and the documentation of care in a person‐centred manner. These findings provide vital insights into the practical implementation of PCC in wound management, highlighting the pivotal role of healthcare professionals in its successful integration. Healthcare professionals must be attentive to both verbal and non‐verbal communication with patients regarding their needs and beliefs, while considering their entire physical, mental, and social context. It is of importance for healthcare professionals to develop the requisite skills and competence to provide person‐centred wound care. This approach, when conducted in the home environment, can contribute to a comprehensive understanding of the patient's overall situation, thereby optimising conditions for effective wound healing.

Author Contributions

A.I., D.T., E.S., I.L., and P.S. designed the study. Applications for funding were submitted by P.S. Data collection was carried out by SK and D.T. Data analysis was performed by A.I., D.T., and E.S. and subsequently discussed with all authors. The manuscript was drafted by A.I., D.T., and E.S. P.S. and I.L. provided critical revision of the paper in terms of important intellectual content. All authors have read and approved the final submitted version.

Ethics Statement

The study was approved by the Swedish Ethical Review Authority (ref. no. 2022‐05837‐01).

Consent

Participants received both oral and written information about the study before the interviews, and all provided written informed consent.

Conflicts of Interest

The authors declare no conflicts of interest.

Irestig A., Tyskbo D., Larsson I., Svedberg P., and Siira E., “Healthcare Professionals' Perceptions of Person‐Centred Care in Wound Management in Swedish Primary Care Services: A Qualitative Study,” Scandinavian Journal of Caring Sciences 39, no. 3 (2025): e70082, 10.1111/scs.70082.

Data Availability Statement

The data are not publicly available due to confidentiality. Access may be granted by the corresponding author upon reasonable request and ethical approval.