That's A Wrap! Exploring Wound Management

In the US, we spend 10 times more on the care of chronic wounds than the entire annual budget of the World Health Organization. This growing, vulnerable patient population is being discharged earlier than ever from the hospital with often large and complex wounds. The transition to outpatient services has led to challenges with access to care, coordination of services and an increased demand for the nurses in various settings to manage the care for the patient and family. With the increased demand and complexity of wound care, how well are nurses supported? Nurses General Nursing Article

That's A Wrap! Exploring Wound Management

It's a typical day in an adult ambulatory clinic where a small handful of nurses scurry around caring for a myriad of patient needs that range from a simple injection to a code blue in the parking lot (thankfully, this is rare). With an unlimited number of walk-ups and physicians calling with unexpected complications in their exam room, we are often stretched. Increasingly, we are called to the exam room to assist a physician who has uncovered a chronic wound or pressure ulcer during an exam. The physician, who has minimal training in wound care, is looking to the nurse for wound management guidance i.e. best dressing, whether to refer to the wound clinic for follow-up, what to use at home to manage the wound, etc.

A typical exchange goes like this:

Physician: "What kind of dressing should we put on this wound?"

Nurse: "I don't know. You tell me!

Physician: "Well, what do you have?"

Nurse: "I've got a lot of different things. What do you want?"

Physician: "WHERE's Nurse X?! " (Nurse X has the most wound care experience and has been declared the 'expert' in the department, but only works part-time)

Nurse: "She's off today. " I'm all you got!

Physician: "Oh forget it!" Show me what you have and I'll do it myself!"

And so it goes...both parties are frustrated.

Nurse X has worked in many outpatient settings where wounds large and small have wondered their way in. She has learned basic wound care through trial and error, rarely with the benefit of employer-sponsored training, nor even a standardized procedure to guide her practice. The physician essentially signs a blank order and looks to the nurse to fill in the details. Nurse X has recently revisited clinics she has worked in and discovered that in some cases, wound care consumes 65% of their day.

I would love to think this is an isolated problem, but I don't think it is. I wonder about my fellow nurses in long-term care, home health and hospice who are caring for increasingly more complex patients who are discharge earlier than ever from the hospital with large wounds.

Do they feel well equipped to handle these patients?

Do they have adequate support, information or resources to care for patients with chronic wounds?

Why does this matter?

The U.S. Wound Registry estimates 3% of the Medicare budget is spent on the care of chronic wounds and ulcers affecting 1.3 million people over the age of 65 in this country.

This vulnerable patient population is more likely to be non-white, elderly, non-ambulatory, poorly insured, unable to provide self-care, or suffering from dementia. (www.uswoundregistry.com)

Despite the scope of the problem, very limited research has been done to explore the factors that influence the management of chronic wounds.

These are the things I wish to explore as a future clinical educator and as a graduate student. My aim is to explore the professional development needs of nurses who are asked to provide wound care; in any amount and in any setting.

I would love to hear from you on this important subject!

I have developed a survey tool and I am hoping you might consider sharing your experience by completing it.

If you are an LVN or an RN working in any patient care setting who provides wound care, then PLEASE consider completing my online survey via the link below.

https://allnurses.com/wound-ostomy-continence/factors-influence-wound-941807.html

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babaloo8

About babaloo8

I am an R.N. with over 20 years of experience in ambulatory care and public health. I am also currently a graduate student at U.C.Davis.

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Specializes in Peds, Med-Surg, Disaster Nsg, Parish Nsg.

Thanks for the informative article!

I hope you get lots of participants for your survey. I'm sure the results of your study can be beneficial to our members in their various areas of practice.

Specializes in mental health / psychiatic nursing.

Not an LPN/RN but still interested in what you learn from your study! Several residents I work with have chronic wound care issues, and these issues are the ones most likely to lead to a trip to the ER or weekly use of their PCP, as well as visits to a specialty wound clinic. In the case of our frequent flyers to the ER it would really be great if we had the training, know-how, and supplies to deal with the issues in-house.

Thank you both for your interest and YES, I too cannot wait to report my findings!

Specializes in Case mgmt., rehab, (CRRN), LTC & psych.

I completed the survey this morning, just so you know. Hopefully the survey results and findings of your research will be interesting and put to great use!

Thank you! If I get enough participants to draw definitive conclusions, I will absolutely pursue publishing the results. The ultimate hope is that managers/administrators/clinical educators will use the results to enhance wound care training programs or at the very least, facilitate networking opportunities with wound care specialists who can support and advise other nurses.

Hoping so much that my contribution to your study won't skew your results, but my experience in Wound Care was far less than ideal. There was daily drama between the center director and one of the patient case workers, so the rest of us had virtually NO clue as to what was expected of us. What the center director wanted, the case worker made happen - and vice versa......talk about co-dependent! The case worker even got the clinical manager fired at one time. Interestingly, the only original member of this wound care team IS the case worker - even the center director was released from her job. Wish I could have learned more about WOUNDS, instead of how to save my own fanny.....again, my apologies - hoping your survey achieves your goal!! :yes:

Don't apologize! Your experience if very valuable to this study. In my experience, there are very few wound care programs that are 'ideal'. Not enough staff, not enough training, poorly managed, nurses not able to dedicate themselves to learning the art/ science of wound care because they are so stretched with other tasks.

Sorry you had such a rough experience, but honestly learning how to survive in a toxic work environment is a valuable education in itself. Hopefully, your current situation is better.

Thank you for participating!

Thank you, babaloo8 - your remarks are deeply appreciated. Right at first, I thought I was the problem, but the longer I was at the WC Center and the more often I worked, then the proverbial light bulb came on. The whole wound care field was very interesting to me, but apparently, not meant to be at that particular time. As you said, that valuable education in itself has given me an entirely new perspective on health care work! Thanks again - I will follow this topic with great interest!!

Specializes in Pediatrics, Emergency, Trauma.

Done!

Specializes in ICU, neuro ICU.

This is an outstanding point. Though I am just starting nursing school, while working as an aide I saw much of what you are referring to. We were given a patient with bed sores the size of two tennis balls on his bottom, and my poor nurse, fresh out of school, was assigned the wound vac to fix on him. She had never done this before, yet was thrown to the wolves on this patient with such terrible wounds. Nobody checked her work or helped her to make sure this was done correctly. When he did have dressings (before the vac was ordered), they were not changed very frequently, even though I was told that the order claimed the dressings were supposed to be changed daily. (I know this, because I was the one who had to see his behind every day, with bandages labeled with dates from three days ago.)

Now first of all, it took several weeks for them to schedule appointments to get him out to clear slough from the wounds (which obviously needed to be done often considering their size and severity.) When the transportation arrived, they did not even have a way to get him in the vehicle. (His legs were black and entirely useless, so he needed a hoyer lift to move anywhere.) Is this common practice for someone who needs this much attention, with wounds only getting worse to be in a rehab facility?

Why was he so severely glossed over? This patient was in rehab, and the therapists wondered why he wouldn't participate and eventually dropped him. Unfortunately, with wounds as severe as his were, he did not make it more than a few weeks in our facility before he passed on.

By the way, we had ONE wound nurse for two floors of a rehab/LTC facility, who was spread so thin she could not often get to all the patients she needed to. This often left (like I said before) a nurse who is not specially trained in wound management to care for these severe wounds. Where is the justice for this man and his family? It's difficult, because I really don't know the answer.

Hello Lori215!

I am sorry for the very delayed response to your great post. You're story is a perfect illustration of what I believe is going on everywhere. I have had some success at getting nurses from LTC/SNF/REHAB to participate in my survey, but I would LOVE even more. Those nurses are the most isolated from their peers and vulnerable to unreasonable work expectations. If you have any LVN or RN nurse friends who would like to participate in my study, send them to the link. Thank you!

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