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wounds and treatment
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One of the most basic principles of nursing is bringing the patient back to optimal functioning. Assisting in healing a wound is one of the most elementary tasks, but can be complicated by many factors. The patient must be assessed for all factors that could affect wound healing. Giving the best care must begin with the knowledge of wounds, wound healing, and available equipment.
Synopsis
Wound healing is very prevalent for a variety of wounds, many of those being pressure ulcers in geriatric patients. The baby boomer generation is very large and within the next 30 years, the aging population will grow enormously, increasing the need for wound care. All nurses must be educated on the most up to date and best practice for healing wounds.
According to Casey in Kai Tiaki Nursing journal (2012), within the last twenty years available dressings for wound healing have increased exponentially now including fifty-eight categories. The nurse has the responsibility to select the best dressing, for a specific wound to promote optimal healing. The idea behind dressings has also changed. Dressings previously were designed to keep a wound dry, absorbing secretion, and preventing infection (Casey, 2012). Dressings today are designed to facilitate healing, provide a moist environment, debridement, infection control, thermal insulations, and possible suction to remove drainage and pull oxygen and nutrients to the wound bed (Casey, 2012).
Relevance
Proper effective wound care is expensive, according to Kaufman and Pahl’s article in Dermatology Nursing (2003), the care of one pressure ulcer can easily cost $23,465 and take an average 247 days to heal. Kaufman and Pahl’s (2003) research showed great success when treating a pressure ulcer with a vacuum assisted closure device, showing closure in 97 days and costing only $14,564. The cost of treatment correlates significantly with the healing time. According to van Anholt, Sobotka,Meijer, Heyman, Groen, Topinkova, van Leen, and Schols (2010), if you decrease wound size, you use fewer dressings, spend less time, and ultimately less money on the wound care.
Beyond the need for knowledge of dressings, the nurse must have the knowledge of types of wounds, and factors affecting healing. Wounds needing to be addressed may be acute, or chronic (existing for more than twelve weeks) (Casey, 2012). The wounds will need to advance through all four stages of healing: inflammation, proliferation, re-epithelialization, and maturation (Casey, 2012). In order for a wound to heal, it must be kept open, healing from the inside out.
Nurses had also suggested debridement, specifically mechanical debridement whenever necessary. Based on some of the responses from nurses, this is not performed by debridement of the afflicted area by the nurse. However, this task is shared with the team of dressings from the
Hinkle, J., Cheever, K., & , (2012). Textbook of medical-surgical nursing. (13 ed., pp. 586-588). Philadelphia: Wolters Kluwer Health
As an ICU nurse I constantly watch how patients develop pressure ulcers, a pressure ulcer is an area of skin that breaks down due to having constant friction and pressure, also from having limited movement and being in the same position over a prolonged period of time. Pressure Ulcers commonly occur in the buttocks, elbows, knees, back, shoulders, hips, heels, back of head, ankles and any other area with bony prominences. According to Cox, J. (2011) “Pressure ulcers are one of the most underrated conditions in critically ill patients. Despite the introduction of clinical practice guidelines and advances in medical technology, the prevalence of pressure ulcers in hospitalized patients continues to escalate” (p. 364). Patients with critical conditions have many factors that affect their mobility and therefore predispose them to developing pressure ulcers. This issue is significant to the nursing practice because nurses are the main care givers of these patients and are the ones responsible for the prevention of pressure ulcers in patients. Nurses should be aware of the tools and resources available and know the different techniques in providing care for the prevention of such. The purpose of this paper is to identify possible research questions that relate to the development of pressure ulcers in ICU patients and in the end generate a research question using the PICO model. “The PICO framework and its variations were developed to answer health related questions” (Davies, K., 2011).
Depending on the situation, determines what type of nursing concept you would need to focus your time on, though this one was one of the most suitable for my patient situation. I feel as if I will use this nursing concept a lot in my practice considering I am working as a registered practical nurse now in the hospital setting and planning on continuing to stay in the hospital setting when I become a registered nurse. Recovery can be a long process, though it is usually a process that starts in a acute care hospital. This will benefit me practicing as a future registered nurse by assessing the situation with using the two nursing care models, as well as the nursing care theory that I researched, learned, and
Utilizing this tool will allow The Restorative Nurse and Wound Nurse to generate a graph based off of the data retrieved from the Center of Medicare and Medicaid Services (CMS) quarterly Quality Measures Report (APPENDIX B). The Wound Nurse and Restorative Nurse will start with the last data reported before the start of the On-Time Project and then graph the data every three months during the On-Time Project for the following areas: falls, weight loss, in- house acquired pressure injuries and nosocomial infection. For that purpose, to monitor the effectiveness of the On- Time Project the Wound Nurse and Restorative Nurse will provide a designated share drive to present to the Director of Nursing and other stakeholders on a quarterly schedule at the quarterly Quality Assurance Improvement Program(QAIP)
Every person’s needs must be recognized, respected, and filled if he or she must attain wholeness. The environment must attuned to that wholeness for healing to occur. Healing must be total or holistic if health must be restored or maintained. And a nurse-patient relationship is the very foundation of nursing (Conway et al 2011; Johnson, 2011). The Theory recognizes a person’s needs above all. It sets up the conducive environment to healing. It addresses and works on the restoration and maintenance of total health rather than only specific parts or aspect of the patient’s body or personality. And these are possible only through a positive healing relationship between the patient and the nurse (Conway et al, Johnson).
Quality improvement issues in healthcare focus on the care that patients receive and the outcomes that patients experience. Nurses play a major advocacy role for ensuring safe and quality care to all patients. Also, nurses share the responsibility in leading the efforts in improving patient care in all settings (Berwick, 2002). One of the ongoing problems plaguing hospitals and nursing homes is the development of new pressure ulcers in patients after admission. A pressure ulcer can be defined as a localized area of necrotic tissue that is likely to occur after soft tissue is compressed between a bony prominence and a surface for prolonged periods of time (Andrychuk, 1998). According to the Centers for Medicare and Medicaid, patients should never develop pressure ulcers while under the supervision of any medical institution because they are totally preventable (Berwick, 2002). The purpose of this paper is to discuss the problems associated with pressure ulcers, examine the progress on improving this specific issue, and explain the Plan, Do, Study, Act cycle that I would use to improve patient care in this area.
Registered Nurses Association of Ontario (RNAO). (2005). Best practice guideline (BPG): Risk assessment and prevention of ulcers. Retrieved from http:// www.rnao.org
Additionally, the LPN cannot push medications into a peripheral intravenous line if the patient “weighs less than 80 lbs, is prenatal, pediatric, or antepartum”, although given that the situation is on a general med-surg floor it is unlikely these patients would be under Sarah’s care at this time. (Rules and Regulations of Practical Nurses. 2015) Sarah can delegate the postoperative patients who need dressing changes and ambulating them to the LPN, but Sarah should assess the wounds for complications initially and serve as resource to the LPN if she has questions about the wounds. Additionally, she could help the nursing assistant with answering calls and serve as a reference for the nursing assistant to ask questions or help with tasks if Sarah is not available. With regards to supervision, the LPN would need continuous supervision given that the working relationship is new. (Cherry and Jacob, 2014) Sarah should be available and willing to answer any questions or address any concerns the LPN
As the healthcare system advances, so too must the nursing field become more advanced within its practice. It is not just enough to become a Registered nurse these days. Healthcare and technology has evolved to produce a smaller, more interconnected world, healthcare costs have increased, which in turn has created organizational restructuring and change in practices; thus, allowing the need for nurses to develop critical thinking skills and take on leadership roles. Many facilities are seeking professionals with leadership skills who can practice in specialty areas which are most needed. One of these areas is in wound care. According to an article published in New Jersey
One day, this writer happened to see another nurse changing a Peripherally Inserted Central Catheter Line dressing. As a nurse leader, this writer asked the nurse why she is changing the dressing. The caregiver explained dressing changes can prevent infection to the site and there are lot of patients readmitted because of central line infections and subsequent complications. This nurse demonstrated good kn...
Nurses are an equally important part of each client’s life. Nurses provide stable care to each client, answers their questions, gives medications and treatments, and assists with medical procedures. They also have the responsibility to explain to clients and family members what they should and should not do as they go through treatment and recovery. Nurses must quickly respond to patients needs. Every individual nurse has his or her own unique way of caring. There are so many ways to show caring that the possibilities are never ending. Nurse’s support, comfort, and help allow the patients to recover to the best of their ability. Their experiences in dealing with different patients that have unique situations on a daily basis helps the nurses become better caregivers. Therefore, every nurse is capable of demonstrating care in their respective environments.
Maintenance of an appropriate healing environment is also essential throughout the management of diabetic foot ulcers. The choice of dressing is dependent on many factors including presence of infection, amount of exudate and the required frequency of wound bed inspection.
Nursing theory is, “the principle that underpin practice and help to generate further nursing knowledge” (Colley, 2003, p. 33). Nursing theory is important in nursing practice. The two theorists that are relevant to my nursing practice are Florence Nightingale and Hildegard Peplau. Florence Nightingale theory was about the patient having a clean and healing environment (Smith & Park, 2015, p. 51). The theory that Hildegard Peplau created was the importance of nurse-patient relationships (Smith & Park, 2015, p. 68). Both of these theories put the patient’s safety and care first. When I am at work I try to form a healthy and healing relationship with all my patients. I also make sure the environment that they are in is conducive to healing, it is hard to do that sometime working in the emergency room. Sometimes it is the little things that a nurse can do for a patient that will make all the difference. Taking both of these theories into
When a wound is determined as non-healable, as described by Sibbald et al (1), it should not be treated with a moist treatment and should be kept dry in order to reduce the risk of infection that would compromise the limb. It is also important to consider the patient 's preferences and try to control his pain, his discomfort in activities of daily living and the odour that their wound may produce. In this case, special attention must be given to infection prevention and control. Some charcoal dressing would be interesting in the care of our non-healable wounds at St. Mary 's Hospital.