What is some of the most important teaching a wound nurse can provide to patients and families?

This course discusses multiple types of wounds that are seen by practitioners in the home health, assisted living, and nursing home settings. As healthcare professionals, the greatest impact we can have is to provide education for our patients, families, caregivers, and each other. The ability to speak to our patients in simple, clear, and concise language greatly benefits everyone involved in their care. Encouraging and empowering caregivers is an important step in patient independence and healing. As caregivers for our patients, families, and their loved ones, our job is to inspire and motivate to create a space of healing and kindness.

Overall, the job of wound care is to teach patients and caregivers how to prevent complications, promote proper wound healing, perform appropriate dressing changes, observe complications, report any abnormal occurrences, and initiate positive lifestyle changes.

Educating the Patient

Patient education requires a collaborative approach among all disciplines, including social work, case management, respiratory therapy—and clergy, if desired. We must address multiple areas as we determine how the patient and caregiver are best able to learn; this includes not only the ability and readiness to learn but also any barriers to learning.

Culture, religion and language differences demand that teaching be adjusted to the patient and caregivers. Emotional, physical, cognitive, and financial limitations are additional issues. Teaching can be both formal and informal, and techniques should be varied to ensure multiple opportunities to retain and comprehend the information and to allow time for questions. Teaching methods used can be lecture, diagram, demonstration, teach-back, discussion, literature and hand-outs.

It is important not to assume anything about the patient or caregiver. Give information in small increments, with as many senses engaged as possible. Address the patient’s goals during the teaching sessions. Always observe the patient and caregiver as they perform wound care, correcting as necessary and providing encouragement.

Documenting of information taught plus any barriers to learning, learning preferences, teaching methods, and evaluation, is helpful to guide other disciplines and to promote patient/caregiver progress. The goal of patient education is to improve the patient’s quality of life and to address any challenges to a healthier life.

A Team Approach

Great outcomes grow from great collaboration. Successful clinicians utilize all possible resources in an effort to obtain the best possible patient outcomes. Wound care, especially, requires input and knowledge from all parties involved, including most of all the caregiver. Never underestimate the value of team discussion and brainstorming.

Ask questions and gather as much information as possible to determine an optimal care plan. Adjust, assess, and reevaluate as needed, especially when the wound healing has stalled. The patient must be involved and onboard with the plan of care or there will be no forward motion. Successfully involving patient and caregivers make all the difference in healing success.

Questions you should continue to ask with each visit to any patient include:

• Who are the key players needed in wound prevention?
• What areas of the skin are we looking at?
• What do you think the caregivers want to learn?

Focusing with each visit on patient and caregiver education about skin care basics, importance of prevention, and the benefits of healthy habits can lead to a safe and happy outcome. Improving quality of life is always the first objective for all patients. Skin care and wound prevention is a group effort that takes constant collaboration, education, and cooperation from the entire healthcare team. There are many ways we serve our patients on a daily basis. Wound prevention is one of the greatest gifts we can provide patients and caregivers to keep them safe and healthy at home.

Published on April 20, 2020 by Carole Jakucs, MSN, RN, PHN, CDCES

Some wound care centers are closed because of the COVID-19 pandemic.

More patients are opting to perform their own wound care at home because they are concerned about venturing out and risking exposure to the virus.

We spoke with three wound care professionals to learn more about care provided in the home and teaching patients and families to care for wounds until life returns to normal. 

How one clinic embraces Telewound 

Michael Miller, DO, is the CEO and medical director of the Miller Care Group in Indianapolis, a frequent lecturer at our annual Wild on Wounds (WOW) conference and adjunct faculty member of the Marian University College of Osteopathic Medicine. 

“We provide comprehensive wound care for patients in our clinic, in long-term care and assisted living facilities, and also via house calls — both in-person visits and telehealth with our Telewound service,” Miller said. 

Miller’s wound care clinic remains open during COVID-19. However, his team ramped up existing Telewound services during the pandemic.   

“We continue universal precautions and have also implemented the CDC recommendations regarding COVID-19 screening of patients and staff along with the use of related PPE,” he said. 

Even if patients opt to perform their own wound care at home, Miller said these patients remain under the clinic’s care. It includes routine visits — either in-person or via Telewound — until the wound has completely healed for at least one to two weeks.

Power of telehealth

Telehealth is very effective, Miller said, when a clinician is with a patient and connects with the prescribing clinician during the visit.  

“With Telewound, the home health nurse contacts the prescribing clinician in real time during the visit,” he said. “This enables the prescriber to conduct ongoing assessment and diagnosis and prescribe the appropriate treatment. One example is asking a home health nurse to explore a wound at a specific location if new tunneling is suspected.”   

Several opportunities are provided to patients for observing their wound care performed by a nurse or clinician before they take on the task themselves, according to Miller.

Then, detailed instructions are provided to patients and families before they begin. “We need to make sure they understand all the necessary steps involved,” he said.  

On the flipside, sometimes there are concerns a patient and their family are unable to perform their own wound care at home. Two examples are if patients or caregivers have debilitating arthritis or cognitive issues, Miller said.   

“If this occurs, their wound care will continue to be performed with home health visits with nurses and house calls, Telewound or clinic visits by clinicians,” he said. 

You might be involved in teaching patients to care for their own wounds, especially now during the COVID-19 pandemic.

Here are some general recommendations to consider, according to husband-and-wife team Bill Richlen, PT, WCC, DWC, and Denise Richlen, PT, WCC, DWC, CLT. They are both clinical instructors with the Wound Care Education Institute (WCEI). 

The Richlens said important strategies for self-performed wound care at home include: 

• Keep wound care and dressing supplies, along with instructions, in one place, preferably a container that protects them. 
• Establish a clean, flat base to work from, such as a clean towel or drape. 
• Place supplies needed on the base you create.  
• Follow any instructions provided by your wound care clinician for cleansing and dressing placement. 
• Wash hands before and after dressing changes. 

If no instructions were provided, the Richlens recommend the following steps: 

• Apply gloves and remove old dressing, then discard it in a plastic bag. 
• Remove gloves and discard in same bag as described above. 
• Change into clean gloves. 
• Clean wound with saline or commercial wound cleanser, which is preferred. 
• Tap water can be used if nothing else is available.  
• Redress wound as quickly as possible to limit time wound is open to air. 
• Secure dressing as needed with tape, elastic bandage, Coban, etc. 

Wound care tips

The Richlens also offered the following informational tips for home wound care: 

Dressing types

The types of dressings needed should be based on exudate levels and frequency of necessary dressing changes. Then followed by appropriate securement products, such as tape, elastic net, tubular stockings, etc. Dressing supplies can be acquired from wound clinics or via third-party durable medical equipment providers that can deliver dressings to the home.   

Measurement devices

Since patients are not adequately trained in wound assessment, measurement would not be necessary. This duty would still fall to clinicians. 

When to seek help

Clinicians should teach patients and families about the signs and symptoms to look for that would require the wound to be seen by a professional.

Patients, wounds best suited for self-care

This varies and is based on the skill and availability of patients or caregivers. Wounds that are the easiest to manage are clean with little necrotic tissue, non-infected and those that require less frequent dressing changes.

Patients, wounds least suited for self-care

Any wound could be managed by the patients and caregivers. However, the important question is how well will it be done?  

Challenging wounds

Some wounds require more challenging wound care at home, such as: 

Complex wounds

Examples are those requiring significant debridement, compression bandages or certain offloading devices.

Infected wounds

These need appropriate diagnosis by a prescribing clinician, followed by antibiotics and effective topical agents. The greatest concern is prevention of sepsis. Knowing when to call a clinician is important. 

Explore our COVID-19 resource page.