Palliative Care

by Heidi H. Cross, MSN, RN, FNP-BC, CWON According to the Agency for Healthcare Research and Quality, more than 17,000 lawsuits related to pressure ulcers (PUs) are filed annually in the United States, second only to wrongful death lawsuits. One of the greatest gifts to defense attorneys was when the Centers for Medicare & Medicaid Services (CMS) published F-Tag 314, finally acknowledging that some ulcers can occur despite best care. The facility essentially can maintain, “Hey, we did everything we were supposed to, and despite that, the patient developed that pressure ulcer”—that is, the ulcer was unavoidable. To prove unavoidability, proper documentation (proof) of best care needs to be in place, as well as documentation that all proper prevention and treatment measures were implemented.

By Bruce E. Ruben MD Life is a bunch of pivotal moments that move you on to the next phase. Like the moment you realize you're no longer a child. Or the moment it becomes clear that you have to change jobs. Later on, it's when you admit you can no longer maintain your home. And for many of us, there will be the moment you come to grips with the fact that you can no longer care for yourself without help.

By Karen Zulkowski DNS, RN, CWS Last month I talked about the issues that occurred during my husband’s knee surgery. This month I want to bring the focus back to lawsuits and how they arise. What are the implications for the patient and family, and how does palliative wound care fit in?

By Paula Erwin-Toth MSN, RN, CWOCN, CNS, FAAN November marks the beginning of National Family Caregiver Month. Many of us are not only health care providers, but we are also family caregiver; some of us are part of the so-called sandwich generation. Caring for aging parents along with raising children can leave you feeling squeezed in the middle. While being a family caregiver can be incredibly rewarding, it can be a challenge physically, emotionally and financially. Caring for a loved one with a chronic wound can be especially daunting since the time, skill and dedication required can be overwhelming. This is especially true for family caregivers who suddenly find themselves needing to learn a multitude of health related skills.

In this interview, Dr. Anthony Tickner outlines the distinction between palliative and hospice care, as well as how clinicians can identify which framework is best for each, individual patient.

By Aletha Tippett MD Once the individual has been thoroughly assessed for palliative care and his or her objectives and needs have been discussed, the wound care provider must determine the wound management strategy to follow. This strategy will depend upon the type of wound being treated for palliation. A summary of each type of wound and an appropriate palliative strategy are listed below, including factors such as removal of the wound cause, pain and drainage management, and odor control:

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?

Article Title: Pressure Injury Progression and Factors Associated With Different End-Points in a Home Palliative Care Setting: A Retrospective Chart Review Study Authors: Artico M, D’Angelo D, Piredda M, et al Journal: J Pain Symptom Manage 2018;56(1):23-31 Reviewed by: Arden Harada, class of 2021, Temple University School of Podiatric Medicine

by Emily Greenstein, APRN, CNP, CWON, FACCWS "When I grow up, I want to be a wound care specialist." That's not something you hear kids going around saying. Sure, kids want to be doctors or nurses. But wound care specialist? When you think about it, being a wound specialist is not a glamorous position, unlike being a neurosurgeon. The best quote that I ever heard from a colleague of mine was, "No one wants to do wound care; wound care isn't sexy." This may be true, but what is wound care then? To me it is ever changing, it is learning new things (most of which are not found in text books), and it is about helping patients heal both emotionally and physically from a chronic condition.