Motivation and education

Stronge (1984) suggests that involving patients in the care or protection of their wounds promotes healing. Logically, careful explanation of the importance of diet or appropriate exercise can only improve the rate of healing. A positive attitude to healing by the nurse has a significant effect on the outlook of the patient. Fernie and Dornan (1976) found it improved the healing of pressure sores.

The education of surgical patients has been studied extensively in the USA and the UK (Cook, 1984). It has been used to reduce the length of hospital admission following surgery and thus costs. A corollary can be drawn: improved recovery implies wound healing without complication.

Numbers corresponding to severity of pain

Excruciating pain

(no control)

Extreme pain (disabling) prevents you from doing your usual activities

Moderate pain

Fig. 2.2 A pain chart (from Bourbonnais, 1981).

Slight pain

No pain

Words to describe your pain

Match the word(s) that apply to your pain with a number in the ruler which corresponds to the severity of your pain. Draw an arrow from the word to the number, or tell the nurse.

tender cruising squeezing stabbing sharp burning feels like an electric shock throbbing cramping dull sore aching gnawing feels like a weight pressure a discomfort

Nyatanga (1997) has reviewed psychosocial theories of noncompliance and divided them into the following categories:

• Perceptual theory: people interpret the world based on what they already know. They may have pre-existing theories about their treatment.

• Value clarification: patients may consider the choices in relation to their treatment and choose whether to comply. An example would be the man choosing not to give up smoking despite knowing it increases his risk of leg amputation.

• Attribution theory: this relates to the locus of control. Patients who feel in control of their treatment or who see a link between their treatment and the healing of their wound are more likely to be compliant.

• Cultural theories: all individuals have a cultural understanding of their wound, its meaning and the treatment. This may lead them to decide not to follow all the treatment requirements, such as not wishing to take analgesia.

• The health belief model, patients may choose to engage in health-related behaviour if they believe that the benefits in terms of health gain outweigh the costs. For example, a leg ulcer patient may choose to wear a four layer bandage which she finds hot and uncomfortable because she believes that it will heal her ulcer.

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