The management of wounds, especially complex and chronic wounds, is a daunting clinical challenge. Achieving progress toward wound closure often depends on the right selection of treatment modalities for the wound and acknowledgment of any other underlying clinical considerations that present...
By Lydia A Meyers RN, MSN, CWCN
I am a Certified Wound Care Nurse (CWCN) and received my Certification with the Wound Ostomy Continence Nurse Association (WOCN). I will not say one certification is better than another, just do your homework and find one that challenges your knowledge. When I was working in the Wound Care Center, I started classes and education journey toward my certification. I had been working in Home Health Care as a wound care nurse and psychiatric nurse. This knowledge and experience gives me a different view of patients and wound care.
It is my experiences that have given me insight into what true wound care is. Many people that have followed me on Twitter and LinkedIn know what my views are. I truly believe a wound care nurse with two to four months of training can handle simple wounds, but lack the tools and knowledge necessary to manage complex wound care. In the healthcare system the cost of doing wound care has become an expensive part of doing business.
This story might help someone to understand why it is important to have a passion and education in wounds to make them heal.
I took care of an elderly patient who originally had a wound on her ankle. The wound was very small, but did heal well in four to five months. This wound was on her right ankle and the left leg was scarred from past healing after pyoderma gangrenosum (PG). The left leg had a wound open up after use of compression hose and a nurse ripped off a bandage when I was not there. The last time I had seen the wound, it was 1.5cm by 1.0cm and ready to heal. The next time, after the patient called me frantic about the increased size of the wound, I could not believe my eyes; the wound took up half her leg and looked very much like PG. I was very upset since the wound clinic had been debriding the wound and ordered Collagenese Santyl® to be used. This is not something you use on PG. That is the first thing I learned in school. Once the treatment became just foam and wrapping, the wound started healing beautifully.
Since I was no longer her nurse, but a friend, I could do nothing to talk with doctors about her treatment. I watched as she went through re-vasculation and then a split-thickness skin graft. The wound is not healed after three months. It hurts my heart to know that many people claim to know about wound care, yet do not study or keep up with the changes in the market.
I will say this, as I have always said: “Heal the patient and not the wound.” The patient is a part of the wound and no one pays attention to that part. Holistic care is looking at the whole patient as a person and treating that person and not just the part that is broken. The patient discussed above wanted to go to her granddaughter’s communion and all the doctors said, not a problem. After the skin graft, it was a problem and she did not get to go. How do you think this patient felt? The doctors did not care about her wants and needs beyond healing the wound. No one stopped to think about her age and what all this meant to keeping her from enjoying the few years left on this earth. Her big wish was to go swimming this summer and that will not come to be either. All she has done for the past two years is to go to wound clinic, hospital and doctor’s office.
A good wound care nurse will care about the entire patient and will not let this happen. A good wound care nurse has the education, experience and passion to evaluate and approach patient care with a wide lens. This patient went through trauma that should never have happened. Her wounds were almost healed and she could have returned to her regular life. She could have even been swimming this year. Instead, she remains waiting for the wound to complete healing and have her strength return. I see this as a problem that will continue for this patient, and perhaps others, until treatment includes a holistic approach backed by knowledge and experience.
About the Author
Lydia Meyers RN, MSN, CWCN has been a certified wound care nurse for over 15 years with experience working in home healthcare, extended care facilities, hospice care, acute care, LTAC, and wound clinics. Her nursing philosophy to "heal wounds as quickly as possible" is the guiding force behind her educational pursuits, both as a teacher and a student.
The views and opinions expressed in this blog are solely those of the author, and do not represent the views of WoundSource, Kestrel Health Information, Inc., its affiliates, or subsidiary companies.
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