ABSTRACT
This article reports the findings of the Unavoidable Pressure Ulcer Committee (of the VCU Pressure Ulcer Summit) that was tasked with addressing key issues associated with pressure injuries that are unavoidable or unpreventable. Our goals were (1) to clarify nomenclature and descriptions surrounding "terminal ulceration," (2) to describe the medical complications and comorbid conditions that can lead to skin failure and/or terminal ulceration, (3) to describe the variable possible causes of unavoidable pressure injuries, and (4) to present clinical cases to exemplify pressure injuries considered to be unavoidable.
Subject(s)
Pressure Ulcer/classification , Severity of Illness Index , Skin/injuries , Humans , Multiple Organ Failure/complications , Pressure Ulcer/etiology , Risk Assessment/methods , Terminal CareABSTRACT
This month, more than 2,000 student nurses and nursing faculty will attend the National Student Nurses Association Annual Convention in Orlando, FL. Thinking about this event presents the perfect time for student nurses, faculty, clinical instructors, and preceptors--anyone involved in wound prevention and care practice or education--to look ahead and ponder the future of nursing in general and wound care nursing in particular.
Subject(s)
Education, Nursing , Skin Ulcer/nursing , Wounds and Injuries/nursing , HumansABSTRACT
Skin Changes at Life's End (SCALE) wounds include wounds of many underlying etiologies that accompany the dying process. These wounds occur due to unmodifiable intrinsic and extrinsic factors unique to each individual. This article describes the case of a dying patient who sustained a skin tear that deteriorated into a SCALE wound that meets the criteria for a National Pressure Ulcer Advisory Panel unavoidable pressure injury.
Subject(s)
Buttocks/injuries , Precision Medicine/methods , Pressure Ulcer/pathology , Soft Tissue Injuries/pathology , Terminal Care/methods , Aged, 80 and over , Buttocks/pathology , Female , Humans , Skin Care/methods , Skin Physiological Phenomena , Soft Tissue Injuries/classification , Wound HealingABSTRACT
PURPOSE: To provide information about palliative wound care management strategies for palliative patients and their circles of care. TARGET AUDIENCE: This continuing education activity is intended for physicians and nurses with an interest in skin and wound care. OBJECTIVES: After participating in this educational activity, the participant should be better able to: 1. Recognize study findings, assessment tools, and non-pharmacologic strategies used for patients with palliative wounds. 2. Summarize pharmacologic and dressing treatment strategies used for wound care management of palliative patients. ABSTRACT: The principles of palliative wound care should be integrated along the continuum of wound care to address the whole person care needs of palliative patients and their circles of care, which includes members of the patient unit including family, significant others, caregivers, and other healthcare professionals that may be external to the current interprofessional team. Palliative patients often present with chronic debilitating diseases, advanced diseases associated with major organ failure (renal, hepatic, pulmonary, or cardiac), profound dementia, complex psychosocial issues, diminished self-care abilities, and challenging wound-related symptoms. This article introduces key concepts and strategies for palliative wound care that are essential for interprofessional team members to incorporate in clinical practice when caring for palliative patients with wounds and their circles of care.
Subject(s)
Disease Management , Palliative Care/methods , Wound Healing/physiology , Wounds and Injuries/therapy , Canada , Continuity of Patient Care , Education, Medical, Continuing , Female , Humans , Long-Term Care , Male , Monitoring, Physiologic/methods , Patient-Centered Care , Skin Care/methods , Surgical Wound Infection/diagnosis , Surgical Wound Infection/therapy , Wounds and Injuries/diagnosisABSTRACT
Too many wound care research studies are poorly designed, badly executed, and missing crucial data. The objective of this study is to create a series of principles for all stakeholders involved in clinical or comparative effectiveness research in wound healing. The Delphi approach was used to reach consensus, using a web-based survey for survey participants and face-to-face conferences for expert panel members. Expert panel (11 members) and 115 wound care researchers (respondents) drawn from 15 different organizations. Principles were rated for validity using 5-point Likert scales and comments. A 66% response rate was achieved in the first Delphi round from the 173 invited survey participants. The response rate for the second Delphi round was 46%. The most common wound care researcher profile was age 46-55 years, a wound care clinic setting, and >10 years' wound care research and clinical experience. Of the initial 17 principles created by the panel, only four principles were not endorsed in Delphi round 1 with another four not requiring revision. Of the 14 principles assessed by respondents in the second Delphi round, only one principle was not endorsed and it was revised; four other principles also needed revision based on the use of specific words or contextual use. Of the 19 final principles, three included detailed numbered lists. With the wide variation in design, conduct, and reporting of wound care research studies, it is hoped that these principles will improve the standard and practice of care in this field.
Subject(s)
Consensus , Delphi Technique , Quality of Health Care/standards , Research/standards , Wounds and Injuries/epidemiology , Adolescent , Adult , Aged , Comparative Effectiveness Research , Female , Humans , Male , Middle Aged , Quality of Health Care/statistics & numerical data , Recurrence , Reproducibility of Results , Risk Assessment , Young AdultABSTRACT
Deficiencies in the current pressure ulcer classification system create the impetus for the current discourse on the clinical, legal, and economic implications of staging and considering shifting the paradigm in pressure ulcer description and assessment.
Subject(s)
Pressure Ulcer/diagnosis , Severity of Illness Index , Aged , Aged, 80 and over , Buttocks , Diabetic Foot/diagnosis , Diabetic Foot/pathology , Humans , Male , Middle Aged , Pressure Ulcer/pathologyABSTRACT
This article builds and expands upon the concept of wound bed preparation introduced by Sibbald et al in 2000 as a holistic approach to wound diagnosis and treatment of the cause and patient-centered concerns such as pain management, optimizing the components of local wound care: Debridement, Infection and persistent Inflammation, along with Moisture balance before Edge effect for healable but stalled chronic wounds.
Subject(s)
Debridement/methods , Pressure Ulcer/therapy , Decision Trees , Humans , Patient Care Planning , Practice Guidelines as Topic , Pressure Ulcer/nursing , Skin Care/methodsSubject(s)
Expert Testimony , Health Personnel/legislation & jurisprudence , Internationality , Medicare/legislation & jurisprudence , Pressure Ulcer/nursing , Wounds and Injuries/nursing , Health Care Reform , Health Personnel/economics , Humans , Liability, Legal , Medicare/economics , Pressure Ulcer/prevention & control , United States , Wounds and Injuries/prevention & controlABSTRACT
PURPOSE: To enhance the learner's competence with knowledge of Skin Changes at Life's End (SCALE). TARGET AUDIENCE: This continuing education activity is intended for physicians and nurses with an interest in skin and wound care. OBJECTIVES: After participating in this educational activity, the participant should be better able to: 1. Apply SCALE knowledge to patient care scenarios and documentation procedures. 2. Analyze the expert panel's 10 statements on Skin Changes at Life's End (SCALE).
Subject(s)
Skin Care , Skin Physiological Phenomena , Skin Ulcer/prevention & control , Terminal Care , Humans , Skin Ulcer/physiopathologySubject(s)
American Nurses' Association , Nurse's Role , Nursing Diagnosis , Pressure Ulcer/nursing , Humans , United StatesSubject(s)
Advisory Committees , Clinical Protocols/standards , Consensus , Health Personnel/legislation & jurisprudence , Pressure Ulcer/therapy , Aged , Aged, 80 and over , Female , Guideline Adherence/legislation & jurisprudence , Humans , Male , Middle Aged , Pressure Ulcer/epidemiology , United States/epidemiologySubject(s)
Benchmarking/organization & administration , Practice Guidelines as Topic , Pressure Ulcer/prevention & control , Quality Indicators, Health Care/organization & administration , Skin Care/methods , Centers for Medicare and Medicaid Services, U.S./organization & administration , Clinical Protocols , Communication , Critical Pathways , Documentation , Health Personnel/education , Humans , Medicare/organization & administration , Nursing Assessment , Organizational Policy , Patient Admission , Patient Compliance , Patient Education as Topic , Primary Prevention , Reimbursement, Incentive/organization & administration , Risk Assessment , Skin Care/nursing , Skin Care/standards , United StatesABSTRACT
Persistent (chronic) wound-related pain is a common experience that requires appropriate assessment and treatment. It is no longer adequate for health care professionals to concentrate on the acute (temporary) pain during dressing change alone. The study provides useful recommendations and statements for assessing and managing total wound-related pain for patients, health care professionals and other policymakers. The recommendations have been developed with the involvement of an interprofessional panel of health care professionals from around the world.
