Palliative Wound Care

WoundSource Practice Accelerator's picture
Palliative Care

by the WoundSource Editors

Palliative care and hospice care are not the same, but they both share one goal. They both focus on a patient's physical, mental, social, and spiritual needs. Palliative care can begin at diagnosis and treatment or for patients at any stage of their illness. Patients may not want to receive aggressive treatment of non-healing wounds because of underlying diseases, pain, and/or cost.

Holly Hovan's picture
The Importance of Palliative Care

by Holly Hovan MSN, APRN-ACNS-BC, CWOCN-AP

As wound care clinicians, one of the first steps we take after meeting our patient and assessing their wound is identifying our treatment goals. Much like managing a complex medical problem, we need to identify if our goals of care are curative or palliative. This is important with all wounds, not just those present at end of life. There are many patients with vascular disease, diabetes, or other co-morbidities that may want to take a palliative approach versus aggressive debridement or amputation. You may have heard the term, “keeping it dry and stable.” This can work at times, but as with any wound, we need to keep an eye out for signs of an active infection and determine if/when we need to further intervene. Wounds can and do resolve with a palliative approach, but it is very important to understand, and explain to our patients, the difference.

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Aletha Tippett MD's picture
doctor giving patient hope

by Aletha Tippett MD

I have written about so many things over the past years… Maybe now is a good time to announce that I am writing a book called Hear Our Cry, an autobiographical story about 20 years of wound care and limb salvage. The process has had quite an impact on me, reviewing all the pictures and notes from my wound patients from the past two decades.

Rick Hall's picture
hospice patient

by Rick Hall, BA, RN, CWON

I have been encouraged to continue with my discussion on Skin Changes at Life's End (SCALE) and the Kennedy Terminal Ulcer (KTU). I have addressed the negatives about SCALE and the KTU, including the legal implications and documentation challenges surrounding the care of patients at the end stages of life.

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Rick Hall's picture
medical research

by Rick Hall, BA, RN, CWON

Those of you who have been following my blog know that I believe the phenomenon we call the Kennedy Ulcer is a form of lividity prior to death, not due to pressure. I find it curious since the publication of SCALE - Skin Changes at Life's End, by the SCALE panel in 2009 and the presentation of this subject throughout my blog series, there has not been much dialogue on the changes we observe in our actively dying patients, especially with the concept of lividity prior to death.

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Rick Hall's picture

by Rick Hall, BA, RN, CWON

Contrary to popular myth, not all pressure ulcers are avoidable. The Skin Changes At Life's End (SCALE) panel concluded that our current understanding of the complex skin changes which occur at life’s end is limited and additional research and expert consensus is necessary.

As a hospice nurse for over six years, I observed many changes in our patients' skin. In the final weeks of life, the body begins to change. Skin temperature may fluctuate. Mottling, a bluish color, may appear on the extremities...

Rick Hall's picture
empty bed

by Rick Hall, BA, RN, CWON
As is often the case in wound care, health care professionals cannot fight what they can't see. In the case of Skin Changes At Life's End (SCALE) and Kennedy Terminal Ulcers (KTUs), education is the first step towards effective management and documentation. Presentations offered to long-term care facilities and other organizations in the states of Kansas and Missouri have made them aware of SCALE and KTUs.

Rick Hall's picture
Patient Care

by Rick Hall, BA, RN, CWON

Treatment of Skin Changes at Life's End (SCALE) and Kennedy Terminal Ulcers (KTUs) is the same as any other ulcer: moist wound therapy if the skin is open, protect and offload the area if the skin is closed. Continue to turn the patient for comfort and alleviate any undue pressure on the already compromised skin. When the patient is in the active phase of dying, caregivers have a tendency not to turn the patient because it may be painful.

Mary Ellen Posthauer's picture
patient centered care

by Mary Ellen Posthauer RDN, CD, LD, FAND

Recently there have been numerous articles and webinars focusing on the methods health care professional can employ to effectively communicate and engage in end of life conversations with patients receiving palliative and/or hospice care.

Rick Hall's picture
elderly hands

by Rick Hall, BA, RN, CWON

Series Note: Dying patients experience a variety of skin changes, including pressure ulcers, as part of the natural dying process. While this phenomenon has been recognized in the health care literature for centuries, the explanations and etiologies have yet to be fully elucidated. In this blog series, I will be discussing key concepts related to Skin Changes At Life's End and the Kennedy Terminal Ulcer from the perspective of a hospice wound care nurse. Suggestions for clinical practice and a case series with discussion will also be presented in future posts.