Published Jun 5, 2003
Hi all! I am a BSN student right now but I used to work as a treatment nurse(LPN) in long term care for about 7 years or so. I am very interested in wound care.
Right now I am taking Scientific Method in Nursing (Nursing Research) and I have to do a proposal for a research paper. My hypothesis is that wounds heal faster at LTC facilities that employ a treatment nurse to do the wound treatments, than at facilities that the charge nurses do the treatments...or something like that. I have just started this process so I may still change my basic research proposal plan, but I believe I will stay somewhat on this topic.
Does anyone have any links they could lead me to or know of any research that supports my theory? I am trying to do a literature review and not finding very much on CINAHL or the other various academic journal search engines. Also, I am not doing the actual research at this time, just the proposal for it (10 pages), but I hope to eventually finish it.
Also, I am curious as to whether the nurses here think I am on track with my proposal idea. I would gladly appreciate any feedback or discussion regarding this.
CoffeeRTC, BSN, RN
Well, no one else responded sooo...I don't have any research, nor do we have a treatment nurse (48 bed facility), but I would venture to say that the wounds might heal faster or be treated better with the same treatment nurse... When I was full time, 3-11 I did the bulk of the wound care and really followed up on wounds, did the inservices and worked on the policy and procedures. Concistancy and education of staff is key. I'd be interested in what the rest has to say.
Hi. I have worked in several long term facilities. My experience has shown that it's not the person DOING the treatment so much as the one devising the correct treatment for the particular wound. I AM the wound committee where I work now....I love wounds and seem to have the knack for picking the right treatment. We have a very high cure rate, no treatment nurses, and different staff all the time. Just make sure they know the proper way to use a wet to dry or santyl or a duoderm.
Hi, good subject for a paper. I've worked in facilities that have done both. I think having a treatment nurse fulltime following the wounds definently helped in the coordination of the care of these pts. I have some nurses that really had a knack for treatments and I thought did a good job. I've seen some nurses that just didn't understand the treatment and not accepting to change their practice. I personally believe it is a big asset to have a specified treatment nurse. They are focused on what can be done to heal wounds including looking at labs, dietary needs, etc to help get all depts focused . Best of luck with your research. Could any of the Skin care product companies help in getting the research you may need?
jschut, BSN, RN
Hmmm.... we DO have a TX nurse.
and isn't it interesting that just last night at work, I changed 3 skin tear bandages that were last changed BY ME over 3 days ago, when I last worked! (Suposed to be b.i.d.)
I'd say TX nurses are a good idea if you can actually get them to do their job! (Not just TX nurses either....a lot of nurses I know!)
I agree with you totally. I presently work in a LTC/Rehab Institution with a total bed capacity of 72. I have just been asked to be their wound care nurse since I have taken such good care of the residents on the LTC side. I am very pleased to be noticed for my hard work and efforts to give the residents good care to enable their pressure/statis ulcers to heal within a timely manner. I rely on good CNA assistance to alert me to any resident with skin problems. Some of our new admits or residents that return from the hospital, return with skin problems from lack of repositioning and skin care. If anyone knows any good websites for wound care, I'd appreciate knowing what they are to assist me in my new role. Thank you.
I am a treatment nurse at a LTC facility, and you are right, it is better if one person is doing the treatment, then say, different persons. For one thing, if one person is doing the treatment, then the changes of the wound would be pick up quicker and report and new orders for treatment would begin faster. Doing the treatment right is good but observation and have a baseline is better. On person can relay back to the physician and report if the treatment is working, if there is any infection or signs of improvement. If several persons was doing the treatment, the same treatment might go on and on. Inservice is very important, it lets the staff know what that perticular patient need, for that perticular wound care, for ex.. floating the heels on pillows, turning more frequently, elevating the legs, ect... I think you are on a very important subject. Check with wound care clinics in your area to get more information, and keep up the good work.
purplemania, BSN, RN
try the WOCN cite for info
Thank you for your encouragement. I officially start my new task in a couple of weeks when we have some new staffing coming on board to fill in for me on the day I do tx care. I have been given a whole day to do the tx care which I am pleased about. In the meantime, I will continue on my unit doing the best care I can for all my residents. It is very difficult to get other shifts to do things like waffle boots on a resident when in bed, off when they are out of bed, swanson cone (which has gone missing) on a stroke pt's bad hand etc. I'm trying to think of ways to solve those problems....maybe an inservice. If you have any suggestions I would appreicate hearing them.
I am a treatment nurse in a 200 bed LTC/skilled facility. Here are some links that might help.
Looking forward to ongoing dialogue.
Mister Chris, MSN, NP
Interesting thread though a bit dated!
Yes we have found in two different nursing homes/aged care facilities where I have worked over several years, that having a designated dressing nurse - the dressings are done thoroughly and none are missed, and progress moniotorred better.
It does seem as if we are going back to the old days of task orientated nursing, but it means the dressing nurse can concentrate and follow up and report better on condition of wounds etc., than if she had a certain allocation of clients with total nursing care.
There have been a lot of votes for the dressing nurse and quite a few against. Probably depends upon the unit.
Then there is the other side to it -Cost!?
Anyway it was just a point that may still have some relevence.
From my experience in Alaska, a Tx nurse is a great asset, but if having one spoils the floor nurses so that they end up sloughing off all Tx-related involvement into the lap of that Tx nurse, then the Tx nurse gets so busy with paperwork, documentation, renewing orders, assessments, committee mtgs, consults & rounds, MDS coordinators and DON constantly riding them for the latest data, etc... that they won't have any time for actual wound care & treatment! They'll be forced to go qoD, q3D, then tempted to go q4d "if it looks OK". etc... OR, some will prefer to take care of the patients really well and let the paperwork slide, which is fine for the patients, but puts the facility and every nurse who works there at great legal risk. Still other Tx nurses might burn out quickly and need to be replaced by other people who may or may not end up being right for the position (many people are not right for the position).
A good Tx nurse has to be supported and appreciated by all staff. CNAs need to actually position pts, people need to do proper admits and weekly assessments (with proper staging, description and grouping of wounds)...
Floor staff need to understand that if their Tx nurse fails, then they'll be back to performing med pass AND Tx simultaneously. A good Tx nurse also has to be pretty strict and tough with those nurses who will try to pass off admits, weekly assessments, brand new skin tears, etc.
The job of the floor staff is (~generally) to get everything into the TAR for the Tx nurse to treat. The job of the Tx nurse is to come into work, look at the TAR, and follow through on what's in there and branch out from that fountain of information (ah, it sounds so easy until you actually work one week of Tx getting elbowed in the face by senile patients who think you are molesting them).
And it's that "~generally" word that some nurses will take advantage of (the slippery slope)... if the Tx nurse is seen doing admin things, people's "wishful thinking" will kick in every time they are faced with dealing with wounds or Tx issues... they will start ignoring any Tx-related orders that come in, calling over the Tx LVN and delegating to them as if they were a CNA for every bruise, etc. The Tx nurse has to say "NO" to all of these things and demand staff compliance with the policies set up by the skin committee and facility. That, or, the facility needs to employ more Tx nurses. Another slippery slope.The Tx nurse needs a very tight set of parameters and job description, yet also have the ability to step in and do extra stuff voluntarily. Basically floor nurses need to be held accountable for getting everything into the TAR. Supervisors need to pass a test on staging and describing wounds. CNAs need plenty of training on prevention and skin issues, maybe even describing staging so they can report what it looks like to the nurses. Having unclear roles and responsibilities gives the slackers plenty of room for excuses and reflects negatively on those doing the best job. At least that's how it works in Alaska.
Here's a little trick for Tx LVNs: when somebody asks "do you want to come do the assessment for the new admit?!" (you are at the end of your shift and yet you have 7 pts who direly need their treatments). DO THE FOLLOWING: 1) ignore the guilt trip being laid upon you, and then 2) mentally translate that question to: "do you want genital herpes?" Your mouth will automatically provide the correct answer, which is "NO". Because you have treatments to execute (just as others have "meds to pass", and after that you have complex documentation and reporting to provide just like everyone else.
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