Prevention and treatment of pressure ulcers.

Pressure ulcer prevention and treatment remains a challenge for interprofessional teams in all health care sectors. Evidencebased pressure ulcer guidelines can be simplified with a bedside enabler utilizing the wound bed preparation paradigm. Key steps involve treatment of the cause, addressing patient-centered concerns, and administering local wound care (debridement, infection/ inflammation control, and moisture balance before considering advanced therapies with the edge effect). Optimal outcomes are achievable with a multi-disciplinary approach that supports patients and their circle of care, which is central to every evaluation and course of treatment decisions.

How to prepare the wound bed.

This clinically focused article addresses the nuts and bolts of wound bed preparation. Preparing the wound bed is a frequently ignored step in the process of treating chronic wounds. In these days of high-tech instrumentation use for chronic wound care (i.e., adjunctive therapies, growth factors, and skin substitutes), clinicians should not forget the basics that are essential for optimizing wound healing. This article introduces the PREPARE Model (see Figure 1) as an aid for guiding care providers in wound bed preparation.

The potential benefits of advanced therapeutic modalities in the treatment of diabetic foot wounds.

This article discusses the advantages and disadvantages of primary wound healing as compared with primary amputation in individuals with chronic diabetic foot wounds. The authors review the potential benefits of vascular surgical procedures and advanced dressings, including two of the most promising modalities in modern wound care: growth factors and bioengineered skin. In this era of cost-conscious health-care administration, it is incumbent on the practitioner to consider not only the basic science of wound care, but also the economic aspect of treatment rendered. These various interventions, dressings, growth factor delivery systems, and new modalities could significantly reduce healing time, thereby reducing the risk of infection, hospitalization, and amputation while improving quality of life. If so, they may be truly cost-effective.

Preparing the wound bed--debridement, bacterial balance, and moisture balance.

Successful diagnosis and treatment of patients with chronic wounds involve holistic care and a team approach. The integration of the work of an interdisciplinary care team that includes doctors, nurses, and allied health professionals with the patient, family, significant others, and caregivers offers an optimal formula for achieving wound resolution. Such an approach challenges practitioners and everyone participating in wound care to integrate data and information that arise from a number of sources and mitigating factors. In this article, the authors define the changing paradigm that links treatment of the cause and focuses on three components of local wound care: debridement, wound-friendly moist interactive dressings, and bacterial balance. The authors demonstrate that the treatment of chronic wounds can be accomplished through a series of recommendations and rationales based on the literature and their experience. These recommendations lay the groundwork for thorough assessment and evaluation of the wound.

Nursing management of chronic wounds: best practices across the continuum of care.

This article highlights the nurse's role within a holistic, interdisciplinary approach to chronic wound management. Best practices for chronic wound care are discussed, drawing on evidence-based science when it is available. The fundamentals of chronic wound care, including cleansing, irrigation, débridement, infection control, and topical treatment are addressed. New devices and technologies are briefly reviewed. Implementing these best practices across the continuum of care will result in greater advances in the management of chronic wounds.

The AHCPR pressure ulcer infection control recommendations revisited.

The 1994 AHCPR Pressure Ulcer Treatment Guideline had five recommendations on infection control topics. A review of the literature since mid-1993 when the evidence to support these recommendations was undertaken is reported on here. The author suggests that the recommendations be revisited in light of two recent quasi-experimental studies, but since no randomized controlled trials were found, the strength-of-evidence ratings should remain at C for all five recommendations. Infection control for chronic wound care is a complex issue and is clearly in need of further research. In the meantime, common-sense, reasonably prudent, do-no-harm interventions should be considered best practice.

Painful venous ulcers: themes and stories about their impact on quality of life.

The purpose of this dissertation research was to describe, to understand and to interpret the meaning of the experience of living with painful venous ulcers. Heideggerian hermeneutic phenomenology, a descriptive, phenomenological approach, was the design used for this study. Fourteen people with active painful venous ulcers at the time of initial interview were engaged in conversation. The semi-structured interviews were audiotaped, transcribed and analyzed using Martin Qualitative Analysis Software (version 2.0). Four of the eight most compelling themes that relate to quality of life are reviewed here: feeling frustrated; interfering with the job; making significant life changes; and finding satisfaction in new activities. Increased sensitivity to and understanding of the impact of painful venous ulcers on QOL may lead to more effective intervention strategies and improved outcomes for these patients.

Painful venous ulcers: themes and stories about living with the pain and suffering.

PURPOSE: Describe and explore the meaning of the experience of living with painful venous ulcers. SUBJECTS AND SETTING: Fourteen people with active painful venous ulcers at the time of initial interview at an outpatient wound center. METHOD: A descriptive qualitative approach, known as Heideggerian hermeneutic phenomenology was used for this study. Semistructured interviews were audio taped, transcribed, and analyzed using Martin Qualitative Analysis Software. RESULTS: Four of the eight most compelling themes identified by the patients are reviewed in this article. These themes are expecting pain with the ulcer, swelling equals pain, not standing, and starting the pain all over again (painful débridements). CONCLUSIONS: The identified pain descriptors and the constitutive pattern "carrying on despite the pain" have important implications for WOC nursing practice, education, and research.

Diabetic ulcers of the lower extremity: a review of comprehensive management.

The management of lower extremity diabetic ulceration exacts enormous emotional and economic costs from patients, their family members and caregivers, and society. A team approach to wound healing has proved effective, but efforts at prevention have been less successful. The etiology of lower extremity diabetic ulcers includes injury complicated by underlying neuropathy, ischemia, or both. Prevention of primary and recurrent ulcers can be increased through programs to educate patients and caregivers. Proper management begins with thorough assessment and continues with various forms of medical and surgical therapy, and timely referral to specialists when appropriate. The use of recombinant growth factors is becoming more widespread as more is learned about their essential role in wound healing. Monitoring the wound while it is being treated is as important as initial assessment. Across the United States and Canada, wound care clinics are being established to provide intensive care directed by specially trained multidisciplinary care teams. Less populated areas must rely on proper education of ET nurses, home care nurses, visiting nurses, podiatrists/chiropodists, and allied healthcare professionals. Challenges for the future include the development of protocols for comprehensive assessment and care, better methods of prevention, a greater understanding of the role of growth factors in wound healing, and optimizing wound care.