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Protocols For Wound Care Management

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Question:

Discuss about the Policies, procedures, and protocols for wound Care Management.
 
 

Answer:

Introduction           

According to Thomas, (1990 pp. 300-310) a wound is a break or a defect on/in the skin as a result of mechanical, physical or thermal damage. It might also develop as a result of an underlying physiological or medical disorder. Collier, (2002 pp. 55-63) it is an abnormal break in the (skin) intact and normal covering of the body. A wound is a break in the dermis or epidermis as a result of pathological changes or trauma on the skin or body, (Collins, Hampton and white 2002). Wounds can be classified according to their severity: acute, chronic, palliative, healed wounds. McCulloch, (2014) wound management involves assessing both the wound and the patient. Then planning intervention using the assessment data obtained. The third thing is regular evaluation of these interventions and lastly educating the patient and the care giver on the wound management after being discharged. The policy main aims are to guide the health care providers on having a standardized way/method/approach towards wound care which will be within the holistic framework of care. Wound healing process is one aspect of the body’s response to trauma/injury, for complete healing the whole person (holistic care) needs to be attended to not just the wound, (Dealey (2005).It was also developed so as to be of assistance to the nursing staff when managing the wounds so that they can be able to choose the appropriate dressings. The market has over 2000 types of wound dressing materials.

 

Policies, procedures, and protocols

Their purpose.

All the policies formulated on wound care management have similarities. They all have similar targets. 1) Provision of a standardized approach within the holistic care framework in wound care. 2) To ensure there is the appropriate management of surgical, acute and chronic wounds. 3) To make sure that the most appropriate product for wound care is being utilized so as to achieve patient's comfort, cost effectiveness, and the most importantly optimum wound healing. 4) It’s a guideline for the nurses to ensure that there are no omissions while managing the wounds that can cause lead to delayed healing or even complications (Australian Wound Management Association, 2010). 5) To help in promoting and having a coordination in systematic approaches towards wound management and ensuring that the patient’s quality of life is maintained while making it known to them that it is not always possible to achieve a complete healing. 5) The last common purpose of the policies and procedures towards wound management is to ensure that the wound care complies with all the requirements as dictated by the Health Act (2006a). It states that there should be a specific Code of professional Practice aimed at reducing the infections related/associated with healthcare (NWS Ministry of Health, Infection Control, 2007)

Two different policies, procedures and protocols on Wound care management.

I identified two policies on wound dressing addressing different institutions. The first one is addressing the Doncaster and Bassetlaw Hospitals. Written by Sue Johnson who is the leading nurse in wound care and Tracy Vernon who is the lead nurse tissue viability. This policy was approved on 2012 and was recently reviewed in 2015. The second policy is the wound management procedures and policy in the community setting. The target group was NHS Walsall Community Health and Allied Health Care Professionals. It was written by Elaine Westwood and directed by the lead nurse Tissue viability. Was published in 2013. As mentioned earlier policies on wound management have similar aims although they all differ. Examples of the differences between the two policies. The first policy: the one addressing Doncaster and Bassetlaw hospital is less detailed in the procedures of the wound management; assessment, intervention, evaluation and the re-evaluation (Carville, 2014) It seems like it is a summary of the procedures and protocols, unlike the second policy which gives detailed information on wound management. The second difference is that the first policy has given the directives of what is to be done and by who. For example to expound on that, in case of wound infection the clinician has been directed to take samples for culture and tissue viability tests.

 

Comparison of the two policies.

Assessment

There should be a comprehensive assessment of the needs and in this regard the health needs of the patient in regards to wound care. Provide a continuity of care on the wound management, it has to be a collaborative care where different nurses meet the needs of this patient. Ensure standardized approaches are the only ones used when it comes to wound care management. Have utilization of the most appropriate and optimum products in wound management which provides patients comfort and are cost effective. For patients with non-healing wounds, the priority in wound care management should be geared towards patient's comfort, pain relief, get rid of malodor and prevent hemorrhage. All these policies aim at a holistic patient and wound healing. 

The differences between the two are the details on assessment. The second policy is more detailed giving the protocols/procedures to be used in each step for example. Assessment can be classified into four major areas, (Morison, 1992). General factors (patient assessment) that could cause a delay in the healing of the wound. The immediate cause of the wounds (the pathophysiology behind it and also the environmental events that may have led to it). The local conditions at the wound site that is the assessment of the wound. Lastly, the effects the wound will be having on the patient that is an assessment of possible outcomes. With this assessment, the health care provider is able to identify the healing capacity of the patient, come up with a treatment plan, know and eliminate factors that delay healing of the wound. The patient assessment is thorough, as they assess all the factors that can cause a delay in wound healing. For example, the nutritional status is assessed as good nutrition provides the raw materials for healing. Gray, D et al (2011); Medline, S (2012 pp. 12-26) states that minerals for example zinc are required for wound healing. Blood circulation is also considered as good circulation in the wounded area causes fast wound healing as there is a good supply of oxygen and nutrients to wound. Smoking habits of the patient as the chemicals in the cigarettes destroy the cells responsible for the wound healing (Krueger and Rohrick 2001). The drug therapy that the patient is on is evaluated. The immunity. Age is evaluated as older people cell replication is lower than cell death. Obesity is examined as in adipose tissues there is very poor vascularity (Mulder et al., 1998; Melling et al., 2001). The psychological status is also evaluated as in stress situations a lot of stress hormones are released causing a delay in wound healing. Anderson, (2014 pp. 84-91) diabetes, low immunity, smoking, use of corticosteroids facilitates wound healing delays.  The second assessment is the environment or the events surrounding the wound healing. The second policy sufficiently exploits this sector unlike the first one. Further mechanical injuries that can cause more harm on the granulation of the cells for wound healing (Pulman 2004), presences of tumors and poor hygiene.  The third assessment is on the wound itself. Both policies explain how it should be assessed the first policy explains more. (Watret, 2005 pg. 18-26) it explains what to look for when assessing the wound.

 

Wound cleansing, Wound infection, Wound dressing and selection of materials,

There are similarities and differences on the guideline of how to do the above. The two agree that wound cleansing is to be done so as to remove contaminants with minimal pain to the patient and also prevent trauma to the healing tissue. The second policy explains more on cleansing. Expounds on debridement both the one that can be done at the bedside and also the surgical one. Unlike the first policy, it expounds on the exudate management from the wound. On wound infection, the second policy helps the health care provider in having a distinction between wound infection and wound colonization. Wound infections are a common hospital acquired infections (Bruce et al 2001 pg. 1-194). It explains on the dressings that are ideal for use. The choices of dressings. It has more explanation on auditing and education to the health care providers. The second policy is more comprehensive compared to the first one. It digs deeper on wound care leaving nothing unexplained. It is more rigorous than the first policy.

Interpretations of the results above.

The second policy(NHS Walsall Community Health and Allied Health Care professionals) is superior to the first policy(Doncaster and Bassetlaw Hospitals) as it is a continuation of the first policy that was developed in 2004 later on amended on 2007 and now this is the polished policy. This policy was developed after the Walsall manor hospital merged with Walsall Community Health. This increased the size of the firm and also the size of the target group, unlike the first policy that serves only two hospitals (Doncaster and Bassetlaw hospitals). With a huge pool of patients, it means a presentation of more complex conditions. This could be the reasons as to why the policy is more expounded. It also covers all types of wounds and their specific wound care as the patient conditions/ presentation are more and more complex. It has a huge responsibility. The second reason as to why their policy is more superior is because more resources are available to the Walsall health care organization. They run a Walsall health fundraising committee which gathers funds to be used for patient care. The second policy is more rigorous than the first policy.

 

Conclusion

Wound care management requires a holistic approach. Treating not only the wounded part but also the whole body. Wounds are caused by several causes and without proper care, they can cause more harm to the body. There are policies, protocols, and procedures that have been formulated to aid the health care provider in wound care management. Doncaster and Bassetlaw Hospital policy (the first policy) and NHS Walsall Community Health and Allied Health Care professionals' policy which is the second policy. From the above, it is clear that both policies strive to achieve the same goals the differences are on the content and the explanations on the procedures, protocols, and policies. From the two policies, they address the same issues when it comes to wound care management. The second policy is more superior and more vigorous than the first policy as it addresses more wound type and their care. It also expounds more on wound care and management.

 

References

Amin, N., (2016). Diabetic Foot disease: From evaluation of the foot at risk to the novel diabetic ulcer treatment modalities. Vol 7(7) pg. 153-164

Anderson, K., (2014) Factors That Impair Wound Healing. J AM COLL CLIN WOUND SPEC. vol 4(4) pg.84-91

Benbow, M., (2010) Mixing and matching dressing products, Nursing standards. Vol 24(49) pg. 56-62

Carville K., (2012) Wound care manual 8th edition, Silver Chain Foundation, Perth.

Dealey, C., (2005). The care oNursingf wounds: A guide for nurses. Oxford Blackwell science limited.

Department of health (2006). The Health Act: A Code of Practice for the Reduction of health care associated infections. London.

Department of health NSW patient Matters, Section 9

Gray D et. al. (2011) Consensus guide for the use of debridement techniques in the UK. Wounds UK. vol 7(1)

Kingsley A., (2009). A proactive approach to wound infection. Nurse standards. 15th edition, vol 30, pg. 50-58.

McCulloch J, et al., (2014). Wound healing. Alternatives in management. 2nd edition, Philadelphia F.A.Davis.

Medlin, S., (2012). Nutrition for wound healing. British Journal of Nursing. Vol 21, issue12, pg. 12-26

Meggers, J., (2008) Defining infection in a chronic wound; does it matter? Journal of wound care. Vol 7(8). Pg. 389-392

Miller, M., Dyson, M., (2016). The principles of wound care. London Macmillan Magazine Ltd.

NMC, (2008).codes of professional practice London NMC.

NWS Ministry of Health (2007) “infection control policy”

Silhi, N., (2008) A review of the diabetes-related factors that affect wound healing. The journal of wound care, Vol 7(1) pg. 47-51)

The Australian Wound management Association Inc. (201
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