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Leg ulcers

Theories of stress and coping and how they relate to individuals with venous leg ulceration

02 July 2022
Practice
02 July 2022
Volume 6 · Issue 2

Abstract

The experience of living with venous leg ulceration has been shown to have a negative effect on an individual's physical, psychological and social functioning. Associated factors such as pain, exudate, odour and limitations to an individual's mobility and social life are common stressors that impact on a patient's quality of life which can lead to stress, depression and anxiety. While acute stress is an innate and necessary physiological response, chronic stress can lead to alterations in the immune system that can prolong wound healing. Cognitive theories of stress and coping can help to explain how people react to these experiences, an understanding of which could help healthcare professionals develop an improved level of concordance with their patients. This narrative review examines existing theories regarding stress and coping and explores how these relate to people who have a venous leg ulcer using a case study approach as a basis for the discussion.

Venous leg ulcers are the most common type of leg ulcer1 with recent estimates suggesting that between 1.5–3.0 people per 1000 population have active leg ulcers.2 A previous estimate of prevalence suggested that this increases with age to about 20 per 1000 people aged over 80 years.3 The annual cost to the NHS in the UK has been estimated at £300 million.4

A venous leg ulcer is defined as an open lesion between the knee and the ankle joint that occurs in the presence of venous disease and takes more than two weeks to heal.5 Patients with venous leg ulcers often present with repeated cycles of ulceration, healing, and recurrence.6 Venous leg ulcers often take months to heal, with 12-month recurrence rates estimated to be between 18% and 28%.7 However, with the correct treatment (ie. compression therapy) venous leg ulcer should heal within 12 weeks.8 The management and prevention of venous leg ulcer recurrence should be treated as a priority and should take into account the psychosocial impact on a person.

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coping
patient experience
stress
venous leg ulceration
wound healing