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Wound Care Challenges
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No two patients are the same and neither are their wounds. That is why wound care requires specialised training and expertise, as well as instinct and intuition. As a clinician, you may face many challenges as you provide wound management for your patients. This includes treating wounds while also working to help maintain patient skin health and protect them from infection.
Wounds may be classified as either being acute or chronic in nature. Acute wounds may be defined as, ‘those healing as anticipated’ and chronic wounds as, ‘Wounds that are failing to heal as anticipated or that have been stuck in any one phase of wound healing for a period of six weeks or more’.
Applying the alphabet to venous leg ulcer management
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A for Assesment and diagnosis
Highlights the importance of establishing correct aetiology and indicators for appropriate management. This includes wound and skin care, patient comorbidities, psychosocial elements and appropriate referral criteria.
Tools including, wound type or T.I.M.E (Tissue, Inflammation/Infection, Moisture, Edges/ Epitheliaisation), lower leg skin changes, healing time expectations, interpretation of vascular assessment and guide for deciding compression therapy level
A for Assesment and diagnosis -
B for Best practice wound and skin management
Highlights the importance of cleansing, rehydrating and protecting the peri-wound skin and the skin of the leg, and the importance of using a barrier film where there is risk of breakdown.
Wound dressing advice & tools:
Unless infection is present or suspected, select dressing type and frequency of dressing change to suit the compression change regimen.The most important factor in reducing exudate levels is appropriate sustained compression therapy, not the dressing.
Properties of a wound dressing to use under compression therapy.
B for Best practice wound and skin management -
C for Compression therapy for leg ulcer management
Compression bandaging is most commonly used for treatment of active venous leg ulcers.
Compression hosiery is mainly used for prevention of recurrence of venous leg ulcers.
Compression bandaging that is stiff and inelastic is preferable.
Factors that affect choice when selecting appropriate compression include:
- Graduated and progressive compression
- Training
- Competency
- Clinical experience
- Patient mobility
- Previous experience
- Pain levels
- Necessary wound care
C for Compression therapy for leg ulcer management
Pressure Ulcers
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- Skin damage has the potential to create serious consequences such as infection.
- Even minor skin injury can create discomfort and pain and add to patient suffering.
- Skin damage constitutes a negative clinical outcome and a poor patient experience.
Warm, moist skin is more vulnerable to the damaging effects of pressure and shear, which are recognized risk factors for pressure ulcer formation. Look for a dressing with properties that reduce the amount of moisture trapped at the skin’s surface.
Anatomical sites that overlay a bony prominence, such as the heel and sacrum, account for more than half of all pressure ulcers³ due to their vulnerability to pressure, friction and shear.
The key principles of best practice ensure that due care and process is followed to promote the delivery of the highest standards of care across all care settings, and by all care professionals. This Best Practice Statement is to provide relevant and useful information to guide those active in the clinical area, who are responsible for the management of skin care in an ageing patient population.
How wounds affect quality of life? - By Mark Collier
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A patient's ‘quality of life’ is dependent upon them being content with the following aspects of their life: physical, psychological, emotional, social (and economic) and spiritual.
There can be many reasons for patients with wounds to feel isolated, lonely or that their quality of life experience has been negatively affected. In the same way that every wound and condition is different, so is every patient. Some patients feel that their wound reduces their quality of life. They may cite the following reasons:
The wound is painful and makes mobility difficult
- The wound produces a lot of fluid and causes embarrassment if it makes bandages and/or clothing wet.
- Some wounds can produce odours which can also cause embarrassment as well as low self-esteem.
Feeling that they are a burden to family and friends
Wounds can have a physical impact such as pain, odour, impaired mobility and sleepless nights, but they also have a social impact as patients may go out less often and see their friends and relatives less frequently. For those patients who are in employment, living with a wound means that they might potentially have to stop working, causing financial issues, as well as a feeling of loss of independence.
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