In the mature population, chronic wounds and pressure ulcers are a significant cause of mortality (McGuiness & Rice, 2009). Over 32,000 adult patients die annually in the United States because of improper wound treatments in the hospital (Cohen, 2007); consequently, costing hospitals to up to $9.3 billion in added expenses (Franz, Steed, & Robson, 2007). When a client receives a wound and it is not treated properly, infection may become a complication and can increase the risk of mortality in an individual up to 55% (Salcido, 2009). As a result of the increasing rates of death due to improper wound management and infections, nurses must be knowledgeable about wound care and pressure ulcers, and how to prevent infection.
Why are nurses having trouble with providing the appropriate care for client’s chronic wounds? Contributing factors to delayed wound healing is due to lack of knowledge on caring for wounds, inadequate supervision by the nurse, and due to the client’s socioeconomic status. According to McGuiness in The Management of Chronic Wounds, “Inappropriate product selection [and]...extended periods of time between assessments… delay healing” (2009, p. 37). If the nurse is unable to take care of the client’s wounds appropriately, the client’s wounds do not heal accordingly.
Prevention
When the nurse receives the client, two main steps need to always be applied. First, the nurse needs to identify and evaluate the risks of the client to gain pressure ulcers or worsening of treatable wounds. At admission, a head to toe assessment should be instigated. Inspect and palpate for changes in skin integrity, texture, temperature, turgor, moisture, color changes, and edema (Blaney, 2010). Document the observation and reassess skin integrity and changes in condition every shift or according to facility policies to track the progress of the injury.
The next step is when evidence-based practices are put into place. Start by minimizing pressure to decrease the start of pressure ulcers. A turning schedule should be implemented (normally every two hours), and using pillows to minimize pressure on bony prominences. According to research, if the turning schedule is used correctly than there could be an 87% reduction of pressure sores (Lyder, & Ayaller, 2008). By using a turning schedule and by continually monitoring the wounds, the nurse will help decrease the incidence of pressure sores.
Adequate hydration and nutrition should also be kept up. Offering small, frequent meals of high-protein, high calorie diet with zinc and vitamin C should be encouraged. Having a proper diet will increase the wound’s healing time. If the patient eats foods that are high in fat, sugar, and salts the healing time of the wounds will decrease. Therefore, it is important that the patient is encouraged to eat a nutritious meal.
As the client lies in bed, the head of the bed should be no more than 30 degrees, unless contraindicated. If the client needs to turn, and can do so without assistance, encourage the client to lift themselves when they are moving instead of sliding around on the bed. When the patient slides on the bed, it produces friction and can create chronic wounds and pressure ulcers (Blaney, 2010). By encouraging the client to lift themselves, the decrease of sliding on the bed will prevent wounds from getting worst and may increase the chance of faster healing. Any potential barrier that could hinder the client would be their socioeconomic status and the deficient knowledge and lack of teaching skills.
Protective Dressings
For each wound, whether it is from pressure ulcers, surgeries, or accidents, the appropriate choice of dressing or therapy and skin protectant must be used. There are many non-adherent dressings available for wound management. They include Urgotul™ and Tegapore ™ (McGuiness, 2009), which can all be used safely with no trauma or pain. They also do not need to be changed regularly. For wounds with high levels of discharge absorbent foam dressings will be required. Nurses need to make sure that “care must be taken… that dressings are adequately sealed preferably without adherence to friable skin to prevent leakage…” (McGuiness, 2009). When the proper dressings and healing techniques are used this helps decrease the wound healing time. However, if the client is unable to pay or have the proper insurances then they might not get the assistance they need. Also, if the nurse does not know how to properly address wounds or pressure ulcers, their lack of knowledge could decrease the chances of the wound to heal.
Preventing Infection
The environment of a wound is an ideal home for bacterial invasion which makes it necessary for the client to take antibiotics. The nurse needs to emphasize to the client the importance of taking the antibiotic as instructed by the doctor. There have been many concerns of antibiotic resistance by the bacteria due to prolonged illnesses and deaths. This antibiotic resistant bacterium is also popularly known as MRSA. By having the client finish the antibiotic the chances of creating antibiotic resistant bacteria diminishes.
Because of the risk of new infections, different hygiene measures should also be considered for the various transmission routes. Not only should dressings and antiseptics should be used, but another way to slow down the spread of infection is for the nurse and other care providers to wash their hands or use hand sanitizers. “At the University of Geneva, a hospital-wide program promoting hand hygiene helped lower the hospital-acquired infection rate from 17 percent to 10 percent between 1994 and 1998” (Jain, 2008). These important steps are key components to be done after contact with an infected client or before caring for a vulnerable one. Any problems that would hinder the client are the lack of knowledge and teachings of the nurse to teach the importance of finishing the antibiotic and the client’s socioeconomic status where they might not be able to afford to buy the medication to prevent infection.
Potential Barriers
Two potential barriers for all these problems is socioeconomic and insufficient knowledge by the nurse. The client’s socioeconomic status may prohibit them from getting the proper help due to lack of income, transportation, or unable to find or obtain adequate health insurance. However, the nurse can help prevent high costs by having sufficient knowledge in prevention and educating the client about wound care and prevention.
To give thorough care for the wound, nurses need to make sure they are doing proper cleansing of the wound, controlling any signs and symptoms of infection, and ensuring the treatment of the underlying condition (McGuiness & Rice, 2009). When the nurse is incapable to properly address the wound and unable to assess the damaged area appropriately and within reasonable time, the damaged area is unable to continue through the normal stages of healing. Once wounds become infected, they are incapable to heal and are caught in a constant inflammatory condition because of a breakdown of the healing process in the tissues (Menke, Menke, Boardman, & Diegelmann, 2008). When there is a breakdown of the healing process, McGuiness (2009) asserts, the “result is often an increased shear and friction on wounds, inappropriate exudates control and the facilitation of infection” (p. 37). It is for these reasons that it is essential for nurses to gain an education and understanding in prevention of pressure ulcers and knowledge in wound management to decrease the occurrence of chronic wounds.
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