“Take a deep breath,” I told Mrs. K, whom I had seen for the past several months for a traumatic injury to her anterior leg. She was breathing rapidly clearly distressed. “Let’s get an oxygen saturation reading,” I indicated to the wound care nurse in our outpatient wound care center. Mrs. K had been coming in for wound care weekly, and I had hoped she would share my excitement with her wound finally being healed. However, as her oxygen saturation reading of 84% indicated, something more significant was affecting her care.

Mrs. K is a 93-year-old White woman with a history of colon cancer, hypothyroidism, and venous insufficiency who presented to the wound center with traumatic wounds on her left lower extremity after a slip and fall. She came under my care when her primary care physician noted poor wound healing. Venous duplex confirmed the diagnosis of venous insufficiency. Mrs. K also underwent an ultrasound-guided venous sclerotherapy procedure on the affected limb while under my care.

As my focus of attention shifted entirely to her, I began to implement my recent knowledge in relaxation techniques. She was not just a patient with a healing wound: She was a person with emotional burdens that I had not previously recognized. In wound healing, anxiety plays a vital role. Anxiety caused by the anticipation of pain, new surroundings of a wound care center, loss of independence in decision-making, fear of surgical procedures, and changes in body image can lead to increased levels of cortisol, adrenaline, blood glucose, and lipid profiles.1 Psychological interventions may mitigate the stress response and thus potentially influence wound repair, inflammation, perception of pain, and the patient’s mood.2 Breathing exercises can reduce anxiety by their effect on vagal tone.3 Performing relaxation therapy may reduce the incidence of hypoxia.4 Thus, understanding not just the physical condition but also the emotional and psychological aspects of a patient’s well-being can impact the patient’s overall outcome.

In this context, it was crucial to recognize the influence of social determinants of health (SDOHs) on Mrs. K.’s condition. Social determinants of health include factors such as socioeconomic status, access to healthcare, and availability of social support systems. These factors have direct causal effects on health and many diseases, and the introduction of this model has led to a paradigm shift in the approach of healthcare professionals to their patients.

Mrs. K had been experiencing anxiety, which I had not realized from her prior encounters. She had recently lost her husband and had undergone a surgical procedure that was complicated by a surgical site infection necessitating hospital admission. Mrs. K.’s anxiety was a direct result of these life events, highlighting the impact of SDOHs on her well-being. The influence of an empathic patient-centered approach on preoperative anxiety and surgical outcomes in outpatients has led to lower levels of preoperative anxiety and pain, enhanced surgical recovery and patient satisfaction, and improved wound healing.5

Patients receiving wound care often face prolonged periods of discomfort, physical limitations, and disruptions to their daily lives. Factors affecting mental health can be associated with increased mortality and chronic illness, which can directly alter the human gene expression in signal transduction to protein synthesis and resulting in impaired wound healing.6 Chronic stress has a significant effect on the wound healing process,7 and these challenges can take a toll on patients’ mental health. In Mrs. K’s case, anxiety had become a significant issue, affecting not only her overall well-being but also her wound-healing process.

After managing her immediate anxiety, I sat down with Mrs. K and held her hand. I knew that addressing her mental health concerns was just as crucial as tending to her physical wound. I assured her that her oxygen saturation had improved to 98%, a sign of physical well-being. It was the link to mental health and visualizing the potential effect of wound healing that was of great concern. Her direct physiologic response to her stress was evident during my clinical examination. This interaction also enabled me to engage in an open conversation about her mental health and to connect her with the appropriate resources for support. Implementing a brief validated depression and anxiety scale can not only foster a better provider-to-patient experience but also help the provider understand what additional resources the patient may need. In addition, creating a list of community resources to give to the patient can be beneficial for the continuity of patient care.

Patients in wound care settings are often seen more frequently than in primary care, making the provider’s understanding of their needs essential. This understanding goes beyond wound assessment and treatment. It involves empathy, consideration of SDOHs, and a focus on mental well-being. In Mrs. K’s case, recognizing and addressing her anxiety was just as vital as ensuring her wound’s physical healing. Our role as providers extends beyond the technical aspects of our profession: It encompasses the compassionate care of the whole person. Empathizing with our patients and assuring them that their apprehensions and concerns for their personal well-being are valid and relatable is vital. Limiting one’s emotional capacity to sympathy for our patients is a disservice. In the realm of healthcare, particularly in specialized fields such as wound care, understanding the needs of patients extends beyond the physical aspects of treatment: It encompasses emotional support, consideration of SDOH, and a keen awareness of mental well-being.

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