Kronik Yara Hastası Bakımında Psikolojik Destek: Kronik Yarası Olan Bireylerde Yara İyileşmesine Etki Eden Psikolojik Faktörler ve Kronik Yarayla İlişkili Psikolojik Sorunlar
Özet
Bu çalışma, kronik yara bakımında psikolojik faktörlerin ve stresin yara iyileşme süreçleri üzerindeki doğrudan ve dolaylı etkilerini kapsamlı bir şekilde incelemektedir. Sağlıklı dokunun yapısının bozulması olarak tanımlanan yaralar, uygun zamanda iyileşmediğinde kronik yara halini almakta; bu durum hastaların yaşam kalitesini, uyku düzenini ve günlük rutinlerini olumsuz etkilemektedir. Hans Selye tarafından bedenin baskıya verdiği tepki olarak tanımlanan stres, "Genel Uyum Sendromu" çerçevesinde alarm, direnç ve tükenme evreleriyle açıklanmaktadır. Tükenme evresinde bağışıklık sisteminin baskılanmasıyla yara iyileşmesinde belirgin gecikmeler ve enfeksiyon riskinde artış gözlenmektedir. Biyolojik olarak, stres durumunda aktifleşen sempatik-adrenomedüller sistem (SAM) ve hipotalamo hipofizer adrenal aks (HPA), kortizol ve katekolamin gibi hormonların salgılanmasını artırarak lokal pro-inflamatuar sitokin (IL-1α, IL-8) üretimini düşürmekte ve yangısal cevabı geciktirmektedir. Deneysel çalışmalar (Punch biyopsi, bant soyma ve kabarcık modelleri), bakım verme yükü, evlilik çatışmaları ve öfke kontrolü sorunları gibi psikososyal stresörlerin yara onarım hızını %24 ila %27 oranında yavaşlattığını nesnel olarak ortaya koymaktadır. Ayrıca stres; sigara, alkol kullanımı ve kötü beslenme gibi sağlığa zararlı davranışları tetikleyerek iyileşmeyi dolaylı yoldan da baltalamaktadır. Sonuç olarak, kronik yaraların getirdiği akıntı, kötü koku ve hareket kısıtlılığı gibi fiziksel sorunlar bireylerde anksiyete, depresyon ve sosyal izolasyona yol açarak iyileşmeyi daha da geciktiren olumsuz bir psikososyal sarmal oluşturmaktadır.
This study comprehensively examines the direct and indirect effects of psychological factors and stress on wound healing processes in chronic wound care. Wounds, defined as the deterioration of healthy tissue structure, become chronic when they fail to heal in due time, negatively impacting patients' quality of life, sleep patterns, and daily routines. Stress, defined by Hans Selye as the body's response to pressure, is explained within the framework of the "General Adaptation Syndrome" through the stages of alarm, resistance, and exhaustion. In the exhaustion stage, significant delays in wound healing and an increased risk of infection are observed due to the suppression of the immune system. Biologically, the sympathetic-adrenomedullary system (SAM) and the hypothalamic-pituitary-adrenal axis (HPA) activated during stress increase the secretion of hormones like cortisol and catecholamines, which lowers local pro-inflammatory cytokine (IL-1α, IL-8) production and delays the inflammatory response. Experimental studies (Punch biopsy, tape stripping, and blister models) objectively demonstrate that psychosocial stressors, such as caregiving burden, marital conflicts, and anger management issues, slow down the rate of wound repair by 24% to 27%. Furthermore, stress indirectly undermines healing by triggering health-damaging behaviors like smoking, alcohol consumption, and poor diet. Consequently, physical problems caused by chronic wounds, such as exudate, malodor, and mobility restrictions, lead to anxiety, depression, and social isolation in individuals, creating a negative psychosocial spiral that further delays healing.
Referanslar
Cherry GW, Hughes MA, Ferguson MW, Leaper DJ. Wound healing.In: Morris PJ,Wood WC, editors. Oxford textbook of Surgery. Oxford:Oxford University Press, 2000. p. 132.
Gottrup F, Holstein P, Jrgensen B, Lohmann M, Karlsmark T. A new concept of a multidisciplinary wound healing center and a national expert function of wound healing. Arch Surg 2001;136:765–72.
Marieb EN. Human anatomy and physiology. 6th ed. San Francisco: Benjamin Cummings, 2004. p. 138–9.
Menke NB, Ward KR, Witten TM, Bonchev DG, Diegelmann RF. Impaired wound healing. Clin Dermatol 2007;25:19–25.
Grey JE, Enoch S, Harding KG (2006)Wound assessment.BMJ,4;332(7536):285-8.
Güneş Yapucu Ü, Kronik Yaraların Değerlendirilmesi, C.Ü. Hemşirelik Yüksekokulu Dergisi 2007, 11(3)
Torun A, Stres ve Tükenmişlik, 2. Baskı, Türk Psikologlar ve Kalder Yayınları, Ankara, 1997.
Selye H. The Stress of life. New York: McGraw-Hill, 1956.
Lazarus RS, Folkman S: Stress, appraisal and coping, 1st Ed, Springer Publishing Company, New York, 1984;11-21.
Kim JJ, Diamond DM. (2002) The stressed hippocampus, synaptic plasticity and lost memories. Nature Reviews Neuroscience. 3, 453-462.
Levi L. The urinary output of adrenaline and noradrenaline during pleasant and unpleasant emotionalstates. Psychosom Med 1965; 27:80-85.
Barbara J. Braham, Stres Yönetimi: Ateş Altında Sakin Kalabilmek (Çeviri: Vedat G. Diker), Hayat Yayınları, İstanbul, 1998, ss. 52-54.
Altan S, Örgütsel yapıya bağlı stres kaynakları be örgütsel stresin neden olduğu başlıca sorunlar, Stratejik ve Sosyal Araştırmalar Dergisi ISSN: 2587-2621 Volume 2 Issue 3, November 2018 sayfa 138-158
Braham BJ, Stres Yönetimi. Ateş Altında Sakin Kalabilmek, Hayat Yayınları, İstanbul, 1998.
Aydın, B. ve İmamoğlu, S. (2001). Stresle başa çıkma becerisi geliştirmeye yönelik grup çalışması. M. Ü. Atatürk Eğitim Fakültesi Eğitim Bilimleri Dergisi,14, 41-52.
McMahon, G. (2011). No more stress! Be your own stress management coach. Karnac Books.
Aydın, İ. (2008). İş yaşamında stres. (3. Baskı). Ankara: Pegem Akademi Yayınları.
Batıgün, A. D. ve Şahin, N. H. (2006). İş stresi ve sağlık psikolojisi araştırmaları için iki ölçek: A-tipi kişilik ve iş doyumu. Türk Psikiyatri Dergisi, 17(1), 32-45.
Gunnar, M., and Quevedo, K. (2007). The neurobiology of stress and development. Annual Review of Psychology, 58, 145-173
Butcher, J. N., Mineka, S. & Hooley, J. M. (2013). Anormal psikoloji (Çev. Okhan Gündüz). İstanbul: Kaknüs Yayınları.
Selye H. The general adaptation syndrome and the diseases of adaptation. J Clin Med 1946; 6:117- 230.
Civan, A., Özdemir, İ., Gencer, Y. G., & Durmaz, M. (2018). Egzersiz ve stres hormonları Türkiye Spor Bilimleri Dergisi, 2(1), 1-14
Baltaş A, Baltaş Z, (1997), Stres ve Başa Çıkma Yolları, 16. Baskı, Remzi Kitabevi, İstanbul
Upton D, Felicty S. The Psychological Consequences of Wounds a Vicious Circle that Should not be Overlooked. Wounds UK, 2011; 7(4):136-138.
Gouin JP, Kiecolt-Glaser JK,The Impact of Psychological Stress on Wound Healing: Methods and Mechanisms,Immunol Allergy Clin North Am. 2011 February ; 31(1): 81–93.
Boeke S, Duivenvoorden HJ, Verhage F, et al. Prediction of postoperative pain and duration of hospitalization using two anxiety measures. Pain 1991;45(3):293–7.
Scheier MF, Matthews KA, Owens JF, et al. Optimism and rehospitalization after coronary artery bypass graft surgery. Arch Intern Med 1999;159:829–35.
Doering LV, Moser DK, Lemankiewicz W, et al. Depression, healing, and recovery from coronary artery bypass surgery. Am J Crit Care 2005;14(4):316–24.
Kiecolt-Glaser JK, Page GG, Marucha PT, et al. Psychological influences on surgical recovery:Perspectives from psychoneuroimmunology. Am Psychol 1998;53:1209–18.
Cole-King A, Harding KG. Psychological factors and delayed healing in chronic wounds.Psychosom Med 2001;63:216–20.
Kiecolt-Glaser JK, Marucha PT, Malarkey WB, Mercado AM, Glaser R. Slowing of wound healing by psychological stress. Lancet 1995;346:1194–96.
Kiecolt-Glaser JK, Marucha PT, Malarkey WB, Mercado AM, Glaser R. Slowing of wound healing by psychological stress. Lancet 1995;346:1194–96.
McGuire L, Heffner K, Glaser R, et al. Pain and wound healing in surgical patients. Ann Behav Med 2006;31(2):165–72.
Padgett DA, Marucha PT, Sheridan JF. Restraint stress slows cutaneous wound healing in mice. Brain Behav Immun 1998;12:64–73.
Bosch JA, Engeland CG, Cacioppo JT, et al. Depressive symptoms predict mucosal wound healing. Psychosom Med 2007;69(7):597–605.
Altemus M, Rao B, Dhabhar FS, et al. Stress-induced changes in skin barrier function in healthy women. J Invest Dermatol 2001;117:309–17.
Denda M, Tsuchiya T, Hosoi J, et al. Immobilization-induced and crowded environment-induced strss delay barrier recovery in murine skin. Br J Dermatol 1998;138:780–85.
Kiecolt-Glaser JK, Loving TJ, Stowell JR, et al. Hostile marital interactions, proinflammatory cytokine production, and wound healing. Arch Gen Psychiatry 2005;62:1377–84.
Gouin JP, Kiecolt-Glaser JK, Malarkey WB, et al. The influence of anger expression on wound healing. Brain Behav Immun 2008;22(5):699–708.
Werner S, Grose R. Regulation of wound healing by growth factors and cytokines. Physiological reviews. 2003;83(3):835-70.
Glaser R, Kiecolt-Glaser JK. Stress-induced immune dysfunction: Implications for health. Nature Reviews Immunology 2005;5:243–51.
Ebrecht M, Hextall J, Kirtley LG, et al. Perceived stress and cortisol levels predict speed of wound heating in healthy male adults. Psychoneuroendocrinology 2004;29(6):798–809.
Detillion CE, Craft TK, Glasper ER, et al. Social facilitation of wound healing. Psychoneuroendocrinology 2004;29(8):1004–11.
Romana-Souza B, Otranto M, Vieira AM, et al. Rotational stress-induced increase in epinephrine levels delays cutaneous wound healing in mice. Brain Behav Immun 24(3):427–37.
Gouin JP, Carter CS, Pournajafi-Nazarloo H, et al. Marital behavior, oxytocin, vasopressin, and wound healing. Psychoneuroendocrinology.
Glaser R, Kiecolt-Glaser JK, Marucha PT, et al. Stress-related changes in proinflammatory cytokine production in wounds. ArchGen Psychiatry 1999;56:450–56.
Broadbent E, Petrie KJ, Alley PG, et al. Psychological stress impairs early wound repair following surgery. Psychosom Med 2003;65(5):865–69.
Hubner G, Brauchle M, Smola H, et al. Differential regulation of pro-inflammatory cytokines during wound healing in normal glucocorticoid-treated mice. Cytokine 1996;8(7):548–56.
Steptoe A, Wardle J, Pollard TM, et al. Stress, social support and health-related behavior: A study of smoking, alcohol consumption and physical exercise. J Psychosom Res 1996;41:171–80.
Hareendran A, Bradbury A, Budd J et al (2005) Measuring the impact of venous leg ulcers on quality of life. J Wound Care 14(2): 53–7
Lo SF, Hu WY, Hayter M, Chang SC, Hsu MY, Wu LY (2008) Experiences of living with a malignant fungating wound: a qualitative study. J Clin Nurs 17(20): 2699–708
Woo KY, Coutts PM, Price P, Harding K, Sibbald RG (2009) A randomized crossover investigation of pain at dressing change comparing 2 foam dressings. Adv Skin Wound Care 22(7): 304–10
Herber OR, Schnepp W, Rieger MA (2007) A systematic review on the impact of leg ulceration on patients’ quality of life. Health Qual Life Outcomes 5(44): 1–12
Mudge E, Spanou C, Price P (2008) A focus group study into patients’ perceptions of chronic wound pain. Wounds UK 4(2): 21–8
Kahan V, Anderson ML, Tomimori J, Tufik S (2010) Can poor sleep affect skin integrity Med Hypotheses 75(6): 535–7
