Psychological Impact of Pressure Ulcers


Pressure ulcers represent a severe condition that immobilizes people and exposes them to additional health issues that are caused by the worsening of blood flow. Soft tissues deteriorate under pressure, which is also rather typical of individuals that are confined to wheelchairs. One of the ideas that are mentioned in the literature is that in order to establish a positive environment, the team should educate patients on why and how to protect themselves from pressure ulcers (Smit et al., 2016). Prevention of pressure ulcers and adequate training are essential because they significantly reduce the treatment period and support individuals that were affected by the given condition the most. Another idea from Smit et al.’s (2016) article was to introduce statewide initiatives that would affect the providers’ ability to prioritize care-related tasks and engage the staff and patients in crucial learning activities.

Patient education should not be overlooked because it could broaden the horizons of care of individuals with pressure ulcers. One of the eventual methods to treat pressure ulcers quicker in adult patients could be to integrate wound care team consultations. The key benefit of learning initiatives is that they create additional opportunities related to the prevention of pressure ulcers in adult patients and help them develop their own strategies of mitigating the influence of pressure ulcers on the quality of their lives.

Health Issue

The specific health problem that the author of the paper is going to discuss is the association between the quality of life and educational activities promoted among patients with pressure ulcers. The significance of the psychological impact of bedsores is also framed by the increasing length of stay and the occurrence of hospitalizations among patients with pressure ulcers who become depressed and experience the worsening of quality of their lives. The increasing number of admissions makes it safe to hypothesize that the perceived disability of remaining immobilized due to pressure ulcers is one of the key negative outcomes characteristic of the condition at hand. The majority of patients tend to refuse to lose their mobility and recognize pressure ulcers as a trivial health condition that does not affect their daily life in a major way. The most common manifestations of bedsores, though, lead to inadequate behavior changes, and a patient’s positive attitude can be quickly turned into its negative counterpart. Notwithstanding, existing literature on the subject does not disclose any evidence regarding the idea that patients with pressure ulcers are more susceptible to self-destruction than patients with other conditions.

The lack of training can be one of the reasons why care providers and patients do not engage in any learning and education activities that could help them gain more insight into how pressure ulcers in adult patients could be prevented. Accordingly, the relationship between major behavioral factors and the biological pathway can be explained by the absence of behavioral adjustment that could improve a person’s understanding of why pressure ulcer care is necessary and how it could be administered to prevent additional negative outcomes, respectively. The psychological evolution of a patient could be achieved with the help of bringing more stability and activity into their life. Overall, the process of rehabilitation is one of the most important steps in helping the patient overcome the psychological implications of remaining immobilized because otherwise, prolonged hospitalization is going to be the only outcome experienced by care team members and their patients.

Pressure ulcers are not viewed by hospitalized individuals as something crucial. This is why they tend to refuse their psychological issues and give up on psychotherapy. Prevention instructions are ignored for the sake of patients remaining able to prove that they are still capable of living their life as if they are not affected by pressure ulcers. Therefore, in order to manage this condition, care providers have to reduce the recurrence of the issue by educating patients and ensuring that recidivist behaviors disappeared. The combination of emotional and physical factors is most likely to lead to psychological maladjustment and prolonged treatment process, which is a severe problem.

Targeted Population

The overall impact of pressure ulcers on the US population may be understood from the evidence presented by Park-Lee and Caffrey (2015) from the Division of Health Care Statistics. They mentioned that at least 10% of the nursing home population had experienced pressure ulcers at least once during their admission. The most common conditions among nursing home residents are stage 2 pressure ulcers (featuring a slight loss of partial-thickness skin), which may lead the author of the current research to an idea that the target population should be aged from 45 to 64 years, as this cohort is most likely to get exposed to the condition mentioned above. According to Park-Lee and Caffrey (2015), pressure ulcers were much more characteristic of residents with shorter stays, which makes it crucial to implement an informative program intended to help patients gain more insight into how pressure ulcers could be prevented. Knowing that at least 35% of adult patients staying in nursing homes suffer from stage 2 pressure ulcers (or higher), it is essential to take action and protect the given population from all the potentially negative influences.

When integrating the health issue and target population, it is critical to remember that pressure ulcers influence the quality of life and make it harder for patients to take care of their psychological health and restore the resident’s social, emotional, and physical dimensions of life. On the other hand, health care providers should recognize the extent to which pressure ulcers affect patients as well. This way, they would have more chances to come up with relevant educational activities and treatment plans that would engage patients and help the latter realize why and how pressure ulcers should be prevented. Nevertheless, the long-term impact of the proposed initiative would be contingent on the individual characteristics of every patient who is willing to receive the given education and gain more insight into how they could improve the quality of their lives.

Another area that should be addressed by the researcher is a plethora of risks and protective factors that affect social and cultural behaviors that are characteristic of patients. The first part of risks is related to the outcomes of physical restrictions that patients have to experience as a part of major lifestyle changes that come with pressure ulcers. The presence of the latter is not always addressed by care providers, which may lead to detrimental behaviors and additional implications related to psychological and social comportments. According to existing evidence, physical limitations linked to pressure ulcers are perceived by patients as severe social isolation and result in psychological blockages that force the patient to behave inadequately (Choi et al., 2016). Interpersonal relations of residents suffering from pressure ulcers are also threatened because of the increased level of dependence that makes patients think they are the burden that everyone tries to get rid of as soon as possible. Accordingly, pressure ulcers generate inconsistent behaviors in patients that have to be addressed with the help of repeated consultations and training sessions.

Social and cultural behaviors in patients with pressure ulcers bear a negative connotation to the process of care because there are numerous psychological challenges that both providers and patients would have to experience. The presence of bedsores makes individuals think they are subject to an utterly severe condition that cannot be healed, leaving them immobilized for the rest of their life. Accordingly, the person would most likely alter their perception of the body image and recreate its flawed counterpart to replace the actual one. This means that even after a person would be able to cure their pressure ulcers, they would still believe that they are not as attractive as prior to the condition. The theory of planned behaviors explains the biggest threat of pressure ulcers as the fact that there may be subjective norms affecting the patient’s motivation to engage with the means of treating pressure ulcers (US Department of Health and Human Services, 2005). This problem is most common for the severest forms of the reviewed condition that not only cause pain but also expose patients’ bones and muscles. The final issue related to social and cultural behaviors is that residents could be emotionally discomfited owing to the potential social isolation and the lack of preventive measures taken by care providers.

As for the positive effects of cultural and social behaviors displayed by patients suffering from pressure ulcers, the two main conclusions may be made by the researcher on the basis of reviewed information. First, proper care could help providers prevent pressure ulcers and carefully monitor the treatment process (Rafter, 2016). In accordance with the social cognitive theory, adequate care could improve patients’ self-efficacy and reinforce behaviors that would reduce reoccurrence of pressure ulcers (US Department of Health and Human Services, 2005). Second, proper behaviors displayed by all actors involved in care provision and reception could lead to a decrease in psychological and social distresses affecting them (Ousey et al., 2016). Not only such an attitude would prevent the formation of pressure ulcers, but also reduce the number of patients who could be embarrassed by their health condition. With a careful approach to the changing lifestyle of their patients, providers could be able to generate a positive care environment and achieve the best health outcomes without major negative implications.

Discussion of Conclusions and Recommendations

The essential problem that relates to the ability to prevent pressure ulcers is that not all adult patients quickly recognize the need to change their lifestyle and adjust to the updated conditions in order to treat pressure ulcers quicker. Different healthcare settings impose a variety of conditions, but the foundation of the issue remains the same: adult patients tend to ignore pressure ulcers and then resort to inadequate behaviors aimed at the substitution of physical pain. The condition reviewed within the framework of the current paper is deeply associated with the psychological and social effects of a person remaining immobilized for an indefinite amount of time. The quality of life depends on how both providers and patients perceive the issue of pressure ulcers and respond to it on both short- and long-term scales. As the existing evidence showed, pressure ulcers are recurrently causing pessimism and depression in older patients who believe that they have become more susceptible to poor living conditions and would never come back to the quality of life that they had before the condition.

Accordingly, even if pressure ulcers affect a person’s general physical health, the biggest threat is the unseen psychological implications that cause patients to engage in self-isolation and borderline behaviors that are not commonly accepted by society. The fact that pain usually accompanies pressure ulcers makes it even harder for patients to recover because of their inner feeling of uselessness. Therefore, agonizing pains go beyond the patient’s body and affect the thinking processes. A redesigned body image in an elderly person is a devastating factor that may be hard to get rid of, especially in the case where the patient showed signs of depression and pessimism earlier. Diminished quality of life is undeniably associated with the lack of proper treatment and inner unwillingness to treat the condition. This is why there are numerous research articles suggesting that patient and provider education could help them overcome the challenges of pressure ulcers and achieve care of better quality.

As for the potential recommendations for practice in terms of treating patients with pressure ulcers, one of the most important ideas was shared by Moore et al. (2015) who focused on the opportunity to utilize eHealth applications and provide individuals with training sessions intended to extend their knowledge and motivate them to display proactive behaviors. The rationale behind improved consultations was that patients would get more knowledge regarding how pressure ulcers could be treated and how digital tools could improve the quality of care. A similar approach was used in an article written by Ousey et al. (2016), where they explored the possibility of updating the reporting mechanisms and facilitating the process of information transmission from provider to patient. The claim was that specialized training in skin management would make nurses more knowledgeable and help them disseminate knowledge in an effective way. Patient health promotion was also touched upon in Rafter’s (2016) article, as he suggested to implement a complex approach including eHealth instruments and face-to-face consultations intended to maintain a positive attitude in patients and help them engage in the reporting procedures.

On the other hand, care consultations might also be beneficial due to the fact that pressure ulcers affect patients on the level of psychology and make it harder for them to grasp the positive influence disseminated by care providers. Because of this, Chen et al. (2015) supposed that the biopsychosocial health of individuals with pressure ulcers is contingent on constant discussions with care providers and the latter’s ability to reduce the burden. Nevertheless, it is not as cost-effective as the PUSH (the Pressure Ulcer Scale for Healing) framework proposed by Choi et al. (2016). It emphasizes the importance of patient education and is believed to increase external responsiveness among patients with the most adverse cases of pressure ulcers. Care consultations might be seen improving patient engagement and create more opportunities for the development of positive relationships among patients and nurses. Similarly, Feng et al. (2016) approached the issue of patient consultations by mentioning the potential value of educational campaigns for patients that would focus on their psychological health and the reasons behind inappropriate behaviors. Out of the concepts in diffusion of innovations, it would be reasonable to assume that communication channels could be improved significantly with the help of a training program established for both providers and patients (US Department of Health and Human Services, 2005). Overall, it may be concluded that educational consultations would be essential for both patients and nurses because all stakeholders would become able to prevent the imminent manifestation of pressure ulcers.

References

Chen, Y. T., Chang, C. C., Shen, J. H., Lin, W. N., & Chen, M. Y. (2015). Demonstrating a conceptual framework to provide efficient wound management service for a wound care center in a tertiary hospital. Medicine, 94(44), 1-7.

Choi, E. P., Chin, W. Y., Wan, E. Y., & Lam, C. L. (2016). Evaluation of the internal and external responsiveness of the Pressure Ulcer Scale for Healing (PUSH) tool for assessing acute and chronic wounds. Journal of Advanced Nursing, 72(5), 1134-1143.

Feng, H., Li, G., Xu, C., & Ju, C. (2016). Educational campaign to increase knowledge of pressure ulcers. British Journal of Nursing, 25(12), 30-35.

Moore, Z., Angel, D., Bjerregaard, J., O’Connor, T., McGuiness, W., Kröger, K.,… & Yderstrœde, K. B. (2015). eHealth in wound care: From conception to implementation. Journal of Wound Care, 24(Sup5), S1-S44.

Ousey, K., Kaye, V., McCormick, K., & Stephenson, J. (2016). Investigating staff knowledge of safeguarding and pressure ulcers in care homes. Journal of Wound Care, 25(1), 5-11.

Park-Lee, E., & Caffrey, C. (2015). Pressure ulcers among nursing home residents. Web.

Rafter, L. (2016). Employing e-health in the palliative care setting to manage pressure ulcers. Wounds UK, 12(1), 114-123.

Smit, I., Harrison, L., Letzkus, L., & Quatrara, B. (2016). What factors are associated with the development of pressure ulcers in a medical intensive care unit? Dimensions of Critical Care Nursing, 35(1), 37-41.

US Department of Health and Human Services. (2005). Theory at a glance: A guide for health promotion practice (2nd ed.). Lulu.com.