This issue of Advances includes three articles that relate to the need for knowledge, skills, and empathy to address patient concerns and improve care.

The continuing education article by Levine and colleagues addresses the lack of knowledge of both healthcare professionals and patients concerning the hazards of contact with wet cement. A patient in the burn unit had helped a neighbour pour driveway cement from a ready-mix bag. He was unaware that cement is caustic and can cause alkali burns. The initial contact is painless and chemical reactions in the skin destroy skin structures due to the high alkalinity of the cement. There is often full-thickness skin loss unless the contact is immediately washed away with copious water flushing. This patient was in wet clothing with a breach in contact precautions between the protective boots and the patient’s skin on both lower legs leading to preventable second- and third-degree alkali burns.

How could this scenario have been improved for this patient? Warning of the dangers of ready-mix cement are often not prominent on the packaging. The patient had a delayed and inadequate shower after he was finished with the cement. He did not experience pain of increasing concern for a couple of days until his skin became slimy from the liquification of the skin cells from the alkali injury. He required extensive full-thickness debridement of the tissue, skin grafting, and negative pressure wound therapy for over 3 weeks along with IV antibiotics. How many clinicians would have recognized this injury in the early stages and the need for early debridement? There also is a need for increased public awareness of the hazards associated with wet cement and the prevention of skin injury by immediate copious water neutralization.

Self-efficacy, as defined by Bandura, is “the belief in one’s capacity to organize and execute activities required to manage prospective situations.”1 Spirituality helps patients feel better and cope with their new conditions more easily.2 Turkish investigators Polat and Burucu conducted narrative interviews and used scales to measure self-efficacy (Stoma Self-Efficacy Scale [SSES]) and spiritual well-being (Three Factor Spiritual Well-Being Scale [TF-SWBS]) in 51 adult nonpalliative care patients with intestinal stomas of at least 3 months duration (two-thirds of which were permanent stomas). The ability to cope with a stoma requires self-care skills. Higher self-efficacy was documented among patients with higher education levels and temporary stomas. Older age and longer stoma duration were associated with higher spiritual wellbeing. Data revealed no correlation between stoma self-efficacy and spiritual well-being. The authors conclude that nurses caring for persons with stomas need to assess and foster these skills and implement/support programs to build self-efficacy and religious spirituality.

Vascular surgeon, Dr Alisha Oropallo, explored clinician and patient attitudes in her Practice Reflections article, “The Importance of Empathy, Social Determinants of Health, and Mental Well-being in Wound Care.” She describes assessing an anxious 93-year-old woman in a follow-up outpatient visit. The patient had a traumatic fall associated with a leg wound, surgical procedure, and infectious complication that required hospitalization. Dr Oropallo utilized breathing exercises as part of performing relaxation therapy. An initial low oxygen saturation level of 83% climbed to 98% when the patient became relaxed. In addition to the patient’s physical condition, the emotional and psychological aspects of a patient’s wellbeing also need to be addressed. Social support systems are key to improving outcomes, and it is important to connect patients with the appropriate resources for support including holistic care needs.

Dr Oropallo chose “empathy” for her title wisely. Empathy means feeling what someone else feels rather than sympathy, which is only understanding someone else’s emotions from your own perspective. As healthcare professionals, we need to be holistic health advocates spreading knowledge about health hazards and appropriate prevention measures. We also need to assess patient’s skills for empowerment through self-efficacy and spiritual wellness while we promote empathetic patient journeys.

We dedicate this editorial to Dr. Gregory Schultz, an empathetic scientist with a deep commitment to the education of wound healing professionals. The wound world is diminished by his passing. To his beloved family, friends, professional associations, and colleagues, we send our deepest sympathies.

R. Gary Sibbald, MD, Med, FRCPC (Med Derm), FAAD, MAPWCA, JM

Elizabeth A. Ayello, PhD, MS, RN, CWON, MAPWCA, FAAN

1. Bandura A. Self-efficacy: toward a unifying theory of behavioral change. Psychol Rev 1977;84(2):191–215. 2. Toledo G, Ochoa CY, Farias AJ. Religion and spirituality: their role in the psychosocial adjustment to breast cancer and subsequent symptom management of adjuvant endocrine therapy. Support Care Cancer 2021;29(6):3017–24.