Odor management practices and challenges for malignant fungating wounds by Wound, Ostomy, and Continence Nurses: A qualitative descriptive study

Abstract Background Malignant fungating wounds (MFWs) often produce distressing odors that significantly impair patients’ quality of life (QOL). Odor is caused by volatile organic compounds from anaerobic bacteria in necrotic tissue and exudate. International guidelines recommend cleansing, debridement, and topical antimicrobials; however, evidence quality varies, and individualized approaches are often needed. Limited research has examined the specific practices and challenges experienced by Wound, Ostomy, and Continence Nurses (WOCNs) in MFW odor management. This study explored WOCNs’ perspectives on necessary practices and perceived challenges. Methods A qualitative descriptive design was used. Twelve WOCNs with MFW care experience were recruited via snowball sampling. Between November and December 2022, three online focus group interviews (four participants each) were conducted using a video conferencing platform and a semi-structured guide. Discussions addressed necessary practices and challenging experiences. Interviews were audio- and video-recorded, transcribed verbatim, and analyzed thematically following Braun and Clarke’s six-phase approach. Two researchers independently coded transcripts, reaching consensus through discussion. Results Nine themes described necessary practices: (1) thorough cleansing as the foundation of odor control; (2) prevention of exudate leakage; (3) appropriate use of topical agents tailored to wound condition; (4) use of local deodorants/fragrances; (5) environmental odor control; (6) care proposals considering lifestyle and economic status; (7) pouching for odor containment; (8) adapting care to wound changes; and (9) standardizing care and strengthening nurse collaboration. Nine themes described challenges: (1) inability to self-care due to fear; (2) odor exacerbation by bleeding or digestive fluid contamination; (3) limited cleansing/dressing due to bleeding risk; (4) persistent odor in head–neck, oral, and perineal wounds; (5) difficulty cleansing/dressing wounds near the head or tracheostomy site; (6) discrepancies in odor perception; (7) care limitations from wound enlargement or pain; (8) difficulty with self-care for back-located wounds; and (9) cost-related restrictions on materials. Conclusion Odor management for MFWs requires a multifaceted strategy integrating wound hygiene, exudate control, tailored topical and dressing use, environmental measures, patient-centered adjustments, and interprofessional collaboration. Addressing psychosocial factors, anatomical challenges, and economic constraints is essential. These findings provide a basis for developing standardized, site-specific, and cost-effective interventions to improve patient QOL and nursing care quality.