Introduction

Patient engagement in wound care improves patient experience and satisfaction and results in increased clinical and economic benefits.¹ As such, it is a worthwhile approach to take, but there are some considerations. The level of involvement desired by a patient is determined by their age, the duration of their wound and underlying disease, and their level of education and literacy.

Determining the Appropriate Level of Patient Engagement

In most studies, patients who are involved in their own care are more motivated and better able to tend to their own health and well-being because they know more about health and illness. Patients are not usually involved in the assessment, management, and prevention of their own wounds because these aspects of care have been seen as the job of a trained health care professional for a long time. However, when patients are involved in their health care, it improves their experience and satisfaction, as well as having clinical and economic benefits.¹

It is vital to understand the patient's desire for involvement and the scope of that involvement. For example, if the patient is confident, capable of making care decisions, and able to monitor and manage the wound on a daily basis, helped by regular clinician visits, the patient may be completely involved. Alternatively, patients may elect to participate collaboratively, sharing responsibility for wound monitoring and management with the practitioner. Advancements in technology give these types of patients other options such as using their personal smartphone to utilize a digital wound management measuring device or choosing telehealth option as a way to increase monitoring of their wound or as an alternative to in-person care during a pandemic. In some cases, however, individuals may be completely excluded from participation if they are unable to accept responsibility for a wound and hence rely on others such as family members or caregivers to make care decisions.^1,2

Clinicians should determine the patient’s level of awareness regarding their wound type and chronic conditions that may affect healing ability. Describing the care plan and stressing the importance for the patient to be involved will help in the patient’s participation.² The following are additional factors to consider when assessing the patient’s ability to participate in their care.

• Level of the patient’s social support
• Patient’s willingness and ability to participate in their own care
• Ability to establish reasonable, attainable goals and maintain effective follow-up
• Identification of anxiety or concerns the patient may have

Patient Education

When possible, involve your patients in their wound care, and offer to review their wound report and images with them. Use these times to educate patients and keep them hopeful by showing them how their wound has progressed toward healing. Discuss the difference between healthy and dead tissue, measurements, and treatment, and strive for positive feedback on adherence to the care plan. Using images may also assist the patient and family in understanding the seriousness of the wound and making decisions. Clinicians should inform patients on the importance of having photographs always taken as part of their medical record.

Inform them that digital images are taken to track the progress of their wounds and to assist them in receiving better care as a result. If the patient is interested in viewing the photographs, then share the images with them so they can be more involved in their own care planning. Educating and explaining how to prepare the wound bed and dress the wound to your patient can have a big impact on how well they heal. Demonstrating the right way to clean a wound and teaching patients or their caregivers what to look for when they have an infection, when to call their doctor, and how to change the dressing are important topics in education.

A patient's feelings about their care, how they follow through with their wound care, and how effectively they heal will all be influenced by the education they receive during the healing process. Patients become more engaged and better learners when they have a voice in their treatment and can ask questions.¹ Advanced technologies not only include the wound assessment measuring and documentation but also provide a focus on the patient’s level of pain within the clinical workflow. Pain is often overlooked when it comes to wound care, but pain that isn't dealt with can have a negative effect on healing. Chronic wounds can also make it hard to figure out how much pain the patient is feeling. This is because chronic wounds have many different causes and associated illnesses. It is very important to measure pain accurately when making a long-term plan of care.³

Conclusion

Patient involvement is critical in health care, given the increasing prevalence of wounds and the limited resources available to manage this increase. Thus, education and training are required to ensure that both clinicians and patients understand where patient involvement fits into the care trajectory and how it is founded on the concept of choice. The evaluation should consider the effect of patient involvement on the individual's knowledge, skills, and attitudes, as well as their perceptions of their level of involvement.

References

1. Vahdat S, Hamzehgardeshi L, Hessam S, Hamzehgardeshi Z. Patient involvement in health care decision making: a review. Iran Red Crescent Med J. 2014;16(1):e12454. doi:10.5812/ircmj.12454
2. Moore Z, Bell T, Carville K et al. International Best Practice Statement: Optimising Patient Involvement in Wound Management. Wounds International; 2016.
3. Bechert K, Abraham SE. Pain management and wound care. J Am Col Certif Wound Spec. 2009;1(2):65-71. doi:10.1016/j.jcws.2008.12.001