Wound and Pain Management Issues - Essay Example

WOUND AND PAIN MANGEMENT Name: Course: Tutor: Date: INTRODUCTION Wound management is a medical practice that incorporates comprehensive patient care strategies associated with effective wound healing process. A single discipline is not capable of meeting the needs of a patient with a wound and therefore the best results are generated by well educated personnel who are dedicated and are from a number of disciplines working together for the common objective of holistic patient care (Diamond 2002). Despite the fact that the range of wound treatment modalities as well as research in this area are high, discussion of treatment of the pain that is related to the wound is relatively absent in the literature (Price 1999). Additionally even though there is better understanding of the effects of pain on one’s quality of life there are still biases against pain management as a whole and a lack of knowledge of the pain relievers that are currently available. According to recent reports released on studies carried out it was revealed that in the past wound care has not been well managed due to the limited understanding of the healing process in addition to the inadequate range of dressing materials available (King 2003). Discussion From an overall assessment it is quite clear that not only is Miss Pickles elderly but also tends to suffer from a number of ailments related to her medical past such as chronic kidney (Hollinworth 2002). According to recently conducted studies, statistics have shown that pressure ulcer incidence is connected to the high morbidity and mortality where an estimated 70% die within 6 months of infection and it is predicted that these incidences will continue to rise with time. It is quite common to find individuals suffering from leg ulcers as compared to those suffering from pressure ulcers where it has been revealed that one in four Americans who are above the age of 65 years will develop a leg ulcer in the course of their lifetime (Dealey & Cameron 2008). Pressure ulcers refer to damage brought about as a result of pressure over time leading to an ischemia of underlying structures (Osterberg & Blschke 2005). They are better known as bed sores. There are a number of factors that contribute to occurrence of pressure ulcers and these may include impaired mobility, infection, advanced age, chronic conditions, malnutrition and dehydration, majority of which were evident in Miss Pickle’s case (Bryant & Nix 2007). Other factors include external factors such as moisture, shear, pressure and friction. An assessment of the pressure ulcers needs to be carried out by the nurse in charge of taking care of Miss Pickles. In this particular case, two main assessments should be carried out, namely holistic and wound assessments. Holistic assessment of any given patient with a wound incorporates local, psychosocial and systematic factors (Baranoski & Ayello 2008). Under local factors low wound temperature, infection, foreign bodies and excess exudates are assessed while under psychosocial factors the patient’s knowledge deficits, financial constraints and cultural beliefs are assessed (Kransner 1995). On the other hand, systematic factors tend to take a look at the duration, decreased oxygenation or perfusion of the wound in addition to host infection and medication of the patient (Diamond 2002). It is necessary that an assessment of the wound be carried out on a weekly basis especially in the case of Miss Pickles as she is quite elderly and in need of more attention from her caregivers. Assessing the appearance of tissue in the wound bed is important as it helps determine appropriate treatment plans as well as evaluate progress towards healing (Dealey & Cameron 2008). Assessment of Biopsychosocial needs of a person suffering Wounding In order to be able to properly and appropriately assess the real problem in regards to an individual’s health status, in this case Miss Pickle’s, a Biopsychosocial Model is used. This model was originally developed by Dr. George Engel who was a cardiologist and has today been widely accepted by the mental health professions (Bryant & Nix 2007). The biopsychosocial model states that psychological, social and biological factors are all interrelated and important in as far as promoting health or causing disease is concerned. It has been observed that what often affects the mind will often affect the body and vice versa meaning that illness or wellness of an individual is not just about one’s physical state but is also influenced by the person’s social and psychological status as well (Baranoski & Ayello 2008). Since Miss Pickles has a chronic wound she is also suffering from a number of biopsychosocial problems for instance social needs, mental anguish especially given her age and physical disability. For her multiple issues to be addressed properly she needs skilled and professional assistance from knowledgeable wound care professionals (Diamond 2002). The combination of professionals that a patient may require will be different from another’s patient’s through individualized patient centered care (Osterberg & Blschke 2005). Each personal healthcare professional’s caring behavior is considered an essential dimension in as far as the biopsychosocial model is concerned. The human touch or reaching out to patients, caregivers and families establishes the confidence and trust that heal wound, patients and lives (Dealey & Cameron 2008). The first priority in assessing the biopsychosocial needs of a person suffering wound is that of the patient, caregiver and family as a number of key patient factors tend to contribute to the development of chronic wounds (Kransner 1995). Studies have shown that majority of people who suffer chronic wounds are often older where the average age is 70 years and such individuals tend to suffer from diabetic neuropathic foot ulcers and leg ulcers, as is with Miss Pickle’s case (Baranoski & Ayello 2008). Moreover, people with such medical conditions have been observed to have other medical needs which hinder effective wound treatment as well as healing. Additionally oral drugs prescribed for patient’s medical needs tend to interfere with the wound healing process (Hollinworth 2002). Those assigned to the care of patients suffering from wound need to consider the fact that these patients also undergo social isolation as they cannot move or eat with the rest of the family due to the odor from the would which is offensive (Bryant & Nix 2007). Miss Pickle did not have any of her family members visiting or living with her and she had been committed to a care nursing home where she lived until her situation got worse and had to be committed to a hospital. An individual with a diabetic neurotrophic foot ulcer can lay awake hours on end due to burning and shooting neuropathic pain in both feet especially during the night (Diamond 2002). Chronic wounds interfere with one’s quality of life as well as activities of day-to-day living and a combination of all these sufferings may lead one to suffer from depression which is quite common in persons with diabetes and other multiple complications such as infection, deformity and ischemia (Kransner 1995). The need for frequent dressing changes may interfere with one’s finances where the cost of supplies may not be able to be covered by the healthcare system. Affected people are also not able to walk long distances or stand for prolonged period of time while trying to find medical supplies such as medication and wound gauze (Dealey & Cameron 2008). They may experience difficulty sleeping and even to some extent being able to maintain an adequate level of self care as can be the case with Miss Pickle who is too elderly and has prior conditions that increases her current pain and suffering (Baranoski & Ayello 2008). Such issues need therefore be addressed during assessment of biopsychosocial needs of a person suffering wound. Implementation of safe, effective wound management strategies Effective wound management of an individual with wound requires specific knowledge regarding the person’s physiology and anatomy, awareness of factors that tend to influence healing results and sound understanding of the wound healing process (Diamond 2002). It is necessary for caregivers and nurses charges with catering to the needs of a patient suffering wound to ensure that they implement safe and effective wound management strategies as a means of restoring back the patient’s freedom to socialize and be with their families and friends. As aforementioned, there are a few factors that may hinder the wound healing process as has been observed through research that is local factors such as low wound temperature, foreign bodies and infection and systematic factors such as decreased oxygenation and host infection of the patient (Bryant & Nix 2007).Effective wound dressing requires that in extreme cases of elderly people as in the case of Miss Pickle, a qualified nurse should assist the patient to dress the wound. This is because they cannot appropriately carry out the wound dressing process themselves as they cause an accident inventing more pain to the wound. In this case it will be my duty as a nurse to help Miss Pickle dress the wound on daily basis until she gets well (Osterberg & Blschke 2005). In effective and safe wound management strategies it is important to invite patient involvement to the extent desired by the patient in order to make them feel more comfortable and trust in the procedures. In Miss Pickle’s case it is important to allow her to pace the procedure offering time outs that are requested either through verbal or nonverbal communication (Dealey & Cameron 2008). When dressing the wound the caregiver should select dressings that minimize the degree of sensory stimulus to the affected area. When removing a patient’s dressing every attempt should be made in avoiding unnecessary manipulation of the wound thus preventing further damage to the peri-wound region (Baranoski & Ayello 2008). Wound bed preparation is one of the established wound management strategies that increase endogenous healing while facilitating the effectiveness of therapeutic procedures (Kransner 1995). This strategy will play a critical role as far as Miss Pixels case is concerned.. It is also vital to keep in mind the potential dangers of wound infection during wound management. Vacuum assisted wound closure, surgical debridement, pressure reduction in wounds, antiseptics and antimicrobial therapy are some of the common techniques implemented in safe and effective wound management (Bryant & Nix 2007). Evidence based Wound Management practices Healthcare professionals are charged with the responsibility of offering their patients wound care management that is founded on scientific guidelines and best practice information (Diamond 2002). There are a number of traditional wound care practices that have been disregarded as some have been discovered to cause harm for instance using betadine to cleanse wounds. Dressing wounds with dry gauze has also been dismissed as the gauze tends to stick to the wound area causing further damage and inflicting further pain for the patient when being removed (Baranoski & Ayello 2008). Healthcare institutions and other agencies are being held to a higher standard of care as compared to the past and it is therefore important for healthcare professionals to take it upon themselves to learn all the current evidence based wound management practices (Dealey & Cameron 2008). With the current changes in technology new methods of wound management are being invented on daily basis to deal with the increasing demands of the patients. Healthcare institutions are finding it a challenge in keeping up with the latest developments in wound care but all in all it is worthwhile as healing time, experience of pain and patient satisfaction will be optimized (Bryant & Nix 2007). Pressure ulcers or leg ulcers are the most difficult to prevent despite the fact that they can be treated. One of the key treatments in regards to leg and pressure ulcers management is compression therapy as it is internationally agreed best practice wound management (Diamond 2002). Since Miss Pickles does not have any family members to cater for her financial costs due to the treatments she is to receive in the process of wound management, this would be quite beneficial. Culturally sensitive wound management processes A recent study was carried out to investigate on wound care self management by indigenous individuals and the manner in which participants perceived their wounds and general health (Osterberg & Blschke 2005). The study was to also identify the influences on these individuals assessing wound care services. It was observed that there is a dearth of information regarding culturally appropriate practice in wound management for indigenous people and it is therefore important to attempt to bridge the gap existing in nursing knowledge of indigenous clients’ perceptions of barriers and enablers of seeking wound care services especially in relation to leg and pressure ulcers (Baranoski & Ayello 2008). Caregivers need to be more trained and educated in assessing and providing wound management to indigenous patients as majority of these individuals’ decisions regarding wound management tend to be influenced by their culture. CONCLUSION Miss Pickle and others in the same condition as hers need extra attention and care in wound and pain management. It is important to ensure that patients suffering from pressure and leg ulcers experience the least pain during dressings and wound management. Use of time outs, careful removal of dressings, use of warm cleansing solutions and correct application of bandages and dressings are some of the procedures caregivers can implement in the course of wound and pain management. Health professionals should also maintain a calm, confident and supportive attitude as this allays patient’s anxiety thus minimizing their pain. REFERENCES Baranoski, S., and Ayello, E.A. (2008). Wound Care Essentials: Practice Principle. 2nd Edition. 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