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?

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