Page 249 - Psychology of Wounds and Wound Care in Clinical Practice ( PDFDrive )

224 Chapter 9. Conclusion

psychological disorders. Finally, support from others, whether
those with a similar condition or from the family can help and
should be actively encouraged by the clinician (see Table 9.1 ).

Stress

A systematic review and meta-analysis (Walburn et al. 2009 )
explored the relationship between stress on a variety of
wound types in different contexts (for example, different
types of acute and chronic wounds and experimentally cre-
ated wounds such as punch biopsies). The findings demon-
strated that the relationship between stress and wound
healing is clinically relevant (Kiecolt-Glaser et al. 1995 ; Cole-
King and Harding 2001 ). For example, in a study of 72 patients
with burns, it was found that the greater the level of distress a
person was under, the slower the wound healing process can
be (Wilson et al. 2011 ). This study, along with many others and
other clinically relevant reviews (e.g. Solowiej et al. 2010a , b ;
;
;
Solowiej et al. 2010 Solowiej and Upton 2010a , b Upton and
Solowiej 2011 ) presented in detail in Chap. 3 demonstrates the
importance of minimising the stress of both living with a
wound and the wound management regime.
Wound-related pain at dressing changes has also been
shown to correlate positively with stress and anxiety (Solowiej
et al. 2009 , 2010a , b ). The relationship between pain and anxi-
ety could be due to the patient being more sensitive to pain
due to increased anxiety and fear, particularly if this is based
on a past experience (Mudge et al. 2008 ; Woo 2010 ).
Alternatively, patients suffering higher pain levels are more
likely to become stressed and anxious. This may, in turn,
impact on their healing rate. Considerable evidence now
exists demonstrating the link between stress and delayed
healing and controlling pain more effectively can affect stress
and should also impact upon healing rates (Cole-King and
Harding 2001 ; Soon and Acton 2006 ; Woo 2010 ; Gouin and
Kiecolt-Glaser 2011 ; Solowiej and Upton 2010a , b ).
Consequently this has considerable implications for practice.
It may be that the continued stress of wound care change
leads to chronic stress. In this way, stress has a cumulative