Page 179 - Psychology of Wounds and Wound Care in Clinical Practice ( PDFDrive )

154 Chapter 6. Treatment

due to compression bandages. Thirty- two per cent needed to
wear open toe shoes, sandals or slip-ons to be able to wear
footwear. Furthermore, some patients wore washable foot-
wear, with others having to wear footwear that was stained.
All of these could contribute to reduced patient concordance,
as well as restricting individuals to only going out when it
was dry, limiting the amount of daily walks they could take,
which ultimately may hinder the healing process (Kroger and
Assenheimer 2013 ).
The literature surrounding itching and compression ban-
dages is limited but informative. Annells et al. ( 2008 ) identi-
fied that some patients removed compression bandages due
to itching and dry skin underneath the bandages. However,
although removing bandages could offer some relief it could
also affect the healing process. Additionally, Edwards ( 2003 )
found that compression bandages caused patients to have
irritation of the skin, which then lead to scratching behav-
iours, where some patients would insert objects in between
the bandages to scratch the skin. This can again affect the
wound by giving the patient additional skin trauma and cause
more pain and exudate for the patient, and consequently
resulting in low concordance to treatment from patients
(Upton et al. 2012b , c ).
A number of issues relating to patient experience using
compression bandages can be identified. In particular, con-
cordance to treatment advice may be limited for a number
of reasons. The pain of the treatment, the inappropriate fit-
ting, mobility problems, and the willingness to adapt to the
treatment are all factors that have been reported as being
influential in concordance to treatment. This is important
whatever the treatment- not just compression therapy. An
effective regime relies on appropriate concordance to treat-
ment by the patient, which in itself relies on communication,
commitment and expertise by the practitioner. Some of the
issues that may face the health care expert have been out-
lined here, and these have to be acknowledged and addressed
by the health care professional in order to improve both con-
cordance and outcomes.