Wounds of the Body, Wounds of the Self: Addressing Shame in the Care of Patients Living With Obesity and Chronic Wounds.

Abstract

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.