The Theory in the Practice and the Transition to Professional Practice in the Management of Wounds - Term Paper Example

Management of Wounds Insert Name Institution Date Tutor Description of a Practice Management of wounds has changed radically over the last 20 years. For example acute wounds were thought to be dealt with by cleansing them with antimicrobial solutions and thereafter dressed with adhesive strips or sterile gauze or be left open and wait for it to form a scab. Research done in the recent past illustrates that there is much to be considered when managing a wound (Vowden 2005). Despite the information that have been provided by previous research the management of wounds should be researched on further to ensure that the necessary management techniques will be taken when managing the different categories of wounds (Ajilia 2010). This paper review the research done on the management of wounds and this includes the appropriate cleansing, dressing techniques, and debridement. It’s a discussion of the collective elements which needs to be considered when managing wounds. The paper seeks to close the information gap between the theory in the practice and the transition to professional practice in management of wounds. Several studies done in the recently have been used to conduct the analysis. There is use of hospital records of the practice of wound management and literature so as to have a holistic overview. Review of Literature Wounds that are clean, healing actively, have the minimal exudates can be easily damaged by daily cleansing. The wounds managed include the management of acute skin lesions for example blisters, incisions, punctures, abrasions, and avulsions. Dressing and cleansing of the wounds without considerations of the wound type and how much it has progressed has shown that it leads to limiting the healing process of the wound, and increases the risk of bacterial infection from staphylococcus and streptococcus pathogens and cross contamination (Beam 2008). Commonly used methods for cleansing of wounds include soaks, scrubbing, and irrigation. Soaks is done by immersing the affected part of the body in water, and this loosen and remove necrotic tissues as well as contaminants from the wound bed (Petherick 2006). However, with this method there is a risk of cross contamination, delays in healing, and damage to the tissues. Scrubbing involves direct contact with the wound by mechanically scrubbing the wound to remove gross contamination. Several researchers however, have criticized this method and have demonstrated this technique to simple redistribute the bacteria, which will harm the tissues (Beam 2008). Wounds cleansing is important as it helps the healing process of wound and limit the potential for infections. It clears cellular debris for example exudates, bacteria, residual topical and purulent agents, from dressings done in the past (Vowden 2005). Daily cleansing and changing the dressings were done without much consideration to the development of the wound. Wound healing is described as the process whereby the tissues are repaired after the tissue respond after an injury. A normal healing process take place in several artificially defined events. These are the homeostasis, which includes the inflammatory response; there is a formation of the connective tissue, which covers the epithelium, and the remodeling of the wound (Beam 2008). In a normal wound, these processes take place with no difficulty and the wound heal within a period of three weeks without any type of complications. The process of healing can often be faced with complications as a result of either intrinsic or extrinsic factors, which will lead to delayed healing. Chronic wounds tend to occur due to factors such as venous hypertension, trauma and presence of some diseases such as diabetes. The wound might also get infected and this will lead to delayed healing as the microbes start invading the viable tissues. Normal wounds can result to chronic wounds due to infection and due other factors. These may lead to risk of systematic complications, followed by sepsis, osteomyelitis and finally can even lead to death if not tackled carefully (Rondas 2009). Wound infection interferes with normal wound healing and there is an attack of viable tissue by the microbes. Inflammatory response, delays collagen synthesis, tissue damage and retard epithelialisation occur. The wound infection may result to a local infection if the wound is not properly managed. Wound infection and the delayed healing of the wound are a challenge to the physician and clinicians. This is in regard to the identification of the infection and the type of treatment to apply on the wound. Inflammation is characterized by edema, erythema, pain and warmth around the wound. During the assessment of chronic wounds, tissue biopsies can be used to quantify the bacteria in the wounds (Ajilia 2010). There are three categories which involves the wound cleansing process. The technique used the choice of equipment, and the agent to use while cleansing. The most favored method currently is the use of low-pressure irrigation, which involves the use of a syringe and using normal saline. Not all the wounds require cleansing and as such, it should first be established whether the wound would require cleansing. Research shows that wound care and management is because of experts’ opinion not based on scientific evidence. Therefore, there rises a need to evaluate the research done on wound care and management (Beam 2008). Antiseptics have been used to cleanse wounds for many years, centuries even. Antiseptics have been used since the 19th century, and have been very popular in wound management. Recently, however the use of antiseptic has been criticized and use of normal saline, which has 0.9%, sodium chloride has been favored over antiseptics. The recommended solutions to cleansing wounds currently are use of normal saline and tap water. Recent evidence demonstrates that there is no significant difference in the use of normal saline and tap water when it comes to the frequency of wound infection. The factors, which will thus determine which solution is used, include availability, ease of use and the cost. When it comes to use of tap water, it is the most affordable and highly available, however its use have been discouraged (Vowden 2005). For instance, the use of water in leg ulcer clinics by immersing the patients legs in water. Many practitioners due to its sterility prefer normal saline and user-friendly formats. Integrating Theory and Practice Practitioners in several parts of the world, to control wound infection, are still using antiseptics. However, the techniques used to handle and cleanse wounds in the management of wounds have changed. For example, swabbing the wound was one of the commonly used methods but it became unpopular when research was done and it was established that it causes damage to the healthy granulating and also the process of epithelialisisng the tissues (Petherick 2006). Evidence based practice is very important in nursing and as such important to management for the wounds. There is no specific definition of a complex wound but several researchers have used the term; this is more especially when referring to the managing of individual cases for example those revolving around plastic surgery and those including orthopedic interventions. Wounds are categorized on how serious they are or how complex they are depending on the size of the wound, the site of the wound, depth, and its status such as it odor, pain etc, or the involvement of other structures of the body (Ajilia 2010). The elements mentioned above are very important as they will determine the treatment method, which will be used to treat the wound, and dressing techniques used. Wound complexity therefore will be useful in the management of the wound. The more complex a wound is, the more knowledge will be required to treat it and some complex cases will require the intervention of a specialist team. The management of complex wounds however, is no different from the management techniques of non-complex wound (Rondas 2009). First, in the management of wounds is the assessment process, which will then be followed by a management plan for the wound. When the healing of the wound is realistic end, the process of management there is an application of moist wound healing followed by the wound bed preparation. This is accompanied by the measurement of the effectiveness of the treatment outcome using a predefined technique for example the Teler. In the case the healing of the wound is not realistic, for example in the cases of malignant wound which is not suitable for revascularization the goal for the treatment will be to control symptoms to ensure that the quality of life is maximized as much as possible (Petherick 2006). When dealing with a complex wound, short treatment objectives should be set, and considered and a dressing protocol to ensure that the aims and objectives. There should be considerations about several elements, which will guide the treatment method taken up and the dressing technique to take. Tissue types within the wound are one of the few essential under considerations. Is the tissue healthy or non-viable? This will give a basis for the kind of treatment that is taken up to manage the wound. Considerations should be made of whether there is infection or any inflammation (Petherick 2006). The moisture balance should also be determined and the issue of desiccation or maceration should be considered. Finally, the issue of the wound edge should be considered. Is the wound non-migrating or non-advancing? This will help in promoting the closure of the wound and therefore there is a need to remove the barriers to manage the wound (Rondas 2009). The treatment goals set are aimed at ensuring that the elements discussed above are dealt with but the treatment will depend on the specific wound type. It is clear thus, that several considerations should be evaluated before making a decision concerning the wound management technique to use. If precaution is not taken, the wound might end up deteriorating due to the inadequate or wrong techniques applied. For the first element of tissue management, there are different stages that will take place; wound dehydration, followed by the maintenance of debridement (Vowden 2005). A wound can be categorized as complex if it does not respond to the standard care .techniques used researched on. The factors, which contributed to the delayed healing, should be reviewed and changed to ensure quick healing for the wound. If the wound persists the patient should be referred to a more specialized care centre and use of advanced wound management techniques referred (Rondas 2009). Surgical site infections are very common after surgery. A surgical site infection can be described as an infection, which occurs within the first 30 days of the surgery and often involves the skin or the subcutaneous tissues around the incision. It also includes the purulent drainage of the incision and organisms, which are isolated from the culture obtained from the tissues or fluid taken from the superficial incision. To prevent these infections, the wound after surgery should be kept clean and its healing process assess and surveyed closely. Patients who have complex wounds should be referred to a more specialized care centre where there should be coordination of the treatment, and a multidisciplinary approach which will combine both medical and surgical care of the wound with an efficient and effective wound management strategy (Beam 2008). Conclusion One of the challenges to the management strategy is to identify planned and short-term goaled strategies, which have the outcome of the management. Therefore, complexity of the wound does not depend on the wound itself but from wound related factors, which can range from co morbidities and the location from the wound (Vowden 2005). An assessment should be done and it should identify the factors that will affect the wound and the impact on the choice of methods of wound management. In case of a delayed healing, a reassessment of the factors, which are causing the delayed healing, should be taken into consideration so that the appropriate techniques should be taken (Petherick 2006). A coordinated, multidisciplinary approach should be taken to ensure the successful management of the complex wounds. The information analyzed should thus be used to determine the techniques to use to manage the wound, the solutions to apply and the equipment that needs to be used to limit wound infection. More research should be conducted in the practice of wound management to ensure practitioners are fully informed on the practice. Bibliography Ajilia, S.A.S.H. et al. "Efficacy of papain-based wound cleanser in promoting wound regeneration." Pakistan Journal of Biological Sciences 13, no. 12 (2010): 596-603. Beam, J.W. "Acute Wound Management: Cleansing Debridement and Dressing." Athletic Therapy Today 43 (2008): 222-224. Petherick, E.S. et al. "Methods for identifying surgical wound infection after discharge from hospital: a systematic review." BioMedcentral Journal 6 no.170( 2006): 1471-2334. Rondas, A.A.L.M. et al. "Defination of Infection Chronic Wounds by Dutch pursuing home physicians." International Wound Journal 6, no. 4 (2009): 267-274. Vowden, K. "Complex Wound or Complex Patient? Strategies for Treatment." British Journal of Community Nursing, 2005; suppl: S6, S8,S10 passim. Read More