Page 255 - Psychology of Wounds and Wound Care in Clinical Practice ( PDFDrive )

230 Chapter 9. Conclusion

potential psychological consequences are recognised and
dealt with appropriately. Similarly, some treatments may
reduce psychological distress whereas others may increase
it- clinicians have to assess individual patients and their inter-
action with their treatments to ensure negative consequences
are minimized. For example, although many of the techniques
and treatments may be familiar to the clinician they may not
be common to the patient that may result in increased pain
and anxiety experienced by the patient, which needs to be
addressed. This may be of particular concern with novel
treatments such as NPWT as presented in Chap. 6 .
In order for any treatment to be effective, of course, it is
essential that the patient follow the advice of the clinician.
Enhancing concordance through a positive therapeutic rela-
tionship is essential in order for effective treatments that, in
itself, can promote healing. This may involve a number of
positive practices: using the correct technique, communicating
effectively, providing education and information, reducing
anxiety and having a positive therapeutic technique.

Communication and Concordance

A positive therapeutic relationship between the health prac-
titioner and the patient can enhance treatment concordance,
which can, itself, improve patient outcomes (Ebbeskog and
Emami 2005 ; Morgan et al. 2004 ). As a first step to cultivating
a positive relationship, clinicians need to clearly acknowledge
that both stress and pain are frequently experienced at dress-
ing changes. Clear information to patients that these symp-
toms are part of a normal response is essential, although a
clinical goal should be to minimize the experience of these
symptoms. Education is a key strategy to empower patients
and to improve wound related pain control. Only a small
proportion of patients are aware of factors contributing to
their chronic wounds and treatment strategies to improve
their conditions (Chase et al. 1997 ). In a pilot study (Gibson
et al. 2004 ), five chronic wound patients described dressing
change pain more manageable after receiving educational
information. Pain related education is a necessary step in