Page 127 - Psychology of Wounds and Wound Care in Clinical Practice ( PDFDrive )

Factors Which Impact on Quality of Life and Well-Being 101

depressed, this does not mean they have hope or happiness.
Likewise, if a patient is anxious or worried, it should not be
assumed that they therefore are unhappy or feel socially iso-
lated. It is perfectly possible – indeed likely – that a patient
will experience a complex mixture of positive and negative
affect, just as we all do everyday. Indeed, some studies have
shown that patients may experience conflicting emotions –
for example feeling both hopeful and pessimistic or despairing
about the future (Ebbeskog and Ekman 2001a ; Hopkins
2004a ).
Which brings us to the second problem of not assessing
well-being, which is that not doing so ignores the potential
psychological resources which an individual may (or may
not) have at their disposal; resources such as hope, self-
efficacy and adaptive coping which make patients more resil-
ient when present, and especially vulnerable when absent.
Identifying and working to improve reduced well-being
should be one of the goals of clinical care. Indeed, the poten-
tially protective value of well-being should not be dismissed
lightly, given the known link between psychological health
and physical healing (Upton and Solowiej 2010 ). Thus it is
essential that clinicians consider both the cognitive and emo-
tional responses of a patient to their wound.

Factors Which Impact on Quality of Life
and Well-Being

The evidence suggests that the QoL of patients with wounds
is compromised in the three primary domains – physical, psy-
chological and social. Several factors contribute to this
reduced QoL, with the most obvious being the physical symp-
toms which patients experience. Pain has been found to be a

significant issue (Walshe 1995 ; see Chap. 2 ), and may relate to
either wound pain or the pain related to dressing change
(Langemo 2005 ). Sleep disturbance (Byrne and Kelly 2010 ;
Upton and Andrews 2013 ), and problems with mobility are
also likely to reduce physical functioning and limit daily