Research Paper on "Wound and Skin Care Determining the Proper Management Course"

Research Paper 12 pages (3684 words) Sources: 15

[EXCERPT] . . . .

Wound Care

Wound and Skin Care: A Critical Review

Initial treatment of medical conditions calls for immediate response such as diagnosis of chronic conditions, the performance of emergency services, an inductive investigation on the contextualizing conditions defining an individual patient's health scenario and the prescription of any medication, therapy or initial treatment which have thus been necessitated. However, the focus on modes of secondary treatment is often just as important in determining likely health outcomes. So is this the case where wound and skin care are concerned. The procedures and approaches which are adopted in this area may be central to the health outcomes experienced by such patient categories as the elderly, those with advanced diabetic conditions and victims of burns or serious accidents, all of whom will be impacted in their treatment consequences by the proficiency, cleanliness and attentiveness with which wound care is accomplished. An array of wound care responsibilities indicate the need for a process which is standardized; which employs up-to-date equipment and/or products; which is administered with compassion; which addresses the pain management realities associated with wound care; which responds to the specific realities created by certain categories of client who are vulnerable to wound development and/or recurrence; and which considers many of the improvements, reflections and innovations which are taking place in the area of wound care today. The research conducted hereafter seeks to consider these various aspects of wound care as a way of more fully understanding the connection between the way this secondary treatment aspect is approached and the impact which this has on health outcomes.

Methods:

The research is conducted here within the framework of a general literature review. This is designed to provide what might be used as an initial investigation of wound care as a specific aspect of healthcare provision. Specifically, the research proceeds from the perspective of the nursing professional, intending to approach the various areas of wound and skin care considered here with respect to the responsibilities and education needed by the nursing professional. Primarily, the articles selected for review were included for their relative currency and the academic credibility underlying them. The body of research intended here should help to promote the importance of proper wound care and to indicate the various practicalities which are implicated by wound care.

This would result in a consideration of such subject areas as the challenges specific to wound care, the role of nursing in proper wound care, the identification of those most vulnerable to severe wound formation or recurrence, the dangers of poor wound care, the steps needed to ensure proper wound care, the consideration of some peripheral areas of concern where treatment is concerned and the identification of some ongoing issues which continue to necessitate research in the field.

Presentation:

What are the challenges specific to wound care?

The field of wound care is defined by the need to help facilitate the healing of wounds, to reduce pain for the patient, the prevent the worsening of wounds and to prevent the recurrence of wounds. According to such research as that provided by Sibbald et al. (2000), this is particularly challenging because it requires the integrated efforts of all attending healthcare providers. Therefore, a key challenge is the establishment of consistency in key areas of wound care such as those relating to the maintenance of the treatment environment, the regularity of redressing, the sanitary state of this process and the humanitarian approach taken by healthcare providers. Accordingly, Sibbald et al. indicates that "successful diagnosis and treatment of patients with chronic wounds involve holistic care and a team approach. The integration of the work of an interdisciplinary care team that includes doctors, nurses, and allied health professionals with the patient, family, significant others, and caregivers offers an optimal formula for achieving wound resolution." (Sibbald et al., 14)

Here, we see that a primary challenge is the establishment of a proper organizational orientation toward proper wound care. As a subsequent section will demonstrate, the elderly are a specifically an example of a vulnerable demographic, with nursing homes often being required to establish proper standards for wound management. These standards are often a key indicators of the degree to which a long-term care facility has properly treated its patients or the degree to which it may be guilty of negligence in a more general capacity. Therefore, the research by Sibbald et al. remarks that the holistic and integrated treatment approach must center on the standardization of key treatment demands. The article reports that "such an approach challenges practitioners and everyone participating in wound care to integrate data and information that arise from a number of sources and mitigating factors. In this article, the authors define the changing paradigm that links treatment of the cause and focuses on three components of local wound care: debridement, wound-friendly moist interactive dressings, and bacterial balance." (Sibbald et al., 14)

What is the role of nursing in proper wound care?

The role of the nurse is one which has taken on increasing importance in all settings. A desire to see an improvement in general standards of nursing education and quality are manifested through a qualified health professional with the training in leadership and health practice to bring the latest knowledge, technique and ingenuity to the field. This is crucial with respect to the gaining awareness of long-term healthcare practitioners as to the need for proper wound care training and procedure. As the text by Ayello et al. (2007) notes that "for a wound to heal, it must have a mircoenvironment free from the nonviable tissue that serves as a bacterial culture medium to increase organism proliferation." (Ayello et al., 120)

This is to indicate that there are serious biological needs concerning wound care that impact the entire bodily system. What may in the past have been considered a matter of peripheral care is increasingly being accepted as a primary avenue for proper long-term care in which extensive training and knowledge are required. The team of nurses will be a defining source for both of these necessities, helping to establish an environment that is sanitary and appropriate for treatment as well as to establish a body of knowledge concerning the proper ways of identifying wound stages, determining treatment courses and executing treatment courses. Nurses with certification in wound specialization will also be equipped with the bedside manner to help improve the quality of life for patients with limited mobility, who are often especially vulnerable to bedsores and other such stagnant wounds.

Who is most vulnerable?

The elderly are most vulnerable to development of wounds, and may have specific limitations in healing capacity, according to the American Association of Dermatology. In the case of the nursing home patient in particular, the nurse will be assisted by a strong familiarity with each patient's background and support team, as these will be crucial features in helping to make informed referral and treatment decisions. Indeed, some patients will demonstrate a greater vulnerability to wounding such as those whose advanced age has compromised such features as skin elasticity. According to the American Academy of Dermatology (AAD), "as skin ages and loses its elasticity, the skin stops springing back to its line-free state, and these grooves become permanently etched on the face as fine lines and wrinkles." (AAD, 1) This makes the elderly especially susceptible to the formulation of wounds which can be caused by friction and movement during rest, during exercise or during health procedures. This is a serious issue in many long-term care facilities that have been criticized for failing to assure a high quality of life for the patience who reside there.

Nursing theories concerning the elderly, which are multifarious and even sometimes divergent from one another, still arise from the common point of interest which is preserving the well-being of individuals suffering from either fleeting or sustained health deficiencies. Another vulnerable group, and one with significant crossover to the elderly, is the demographic of diabetics. This group is particularly vulnerable to circulatory issues which result in wounding in the foot or heal. Poor or improper treatment in these cases, can have dire consequences.

What are the dangers of poor wound care?

As this discussion demonstrates, it is absolutely essential that organizational orientation reflect the heightened level of ethical consciousness implied. The demands placed upon the nursing home by these standards has created a socially responsible form of healthcare entrepreneurship that is highlighted by concerns over wound care. In long-term care facilities that lack the proper training in this area, wound care tends to function as a reflection both of the quality of healthcare and of the quality of life for patients. A recent article by Holleran (2009) highlights the importance of this issue, citing a case in which a "woman died after employees at an Illinois nursing home allowed her pressure sores to deteriorate, causing sepsis to flow throughout her blood." (Holleran, 1)

The story was invoked by a lawsuit claiming multiple acts of negligence against the facility in question, all… READ MORE

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