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During community placement, my mentor and I visited M (patient), a 75years old lady, who was presented with a Pressure Ulcer, on the heel of her right leg. On arrival, my mentor asked me to manage M’s wound. However, I have observed and participate in carrying out this skill (wound care) with my mentor on several occasions. I explained the procedure to M and gained her consent to carry out the procedure.
The preparation and application of aseptic technique was quite challenging in M’s home, however I washed my hands, worn apron and gloves, and adopt aseptic technique. When I remove the old dressings and assessed the wound, I observed that M’s wound was slightly exudates, odour, sloughs and dry skin (flakes) around the wound. When M asked me, how the wound was, I was not confident to answer her question, but rather turn to my mentor, who then answered her.
I displayed the sterile pack on a flat surface and I dipped the gauze into a warm normal saline and gently cleaned the wound; I cleaned the slough and remove the dead tissues, under my mentor’s supervision and I also applied intrasite gel unto the wound bed, and put an antimicrobial heel dressing and securing it with a two way stretch bandages (tubifast).
I was nervous, when my mentor asked me to carry out this procedure and thus, became very careful not to cause more pain to M. Being an invasive procedure, I was worried not to infect the wound when it was exposed, and when I could not answer her question, I felt uncomfortable.
Being an invasive procedure, I adopt aseptic techniques; Hart (2007) state’s that, employing aseptic technique helps to create an environment (asepsis) free from living pathogenic micro-organisms. Aziz (2009) conceded that, it helps prevent wound from contaminations and other susceptible site, by organism that could cause infection (HCAIs). I gently remove the slough and dead tissues, and applied an intrasite gel unto the wound bed, and then I put an antimicrobial heel dressing on the wound. Fletch (2007) suggests that, the removal of necrotic tissue and thick slough from wound bed, helps to promote healing by creating moist balance and controls bio burden to ensures optimal healing environment. Barrett (2009) concurs that, the management of wound required dressing that can maintain a moist environment, absorbs exudates as well as remain in situ over number of days.
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As a novice practitioner, I found it quite challenging carrying out aseptic technique in M’s home. Hallett acknowledge this situation and state’s that
“The nature of the home environment makes it difficult to maintain control over any procedure, but particular problems arise when the procedure involves trying to prevent contamination” (Hallett 2000 cited in Unsworth 2011).
Another bad situation was when M asked me ‘How is the wound?’ I could not answer her and my mentor had to rescue me. NMC (2004) warns that, Nurses are accountable for their actions in practice and it’s the nurse responsibility to explain treatments to the patients.
On assessment, the wound was slightly exudates, odour, sloughs and dry skin patches on the surroundings. Sprakes (2010) state that, holistic assessment of patient and the wound are essential in order to facilitate the wound healing process. Ousey and McIntosh (2010) points out that, chronic wounds are exacerbated by a sequence of misdiagnosis, neglect, incompetence or inappropriate treatment strategies. I observed that, M’s wound was with exudates and sloughs; this made me to identify and address the potential barriers to healing (Alexander et al 2006). Hence, I soak gauze in saline water to clean the exudates and remove sloughs from the wound bed, and I applied intrasite gel unto the wound bed and covered the wound with an antimicrobial heel dressing.
Dougherty and Lister (2008) concurs that, wound bed preparation, involves a systematic and deliberate approach to remove barriers, in order to allow natural healing, and enhance the effects of advanced therapies. Adderley (2010) added that, the presence of a sloughs or dead tissue can make wounds susceptible to infection, inflammation, bacteria and becoming non-viable. However, Dowsett and Newton (2005) points out that, inflammation is a normal stage in healing process, but when wound healing becomes stuck on inflammatory, it produces exudates as a reaction to tissue damage and causes delay to wound healing process. therefore, practitioners need to be able to distinguish between a normal inflammation and infected wound. Infected wound causes pain, discomfort and delay healing as well as life threatening to the patients (Benbow 2009). Therefore, in order to promote wound healing, I use bandage to secure the dressings and allow the wound to produce moist environment suitable for skin re-generation (Andrews 2010).
Assessment and treatment strategies are important procedures for hard-to-heal wounds like pressure ulcer, it requires in-depth knowledge base and skills, in order to ensure safe interventions and maintain quality standard of care.
Wound care (pressure ulcer) is a complex procedure. In future practice, I will read in-depth, on assessment and treatment of patient and the wound, in order to ensure that patients receive the best possible evidence-based care.