Wounds of the Body, Wounds of the Self: Addressing Shame in the Care of Patients Living With Obesity and Chronic Wounds
Tim Porter O'GradyABSTRACT
PURPOSE
The purpose of this integrative review was to examine shame as a hidden determinant of outcomes among patients living with obesity and chronic leg and foot ulcers and to offer evidence-based strategies for wound, ostomy, and continence (WOC) nurses to recognize, mitigate, and transform shame in clinical practice.
DESIGN
Integrative review and practice synthesis.
SEARCH STRATEGY
Targeted integrative review of literature (2020–2025) using PubMed, CINAHL, PsycINFO, and Cochrane databases with supplemental ancestry or hand searching. Topics included weight stigma, psychosocial determinants of wound care engagement, trauma-informed and dignity-conserving approaches, and service models (telemedicine, peer support, integrated behavioral care).
FINDINGS
Shame-amplified by weight stigma and structural inequities-erodes trust, adherence, and engagement, and is associated with poorer healing trajectories. Interventions grounded in the Presence-Partnership-Dignity framework-pairing technical excellence with relational competence-integrate behavioral health and redesign services for emotional safety, thereby improving participation and outcomes.
IMPLICATIONS
Addressing shame is not an ancillary concern; it is central to wound care quality. WOC nurses are uniquely positioned to lead practice, education, and system redesign that restores dignity, strengthens self-efficacy, and advances equitable healing.