Chronic Ulcers and Everyday Living: Patients’ Perspective in the United Kingdom
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Abstract: Our knowledge of patients’ concerns with regard to living with chronic ulceration remains incomplete. This cross-sectional survey collected the self-reported views of patients using a specifically designed questionnaire developed from issues relevant to UK patients captured through focus groups. Results were obtained for 196 patients from Wales and England with a mean age of 74.4 years (SD 12.86), and mean wound duration of 25.52 months (SD 56.95). Wound symptoms reported by patients as problematic in every day life were pain, difficulties in bathing, leakage, impaired mobility, odor, and slippage of the dressing or bandage; pain symptoms were reported as particularly distressing. In free text responses, many patients stated that nothing could be done to ease pain at dressing related procedures either on their own at home or by the healthcare professionals involved in their care. However, many patients were able to identify several factors that were important to them in reducing pain at dressing related procedures. For example, the way in which the wound was treated was important in reducing the severity of pain whilst having consistent quality of care, thorough communication, and rapport was beneficial in easing pain at dressing related procedures. Being consulted, listened to, and distracted from the procedure itself was helpful. There was a small portion of patients who volunteered that they were satisfied with their current care regardless of pain. These data highlight the importance of gaining insight into which factors and processes aid successful psychosocial adjustment and coping mechanisms associated with chronic ulceration.
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
Anyone who becomes ill or sustains an injury, whether present at birth or acquired later in life, experiences a change and loss in one way or another. For example, physical diseases/injuries and their treatments can dramatically change the functionality and appearance of the body, which in turn can alter psychosocial well-being.1,2 Chronic wound healing is generally a long and uncomfortable process,3 and while many individuals adapt to the demands placed upon them and appear relatively unaffected, others experience psychosocial adjustment difficulties including adverse effects on quality of life (QoL) such as pain, negative mood, decreased activities of daily living, sleep disturbance, reduced mobility, and social withdrawal.3–11
Due to the chronic nature of ulceration, pain can be persistent and coping efforts typically involve individual cognitive and behavioral strategies to cope with and minimize pain and pain-related stress; many patients require extensive social support during these experiences.12 Coping strategies tend to change depending on the nature of the illness. A person’s resources relate to the desire for information and willingness to seek advice or support13 and can be grouped into appraisal-focused coping (attempting to understand the illness), problem-focused coping (tackling the problem and viewing the problem as manageable), and emotion-focused coping (dealing with the feelings associated with the illness).14
Although little research has been conducted on coping strategies used by patients with chronic ulceration, a study by Keeling et al15 looked at coping strategies used by patients with chronic leg ulcers and diabetic foot ulcers using the Coping Response Inventory. They found that patients used the entire range of strategies at close to the expected levels, but that these strategies did not change over time (4 months), which would be expected as part of an adaptation process.
1. Rumsey N, Clarke A, White P, Hooper E. Investigating the appearance-related concerns of people with hand injuries. Br J Hand Ther. 2003;8(2):57–61.
2. Cash TF, Pruzinsky T, eds. Body Image: A Handbook of Theory, Research, and Clinical Practice. 2002; New York: Guilford Press.
3. Mudge E, Meume S, Woo K, Sibbald G, Price P. The patients’ experience of wound pain: an international perspective. J EWMA. 2008;8(2):19–28.
4. Edwards H, Courtney M, Finlayson K, Shuter P, Lindsay E. A randomised controlled trial of a community nursing intervention: improved quality of life and healing for clients with chronic leg ulcers. J Clin Nurs. 2009;18(11):1541–1549.
5. Price PE, Fagervik-Morton H, Mudge EJ, et al. Dressing-related pain in patients with chronic wounds: an international patient perspective. Int Wound J. 2008;5(2):159–171.
6. White RJ. Pain assessment and management in patients with chronic wounds. Nurs Stand. 2008;22(32):62–68.
7. Price P. A holistic approach to wound pain in patients with chronic wounds. WOUNDS. 2005;17(3):55–57.
8. Ebbeskog B, Ekman SL. Elderly people’s experiences. The meaning of living with venous leg ulcer. J EWMA. 2001;1(1):21–23.
9. Price P, Harding KG. Measuring health-related quality of life in patients with chronic leg ulcers. WOUNDS. 1996;8(3):91–94.
10. Walshe C. Living with a venous leg ulcer: a descriptive study of patients’ experiences. J Adv Nurs. 1995;22(6):1092–1100.
11. Franks PJ, Moffatt CJ, Connolly M, et al. Community leg ulcers clinics: effect on quality of life. Phlebology. 1994;9:83–86.
12. Keeling D, Price P, Jones E, Harding KG. Social support for elderly patients with chronic wounds. J Wound Care. 1997;6(8):389–391.
13. Price PE, Moffatt CJ. Psychological aspects of wound healing. In: Morison MJ, Moffatt CJ, Franks PJ, eds. Leg Ulcers: A Problem-based Learning Approach. London; 2007; Mosby Elsevier: 529–542.
14. Moos RH, Schaefer, JA. The crisis of physical illness: an overview and conceptual approach. In: Moos RH, ed. Coping With Physical Illness: New Perspectives. New York; Plenum Press: 1984:3–25.
15. Keeling DI, Price PE, Jones E, Harding KG. Social support: some pragmatic implications for health care professionals. J Adv Nurs. 1996;23(1):76–81.
16. Barrett C, Teare JA. Quality of life in leg ulcer assessment: patients’ coping mechanisms. Br J Community Nurs. 2000;5(11):530–540.
17. Herber OR, Schnepp W, Rieger MA. A systematic review on the impact of leg ulceration on patients’ quality of life. Health Qual Life Outcomes. 2007;5:44.
18. Hareendran A, Bradbury A, Budd J, et al. Measuring the impact of venous leg ulcers on quality of life. J Wound Care. 2005;14(2):53–57.
19. Persoon A, Heinen MM, van der Vleuten CJ, de Rooij MJ, van de Kerkhof PC, van Achterberg T. Leg ulcers: a review of their impact on daily life. J Clin Nurs. 2004;13(3):341–354.
20. Fox C. Living with a pressure ulcer: a descriptive study of patients’ experiences. Br J Community Nurs. 2002;7(6 Suppl):10–22.
21. Charles, H. The impact of leg ulcers on patients’ quality of life. Prof Nurse. 1995;10(9):571–574.
22. Rich A, McLachlan L. How living with a leg ulcer affects people’s daily life: a nurse-led study. J Wound Care. 2003;12(2):51–54.
23. Brennan F, Carr DB, Cousins, M. Pain management: a fundamental human right. Anesth Analg. 2007;105(1):205–221.
24. Gatchel RJ, Peng YB, Peters ML, Fuchs PN, Turk DC. The biopsychosocial approach to chronic pain: scientific advances and future directions. Psychol Bull. 2007;133(4):581–624.
25. Jensen MP. Research on coping with chronic pain: the importance of active avoidance of inappropriate conclusions. Pain. In press.
26. Novy DM, Nelson DV, Francis DJ, Turk DC. Perspectives of chronic pain: an evaluative comparison of restrictive and comprehensive models. Psychol Bull. 1995;118(2):238–247.
27. Bechert K, Abraham SE. Pain management and wound care. J Am Coll Certified Wound Specialists. 2009;1(2):65–71.
28. Skevington SM. Coping with pain. In: Skevington SM, ed. Psychology of Pain. Chichester: John Wiley and Sons; 1996:210–242.
29. Benbow M. Exploring wound management and measuring quality of life. J Community Nurs. 2008;22(6):14–18.
