This month, more than 2,000 student nurses and nursing faculty will attend the National Student Nurses Association Annual Convention in Orlando, FL. Thinking about this event presents the perfect time for student nurses, faculty, clinical... more
This month, more than 2,000 student nurses and nursing faculty will attend the National Student Nurses Association Annual Convention in Orlando, FL. Thinking about this event presents the perfect time for student nurses, faculty, clinical instructors, and preceptors - anyone involved in wound prevention and care practice or education - to look ahead and ponder the future of nursing in general and wound care nursing in particular.
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Research Interests: Nursing, Wound Healing, Humans, Female, Male, and 5 moreClinical Sciences, Newborn Infant, Aged, Pressure Ulcer, and Colostomy
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The previous critique of the "mini-article" merely scratches the surface with respect to critical reading of the literature. However, it is of vital importance to know whether the... more
The previous critique of the "mini-article" merely scratches the surface with respect to critical reading of the literature. However, it is of vital importance to know whether the authors' conclusions are substantiated by the results obtained. Therefore, do not be intimidated by the data; pull out your calculator, verify the numbers, and practice your critical reading skills. After all, practice makes perfect!
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Chronic wound pain is experienced to a greater or lesser degree with most types of chronic wounds, yet research to date on this subject has been extremely limited. This article presents an empirically and inductively derived model,... more
Chronic wound pain is experienced to a greater or lesser degree with most types of chronic wounds, yet research to date on this subject has been extremely limited. This article presents an empirically and inductively derived model, including a theoretical definition of the chronic wound pain experience (CWPE) and its subcomponents (noncyclic acute wound pain, cyclic acute wound pain and chronic wound pain). The model relates the CWPE to the nursing process and to nursing diagnoses and proposes intervention schemes to optimize patient outcomes. Avenues for future research are delineated.
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Chronic wounds present tremendous challenges to the healthcare team. Unlike acute wounds that usually progress neatly in a timely manner through the inflammation, proliferation and maturation phases of the healing process, chronic wounds... more
Chronic wounds present tremendous challenges to the healthcare team. Unlike acute wounds that usually progress neatly in a timely manner through the inflammation, proliferation and maturation phases of the healing process, chronic wounds deviate from the predictable sequence of regeneration and repair. To aid the healing process, there are five questions a nurse should ask when assessing a wound: "What is it?" "At what stage in the wound healing process is this wound?" "Is this wound healing at the expected rate?" "What local factors exist that may be delaying the healing process of this wound?" and "What systemic factors exist that may be delaying the healing process of this wound?" At various points in the process, specific concerns then need to be targeted. Initially, prevent or control infection. Then optimize exudate control and remove foreign bodies. Finally, prevent premature wound closure or contracture, especially in infected or undermining wounds. When the five assessment questions are answered and specific concerns have been addressed, the wound should proceed through the normal phases of the wound healing process. Throughout the process, attention to factors such as nutrition, systemic conditions, and perfusion is essential if healing is to be optimized.
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Writing an abstract is a challenging skill that requires precision and care. Criteria for well-formulated abstracts and abstract guidelines for 2 types of articles (empirical studies and reviews or theoretical articles) as well as a... more
Writing an abstract is a challenging skill that requires precision and care. Criteria for well-formulated abstracts and abstract guidelines for 2 types of articles (empirical studies and reviews or theoretical articles) as well as a description of the content of a structured abstract are presented. Details were gleaned from a review of the literature including the American Medical Association Manual of Style, Eighth Edition and the Publication Manual of the American Psychological Association, Fourth Edition. A good abstract is like a crystal: it is a clear, sharp synthesis that elucidates meaning for the reader.
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This article highlights the nurse's role within a holistic, interdisciplinary approach to chronic wound management. Best practices for chronic wound care are discussed, drawing on evidence-based science when it is available. The... more
This article highlights the nurse's role within a holistic, interdisciplinary approach to chronic wound management. Best practices for chronic wound care are discussed, drawing on evidence-based science when it is available. The fundamentals of chronic wound care, including cleansing, irrigation, débridement, infection control, and topical treatment are addressed. New devices and technologies are briefly reviewed. Implementing these best practices across the continuum of care will result in greater advances in the management of chronic wounds.
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The management of lower extremity diabetic ulceration exacts enormous emotional and economic costs from patients, their family members and caregivers, and society. A team approach to wound healing has proved effective, but efforts at... more
The management of lower extremity diabetic ulceration exacts enormous emotional and economic costs from patients, their family members and caregivers, and society. A team approach to wound healing has proved effective, but efforts at prevention have been less successful. The etiology of lower extremity diabetic ulcers includes injury complicated by underlying neuropathy, ischemia, or both. Prevention of primary and recurrent ulcers can be increased through programs to educate patients and caregivers. Proper management begins with thorough assessment and continues with various forms of medical and surgical therapy, and timely referral to specialists when appropriate. The use of recombinant growth factors is becoming more widespread as more is learned about their essential role in wound healing. Monitoring the wound while it is being treated is as important as initial assessment. Across the United States and Canada, wound care clinics are being established to provide intensive care directed by specially trained multidisciplinary care teams. Less populated areas must rely on proper education of ET nurses, home care nurses, visiting nurses, podiatrists/chiropodists, and allied healthcare professionals. Challenges for the future include the development of protocols for comprehensive assessment and care, better methods of prevention, a greater understanding of the role of growth factors in wound healing, and optimizing wound care.
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While certain issues related to time, such as time to healing, are frequently discussed in the wound care literature, other important time-related issues for conducting and interpreting wound research are only rarely addressed. Time... more
While certain issues related to time, such as time to healing, are frequently discussed in the wound care literature, other important time-related issues for conducting and interpreting wound research are only rarely addressed. Time presents serious philosophical and methodological challenges that can have a significant impact on the validity, reliability or rigor of a study and are, therefore, worthy of consideration. This article discusses four commonly encountered time-related problems for wound research (time-congruent research questions and designs, time specific measurement tools and protocols, retrospective versus prospective studies, and time sampling/sequential triangulation), presents examples to illustrate these problems, and posits some solutions. Five questions are offered as a guide for determining whether wound research tools and protocols adequately address time-related research issues.
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Research Interests: Nursing, Aging, Wound Healing, Nursing Management, Humans, and 3 moreGeriatric Nursing, Skin Care, and Aged
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The Wound Healing Scale is a user-friendly, descriptive scale for assessing healing in all types of wounds, both acute and chronic. The scale consists of eight alphabetic modifiers that can be combined with the score from a number of... more
The Wound Healing Scale is a user-friendly, descriptive scale for assessing healing in all types of wounds, both acute and chronic. The scale consists of eight alphabetic modifiers that can be combined with the score from a number of different existing scales that assess wounding. The WHS can be utilized with large and small data sets and resolves the problem of reverse staging posed by regular reassessments using the Health Care Financing Administration's Minimum Data Set, version 2.0.
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The use of the Minimum Data Set (MDS) for documentation in long term care has resulted in the widespread reliance on reverse staging to document the healing of pressure and venous ulcers. This article presents a pragmatic approach for... more
The use of the Minimum Data Set (MDS) for documentation in long term care has resulted in the widespread reliance on reverse staging to document the healing of pressure and venous ulcers. This article presents a pragmatic approach for defining the healing process in a staging nomenclature so that it is physiologically accurate.
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The 1994 AHCPR Pressure Ulcer Treatment Guideline had five recommendations on infection control topics. A review of the literature since mid-1993 when the evidence to support these recommendations was undertaken is reported on here. The... more
The 1994 AHCPR Pressure Ulcer Treatment Guideline had five recommendations on infection control topics. A review of the literature since mid-1993 when the evidence to support these recommendations was undertaken is reported on here. The author suggests that the recommendations be revisited in light of two recent quasi-experimental studies, but since no randomized controlled trials were found, the strength-of-evidence ratings should remain at C for all five recommendations. Infection control for chronic wound care is a complex issue and is clearly in need of further research. In the meantime, common-sense, reasonably prudent, do-no-harm interventions should be considered best practice.
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The AHCPR Clinical Practice Guideline: Treatment of Pressure Ulcers is a comprehensive, one-stop reference with enormous utility for wound care providers in a diverse array of settings. Following a brief review of the Guideline... more
The AHCPR Clinical Practice Guideline: Treatment of Pressure Ulcers is a comprehensive, one-stop reference with enormous utility for wound care providers in a diverse array of settings. Following a brief review of the Guideline development process, the Guideline is critiqued using a pragmatic perspective. Five specific issues are discussed in detail, followed by recommendations to providers for addressing these concerns. Guideline No. 15 is not a perfect document and it should not be taken as the final word on the subject of pressure ulcer care.
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This clinically focused article addresses the nuts and bolts of wound bed preparation. Preparing the wound bed is a frequently ignored step in the process of treating chronic wounds. In these days of high-tech instrumentation use for... more
This clinically focused article addresses the nuts and bolts of wound bed preparation. Preparing the wound bed is a frequently ignored step in the process of treating chronic wounds. In these days of high-tech instrumentation use for chronic wound care (i.e., adjunctive therapies, growth factors, and skin substitutes), clinicians should not forget the basics that are essential for optimizing wound healing. This article introduces the PREPARE Model (see Figure 1) as an aid for guiding care providers in wound bed preparation.
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The etiology and management of wound pain for patients with vacuum-assisted closure devices can be complex. Patients, such as the patient with necrotizing fasciitis described in this case study, may experience all three types of pain... more
The etiology and management of wound pain for patients with vacuum-assisted closure devices can be complex. Patients, such as the patient with necrotizing fasciitis described in this case study, may experience all three types of pain described in the Chronic Wound Pain Experience Model--acute noncyclic, acute cyclic, and chronic. Strategies that include local wound management to reduce all three types of pain and holistic psychological care to reduce the ache and anguish that may accompany dressing change procedures may help provide comfort and reduce pain and suffering.
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Abstract An expert panel was established to formulate a consensus statement on Skin Changes At Life’s End (SCALE). The panel consists of 18 internationally recognized key opinion leaders including clinicians, caregivers, medical... more
Abstract An expert panel was established to formulate a consensus statement on Skin Changes At Life’s End (SCALE). The panel consists of 18 internationally recognized key opinion leaders including clinicians, caregivers, medical researchers, legal experts, academicians, a medical writer and leaders of professional organizations. The inaugural forum was held on April 4-6, 2008 in Chicago, IL, and was made possible by an unrestricted educational grant from Gaymar Industries, Inc. The panel discussed the nature of SCALE, including the proposed concepts of the Kennedy Terminal Ulcer (KTU) and skin failure along with other end of life skin changes. The final consensus document and statements were edited and reviewed by the panel after the meeting. The document and statements were initially externally reviewed by 49 international distinguished reviewers. A modified Delphi process was used to determine the final statements and 52 international distinguished reviewers reached consensus on t...