by Nchimunya Mwiinga
A Pressure Injury (PI) is a localized area of damage that affects the skin and, potentially, the underlying tissues, usually occurring over a bony prominence. It can manifest as either intact skin or an open wound, and it arises due to sustained pressure applied to that area for an extended period of time (Bharucha et al., 2018). PIs develop as a result of mechanical loads such as friction but usually occur amongst people that spend most of their time sitting like wheelchairs users, patients with Spinal cord Injury and patients bedridden in Intensive Care Unit. A Combination of external forces as well as weight, internal forces and other factors such as bone anatomy, microclimate and tissue thresholds, integratedly lead to either internal deep tissue injury or deformation of cells, which eventually leads to a reduction in blood fall in the loaded areas, which consequently leads to the development of a pressure injury(Grey et al., 2006, Gefen et al., 2022). Statistical data shows that an estimate of between 1 and 3 million individuals in the United States experience pressure injuries each year (Mondragon & Zito, 2024). The incidence rate varies depending on the clinical setting. For instance, the prevalence of pressure injuries among patients admitted to hospitals ranges from 5% to 15%, while the percentage tends to be considerably higher in long-term care facilities and intensive care units. This emphasizes the urgency with which PIs should be addressed (Mondragon & Zito, 2024).
While the physiological impact of PIs is well-documented, the psychological ramifications for both caregivers and patients are often overlooked. This blog reviews some of the research work that has been done in analyzing the relationship between pressure injuries and psychological well-being. By exploring this work, we can understand the importance of a holistic approach towards healing and treatment of pressure injuries, emphasizing the importance of mental health for all parties involved.
Pressure Injuries and Patient Psychological Wellbeing
Patients with pressure injuries often experience a range of psychological effects beyond physical discomfort and pain. They may experience feelings of humiliation, social isolation, and a loss of a sense of autonomy, which can be emotionally and mentally challenging (Qian et al., 2024). Due to the close care required for treatment, patients may struggle with anxiety, which can lead to feelings of helplessness. Social withdrawal could result from stigmas surrounding wounds from people around them, exacerbating feelings of loneliness and desolation. The malodors and leakage associated with pressure injuries have been shown to also contribute to patients' social withdrawal and feelings of humiliation (Charalambos et al., 2018). Harding-Okimoto (1997, as cited in Charalambos et al., 2018) interviewed patients with pressure injuries and found that they often experienced negative body-image perceptions, which can be highly distressing and lead to mental complications such as depression and social anxiety.
Further research shows that other factors are likely to affect one's mental well-being regarding having a pressure injury. Qian et al. (2024), in a study examining 215 patients with pressure injuries, found a direct relationship between a patient's level of depression and the progression of the pressure injury stages. Patients with more severe injuries reported higher levels of depression.
Additionally, they found an inverse relationship between the length of care and quality of life – the longer the duration of the pressure injury, the lower the reported quality of life scores. Qian et al. (2024) found that patients' anxiety levels increased with age, which may be attributed to mobility and health issues over time, as well as a higher susceptibility to pressure injuries accompanying aging.
Pressure Injuries and Caregivers Psychological Wellbeing
The psychological consequences associated with pressure injuries do not only exist in the patients but the caregivers as well. Caregivers, whether healthcare professionals, spouses, or relatives, face significant challenges and stressors when managing pressure injuries. Qian et al. (2024) also examined 216 caregivers along with 215 patients and found that caregivers experience higher levels of stress, anxiety, and depression compared to patients. They also found that the location, particularly sacral and ischial injuries, of a pressure injury was found to be a significant determinant of more extensive care, placing a heavy burden on caregivers. This implies that caregivers had invested more of their time and emotional capacity to be available and present for their patients. Furthermore, the study revealed a direct correlation between caregiver stress and the progression of pressure injury stages, reflecting the impact of the injury's severity on caregivers' mental well-being.
The psychological toll on caregivers is multifaceted. Feelings of stress, anxiety, and burnout can arise from the demanding nature of providing care for patients with pressure injuries. The need for constant vigilance, attending to wound care, and managing pain can be emotionally and physically taxing. These findings highlight the importance of recognizing and addressing caregiver stress and the need for support systems and self-care strategies. Neglecting the emotional well-being of caregivers can lead to burnout, compromised quality of care, and negative patient outcomes.
Psychological ramifications experienced by both groups
Quin et al. (2024) found a statistically significant correlation between patient depression and caregiver burden, reflecting the patient-caregiver dynamics present when treating pressure injuries. They also discovered that the sleep quality of both patients and caregivers deteriorated as the pressure injury stage became more severe. Patients experienced sleep difficulties due to pain, while caregivers had to provide heightened nocturnal care. Similarly, depression and stress levels increased for both parties as the pressure injury progressed, highlighting the direct correlation between injury severity and psychological distress. Notably, as caregivers' burden increased, there was a significant rise in the probability of patients experiencing high levels of depression. They also found a correlation between the duration or length of care provided and the well-being of both patients and caregivers, with both groups experiencing lower levels of mental well-being as the length of care increased.
Integrating Mental Health in Pressure Injury Care: A Holistic Approach
The interconnectedness of physical and mental health in pressure injury care cannot be overlooked. Charalambos et al. (2018) suggest that stress can impair the healing process in humans, thereby affecting the treatment of pressure injuries. They discuss how stress can impair the healing process by affecting various biochemicals and hormones essential for wound healing. Ebrecht et al.(2004) found that as perceived stress increased, the speed of wound healing decreased, highlighting the direct impact of psychological factors on physical recovery.
To address this, a holistic approach that integrates mental health support is crucial. Incorporating mental health professionals into care teams can ensure that both the physical and psychological needs of patients and caregivers are addressed. Open communication and education about the psychological impacts of pressure injuries can empower caregivers and patients to prioritize their mental well-being. Furthermore, technological innovations like Kalogon's products can play a significant role in alleviating the burden on both patients and caregivers. By promoting autonomy, mobility, and advanced air pressure management, these devices can restore - to some degree - a sense of control and independence for patients, while reducing the caregiving demands on loved ones or healthcare professionals. For instance, products such as the Booster are useful for leak detection in air-based cushions, maintaining pressure in case of a leak, and adjusting to environmental pressure changes, which can reduce the anxiety that deflation may result from unexpected deflation. Meanwhile, products like the Orbiter and Arbiter Med can assist wheelchair users with pressure offloading and pressure control, all of which help patients and ease the burden on caregivers.
Collaboration between healthcare providers, mental health professionals, and companies like Kalogon can pave the way for a comprehensive approach to pressure injury care, addressing the multifaceted needs of all parties involved.
Conclusion
The relationship between pressure injuries and psychological well-being is undeniable. Patients with PIs often experience negative emotions, social isolation, and a diminished quality of life, while caregivers grapple with stress, anxiety, and burnout from the demands of providing care. Neglecting mental health can impede the healing process and exacerbate the detrimental impacts of pressure injuries.
To truly promote holistic healing and well-being, it is crucial to integrate mental health support into pressure injury care plans. By acknowledging and addressing the psychological needs of both patients and caregivers, healthcare providers can create a more comprehensive and effective approach to treatment. Additionally, leveraging innovative technologies that restore autonomy and alleviate caregiver burdens can further support a multifaceted approach to pressure injury management.
Prioritizing mental health is not only a matter of compassion but also a fundamental aspect of effective pressure injury care and overall well-being. Kalogon is not just concerned about improving the sitting lives of its clients but also their holistic well-being.
References
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