Introduction

An important step in wound management is identifying wound etiology. Pinpointing the problem often helps guide patient treatment. Identifying the cause of the wound, employing evidence-based interventions, and initiating an appropriate topical therapy will help to stabilize and, oftentimes, heal the wound.¹

However, the decisions patients make on a daily basis, along with activities (time spent in bed, chair, with legs dependent, etc), have a significant impact on healing outcomes, independent of the wound care professional. Patient-centered education is a huge piece of effective self-management and an essential component of the nursing plan of care.² This blog will focus on the importance of initial and ongoing patient-centered education in chronic wound management.

What Caused the Wound to Develop?

The first step in wound management is identifying the factors contributing to the wound’s development. This identification is achieved through physical assessment and patient interviews. Chronic wounds often have not only a systemic cause but an environmental cause as well, which is why it is so important to assess and look at the whole patient, not just the hole in the patient. Physical assessment should include identifying if the following is present¹:

• Sensory and functional limitations
• Continence (or incontinence)
• Vascular/perfusion status (especially for lower extremity wounds)
• Nutritional status
• Mobility (limitations)
• Any risk for forces of friction and shear
• Any underlying comorbidities which may impact healing

Pain and Patient Adherence

Pain is a major factor in wound management. Patients with uncontrolled pain may be less accepting of dressing changes or other interventions that may worsen their pain. Unrelieved pain may lead to limitations in mobility, a decrease in functional status, quality of life, an impact on mental health, and an overall delay in wound healing.¹ Ensuring appropriate pain management before, during, and after wound care is essential to managing the entire patient and providing a holistic treatment plan.

The Link Between Patient Education and Adherence

After an assessment, and as the clinician develops the treatment plan, it is vital to involve the patient in this planning and focus on patient-centered education. Education should be tailored to match the patient’s health literacy, language, culture, and specific concerns.² Self-management skills wound care professionals should educate the patient and/or caregiver on include the following:

• Wound cleansing
• Applying an appropriate topical treatment
• Recognizing a wound infection

Self-care skills are essential components of patient education, along with discussions on how to recognize and respond to a problem and preventative management.² An understanding of these concepts usually helps promote patient adherence to the care plan.² Verbal instruction, written communication, and hands-on demonstration often yield the best outcomes and level of understanding since patients often have unique learning styles. Effective education and subsequently enhanced adherence often may lead to reduced complications.

Theoretical Wound Care Nursing Frameworks

It's important to remember that theoretical frameworks guide the nursing practice in particular, and in this case, patient-centered education. The following frameworks discuss factors that influence adherence, behavior, readiness to engage in education/change, and the importance of self-efficacy²:

• The Health Belief Model (HBM)
• Theory of Planned Behavior (TPB)
• Social Cognitive Theory (SCT)
• Transtheoretical Model of Behavior Change (TTM)

Motivational interviewing (MI) is another significant communication technique that may help patients recognize discrepancies between nonadherence and treatment outcomes. Providers may use MI to encourage patients to prioritize outcomes based on personal values and create individual goals and wound management strategies while respecting patient autonomy.² Communication throughout the treatment plan and follow-up allows providers to continue reinforcing motivations and gains while reframing failed attempts as opportunities to learn about adherence and identify alternatives.²

Conclusion

Achieving wound care goals is rewarding but can be a challenging process. Health care providers can become discouraged by patient nonadherence and the impact this behavior has on chronic wound outcomes. Looking at the reasons for nonadherence and applying theory, MI, and individualizing the patient’s plan of care may help providers to respond more effectively.

Oftentimes, patients are overwhelmed by physical and psychological changes along with the complexity of treatment recommendations involved in chronic wound management. Positive outcomes and successful wound management may take time and effort to develop a rapport with our patient population (and their support systems/caregivers), and establish a therapeutic, trusting relationship.²

References

1. Calianno, C. How to choose the right treatment and dressing for the wound. Nursing Med/Surg Insider: October 2003 - Volume 33 - Issue - p 6-14.
2. Callender, LF, Johnson, AL & Pignataro, RM. Patient-Centered Education in Wound Management: Improving Outcomes and Adherence. Advances in Skin & Wound Care: August 2021 - Volume 34 - Issue 8 - p 403-410.

About the Author

Holly is a board certified gerontological nurse and advanced practice wound, ostomy, and continence nurse specialist at VA Northeast Ohio Healthcare System in Cleveland, Ohio. She has a passion for education, teaching, and our veterans. Holly has been practicing in WOC nursing for approximately ten years. She has much experience with the long-term care population and chronic wounds as well as pressure injuries, diabetic ulcers, venous and arterial wounds, surgical wounds, radiation dermatitis, and wounds requiring advanced wound therapy for healing. Holly enjoys teaching new nurses about wound care and, most importantly, pressure injury prevention. She enjoys working with each patient to come up with an individualized plan of care based on their needs and overall medical situation. She values the importance of taking an interprofessional approach with wound care and prevention overall, and involves each member of the health care team as much as possible. She also values the significance of the support of leadership within her facility and the overall impact of great teamwork for positive outcomes.