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This highlights the seriousness of the need for proper wound care in long-term care facilities, demonstrating the extent to which the nurse must define and provide oversight to standards in this area.
What steps should be taken to ensure proper wound care?
The first and most important aspect of ensuring that wound care is attended with proficiency is the provision of comprehensive training for nurse professionals. There are an array of strategies which can be applied to help hasten the process of healing or which can have the impact of lessening the likelihood or severity of recurrence. Indeed, the study by O'Meara et al. (2000) recognizes that such high risk individuals as diabetics are particularly vulnerable to recurrence and that 'secondary wound care' is a central part of reducing this likelihood. Accordingly, O'Meara et al. indicate that "the prevention and treatment of chronic wounds includes many strategies, including the use of various wound dressings, bandages, antimicrobial agents, footwear, physical therapies and educational strategies. This review is one of a series of reviews, and focuses on the prevention and treatment of diabetic foot ulcers and the role of antimicrobial agents in chronic wounds in general." (O'Meara, 237)
Using a set of electronic databases, including the Cochrane Library, the O'Meara source yields the best practices in preventative wound treatment based on trials conducted with diabetic foot-wound patients. Here, the measure of the success or effectiveness of certain measures would be determined by outcomes in health. These measured outcomes would include "(1) development or resolution of callus; (2) incidence of ulceration (for diabetic foot ulcer prevention studies); (3) incidence of pressure sores (pressure sore prevention studies); (4) any objective measure of wound healing (frequency of complete healing, change in wound size, time to healing, rate of healing); (5) ulcer recurrence rates; (6) side-effects; (7) amputation rates (diabetic foot ulcer treatment studies); (8) healing rates and recurrence of disease, among others, for pilonidal sinuses." (O'Meara, 237)
This range of measures for treatment success helps to provide some basic target points for nursing professionals whose primary training may be in other areas of treatment. The identification of wound dressing, redressing, cleaning and environmental maintenance are here recognized as direct determinants of health outcomes relating to the severity of diabetic wounds. Thus, the standardization of these in terms of timing, procedure and bedside manner all will be central in the predicting treatment outcomes. Beyond these standard secondary care measures, there is evidence that some of the most dire consequences of wound recurrence can be diminished by proper screening and prevention. Accordingly, O'Meara et al. find that "there is some evidence (1 large trial) that a screening and foot protection programme reduces the rate of major amputations." (O'Meara et al., 237) This helps to provide our research with the resolution that in addition to the procedures which are adopted to clean and dress wounds, those who have demonstrated specific medical or metabolic reasons for the emergence of wounds must also be entered into a screening and prevention program. Regular attention to vulnerable spots for the elderly or for diabetics can help to reduce the need for amputations or other extreme measures against the spread of wounds.
This must be instilled through example and explanation of nurse leaders in all processes, with wound care constituting one that arises daily in such a setting. In many ways, the nature of the ailment afflicting an individual will have a significant impact on the informational and theoretical conceptualization which the nurse will employ to make treatment decisions concerning the type of wound dressings used, the frequency of dressing changes, the debridement of necrotic skin tissue and the maintenance of bodily hygiene. This means that an effective wound care nurse will be capable of making such decisions on his or her feet, applying a proper interpretation of a patient's condition and needs, as well as the facility's treatment capacities, in order to determine the dressing and cleaning plan best suited to a case. It is therefore vital that the well-trained nurse working in the nursing home context be armed with a thorough understanding of the principles underlying the multitude of treatment theories in circulation and the ability to extend these principles to others. Such is to indicate that "nursing must have a comprehensive paradigm that honors the relational nature of the nurse-patient relationship, the critical influence of environment and the importance of biological factors." (Raingruber, 1) Given the opportunity to decide the best course of action for contending with any number of scenarios, a wound care nurse will find that possessing an awareness of the standards, practices and even the philosophies informing a variety of theoretical frameworks will enable him to approach a treatment dilemma with a compass that is dually empirical and humanistic in its nature.
What are some peripheral issues of relevance to wound care proficiency?
A major issue relating to the treatment and care of wounds is the management of pain. This is frequently an aspect of the patient's experience which is difficult to reign in simply through proper cleaning and dressing. Instead, pain management is often viewed as its own aspect of wound treatment, and has thus instigated its own body of research such as is demonstrated in the article by Hoffman et al. (2000). Here, pain management is the focus of more progressive treatment approaches which are designed to supplement more traditional drug treatments. The research article in question focuses on burn management, with burn wounds often generating the most extreme pain management demands. Quite to the point, Hoffman et al. argue that "for daily burn wound care procedures, opioid analgesics alone are often inadequate. Since most burn patients experience severe to excruciating pain during wound care, analgesics that can be used in addition to opioids are needed. This case report provides the first evidence that entering an immersive virtual environment can serve as a powerful adjunctive, nonpharmacologic analgesic. Two patients received virtual reality (VR) to distract them from high levels of pain during wound care." (Hoffman et al., 305)
The article by Hoffman et al. reports that patients who were psychologically immersed thusly experienced considerably less of the pain and discomfort which can be elicited by the necessary rigors of debridement, wound cleaning, dressing changing and in the case of the subjects studied for this research article, the removal of staples. The research reports findings in two study subjects, both teenage boys with extensive surface burns. The two subjects were asked to report on their levels of pain awareness during wound dressing and treatment procedures both on opioids alone and, subsequently, on opioids and immersed in virtual reality activities. Both subjects reported a significant decrease in measures of pain awareness during this latter experimental procedure. This would prompt the resolution of the research article endorsing further exploration of this experimental procedure. Accordingly, the research would report that "VR is a uniquely attention-capturing medium capable of maximizing the amount of attention drawn away from the 'real world', allowing patients to tolerate painful procedures. These preliminary results suggest that immersive VR merits more attention as a potentially viable form of treatment for acute pain." (Hoffman et al., 307)
The study's focus on two young subjects denotes that there is a need for a wider and more scientifically constructed sample for research. Moreover, its focus on young wound victims leaves some question with respect to the cultural viability of such methods for those who are older and may lack either the experience or even the psychological wherewithal to experiment with virtual reality methods of treatment. Therefore, in its current form, the research produced findings with little immediately applicability for the elderly subjects which dominate the research. However, as a point of more universal consideration, the focus here on methods of pain management for wound treatment which are psychological or psychosomatic in nature demonstrates the high level of opportunity for experimental treatment improvement that does focus on redirecting the mind's attention.
One area in which research is today ongoing, and which thus might warrant further individual exploration subsequent to this review, is that relating wound care to telemedicine. With new technologies making it increasingly possible to perform critical diagnostic functions from remote locations, studies such as that by Braun et al. (2005) have considered the ramifications of wound care via such web-enabled video conferencing media. The study named here asserts that based on its trial studies, there is significant similarity in the diagnoses and treatment approaches determined by physicians conducting traditional wound care observation and by physicians taking web-mediated approaches to the same tasks. In the observation by Braun et al., "one physician performed the face-to-face consultation (gold standard), and 2 others performed the remote evaluation. The image was obtained with the mobile telephone and immediately sent via e-mail. To measure the agreement of the evaluation among the 3 physicians, we used Cohen…[continue]
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