By Laurie Swezey RN, BSN, CWOCN, CWS, FACCWS

Patient care must always be centered holistically, considering the specific problem that the patient is being treated for, as well as all other factors that may affect patient wellbeing. Wound care is no different: in addition to wound assessment and treatment, all other considerations that may impact the patient must be taken into account. Such considerations may include social, psychological, physical, nutritional, and lifestyle factors. Overlooking one of these important realms may lead to non-adherence on the part of the patient, which in turn may lead to a non-healing, chronic wound.

Social Factors

Social factors that may impact patient care and adherence to treatment include the patient’s ethnicity and cultural beliefs. Financial considerations may be a factor for some patients, as well as employment status. Patients who have a strong support base of family and friends and no financial worries may fare better than patients who are marginalized financially and have little or no social support. It is important to obtain background information from the patient, so that any social factors that may affect care can be addressed.

Psychological Factors

Health conditions such as diabetes, cardiovascular, and peripheral vascular disease may lead to depression. Depression may impact patient care in that patients may believe that there is little they can do to alter the course of their condition. Patients who suffer from depression may find it more difficult to change harmful lifestyle habits. Patients may also feel shame associated with their condition, which may cause isolation and worsen depression. For example, a patient with a foul smelling, heavily draining wound may be reluctant to engage in their usual social activities. Patients who exhibit signs of depression can be referred to their family physician for screening and treatment if deemed necessary.

Physical Factors

It is important for clinicians to be aware of all health conditions that may impact the patient’s ability to care for themselves and their wound, as well as their ability to heal. Conditions that may impact ability to heal include cardiovascular disease, pulmonary conditions that affect tissue oxygenation, peripheral vascular disease, diabetes, obesity, immune disorders, and others. Essentially, many chronic health conditions play a role in influencing the healing of wounds. Obtaining a thorough health history, as well as a list of medications the patient is currently taking, is important in developing a plan for wound management.

Nutritional Factors

A healthy diet containing the right combination of protein, carbohydrates, minerals, and vitamins is essential for wound healing. Patients with diets deficient in any of these categories may be at a higher risk for infection and impaired healing. All patients with wounds should be assessed for dietary intake and signs of malnutrition. If necessary, a nutritional consultation should be considered, particularly for patients who are morbidly obese or underweight. A number of other variables should also be considered in the nutritional management of wound care patients. A proper diet can be a powerful tool in wound care management.

Lifestyle Factors

Alcohol abuse and smoking are two lifestyle factors that negatively affect wound healing. Patients should be asked about alcohol and tobacco intake, and should be provided with material at their level of understanding detailing why and how these practices can slow or prevent wound healing. For patients who are interested in or ready to make a lifestyle change, for example smoking cessation, referral to their primary physician can be made. Patients should be encouraged by clinicians to make the necessary lifestyle changes in a nonjudgmental and supportive manner.

All of the above factors may influence wound healing. Information that may impact patient care and wound management should be uncovered early in the clinician-patient relationship. Patients must understand the effect that various, seemingly unrelated factors can have on their health. The clinician should endeavor to point the client to appropriate resources as necessary and appropriate. Treating a patient’s wound means addressing all aspects of their life that may affect wound healing.

Sources
Myers, B (2008). Wound Management: Principles and Practice. (2nd Edition). Pearson Prentice Hall. Upper Saddle River, New Jersey.
Worley, C (2004). Why won’t this wound heal? Factors affecting wound repair. Dermatology Nursing. Downloaded from the web January 18, 2011 http://findarticles.com/p/articles/mi_hb6366/is_4_16/ai_n29117342/

About The Author
Laurie Swezey RN, BSN, CWOCN, CWS, FACCWS is a Certified Wound Therapist and enterostomal therapist, founder and president of WoundEducators.com, and advocate of incorporating digital and computer technology into the field of wound care.