Page 247 - Psychology of Wounds and Wound Care in Clinical Practice ( PDFDrive )

222 Chapter 9. Conclusion

a lack of self-esteem, frequency and regularity of dressing
changes, which affect a patient’s daily routine, feeling of con-
tinued fatigue due to lack of adequate sleep, restricted mobil-
ity, persistent pain, exudate, odour and social isolation (Upton
and South 2011 ). Mobility restrictions may effect every aspect
of the patients life, limiting their availability to work or per-
form household tasks. Even attending to personal hygiene
may become difficult, as previously independent patients
become reliant on others and report loss of self- worth and
role reversal within families. Social isolation may be exacer-
bated by the impact on self-esteem of the physical conse-
quences of the wound- the odour, any strike-through or
required dressing changes. These may increase anxiety and
depression, embarrassment, negative body image and social
isolation, which can all impact negatively on quality of life
;
(Hareendran et al. 2005 Herber et al. 2007 ).
All of these factors may contribute to the psychological
distress experienced by both the patient and their carer.
Furthermore, some individuals may try different methods of
coping with the physical manifestation of the wound. Such
actions are often ineffective and, in some cases, can worsen
the condition of the wound. For example, Lo et al. ( 2008 )
reported the experiences of cancer patients living with a
malignant fungating wound. Findings suggest that some
patients would attempt to cover wounds to avoid leakage,
would drink less fluid in the hope of reducing the amount of
exudate produced and would remove bandages to help exu-
date disperse. Patients often feel embarrassed about exudate
leakage and malodour and have difficulty maintaining dignity
and outward appearances (Walshe 1995 Hyde et al. 1999 ).
;
It is therefore essential that the clinician recognises and
responds to these psychosocial issues: dealing with any self-
esteem issues, any psychological distress or social isolation
and importantly providing accurate information and educa-
tion for the patient to reduce any misunderstanding or inap-
propriate coping mechanisms. In this way it should be possible
to promote a positive approach to the patient’s situation and
their treatment. This may involve information on self-man-
agement, self-care, and social integration (see Table 9.1 ).