Page 142 - Psychology of Wounds and Wound Care in Clinical Practice ( PDFDrive )

Burns 117

psychopathology when compared with the general popula-
tion. This has been highlighted previously by findings that
pre- existing psychological disorders, substance and alcohol
abuse and depression have a causal role in the aetiology of
the burn itself (Dyster-Aas et al. 2008 ). Hence, it has been
suggested that patients who have sustained a burn wound
may have had diminished cognitive processes related to
such pre-burn factors that, in turn, predisposed them to such
an injury (Klinge et al. 2009 ). For example, a meta-analysis
conducted by Noronha and Faust ( 2006 ) highlighted such a
link with pre- existing psychopathology increasing post-burn
psychological maladjustment.
Clinicians need to account for such issues within their daily
wound care regimes as these psychological factors can have
significant implications on satisfactory healing. For example,
in a longitudinal study considering the relationship between
pre-existing psychological issues and post-burn outcomes,
the degree of impairment and healing rate of patient’s expe-
riencing differing levels of physical and psychological burden
were examined (Fauerbach et al. 2005 ). It was found that
an intervention based around the reduction of in- hospital
distress and support psychological well-being proved to be
as effective as surgical interventions. Research has heighted
two forms of distress that burn patients’ perceive during their
hospital stay; alienation and anxiety (Fauerbach et al. 2007 ).
Hence, clinicians need to be aware of these and the poten-
tial implications such psychological issues may have on the
patient’s subsequent experiences of pain, and further psycho-
logical distress. A cyclical relationship has been reported in
patients with burn injuries, whereby depression and anxiety
influences pain perception and reduced physical function-
ing which, in turn, further impacts anxiety and depression
(Edwards et al. 2007 ). Hence, it is essential for clinicians to
acknowledge and manage not only physical symptoms but
emotional symptoms also (see Fig. 5.1 ). Such concurrent
management strategies will then result in an improvement in
a variety of long-term post-burn outcomes (including wound
healing and physical functioning).