Page 155 - Psychology of Wounds and Wound Care in Clinical Practice ( PDFDrive )

130 Chapter 5. Different Wound Type

been attributed to physical complications of wounds such
as leakage of exudate and malodour. For example, research
conducted by Rich and McLachlan ( 2003 ) highlighted
patient’s concern surrounding their exudate, often consid-
ering it to be unbearable with methods of odour manage-
ment being inadequate. These complications often leave
patients feeling isolated due to self-imposing restrictions
that resulted in them being housebound (Walshe 1995 ).
Often patient’s concerns surrounding the odour associ-
ated with their wound led to increased self- consciousness
and subsequent restricted social interactions. Hence, social
contact may be significantly reduced. This can have a sig-
nificant impact upon the psychological health of patients,
particularly when considering research highlighting the link
between ulcerations, exudate and depression. For example,
a direct correlation between problematic exudate, malodour
and depression and anxiety has been discovered in rela-
tion to venous leg ulcers (Jones et al. 2008a , b ). Hence, it is
essential for clinicians to assess patient’s needs holistically,
providing appropriate treatment, advice and support.
Additionally, such social isolation may be sustained by
participants’ inability to maintain personal hygiene, sub-
sequently impacting on their well-being (Douglas 2001 ;
Ebbeskog and Ekman 2001a , b ). Due to such issues, patients
have reported excluding themselves from public in order to
avoid embarrassment related to the odour emanating from
the wound (Rich and McLachlan 2003 ). Such self-imposed
exclusion can often lead to patient’s limiting contact to close
family and friends (Ebbeskog and Ekman 2001a , b ). Findings
such as these can be linked to the concept of ‘biographical
disruption’ (Hopkins 2004a , b ), whereby distinctions are
made between life before and life after ulcerations. Such ‘bio-
graphical disruption’ is distinguished by a negative impact
on both the patient’s physical and social activity. However,
despite the negative affect occurring in relation to living with
ulcerations, patients also display hope for future life expecta-
tions (Hopkins 2004a , b ). Hyde et al. ( 1999 ), for example, also
reported patients to display an inner strength that encom-
passed a determination to cope with the ulceration through