Page 84 - Psychology of Wounds and Wound Care in Clinical Practice ( PDFDrive )

58 Chapter 3. Stress

For example, the novelty of certain treatments- negative
pressure for example- or the pain associated with wound
management. Given the range of factors that are associated
with wound related stress it is important that the health care
professional understands the nature and model of stress,
how best to assess it in practice and how any stress can be
managed. These will be the foci of this particular chapter.
Stress may be a consequence of several wound related fac-
tors: most particularly pain and wound management pain
in particular. Preventing stress, and stress related to pain, is
important not just for the relationship with delayed wound
healing, but importantly, to understand that this may be an
ongoing deleterious cyclical relationship. Increased wound
related pain leads to increased stress which leads to delayed
healing, which can lead to more pain. It is this cycle that this
chapter addresses and suggests methods to break this damag-
ing predicament.

Introduction

Many clinicians, when asked, believe that there is a relation-
ship between stress and delayed healing (Upton and Solowiej
2011 ). It is evident from the research literature that there is
strong empirical support for this belief (Broadbent et al.
2003 ; Ebrecht et al. 2004 ; Francis and Pennebaker 1992 ;
;
;
Gouin et al. 2008 Jones et al. 2006 Marucha et al. 1998 ;
Weinman et al. 2008 ; Kiecolt-Glaser et al. 1995 ; Glaser et al.
1999 ; Cole-King and Harding 2001 ) with a major theme sug-
gesting that interventions need to be implemented as part of
the wound care process in order to minimise patients’ psy-
chological stress/anxiety. This delayed healing may be evident
in both acute and chronic wounds. For example, wound heal-
ing is a critical outcome in acute surgical wounds (Broadbent
et al. 2003 ). Poor healing can result in wound infections or
complications, as well as prolonged hospital stays, increased
patient discomfort, and delayed return to activity (Broadbent
et al. 2003 ). It is therefore important to maximise the healing
rate by minimising any stress (see Box 3.1).