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by Karen Zulkowski DNS, RN, CWS

Back in 2012, I blogged about glove change frequency and hand washing during dressing changes. Your comments were very informative. It is sad that facilities are being cited for not changing gloves, and rewashing and sanitizing hands during a dressing change. There is no evidence this does anything but add to the cost. What's important is to protect yourself from the patient's bacteria.

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by Karen Zulkowski DNS, RN, CWS

There are several issues in pressure ulcer definitions. For example, exactly what is the definition for eschar? What is an unavoidable pressure ulcer? How can you decide it really was unavoidable?

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Skin Conditions

by Karen Zulkowski DNS, RN, CWS

I previously discussed the need for a complete head-to-toe skin assessment. Certainly this can tell you whether or not the person is dehydrated, has open or discolored areas, and many other things about their overall health. Color, for example, can give you clues to additional problems such as vitamin and mineral deficiencies that can show on the skin.

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by Karen Zulkowski DNS, RN, CWS

Looking at a person's skin from head to toe is an important nursing function. Certainly nurses document this on the patient's admission, but not so much thereafter. Often the CNA is the first person to notice a problem. Yet there may not be good communication between disciplines or training of the CNA to understand the significance of what they are observing.

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by Karen Zulkowski DNS, RN, CWS

In my last blog, I talked about cultural beliefs affecting care. But there are geographic differences in North America that do also; for example, temperature. Temperature as a concept in the Chinese culture balances hot and cold illnesses with corresponding foods. However, in macro terms outside temperature also affects care.

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by Karen Zulkowski DNS, RN, CWS

All medical personnel strive to provide care based on the strongest available evidence. Yet how many of us provide culturally competent care? Culturally competent care is defined as having specific cognitive and effective skills that are essential for building culturally-relevant relationships between patients and providers.1 We may know about local customs but in today’s global world our patients may be from a different area of the world. So how would you react if your Asian patient wanted to use non-traditional medicine or your patient of the Sikh faith refused to remove their underpants prior to surgery?

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by Karen Zulkowski DNS, RN, CWS

I have talked about treating wounds, assessing wounds and care planning, but have not discussed the patient as a person. I always talk to the patient and family about options for care, how aggressive they want to be in their treatment plan and explain to them what I am doing and why I am doing it. The importance of this communication process is one of the reasons why I got involved in the Wound App project. I realized rural facilities don’t have wound expertise available and additional testing may mean many miles of travel. The consultation plan calls for patient/family involvement. But the communication with the patient and family is important regardless of how or where you are doing wound care.

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by Karen Zulkowski DNS, RN, CWS

Documenting wounds is always problematic for staff. It is important that wounds be assessed consistently both for measurement and characteristics. The use of pictures is also controversial. Pictures can help or hurt you if you are sued. However, consistent documentation of the wound, treatment and care planning that accompanies a picture would be useful.

While most of us go to the app store and download things we like, developing any app is actually time consuming. In working on our wound app we had many face-to-face meetings, calls, and trials of prototypes. Developers think differently than nurses so communicating what we wanted was interesting at best, and frustrating for our developer. However, we persevered and have the basic app model completed and will be adding the care planning piece soon.

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by Karen Zulkowski DNS, RN, CWS

Part 3 in a series on Pressure Ulcer Knowledge
For Part 1, Click here
For Part 2, Click here

Last time I wrote about my research results of nurses’ pressure ulcer knowledge. The Pieper Pressure Ulcer Knowledge Test has been widely used to examine nurses, medical residents and CNA's knowledge of pressure ulcer prevention and treatment. The test consisted of 47 questions answered as true, false, don't know. Sub-scores included in the scale were prevention (33 questions), staging (7 questions) and wounds (7 questions). Mean scores for nurses have shown to be fairly consistent across settings over time, remaining at approximately a 78% level.

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by Karen Zulkowski DNS, RN, CWS

Part 2 in a series on Pressure Ulcer Knowledge
For Part 1, Click here

I have used the Pieper Pressure Ulcer Knowledge Test for many years to examine nurse's knowledge. It actually started as a "bet" between my friend Elizabeth Ayello and me. Elizabeth thought her urban New York City nurses would have more CEU opportunity and would score better than my rural Montana nurses. So she gave the test to nurses employed in a New York hospital and I sent it to rural Montana facilities. We were both surprised when my nurses won by two points. The bad news was everyone scored at a "C" level. We found this very interesting but rather distressing.

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