Chronic wound care in psychiatric nursing practice. A case study

Abstract

Individuals suffering from mental illnesses are characterized by poorer health and live shorter than the general population. Health problems, improper lifestyle, non-compliance with therapeutic recommendations, and the use of neuroleptics contribute to the occurrence of chronic wounds. The most common types of chronic wounds observed in the mentally ill include pressure ulcers, leg ulcers and the diabetic foot. The aim of the study was to present the specificity of the care provided for a patient with a chronic wound complicated by mental illness in the view of the diagnosis of nursing and caring problems. The study involved the use of a case study method. In planning patient care, data collected through interviews, direct observation, and documentation analysis were used, whereas the severity of symptoms was assessed with the VAS scale and Broset Violence Checklist. The ulceration was evaluated by means of the LUMT scale. Subsequently, the nursing issues were identified and interventions were implemented in line with the Evidence Based Practice. Following the implementation of topical and systemic therapy, the condition of the wounds improved by means of fibrin clearing, removal of dead epidermis from the wound edges, and gradual development of granulation tissue. The size of the wound on the left lower leg was reduced by about 20%, and on the right lower leg by about 30%. The improvement in the body hydration, nutritional status, biochemical parameters was achieved in the course of the systemic treatment and a proper diet. Not only did the patient’s mental condition improve, but also the willingness to cooperate with the staff. This allowed for the transfer to an open ward, where the wound treatment was continued. Another accomplishment was the positive impact on the patient’s awareness regarding wound care self-management. However, since the patient was discharged on his own request, complete wound healing was not achieved during hospitalisation. It is unknown whether he has undertaken further treatment at the indicated wound treatment clinics. Treatment of chronic wounds in patients with mental illnesses is a difficult process, since during the period of exacerbation of the disease, they tend to neglect their healthy needs. In the care of chronic wounds in patients with mental illnesses, treatment should be gradually introduced, adapting it to the patient’s needs, lifestyle and acceptance of the proposed treatment methods. Interventions against their will and expectations results in the loss of trust in the staff, non-compliance and even aggression. The multidimensional impact on the patient with a chronic wound increases the probability of complete healing of the wound. Care for a non-healing wound in patients with mental disorders should be comprehensive and include the treatment of both the wounds and mental disorders. Therefore, focusing solely on the wound is not enough, as only holistic measures will optimize wound care, leading to its healing.