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Quality of Life - Part I: Using the Holistic Caring Praxis in Skin and Wound Care

Posted on: Thursday, 16 December 2004, 03:00 CST

"Not life, but good life, is to be chiefly valued. "- Socrates

Along-time friend was diagnosed with Type II diabetes several years ago. She was placed on the "antihyperglycemic medication du jour" to control her glucose levels. The medication gave her diarrhea to the extent that she had to know the locations of all the public bathrooms at the local shopping malls. Her remark to me one day was, "This medication is making my quality of life suffer." When I asked her what she meant, she replied that she was planning her life around the side effects of the medication. She couldn't travel far from home for fear of an "accident" and had to carry extra underwear when she did go out. Subsequently, she was taken off that medication and responded to a different medication. She's doing very well, but her comment made me pause and wonder about our skin-care patients' experiences.

Quality of life is an abstract concept that creates a working theoretical framework reflective of the impact of disease on daily life. Since nursing care should consist of caring for the whole patient, consideration of the patient's physical, emotional, economic, spiritual, cultural, social, and political environments are important in providing care to the chronically ill patient (Popoola, 2003). The holistic caring praxis consists of providing care in each aspect of the patient's life.

The skin is the largest organ of the body and the most visible part of us. It represents "our identity" to the external environment. Healthy skin is defined as fulfilling all its functions in such a way that an individual's quality of life is not adversely affected (Penzer & Finch, 2001). Nursing assessment of skin tends to concentrate on the physical conditions and managing those characteristics. But the impact of skin and wound conditions affects all of the patient's life and must be measured and treated as well.

Physical Aspects of Skin Care

Nursing assessments of the physical components of skin and wound care usually focus on observations. Physical characteristics of the wound such as dimensions, pattern of lesions, tissue color, drainage, and odor are usually well documented in the patient's medical records. Other physical wound and skin characteristics that influence QpL include underlying etiology, pain, nutritional assessment, and mobility. Pain, although mostly a physical characteristic of wound and skin care, carries a psychosocial component when the pain is severe enough to limit normal daily activities. Skin and wound conditions producing drainage can also limit or curtail a patient's pleasure in his/her normal lifestyle.

Psychosocial Aspects of Skin Care

Psychosocial assessment of patients with skin and wound problems is usually not performed (or documented) unless there is an obvious problem. Wound and skin care issues threatening body image are usually considered by nurses as requiring psychological support and the greater the threat, the greater the need for intervention (Newell, 2000; Teare & Barrett, 2002). Skin conditions can also affect interpersonal relationships, carrying an impression of lack of hygiene or contagion. Skin treatments can be messy, staining clothing and furniture. Flaking skin from pruritic conditions or blood left on clothing or sheets can result in social fear or embarrassment. Loss of functions has both a physical and psychological impact. Disfiguring conditions can cause depression and isolation. Many patients feel self-conscious because people are more likely to stare at them. Adolescents with acne can become moody, frustrated, and irritable. Patients with malodorous wounds fear that "everyone" can detect the odor. A recent breast cancer patient with a fungating lesion stated that she did not leave home, "not even to go to church," because of the odor.

Spiritual Aspects of Skin Care

Cultural issues, the patient's support systems, and self- motivation are all examples of the spiritual environment. Cultural beliefs and values refer to the prevailing philosophies that guide thinking and actions within a society (Engebretson, 2003). Many Hispanic cultures embrace both their traditional and modern medical treatments. I was once called to see a newly admitted breast cancer patient. She had a dried herbal mixture on her left breast that was prescribed by a physician in Mexico that was supposed to draw the tumor out (which would then "fall off" and she would be cured of cancer). Asian medicine can encompass a variety of treatment modalities (acupuncture) that Western health care providers view as "alternative therapies" but are a way of life in these cultures.

The ability to cope with chronic skin diseases or wound problems may also largely be predicated upon the patient's support systems. Cancer care has been based for decades on the premise that the patient responds better psychologically to outpatient treatment rather than treatment in an inpatient setting. Patients with visible or disfiguring disease express concerns that their disease will change how their families and friends view them. Patients with good relationships indicate that their disease does not affect those ties.

Because of the time nurses spend providing patient care, our patients look to us to help them integrate their illness into their lives, not the other way around. Only by "knowing" the patient, can we "know" their care.

To be continued.

References

Engebretson, J. (2003). Cultural constructions of health and illness: Recent cultural changes toward a holistic approach. Journal of Holistic Nursing, 27(3), 203-227.

Newell, R. (2000). Body image and disfigurement care. London: Routledge.

Penzer, R., & Finch, M. (2001). Promoting healthy skin in older people. Nursing Standard, 75(34), 46-52.

Popoola, M.M. (2003). Complementary therapy in chronic wound management: A holistic caring case study and praxis model. Holistic Nursing Practice, 77(3), 152-158.

Tcare, J., & Barrett, C. (2002). Using quality of life assessment in wound care. Nursing Standard, 77(6), 59-60, 64, 67-68.

Cynthia A. Worley, BSN, RN, COCN, CWCN, is a Board Certified Wound, Ostomy, and Continence Nurse, University of Texas, M.D. Andersen Cancer Center, Houston, TX; and a Dermatology Nursing Editorial Board Member.

Copyright Anthony J. Jannetti, Inc. Dec 2004

Source: Dermatology Nursing

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