The aim of this essay is to explore the underlying theory of wound care. This will be broken down and looked at in terms of comfort, safety, and status and assessment of the nursing model - activities of daily living concerning wound care. Under examination will be definitions of care and comfort, and biological theories of wound care. In addition, I will examine holistic care (looking at the whole person, not just the wound) and the skills required by the nurse in order to fulfill this. Reflection from practice experience will be included.
The concept of care has wide-ranging definitions and theoretical perspectives, and can sometimes be taken for granted (McKenna, 1993). McFarlane (1976, cited in McKenna, 1993) points out that nursing is the same as caring and Leininger (1986, cited in McKenna, 1993) defines caring as "the essence of nursing". McFarlane and Leininger share a consensus here, however, there is a lack of agreement between nurses and patients on the concept of care. Nurses tend to consider trusting and comforting types of behavior essential to care whereas patients prefer behaviors associated with competency and physical care (McKenna, 1993).
[...] Produced during this phase is wound exudate, which contains proteins and a variety of nutrients, growth factors, and enzymes, which cleanse the wound surface and assist healing. Wound exudate also has anti-microbial properties (Hutchinson cited in Miller and Glover, 1999). This phase can last from the moment damage to the skin has occurred and can last for two to five days (Wound Expert, 2001). The next stage of wound healing is the proliferative phase when the formation of new connective tissue occurs. [...]
[...] A good blood supply to the wound and a sufficient supply of oxygen, are essential to the healing of the wound. Factors that can affect this include age and cardiovascular disease. The activities of daily living, ‘eating and drinking', are necessary for health, well-being and wound healing. There is significant research that shows impaired wound healing in malnourished patients (Haydock and Hill and 1987, Delmi et al Paterson et al Tkatch et al cited in Dealey, 1994). An assessment should identify those at risk, the inclusion of a dietary history, observation of obvious signs of obesity, emaciation, or muscle wasting, and the patient weighed for comparison with ‘usual weight' (Dealey, 1994). [...]
[...] Before a nurse commences any care, he or she should have a good theoretical knowledge of the skill they are about to put into practice. References. Bale, S. and Jones, V. (1997) Wound Care Nursing. A Patient-Centred Approach. London: Harcourt Publishers Limited. Casey, G. (2000) Modern Wound Dressings. Nursing Standard. Vol No pp.47-51. Dealey, C. (1994) The Care of Wounds. A Guide for Nurses. Oxford: Blackwell Sciences Limited. Kolcaba, K. (1994) A Theory of Holistic Comfort for Nursing. Journal of Advanced Nursing. [...]
[...] During sleep, the release of growth hormone from the anterior pituitary gland stimulates protein synthesis and the proliferation of a variety of cells including fibroblasts and endothelial cells which assist wound healing (Lee and Stotts cited in Dealey, 1994). Factors that can disturb sleep include anxiety, pain, uncomfortable beds, noise, and pyrexia (Closs cited in Dealey, 1994). It should be possible to provide an environment, which is comfortable and conducive to sleep (Dealey, 1994). The nursing of terminally ill patients with wounds should consider that there might not be sufficient time left to the patient to heal a large wound, and the disease process may affect the healing process. [...]
[...] There are a wide variety of dressings and wound management products available today, however the appropriate use of these products is widely disputed. A dressing is defined as covering on a wound which is intended to promote healing and provide protection from further injury” (Dealey, 1994). Inappropriate use of dressings can delay and prevent healing. It is important when choosing a wound dressing that the nurse chooses the right type of dressing for the wound that is being dressed. Wound care should provide the best possible environment for the natural wound healing process to occur. [...]
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