Page 205 - Psychology of Wounds and Wound Care in Clinical Practice ( PDFDrive )

180 Chapter 7. Concordance

rates of non-concordance in burns patients, to a lack of
encouragement from their families to wear their pressure gar-
ments. The family appears to be particularly important in this
regard, with concordant patients being more likely to report at
least one family member supporting them in following recom-
mended treatment regimens (Barnhoorn and Adriaanse 1992 ;
Liefooghe et al. 1995 ). According to social learning theory
(Ajzen and Fishbein 1980 ), patients are much more likely to
engage in health-promoting behaviour when their significant
others have high expectations that the patient will engage
in that behaviour as opposed to when such expectations are
lacking; the expectations and encouragement of others (or the
imposition of sanctions for non- concordance) is likely to act
as an external motivation, and as has already been discussed,
patients need to be motivated to follow treatment regimes.
The importance of social support is very significant for

wounds patients; as already noted in Chap. 2 , a number of
physical and psychosocial factors associated with having a
wound may lead to social isolation in these patients (and the
importance of social support is detailed in Chap. 8 ). For these,

and others patients (such as the elderly) who may not have
family or friends living very close to them, the immediate
social support network may be the clinician. Furthermore, the
social support provided by clinicians has been shown to pro-
mote adherence in some patients (Sherbourne et al. 1992 ).
There are a number of different kinds of social support from
emotional through to educational/informational support
(Heaney and Israel 2002 ). Whilst the clinician can provide
different kinds of social support to the patient, there is evi-
dence that the most effective support from the health care
practitioner is informational (Heaney and Israel 2002 ) – so
providing information about the wound and its healing, pro-
viding instructions to the patient about interventions and
treatment. It has however been suggested that patients do not
see nurses as social support contacts (Charles 2010 ) and that
patients need emotional support from family and friends
rather than from health care professionals (Blanchard et al.
1995 ). This may be in part because of the power differential
between the health care professional and the patient and this