Chronic Wound Care 4th Edition Excerpts
Chapter 21
Mentoring: The Ultimate Professional Relationship
Anne E. Belcher, PhD, RN, CNE, AOCN, FAAN; R. Gary Sibbald, BSc, MD, FRCPC (Med Derm), ABIM DABD, MEd
The purpose of this chapter is to place the role of mentor in the context of various relationships that are believed to promote the individual’s professional growth and development. The mentee’s development involves knowledge, skills, and appropriate attitude acquisition (especially the concept of professionalism), facilitated by interaction with other more experienced and proficient professionals. The Belcher-Sibbald Continuum of Learning describes the relationship among the concepts of role modeling, networking, preceptoring, and mentoring. Each concept will be defined and described as a unique relationship that promotes professional growth and development.
Chapter 22
Opportunities for Wound Care Specialists
Janice M. Stanfield, MBA, RN, CWOCN
The needs posed by patients with chronic wounds continue to overwhelm the healthcare system. Navigating the ever-changing face of reimbursement while addressing the needs and desires of our aging population remains a challenge. However, over the past several years, wound care specialists have been quite successful in proving their value in all healthcare environments. With increased focus on quality of care and cost-effective management, the demand for wound specialists is increasing. It is important that wound care specialists continue to focus marketing efforts on the impact that they can make to maximize quality care while containing costs across the healthcare continuum. It is also essential to remain sensitive to the needs of a more informed and involved patient population. Understanding and addressing these needs in a bold and creative way will continue to lead us toward strategies that maximize patient outcomes and wound care specialist opportunities.
Section 4: Moisture Balance and Local Wound Care
Chapter 23
Moist Wound Healing: Optimizing the Wound Environment
Vanessa Jones, MSc, RN, RCNT, PGCE; Keith Harding, MB, MRCGP, FRCS
Moist wound healing is considered to be the ideal environment for optimal wound healing. The work of zoologist George Winter (1927–1981) stimulated a great deal of research into the development of new types of dressings that completely revolutionized the care of wounds. Research before and since Winter’s work suggests that moisture under occlusive dressings promotes healing through moisture itself, some of the components of wound exudate, and the presence of low oxygen tension. Occlusive dressings increase cell proliferation and activity by retaining vital proteins and cytokines contained within wound exudate produced in response to injury. Although there have been some concerns regarding increased infection in a moist wound environment, these concerns appear to be unfounded. The benefits of the patient’s use of moist interactive dressings may also include the reduction of pain both during dressing wear and on removal. The major area in which further research is now concentrated surrounds the ideal level of moisture necessary to achieve optimal healing for an individual patient.
Chapter 24
Wound Environment: Implications from Research Studies for Healing and Infection
Stephen C. Davis; Robert Perez, PhD; Fotios Andreopoulos, PhD
The purpose of this chapter is to discuss the importance of delivery systems for active agents (eg, growth factors) and review the possible role of bacterial biofilms and the occurrence of antibiotic-resistant bacteria. We will also present some preclinical data using our porcine wound healing and infection models, which may lead to new therapeutic agents for the clinic.
Chapter 25
Cofactors in Impaired Wound Healing
Nancy A. Stotts, RN, EdD; Deidre D. Wipke-Tevis, RN, PhD; Harriet W. Hopf, MD
Many factors are associated with impaired healing of chronic wounds. These factors vary to some extent by the nature of the wound. A complete list of the factors related to impaired healing across all populations would be long and not very meaningful. There are, however, factors related to healing that cross the various wound populations. Understanding these factors will allow the practitioner to screen patients and address the major and most common factors known to impair healing in chronic wounds. Thus, this chapter describes the major factors in impaired healing of chronic wounds, the effect of each factor on wound healing, and the mechanism by which each is thought to lead to impairment.
Chapter 26
Dermatological Aspects of Wound Care
R. Gary Sibbald, BSc, MD, FRCPC (Med Derm), ABIM DABD, MEd; Janice Cameron, Mphil, RN, ONC; Afsaneh Alavi, MD
Intact skin is the body’s best defense against fluid and electrolyte loss as well as infection or external trauma that may impair healing. The early recognition, accurate documentation, diagnosis, and treatment of cutaneous disorders can prevent complications that delay the wound healing process. Topical applications should be appropriate to maintain hydration but avoid maceration. Allergens should be avoided, and adverse reactions require a precise diagnosis to avoid future exposures.
Chapter 27
The Development of Wound Management Products
Sarah M.E. Cockbill, PhD, LLM, Bpharm, Mpharm, DAgVetPharm, MIPharmM, FCPP, FRPharmS; Terence D. Turner, OBE, FRPharmS, MPharm
This chapter surveys the progressive development of wound management products and offers performance profiles for different product groups with their possible clinical usage. The ever-increasing new product appearance in the medical market, many of which are “me-too” duplicates of other products, precludes the use of brand names and allows a broader perspective of the advances in real-term formulations.
Chapter 28
Dressing Decisions
Craig L. Broussard, PhD, RN, CNS, CWS, FCCWS
Wound healing is a complex process, involving strategies that address the underlying etiology (or etiologies) as well as strategies that optimize the host and wound environments for healing. Dressings are one of several interventions that will be required for each individual with a wound. Dressings do not heal wounds; properly selected dressings enhance the body’s ability to heal the wound.
Chapter 29
Wound Product Selection Challenges: Developing Strategies for Your Practice Setting
Sue Currence, BSN, RN, CWCN, COCN; Diane L. Krasner, PhD, RN, CWCN, CWS, BCLNC, FAAN
Developing an all-inclusive wound product formulary has never been more challenging. Given the myriad of products, tools, devices, and primers available for today’s management of wounds, the selection process can be daunting. The statement “so many wounds, so little time” often comes to mind. In this instance, it could be rephrased to “so many products, so little space.” It is the practitioner’s challenge to identify and select those tools that will best fit the setting in which one practices. It has usually been the setting that drives the selection process; more frequently, the organization’s contract, purchasing group, and/or reimbursor come into the equation. This chapter addresses strategies to optimize wound product selection.
Chapter 30
Negative Pressure Wound Therapy
Adrianne P. S. Smith MD, FACEP; Kris Kieswetter, PhD; Alice L. Goodwin, BA; Amy K. McNulty, PhD
Negative pressure wound therapy (NPWT) is the process by which negative pressure is distributed across a wound base via a dressing with the specific intent to promote wound healing. Negative pressure (subatmospheric pressure) has been used to treat a variety of wound types. Secondary to the widespread applicability of therapy in acute and chronic wounds, this technology has received general acceptance in the wound care community for surgeons and nonsurgeons alike.
Chapter 31
Nontraditional or Alternative Topical Therapies for Wound Care
Cecilia Rund, BSN, CWOCN; Geoff Sussman, PhD, FPS, FACP, FAWMA
Alternative (topical) therapies may include treatments that are well described in the literature, as well as treatments that are unordinary, unusual, or not well defined. Nontraditional treatments include complementary and alternative medicine (CAM). This chapter will briefly discuss the road less taken for wound care by investigating various topical therapies that one may not see in an everyday healthcare setting.