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Question from a clinical instructor

Posted
by luv2quilt luv2quilt (New) New

Hi all,

I am a clinical instructor for RN students and will be taking turns sending my first semester students on rounds with the wound care nurse during a clinical day. After all, you can't be a bedside nurse if you don't know what other members of the team do! Since they obviously can't do their usual clinical paperwork (come up the night before to gather pt info, Hx, meds, patho, nursing dx / careplans, etc) do you have any suggestions or examples of what they could do instead? There is so much to be learned, but I'm not sure what will end up being on the schedule each time they go. They've learned about pressure wounds ad nauseum so I hate to put that on there and beat the dead horse. Maybe some definitions/examples of different types of wounds (laceration vs skin tear...)?

Any suggestions? I should probably have it made up by the weekend so I can send it out to next week's students.

Thanks!

Rose_Queen, BSN, MSN, RN

Specializes in OR, education. Has 16 years experience.

What about different types of dressings? VAC dressings, hydrogel, hydrocolloid, alginate, collagen, etc. Different than the wounds themselves and something they could work on before/after actually seeing the dressing.

WKShadowNP, DNP, APRN

Specializes in Hospital medicine; NP precepting; staff education. Has 20 years experience.

Also ostomy issues. Our Wound nurse is the ostomy certified person.

KatieMI, BSN, MSN, RN

Specializes in ICU, LTACH, Internal Medicine. Has 8 years experience.

Assessment and history pertaining to wound/ostomy care would be nice thing to teach. It is ridiculous how often patients go for weeks in specialized wound care clinic and end up in LTACH with critical malnutrition (we had a case of real scurvy not so long ago), severe anemia, wounds dutifully treated on an extremity with no peripheral pulses, elemental loss due to unbalansed nutrition in case of high-output fistulas, etc.:banghead:

nursej22, MSN, RN

Specializes in med/surg,CV. Has 36 years experience.

When our students go to specialty areas, they are to devise a teaching plan for a client they see, including possible community resources.

sailornurse

Specializes in ER/Tele, Med-Surg, Faculty, Urgent Care. Has 39 years experience.

Discuss hyperbaric chambers & use in wound care. Where is the closest one located to you? What types of wounds are treated with this modality? What precautions, how does it work?

I remember my entire clinical group all 8 sitting inside the multi chamber at one facility.

WKShadowNP, DNP, APRN

Specializes in Hospital medicine; NP precepting; staff education. Has 20 years experience.

Discuss hyperbaric chambers & use in wound care. Where is the closest one located to you? What types of wounds are treated with this modality? What precautions, how does it work?

I remember my entire clinical group all 8 sitting inside the multi chamber at one facility.

Now that sounds like a memorable experience. I'd love to have had that.

Most of my wound/ostomy education was gained and supported as a home health nurse.

annabanana2

Has 2 years experience.

I honestly think the most useful thing would be to read up on various wound care products - whichever ones happen to be on the hospital's formulary. If you don't know what the products are for or what they do, you don't know why we're using them, and so you really have no sense of the plan of care.

I use this website: https://www.clwk.ca/communities-of-practice/skin-wound-community-of-practice/ a whole bunch for looking up different products as well as the learning e-modules (click on the blue tab that says "Knowledge Library eModules). They have one for how wounds heal, one for wound assessment, wound cleansing, packing and how to do an ABI. Depending on what your students have already learned, maybe they'd benefit from the wound assessment or how wounds heal ones? I found them useful as a student.

The "Knowledge Library Documents" tab has a section for product information sheets - very clear one or two pagers on every product in our formulary. You folks probably use some of ours and some that are different, but probably some of the basics are there.

KatieMI, I love that - how would you word it, though? Ask them what aspects of the patient are involved in maintaining healthy skin / decreasing risk? I'll probably also do a bit on the Braden Scale here pretty soon since it seems that nobody scores correctly (anywhere... nurse or student!)

Edited by luv2quilt
added a user's name

WKShadow, so is ours. That's good to add, for sure! Since ostomies are so "scary" to many, and I know they haven't learned about them yet, I was thinking it would be good to keep it simple - What is an "ostomy" in general, describe the three BASIC types of ostomies (colostomy, ileostomy, urostomy), what patient teaching should be done for a pt with a new ostomy, what psychosocial issues - anything else? I wish I could find a good "label the parts of the ostomy" type diagram.

Edited by luv2quilt
added a user's name

delawaremalenurse

Specializes in Occ. Hlth, Education, ICU, Med-Surg.

When our students go to specialty areas, they are to devise a teaching plan for a client they see, including possible community resources.

This...and they could develop a mini case-study to put the information into context

I honestly think the most useful thing would be to read up on various wound care products - whichever ones happen to be on the hospital's formulary. If you don't know what the products are for or what they do, you don't know why we're using them, and so you really have no sense of the plan of care.

I use this website: https://www.clwk.ca/communities-of-practice/skin-wound-community-of-practice/ a whole bunch for looking up different products as well as the learning e-modules (click on the blue tab that says "Knowledge Library eModules). They have one for how wounds heal, one for wound assessment, wound cleansing, packing and how to do an ABI. Depending on what your students have already learned, maybe they'd benefit from the wound assessment or how wounds heal ones? I found them useful as a student.

The "Knowledge Library Documents" tab has a section for product information sheets - very clear one or two pagers on every product in our formulary. You folks probably use some of ours and some that are different, but probably some of the basics are there.

FANTASTIC!!! I have some ppt presentations from education I received at my last hospital and a really great chart outlining the different categories, which I will post if I can get it in electronic form, but I love those videos! Great for new and seasoned but refreshing nurses alike!

Now that sounds like a memorable experience. I'd love to have had that.

Most of my wound/ostomy education was gained and supported as a home health nurse.

I have to admit that even I don't know a ton about hyperbaric chambers. One thing teaching does for you is it makes you learn stuff you either never thought about or forgot along the way! I'll totally add a small bit about that.

This...and they could develop a mini case-study to put the information into context

Since far be it from me to deprive them of their weekly care plans (they do a medical and psychosocial one for their patient each week), I will probably have them do this and one care plan on one of the patients they see. I figure all of the definitions / research is equivalent to the clinical paperwork portion (their assignments are detailed and thorough), and one mini-study with care plan will equal out the paperwork of their peers. Maybe a little bit easier since I will email them all what materials and links I have.

amoLucia

Specializes in LTC.

Diabetic pts with their increased risk for skin compromise and wound healing complexity seriously impacts this huge (and increasing)population.

This topic is significant in LTC.

And a topic near and dear to my heart (or rather should I say, my abdomen) is dehiscense (sp?).

poko, BSN, RN

Specializes in Community/ Home Health. Has 6 years experience.

Maybe the students could practice documenting wound assessments as they do rounds with the wound care nurse (assessing type of wound, measuring, etiology, exudate, periwound skin etc).

Understanding wound care products- foams, gauze, packing, various topical dressings (iodine, silver, chlorhexidine etc), hydrocolloids etc...

Sugarcoma, RN

Specializes in Trauma/Tele/Surgery/SICU. Has 2 years experience.

You could give each student or couple of students mini case studies for different types of wounds. For instance: A pressure ulcer, an infected surgical site, an MVA with multiple skin abrasions, a vascular ulcer, an arterial ulcer, etc. You could ask them to identify what type or types of dressings would be suitable for each wound and ask them to identify what else would be important for proper wound healing such as nutrition/pain control/positioning etc.

My mind is running away with this. Mr. smith is 89 years old and has been admitted to the hospital for pneumonia. He has a history of DM, CAD, and COPD. He is confused, has a foley, and is unable to ambulate or turn himself. Mr. smith has an area on his coccyx measuring 3x2 cm with a small area of dermis that is open (Picture of wound)

Braden score for Mr. Smith? Identify the type of wound? What type of dressing would be appropriate for this wound. Is there anything in Mr. Smith's history that would cause him to be at increased risk of developing this type of wound? Aside from dressings what other aspects of Mr. Smith's care are important to facilitate wound healing? What action can the nursing staff take to decrease the likelihood of Mr. smith developing a wound like this in the future?

I guess that would be a lot of work for you to come up with little scenarios for each type of patient. Pressure ulcers lend themselves to this type of assignment much easier than other types of wounds.

This is more difficult than it seems because they are newer students without much exposure. Even a teaching plan or having them learn the types of products to present a mini inservice to their classmates would be limited by what they saw on their observation day.

Maybe you could simply have them write up their experience with the wound nurse. What types of wounds they saw, what types of products used, what they thought of the job of wound care RN, why they think the job is important, what type of education is necessary to become one and if it is something that they think interests them?