Wound Cleansing

I can relate to one of the points in your discussion. I work in a small community hospital in the Wound Healing Clinic. We are an outpatient addition to the hospital. We have one nurse who has the primary responsibility of the acute admissions wound care. Last year we were bought by a large health systems. Recently, we were informed that we, the Wound Center, are held responsible if a patient has a hospital acquired pressure ulcer (HAPU). As part of this new directive we were also informed that prevalence rounds were to be done weekly. This is what you described your facility does once a month. These changes place responsibility for care which our staff does not even provide, moreover the changes were never discussed with our clinical coordinator.

My new role as an adult/gerontology nurse practitioner (AGNP), will be part of team that provides care for Long-term acute care LTAC, Skilled Nursing Facilities (SNF), or Rehabilitation hospital. After gaining considerable experience, my focus in future will be working in home healthcare and primary care clinics. My scenario will involve an organization that provides innovative, collaborative, health care team for one hundred bed LTAC Hospital. Working as an LTAC registered nurse, I noted that, despite the variety of diagnosis, majority of patients’ presents to LTAC hospital have wounds that require complex wound care management. The wounds can range from pressure ulcers to non-healing illness/injury wounds such as diabetic foot ulcer, venous leg ulcers, and post-surgical wounds among others. For this assignment, my scenario will focus on the role of Nurse Practitioner (NP) on skin care and wound managements.

Once the dressings were securely on and the procedure had been finished, I removed my apron and gloves and disposed of them in the plastic bag, along with everything thing else I had used and then washed my hands again. After leaving the patients home I discussed my practical experience with the Nurse who informed me that I although I had carried out the procedure well it was actually carried out using a clinically clean technique rather than the Aseptic Non Touch Technique as I had thought. As I had used the same gloves to remove the dirty dressings from the leg ulcer and then apply new sterile dressings I had not maintained the Aseptic Non Touch Technique. The Nurse informed me that this was perfectly suitable for the procedure I carried out as the wound was still kept as clean as possible and dressings and equipment used were sterile.

Tammy, I would agree there is a major difference between knowing how to perform a specific skill and knowing how to perform that skill effectively. I think it is great that you offer new nurses to your department an extensive orientation and training. Wound vac care can be tedious, depending on the wound, requiring much training and then follow-up training to ensure it is being performed correctly. The surrounding skin appearance of a wound bed is a good indicator of correct wound vac application. Your expertise in wound care with precise skin barrier methods prevented further complications with this already painful wound. When patients get, frustrated or are having a lot of pain related to a treatment or procedure, many times they will refuse

The practical nature of Wound Capture provides interesting opportunities for using and commercializing the application. To move forward with the application further development would be necessary. Partnering with a healthcare organization could provide the opportunity to secure funding to customize the documentation and system integration to a specific organization’s electronic records and documentation standards. Another opportunity might be grant funding to partner with a group of wound care specialists to further develop the application. Alternatively, working with a company that employees developers and provides mobile based systems to health care organization could provide necessary labor for the project and provide a potential

Researchers will decide to select wound infections that occur after open heart surgery as a topic for their study, because it is significant for staff nurses to know the effect of wound infections that occurs with the adult patients. Researchers will obtain permission from the cardiac surgery center so that they could collect information from adult patients. They will also contact and meet with staff nurses in cardiac surgery center. Nurse educators will provide the form to all staff nurses working in the operating room. The form includes the title of the study, the purpose of the study, place of the work, duration of the study, potential benefits, potential risks, participant signature, and date. The reader can follow that consent

* Hand washing is the most important method of preventing the spread of infection by contact (Ayliffe et al 1999). The Nottingham University Trust Policy on Hand Hygiene (2009) states that there are three types of hand hygiene, the first is ‘routine hand hygiene’ which involves the use of soap and water for 15 – 20 seconds or the application of alcohol hand rub until the hand are dry. The second is ‘hand disinfection’ which should be used prior to an aseptic procedure by washing with soap and water and applying alcohol hand rub afterwards. The third is ‘surgical hand washing’ which is the application of a microbial agent to the hands and wrists for two minutes. In addition to which a sterile, disposable brush may be used for the first surgical hand wash of the day although continued use will encourage colonisation of microbes. The third example is the most appropriate to any O.D.P undertaking the surgical role as it is the best way for the surgical team to eliminate transient flora and reduce resident skin flora (World Health Organization 2010). The first and second are important to any O.D.P undertaking any other role within the Operating Department as this is the best way to reduce the transient microbial flora without necessarily affecting the resident skin flora

Performs patient teaching on surgical topics including DVT prevention and importance of skin preparation. While assessing a patient, Ms Davidson noticed that a patient has an open wound. She offered to clean and bandage patient wound. She

I showed the supernumerary nurse the proper way of preparing an NPWT using a non-touch sterile technique, started by slowly cleaning the surrounding skin prior to the application of the pressure dressing. Since it was the first time of the preceptee to perform a pressure dressing, I have provided my preceptee the principles of wound management so that it will reinforce the knowledge of the supervised nurse and skills on the management of wound using NPWT. I also provided the preceptee the protocols and the wound management chart to take note of the type of solutions to be used in managing a surgical wound. We also documented in the progress notes what we have performed, and informed the nurse in-charge on the frequency of dressing change in a week.

Research has been done around the use of sterile vs. clean technique in the management of wounds, trying

Dale Gordon has been a patient in the ICU for 6 days after developing complications after open heart surgery. He is an 82-year-old African American who is disoriented to place and time. He lives with his daughter Claudia in her home. Claudia and her two brothers visit Mr. Gordon daily since he has been hospitalized. Mr. Gordon has not been eating well since the surgery and has lost 3 pounds. Mr. Gordon has type 2 diabetes and is on oral antihyperglycemic medication. Before he came to the hospital, Mr. Gordon was able to only ambulate for short distances. He has orders to get up in a chair twice a day. Joan, a student nurse, is caring for Mr. Gordon this morning. She has reviewed his medical record and is now ready to start caring for him.

Wound management is one of the cornerstones for nursing care however, effective wound care extends far beyond the application of the wound itself. Nurses may be required to assess, plan, implement, and evaluate wound care; therefore, order to fill these roles it’s critical to have an understanding of the several different areas of wound care such as, integumentary system, classification of wounds, wound procedures, and documentation. Knowledge in each of these areas will allow nurses to make well informed decisions about wound care, and as a result play an active part in wound healing.

Outline and discuss a clinical audit that you have undertook into one aspect of care delivery and reflect upon the experience using Driscoll’s model of structured reflection. Word Count (2197)

Patients come from a spectrum of personalities, leading to a spectrum of willingness or resistance to the multitude of requirements for cleaning and maintaining hygiene around the incision site. The efforts needed to maintain the incision site

In searching for a topic pertaining to my area of nursing specialty, I began my search in Google and searched “trends in I.V. therapy”. This topic is of interest to me because as a high tech infusion home care nurse, I currently have been seeing an increase in peripheral intravenous (PIV) infections. Due to insurance cut backs and their refusals to pay for hospital admissions patients are being discharged home to receive their IV antibiotic therapy or other peripheral medications. As a high tech IV infusion nurse myself, I am responsible for instructing and educating my patients on proper hand hygiene prior to any contact of their PIV and medication. Infection control is so important when dealing with peripheral intravenous lines, hand hygiene, aseptic technique and cleansing the area prior to placement are top priorities (Hadaway & Millam, 2007). This practice personally shocks me that patients are expected to learn, in only one or two visits, how to calculate IV drip factor rates and properly flush their PIV’s with saline prior and after medication administration.