Page 34 - Psychology of Wounds and Wound Care in Clinical Practice ( PDFDrive )

Emotional Response 7

et al. 1994 ). Compression bandages, wrapping, and other
dressings can be bulky and may require a wardrobe adjust-
ment and this can lead to a perceived loss of femininity for
some women (Hyland et al. 1994 ). Feelings of shame, embar-
rassment, and diminished femininity have also been observed
in women with malignant fungating wounds in progressive
breast cancer (Boon et al. 2000 ). Given the significance of the
female breast as a symbol of sexuality and femininity,
learning that a wound in this area can impact on a woman’s
body image and self-concept is not surprising. Furthermore,
symptoms such as malodour, an excess of exudate and relent-
less seepage, need constant vigilance and management when
in public (for example having to carry additional changes of
clothes). Such extreme changes in behaviour can contribute
to the loss of sense of self and social identity (Probst et al.
2013 ). Moreover malodour and excessive exudate can also
lead to feelings of disgust, self-loathing, and low self-esteem
(Jones et al. 2008 ).

Emotional Response

The emotional reaction to having a chronic wound usually
includes some form of distress –depression, anxiety and stress
are common responses. For example, burn injuries have been
linked to serious emotional difficulties including anxiety and
post traumatic stress disorder (Van Loey and Van Son 2003 ;
Loncar et al. 2006 ). Furthermore, research exploring the
prevalence of depression and anxiety in 190 patients with
chronic venous ulcerations, indicated that 27 % of patients
were experiencing depression with 26 % being highly anxious
(Jones et al. 2006 ). In a similar vein, Searle et al. ( 2005 ) found
that following diagnosis with a foot ulcer, depressed mood was
a very common response to a number of features of the
wound including the time taken to heal, loss of independence,
and the limitations of daily living. Changes in role and an
increase in dependency on others can also trigger anxiety
(Herber et al. 2007 ) and guilt (Walshe 1995 ). In addition, the