Chronic Wound Care 4th Edition Excerpts
Section 2: Holistic Patient Care
Chapter 10
Health-Related Quality of Life
Patricia Price, BA (Hons), PhD, AFBPsS, C H Psychol
There is growing awareness that the patient perspective on health and illness represents an increasingly important aspect of total healthcare. In areas like oncology, such work has been undertaken over many years with the result that there is a substantial body of research that supports the idea that the attitude of the individual toward the condition can impact health outcomes. In wound care, this work has developed substantially in the past 10 years. Unfortunately, there is little agreement about what the concept of “the patient perspective” involves, but most research has focused on investigating the impact of a disease or disorder on everyday living. While few clinicians would disagree that the presence of a wound has a great impact on the individual, formal research in this area has only recently started to develop in relation to chronic wounds.
Chapter 11
Helping Patients Out of the SWAMP©: Skin and Wound Assessment and Management of Pain
Diane L. Krasner, PhD, RN, CWCN, CWS, BCLNC, FAAN; Judy Papen, MSN, RN, CNS, CWOCN; R. Gary Sibbald, BSc, MD, FRCPC (Med Derm), ABIM DABD, MEd
This chapter focuses on the SWAMP©: Skin and Wound Assessment and Management of Pain. The common causes of skin and wound pain are differentiated, incorporating definitions commonly used in the pain world and highlighting patient-centered concerns. Wound pain models and the ACTS Approach© will be presented.
Chapter 12
Is Bed Rest an Effective Treatment Modality for Pressure Ulcers?
Linda Norton, OT Reg (ONT); Patricia Coutts, RN; Chris Fraser, HBSc, RD; Todd Nicholson; R. Gary Sibbald, BSc, MD, FRCPC (Med Derm), ABIM DABD, MEd
Dr [Richard] Asher’s eloquent description of bed rest has been repeatedly quoted in the medical literature since 1947. He succinctly summarizes the profound impact of bed rest as a treatment. Since then there have been many studies published regarding the harmful effects of bed rest. In article after article, the reader is cautioned about the severe complications of bed rest. Physical complications are numerous and include: joint contractures, muscle atrophy, osteoporosis, pathologic fractures, urinary tract infections, decreased cardiac reserve, decreased stroke volume, resting, and post exercise tachycardia, orthostatic hypotension, pulmonary embolism, deep venous thrombosis, pneumonia, anorexia, constipation, and bowel impaction. The complications of bed rest are not limited to physical complications, but also include psychological complications, such as depression, learned helplessness, and decreased executive functioning. Despite these medical complications, bed rest is often prescribed as a treatment modality for pressure ulcers.
Section 3: Wound Care Processes—From Patient Assessment to Healthcare Delivery Systems
Chapter 13
Wound Assessment and Documentation
Lia van Rijswijk, RN, MSN, CWCN; Jo Catanzaro, MSN, RN, CWOCN
Slowly but surely, we are starting to understand which indices of wound healing are most appropriate to evaluate. In addition, in clinical practice, it is generally believed that it is better to regularly assess using the same possibly less-than-perfect tool than not to assess at all. Every plan of care and intervention as well as the clinician’s ability to determine the effectiveness of care is based on a complete patient history, assessment, and regular follow-up assessments. This chapter will focus on the practical application of available research as it pertains to the clinical assessment and documentation of nonsutured, mostly chronic wounds.
Chapter 14
Nutritional Assessment and Intervention in the Adult with a Chronic Wound
Allen J. Zagoren, DO, MPA, FACOS, FACN; Deborah R. Johnson, MS, RN, CWOCN; Nancy Amick, MPA, RN, CWOCN
The facets of the chronic wound are many and varied. Consensus exists among healthcare professionals to explain why some wounds do not heal: constant focal pressure, poor vascular inflow, infection, concomitant diseases, and poor venous return. However, healthcare professionals often neglect to identify the concomitant and subtle nutritional defects that might prolong the healing process or contribute to nonhealing. This chapter will assist the reader to understand nutrition screening, nutritional assessment, and the impact of poor nutrition on the wound healing environment.
Chapter 15
Wound Care Epidemiology
David J. Margolis, MD, MSCE, PhD
Epidemiology is the study of the distribution and determinants of disease in populations. In the beginning, it was primarily the study of epidemics—outbreaks of infectious diseases in large populations. Over the past several years, epidemiologists have become concerned with the study of chronic diseases and noninfectious acute illnesses. The purpose of this chapter is to explore study designs used by epidemiologists to establish a framework for evaluating the treatments used to care for wounds.
Chapter 16
Running an Outpatient Wound Clinic
Laurel A. Wiersema-Bryant, APRN, BC; Linda A. Stamm, APRN, BC, CON; Cassandra Ward, APRN, ANP-C; John P. Kirby, MD, FACCWS, FACS
This chapter discusses the development of an outpatient wound clinic for the care and management of nonhealing and chronic wounds. Providing for the coordinated management of patients with wounds is the focus of an outpatient wound clinic.
Chapter 17
Wound Care in Home Care
Ben Peirce, RN, CWOCN; Rodney Hornbake, MD, FACP
A quiet revolution is taking place in healthcare in the United States. Consumers and payers prefer care at home rather than in hospitals, nursing homes, or emergency departments. This trend is being fueled by new technologies that reduce the length of hospital stay for many procedures and increase the complexity of care that can be managed in the home.
Chapter 18
Cost Effectiveness in Wound Care
Tania J. Phillips, MD, FRCPC
Throughout the world, efforts to control healthcare costs while maintaining high quality patient care are increasing. One result of these efforts has been decreased lengths of stay in acute care facilities. Wound care is now often provided in the home, outpatient, or extended care setting. Without any unifying definitions of formulas for calculating the costs of wounds and measuring costs and benefits of different wound care methodologies, it is difficult to compare cost effectiveness of different wound care treatments.
Chapter 19
Regulatory Issues and Reimbursement Challenges
Glenda J. Motta, RN, MPH, ET
Regulatory issues and reimbursement mechanisms have enormous impact on the quality of care, the introduction of new technologies, the utilization of products and services, patient access to care, payment for providers, and the actual outcomes of care delivered. Program budgets, such as those for Medicare and Medicaid, are fixed in advance, and the reimbursement or payment mechanisms often determine how funds are distributed and which services, products, and technologies are covered.
Chapter 20
Best Practice Guidelines, Algorithms, and Standards: Tools to Make Evidence-Based Practice Available and User Friendly
Heather Orsted RN, BN, ET, MSc; David Keast, BSc(Hon), MSc, Dip Ed, MD, CCFP, FCFP; Karen Campbell, RN, MScN, PhD(c), ACNP
As evidence accumulates regarding healthcare practices, doing things “the way we have always done them” is no longer acceptable. In the past, part of the art and necessity of the practice in healthcare was making decisions on the basis of tradition and, in many cases, inadequate evidence. This often led to variances in practice, inappropriate care, and uncontrolled costs. Rapid advances in healthcare make it almost impossible to keep up to date on what is “known.” Inadequate care is now a response to inadequate production, evaluation, dissemination, and use of information. The provision of care based on evidence is required to support a best practice approach that requires standards of quality, performance measures, and review criteria.