Page 30 - Psychology of Wounds and Wound Care in Clinical Practice ( PDFDrive )

Introduction 3

differ substantially. As is discussed in more detail in Chap. 5 ,
wounds can be acute or chronic, which, along with the type
(e.g. venous leg ulcer, pressure ulcer or burn) and site of the
wound will have different implications for pain (Chap. 2 ) and

stress (Chap. 3 ). This is also true in regard to the broader
psychosocial impact of having a wound. Thus a patient’s
experience will differ depending on whether their wound is a
chronic, persistent wound such as a venous leg ulcer or a dia-
betic foot ulcer for instance, or a trauma related wound such
as that resulting from a burn or a surgical procedure.
Such psychological consequences can result from the
wound itself, pain experienced from the wound and other
physical consequences For example, it has been found that
the common symptoms of chronic wounds – malodour and
exudate – can increase negative emotions such as anxiety and
depression (Hareendran et al. 2005 ; Herber et al. 2007 ).
Furthermore many of the social implications of living with a
wound can further exacerbate psychological health problems.
Patients with exudate leakage and malodour often feel
embarrassed, experiencing difficulty in maintaining outward
appearance and dignity (Hyde et al. 1999 ; Walshe 1995 ). Such
experiences can in turn lead to patients adopting maladaptive
coping strategies, which can sometimes lead to the worsening
of wounds (Lo et al. 2008 ). Such strategies might include the
limiting of fluid intake in the hope of reducing exudate pro-
duction, covering wounds to avoid leakage, and removing
bandages in order to disperse exudate. Such experiences of
exudate and malodour can also result in changes to a patient’s
appearance and choices of clothing and footwear (Persoon
et al. 2004 ). This can also cause patients to feel embarrass-
ment and negative body image (Herber et al. 2007 ), which
causes them to retreat from social activities and contact with
others, resulting in social isolation (Jones et al. 2008 ).
Moreover this can lead in turn to a reduction in a patient’s

quality of life (Chap. 4 ). Thus we can see a cycle of physical
problems and psychosocial difficulties which can ultimately
delay the healing process (Fig. 1.1 ). This chapter provides an
overview of the main psychosocial consequences of living