Page 151 - Psychology of Wounds and Wound Care in Clinical Practice ( PDFDrive )

126 Chapter 5. Different Wound Type

results suggesting that promoting “effective coping could
significantly improve healing rates” (p. 1596). They described
confrontational coping as the least effective and related to
delayed healing. This coping style is characterised by more
controlling, competitive and extroverted. These patients
are therefore more likely to challenge the advice of health
care professionals and be less willing to follow treatment
recommendations. Thus, if these coping techniques could
be improved then so could healing- a role for psychological
interventions.
Importantly, if the psychological issues can be addressed
then there may be an improvement in outcome- both psycho-
logically and medically. Education by itself may not necessarily
improve patient self-care although motivational interviewing
shows promise in developing patient skills (Gabbay et al.
2011 ). Given that the single greatest risk factor for DFU is a
previous ulceration or amputation (Boulton et al. 2005 ), with
just over a third of patients re-ulcerating within 12 months,
interventions are required that can improve self-care, reduce
psychological distress and promote protective psychosocial
resources (Hunt 2011 ). In contrast to the limited educational
interventions, Vedhara et al. ( 2012 ) developed and evaluated
a multi-modal psychosocial intervention aimed at modifying
potential psychosocial risk factors associated with foot re-
ulceration in diabetes (see Fig. 5.2 ).
Delivered by a specialist diabetic nurse and podiatrist fol-
lowing CBT training, the intervention consisted of weekly
60–90 min sessions for the first 10 weeks, followed by
3 bimonthly maintenance sessions commencing 2 months
after the initial phase completion. The intervention was
based on the model described in Fig. 5.2 and was designed
to achieve the behavioural, emotional, cognitive and social
goals outlined with a view to delaying the onset of further
DFU development. The results of the study revealed that the
participants found the intervention effective and changed
their behaviour positively. Whether there was any impact on
re-ulceration is yet to be determined. However, the benefits
of group interventions for those with potential DFU re-
ulceration is evidenced and may support other studies with
other wound types (see Chap. 8 ).