Introduction

Patient education should be a priority to empower patients to care for themselves and improve patient outcomes. Involving patients in their own care can help them to understand about their wound and be more adherent to the overall treatment plan. Remember to involve the caregiver or family if applicable. Ask your patient questions about who will be changing the dressing so the appropriate parties can be involved. Educating and explaining wound bed preparation to your patient are vital in impacting their healing outcome. Demonstrating the appropriate technique for wound cleansing and explaining the signs and symptoms of infection to watch for, when to call their doctor, and how to change the dressing are all examples of topics that are essential in education.

As clinicians we tend to forget how the patient with an open wound must feel. Most patients have feelings of fear and uncertainty, and they may also experience feelings of depression and reduced self-image. Providing ongoing education from admission to discharge, while keeping your patient or caregiver involved in their care, will support all aspects in their plan of care.

Debridement

Remember to educate patients on their level for best understanding. Not every patient learns the same way. Explaining the debridement procedure to patients will help them know what to expect, lessen any fears, and involve them on how their wound healing outcomes will be impacted. Common questions from patients normally include:

• What is debridement? Explain the procedure, benefits, risks, and pain management. Instruct them to call the doctor if there is bleeding that will not stop, signs of infection, or uncontrolled pain.
• Why does my wound need debrided? Explain how this helps clean their wound and heal faster. There may be some minor bleeding, and a dressing will be applied.
• How often will my wound be debrided? Explain that some wounds are debrided every week or as needed. Other debridement methods may be used alone or in conjunction to keep the wound clean.
• Will it hurt when you debride my wound? Explain about any expected discomfort and steps to prevent pain (such as the use of lidocaine or other preventative measures), and establish that the provider will stop if pain is intolerable.

Infection Prevention and Management

Wound cleansing is very important in wound bed preparation, and it should be explained to patients how this step will help their wound to heal. This process optimizes the healing environment by loosening and washing away debris, exudates, foreign matter, and bacteria, thereby promoting healing and preventing infection. It should be explained to patients that removing surface contaminants, bacteria, and remnants of previous dressings from the wound surface and surrounding skin is needed to prepare the wound bed for healing and to maintain the wound bed.¹ Again, it is important to discuss with patients beforehand any possible discomfort they may experience.

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The use of antimicrobial dressings is indicated in wounds for prevention and management of infection, and clinicians should maintain practical knowledge of dressing properties and when to start and stop treatment for best clinical effective care. Antimicrobial dressings kill microorganisms by exerting a broad spectrum of non-selective antibacterial action. The benefits of using antimicrobial dressings are easy use, availability, cost-effectiveness, and less risk of drug resistance.² Patients should understand what dressings are being used on them and why, as well as receiving detailed instruction on how and when to perform dressing changes.

Moisture Management

Maintaining a dry and intact wound dressing is important because it will help to maintain an optimal moist wound healing environment. Monitoring moisture at the dressing site enhances healing. For example, if there is strikethrough or leaking from a dressing, a dressing change is needed. Too much moisture will macerate the wound and surrounding tissue, and too much dryness will desiccate the wound and surrounding tissue.³ Educating patients on the role of moisture in wound healing and the signs to watch for in their dressings that their wound is either too wet or too dry will involve them in care and ensure that moisture balance issues are addressed early.

It will also help to combat certain beliefs, such as the idea that wounds need to be “aired out” occasionally. Airing out wounds can lead to drier wound beds and reduced temperature, both of which can have negative impacts on wound healing. Negative pressure wound therapy (NPWT) may be used on wounds with excess exudate. NPWT is the use of negative pressure on a wound to remove exudate and debris and to facilitate granulation tissue growth. If NPWT will be used as part of the wound management plan, patients should receive education on what the NPWT device is, what it does, and how often the dressing will need to be changed and the canister emptied. A schedule should be set up for when they need to come into the clinic, and what at home activities they need to avoid or modify in order to achieve best outcomes, such as detaching the hose and suction device from the dressing when showering.

Many NPWT devices can be worn for seven or more days, reducing the number of dressing changes needed. Further, advances in NPWT technology have made these devices smaller and more discreet, helping patients to maintain their normal daily activities. Patients who are not educated on the proper care of their wound may cause complications in healing or may even worsen the wound’s condition. A prime example of the dangers of ignorance is bathing. Showering is preferred to bathing in patients with wounds because soaking a wound is a potential risk for infection and maceration. For some wounds, even showering may not be recommended for a period of time; in surgical wounds, physicians normally advise patients to wait two to three days to shower.⁴

Conclusion

Education provided along the wound patient’s journey will impact how they feel about their care, will affect their adherence to wound care, and ultimately will lead to better healing outcomes. When patients and family or caregivers are involved in their care and are given an opportunity to ask questions, they become more engaged and therefore learn effectively. Communication between you and your patient is key in the overall care. Talk and listen to your patient to better understand their needs for successful care planning. Sometimes your patient is giving you the answer you are looking for.

References

1. Winter GD. Formation of the scab and the rate of epithelialisation of superficial wounds in the skin of the young domestic pig. Nature. 1962;193:293-294.
2. Rodeheaver GT, Ratliff CR. Wound cleansing, wound irrigation, wound disinfection. In: Krasner DL, van Rijswijk L, eds. Chronic Wound Care: The Essentials e-Book. Malvern, PA: HMP; 2018:47-62.
3. Vowden P, Vowden K, Carville K. Antimicrobials dressings made easy. Wounds Int. 2011;2(1).
4. Schultz G, Mozingo D, Romanelli M, Claxton K. Wound bed healing and TIME: new concepts and scientific applications. Wound Repair Regen. 2005;13(4 suppl):S1-S11.
5. Toon CD, Sinha S, Davidson BR, Gurusamy K. Early versus delayed post-operative bathing or showering to prevent wound complications. Cochrane Database Syst Rev. 2015;(7):CD010075. doi:10.1002/14651858.CD010075.pub3