Managing wounds in the home
Submitted by Judy Berden RN, MSN ED
With the cuts in Medicare more families will be completing non-complex and complicated wound care at home. Educating the family on wound care can help to reduce the stress levels of the patient and family. Using best practice guidelines nurses sending people home from the hospital with wounds, home health nurses, or nurses at wound care centers can reduce this stress by educating caregivers on caring for complex wounds in the home.
Managing wounds and promoting healing of wounds requires a set of interventions that used together can speed healing and help to maintain over-all health. Wounds are complex for nurses and families. Teaching families to do wound care must be simplified and does not require the depth of knowledge that nurses have. Instructing on the basics is all that is needed in this type situation. The nurse will evaluate the patient at regular intervals and change the treatment as needed.
Families need to know the triad of wound care; nutrition, technique, and infection control to handle their loved ones at home. Instructing in the basics of these three items will improve wound care outcomes and patient care. The first step is simply finding out how your family learns best. Just ask the caregivers do you learn better by seeing it done, following a list, or would you prefer both? Then set up a teaching session that encompasses as many participants as possible.
The first corner of the triad is nutrition, be sure to include the patient in this discussion. Patients with wounds have to have adequate nutrition to help heal wounds. Patients with heavily draining wounds can lose large amounts of protein without knowing it (Dealey PhD, 2005, p. 23). Therefore, supplementing protein becomes a very important part of wound healing.
Some important ways to suggest improving nutritional status is to supplement protein in the diet. Suggest Boost, Ensure or Carnation Instant Breakfast as a between meal snack. Try putting a spoonful of peanut butter in a chocolate Boost to add a little more protein and flavor. Frozen fruit and a small amount of yogurt added to a very cold drink supplement will make it almost like a smoothie and add to the pleasure of drinking one. Most stores carry protein powder that can be added to many foods to increase the protein content.
Keeping dietary restrictions in mind such as diabetics, renal patients, or patients that have difficulty swallowing will require a specialized diet plan. Patients should also try to eat 6 small meals instead of three large meals. Always use high quality proteins and avoid junk food that fills but does not provide much nutritional value.
The next corner of the triangle is instructing on the wound care. Arrange for as many caregivers to be present as possible and demonstrate the wound care to them. Simple or complex wounds all require the same steps to complete a dressing change.
- Step one: gather supplies needed and a stable place away from the bed to place the supplies while you are working at this time get a garbage bag to dispose of soiled dressings.
- Step two: wash hands, put on gloves, and arrange patient for best exposure of wound.
- Step three: remove old dressing and dispose of in your garbage bag, wipe any drainage away from the wound.
- Step four: change gloves, using alcohol wash to clean hands between glove changes and open needed supplies. Clean wound as ordered by physician. Measure wounds and reapply dressing and cover. Then assist the patient back to a more comfortable position.
The last step in the triangle of healing a wound is to teach caregivers how to recognize a good wound and a wound which is going bad, or becoming infected. Remember the simpler the directions the better. Caregivers have enough stress so keeping it simple will reduce the stress. The things to watch for are color, drainage, and odor.
Color: the inside of the wound should be beefy red, but not the outside of your wound. Redness outside the wound bed is a sign of infection. Often in home care nurses take a permanent marker and mark the line of redness outside of the wound to see if it is getting larger. A small amount of yellow tissue can be slough if it wipes away easily just note the amount and watch for increases. Black inside a wound is dead tissue and should only be removed by a professional, just note the size of the black area. If the temperature around the wound begins to feel hot or becomes hard that is also a sign of infection.
Anytime you have an increase in drainage it is a sign of problems. Pain also should be decreasing not increasing. How many layers of bandages does the wound soak through and how many times a day does the dressing need to be changed. Drainage color should also be noted a change in color of the drainage is significant.
Odor is the next thing to be considered when assessing a wound. Most wounds do have an odor, note how far away you are when you smell the odor, for example; an arm’s length away, after positioning the patient, or when the old dressing is removed. Wound smells can be compared to a rusty smell like blood, a smell almost like a dead animal or a musky smell is also a common way to describe wound smells. The rusty smell is the best smell to uncover when it comes to wounds.
These guidelines can be enlarged on or even further simplified according to the education level, experience and willingness to learn the caregivers show. Each teaching plan should include the level of understanding the caregivers have. No two patients are going to be the same and their learning needs will be different as well. Being adaptable is very important in health care at every level and adapting the teaching in the home care setting is a must.
If you have a family that understands high absorbing material or material that promotes epithelial growth you can give more details, but the simpler the better is a good rule of thumb.
Use the questions they ask as a guideline on how much information to give them.
Building a partnership with patients and caregivers will help reduce stress levels, raise confidence levels, reduce the risk of infection and improve outcomes. It can also reduce calls and unnecessary visits when caregivers feel confident to recognize problems and know the steps to follow with concerns.
Dealey PhD, C. (2005). The Care of Wounds: A guide for nurses (3rd ed.). [Adobe Digital Editions]. Retrieved from University of Phoenix online library