Page 35 - Psychology of Wounds and Wound Care in Clinical Practice ( PDFDrive )

8 Chapter 1. Psychosocial Consequences of Wounds

visibility of the wound, including smell and leakage of exudate
may also lead to feelings of vulnerability and embarrassment
resulting in further anxiety and distress (Piggin and Jones
2007 ; Lo et al. 2008 ; Alexander, 2010). Treatment may also
trigger feelings of distress: studies in patients with a range of
different types of chronic wound have shown that stress and
anxiety is linked to the pain of dressing change as well as the
stress of background pain (Upton et al. 2013c ; Upton et al.
2012b , c ) Finally, the sleep disturbances which many experience
because of wound pain can also lead to patients experiencing
heightened worry and frustration – which further disrupts
sleep; Cole-King and Harding ( 2001 ) and Fagervik-Morton
and Price ( 2009 ) have discovered that anxiety and depression
can also contribute to sleep disturbance.
Sleep deprivation, which is thought to impact on healing,
has been found to be particularly prevalent in patients living
with chronic wounds. Research suggests that approximately
25 % of patients experience at least three nights of sleep dis-
turbance due to their wound, whilst 49 % of patients reported
experiencing sleep disturbance due to their wound on six or
more nights (Price and Harding 1993 ). Upton and Andrews
( 2013a , b , c ) also reported on the sleep disturbance in those
with chronic wounds, with their results suggesting a more sig-
nificant issue than that Price and Harding ( 1993 ). Specifically,
Sixty-nine per cent of their leg ulcer patients reported sleep
disruption, with 88 % stating that they wake at least once dur-
ing the night. General wound pain was the most frequently-
cited cause (58 %), while pain associated with treatment
affected the sleep of 38 % of respondents. Sleep disruption in
people with chronic wounds is an important issue since it can
impact on pain levels, wellbeing, quality of life and healing.

Changes in Health Behaviours

There is evidence that psychological distress can increase
risky health behaviours such as smoking and alcohol con-
sumption (Upton and Thirlaway 2014 ); thus individuals