Page 125 - Psychology of Wounds and Wound Care in Clinical Practice ( PDFDrive )

Measuring Well-Being 99

Well-Being

Physical Social Mental
Impact on Uncertainty
Diagnosis Treatment Pain Isolation family and Stigma Depression Stress and and
friends worry frustration
Figure 4.3 Domains of well-being proposed by International

Consensus Document 2012
wellbeing is the principle focus of care’ (International
Consensus 2012 ). However, whilst this document provides an
excellent starting point for taking this vital work forward,
there remains much to be done in relation to defining dimen-
sions and developing assessment tools. For example, whilst
the consensus document tries to make a differentiation
between QoL and well-being, the domains of well-being
described appear to be identical to those used traditionally
used in QoL definitions (physical, mental and social well-
being) with the addition of spiritual and cultural well-being
(see Fig. 4.3 ) The distinction between QoL as a cognitive
appraisal and well-being as an emotional response appears to
be missing.
As already described, we can see QoL and well-being as
distinct yet related concepts. Both are influenced by a
patient’s context – the wounds, its symptoms, treatment,
changes in social and physical functioning (e.g. pain). In addi-
tion each influences the other in a continual feedback loop.
Thus it would be possible for a patient to be caught in a
downward spiral where increasing pain reduces QoL and
well-being, resulting in reduced social contacts, in turn lead-
ing to further reductions in QoL and well-being (see Fig. 4.4 ).
It can be hypothesised that by making a break in this cycle,
potentially by boosting a patient’s psychological resources
(improving coping, or social support for example) well-being
can be enhanced and patient outcomes can be improved
(Upton et al. 2014 ).
Furthermore, in contrast to the many measures of HRQoL
available for use in wound care, there are currently no