Page 131 - Psychology of Wounds and Wound Care in Clinical Practice ( PDFDrive )

Implications for Clinical Practice 105

Stressors: Pain, social and psychological factors

Protector variables: Coping, hope, resilience, personality, social support (well-being)

Psychological stress

Hypothalamus Psychological responses Autonomic nervous system

Hypothalamic-pituitary-adrenal Unhealthy behaviors Sympathetic-adrenal medullary
Glucocorticoid Depression and anxiety Cigaratte smoking Norepinephrine and
hormones, cortisol↑ Alcohol consumption epinephrine↑
Disturbed sleeping
Poor nutrition
Altered immune response Hyperglycemia
Impaired wound healing

Figure 4.5 The importance of wellbeing for physical and mental health

these psychosocial factors and allows clinician to put
interventions in place to address any deficits in functioning
such as stress or depression.
In the same way assessing well-being is also important, as
the presence of positive psychological factors associated with
well-being – such as hope and optimism – are likely to enable
better overall psychological health, increased treatment con-
cordance, and improved healing speed. Such an association
has been discovered in other long term conditions, with posi-
tive well-being being related to improved outcomes (Rozanski
et al. 1999 ).
Whilst it is currently unclear why some people with
wounds are able to retain a sense of positivity and well-being
in spite of their difficulties, insights derived from other condi-
tions strengthen the view that it is not the wound per se that
is the decisive factor in wellbeing, but rather that fundamen-
tal psychosocial factors are protective (Rozanski et al. 1999 ).
Identification of these factors is important so that maladap-
tive elements can be replaced with protective ones. Figure 4.5
demonstrates a possible mechanism through which wellbeing
may protect against psychological stressors which impact on
wound healing.