Psychosocial Aspects of Wound Healing

It is always an honour to be asked to put together a special edition of a journal, particularly when it focuses on topics that are close to your heart. Keeping patients as the focus of our practice ensures that we focus on their health-related experiences and not just on the clinical signs and symptoms of their wounds. Recently, there has been a substantial increase in the volume of published work regarding the psychosocial issues in wound care, but we are still only scratching the surface of understanding the ways in which psychosocial elements impact healing or affect the ways in which individuals cope with long-term wound related problems.      

Several recent studies report that chronic wounds pose a threat to physical functioning and have a negative impact on psychological functioning, and to a lesser degree, on social functioning.1–6 Major limitations reported in these studies were pain and immobility, followed by sleep disturbance, lack of energy, limitations in work and leisure activities, worries and frustrations, and a lack of self-esteem. Patients have a significantly poorer quality of life compared to healthy people. The specific reasons for the poor levels of health-related quality of life are multi-factorial and include: frequency and regularity of dressing changes, which affect a patient’s daily routine; a feeling of continued fatigue due to lack of adequate sleep; restricted mobility; persistent pain; wound infections; and social isolation. The requirements and consequences of having a chronic wound also have an enormous impact on the patient’s social life, as well as the lives of their caregivers. The loss of independence associated with functional decline can lead to several, sometimes subtle, changes in overall health and wellbeing. These changes include altered eating habits, depression, social isolation, and a gradual reduction in activity. The presence of these factors, along with immobility, not only influences the occurrence of further wounds but also exacerbates their severity and jeopardises their ability to heal. From a clinical perspective, it is important to recognise these debilitating aspects of living with chronic ulceration and to develop comprehensive packages of care that focus on the needs of the patient.      

This special issue of WOUNDS presents a range of manuscripts that tackle some of these difficult issues. We are fortunate that we are able to include the new SCALE document, which outlines the consensus statements for skin care at life’s end—a particularly vulnerable group with a wide range of health and social care needs. By contrast, we have also included research on the psychological approaches to behaviour change, which represents an increasingly important issue for all of us as we try to focus on both primary and secondary prevention and work with patients to change their life-long, firmly entrenched health behaviours. The two additional manuscripts address the issue of coping with the ongoing care of a chronic wound and considers how to include the patient’s view regarding how healthcare professionals should interact with patients in a way that can help them to cope more successfully.      

Within wound care management we must be careful to ensure that the patient remains the centre of our focus and that all aspects of wound management are considered a package of care that reflects a consideration of the person, as well as the wound.      

A clinical service must focus on a range of issues that ensure adequate and appropriate referral patterns with clear levels of competence and that clinical pathways are in place. Adequate education and training of staff and patients must be provided. Care needs to be efficient while prioritising patients’ needs and sophisticated methods of measuring outcomes must be used in order to demonstrate to service providers the impact of such a comprehensive approach to care. These are clearly important issues, but at a time when health professionals are constantly bombarded with new initiatives to improve the efficiency of service, we must keep the patient at the centre of wound care so that we can truly provide a service that helps patients meet the challenges of the 21st century.

Address correspondence to: Patricia Price, BA(Hons), PhD, AFBPsS, CH Psychol Department of Wound Healing, School of Medicine Cardiff University Heath Park, Cardiff, UK CF14 4XN
Email: pricepe@Cardiff.ac.uk