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6 JCN
2015
JCN Roadshow
illness which may be delaying
healing
Managing systemic illnesses that
influence healing
Promoting wound contraction.
The session also highlighted
the role of exudate, with healing
requiring a moist wound bed, which
is neither too wet nor too dry as both
will affect healing.
Dressing selection
One of the main treatments for any
type of wound is an appropriate
dressing, but with so many dressings
available the choice can be daunting.
Below are some basic principles
that nurses should remember when
approaching dressing selection:
Evidence: is the dressing
supported by research evidence
or in guidance from bodies
such as the National Institute
for Health and Care Excellence
(NICE)?
Past dressing experience: which
types of dressings have worked
for previous patients
Aim of treatment: is the
treatment goal to absorb
exudate (higher absorbency
dressing), fight infection
Assessment
Because there are so many reasons
why wounds may not heal, a
proper holistic assessment that
considers all areas of the patient’s
life, including physical and
psychological wellbeing, is crucial
— without a complete assessment
it is impossible for the nurse to
identify the particular causative and
contributory factors that may be
influencing wound healing.
For example, if a patient with
significant oedema and a lower-
limb leg ulcer spends a lot of the
day sitting in a chair watching the
television, this will have an impact
on the potential for healing, but the
nurse will only discover this during a
conversation about lifestyle.
Similarly, comorbidities such as
diabetes or chronic heart failure, may
seriously affect a wound’s capacity
for healing, but this will only be
revealed by a detailed examination
of the patient’s medical history.
THE MAIN GOALS OF HEALING
When the holistic assessment has
been completed, it is time to turn the
attention to healing. In wound care
the main goals of healing are:
Resolving infection
Removing excess slough and dead
tissue from the wound
Managing exudate
Managing underlying systemic
Figure 1.
Reasons for delayed healing.
Case 1
In this case the female patient
presented with vasculitis on
both lower legs. The underlying
haemolytic disorder put her at
increased risk of infection and both
feet had broken down resulting in
painful wounds over the Achilles
tendons. This meant that she could
not walk independently and was
not sleeping.
From a nursing management
perspective the patient required
pain control, a plan to deal with
exudate, and desloughing of the
wound bed. From a dressing-
selection point of view, a product
was needed that would promote
healing and provide pain-free wear
time and removal.
Support was also sought from
the dermatologist, haematologist,
physiotherapist and occupational
therapist. The author chose to use
UrgoClean
®
(Urgo Medical) for
its desloughing properties and its
ability to stimulate the activity of
fibroblasts in the wound bed. An
adhesive foam dressing was used as
a secondary dressing.
At the end of the treatment
period, the level of slough had
been reduced and the volume of
exudate from the wound controlled.
There was fresh granulation tissue
covering the tendon and the wound
began to heal rapidly. The patient
also reported that her pain and
quality of life had improved.