The following post was written by Xiang Liu, a student at the Medical University of South Carolina.
Ever since I enrolled in the BSN program, I have heard a lot about specialized nursing. I became interested in wound care right after I did my first “wet to dry” dressing change in the Simulation lab.
Wound care is a science and is accompanied by its own pathology, language, nursing skill set and patient education. Fortunately, the Guided Nursing Electives course at Medical University of South Carolina gave me an opportunity to better understand wound care, and I was blessed with wonderful mentors and preceptors who provided me with a great start for becoming a wound care nurse.
By working with my mentor at Roper Hospital, SC, I saw a variety of wounds, I acquired knowledge and skills relative to management of wounds, incisions, skin ulcers and ostomies. I noted the different types of dressings and the different practices in day to day performance. I realized how medical complications could be prevented by providing patient education and by simply proper hand washing and infection control. I observed how my mentor changed dressings, how she handled wounds; more importantly, I was fascinated by how she interacts with patients, patients’ families and how she applies her global nursing skills. She is not only a great role model for wound care, she is also a role model to me personally with respect to becoming an excellent nurse in general.
I have gained additional learning experiences in this rotation.
First of all, I became familiar with ostomy and continence management. When I first studied ostomies, I believed no surgical procedure created more misunderstanding and fear than this one does. Through the time with my mentor, I gained a wealth of knowledge related to ostomy care). First I learned that ostomies are not only from some colon cancer procedures, other bowel diseases such as diverticulitis, inflammatory bowel disease and even traumatic injury to the bowels may also require an ostomy. I learned that an ostomy can be temporary or permanent. I learned that there are a variety of ostomy procedures including colostomy and ileostomy depending on the location of the disease. I learned how to manage the stoma as well as pouches. On top of this, I realized how important it is for an ostomy nurse to be present for pre- and post-surgical management of the patient.
Every Monday morning, I followed my mentor to mark the stoma sites for the patients who were scheduled to have bowel surgery. We assessed their abdomen in order to decide where the stoma should be. We made every effort to help the doctor create the stoma in an area that the patient can easily see, reach and take care of. Stoma site selection was a priority during the preoperative preparation; it helps to reduce postoperative problems including leakage, skin irritation, and clothing concerns. Furthermore, we also assist patients and their family in understanding about stoma care and the use of ostomy appliances prior to surgery.
Having an ostomy is a life changing experience for many patients, but patients should still be able to work, play sports, and exercise. This indicates another important role of an ostomy nurse: an ostomy nurse is the one who provides continuous personalized care for the best outcome possible; we are the one who guides the patient to maintain their healthy active lifestyle.
At the end, I was so fortunate and was privileged to observe the physician (Dr. Lagares-Garcia) performing laparoscopic robotic bowel surgery. This helped me to integrate my experiences and knowledge into a complete picture and was invaluable.
Second, I learned that excellent wound care means treating the whole patient, not just the wound. For example, we had a patient who was young but had an abscess that refused to heal. The patient has a long history of diabetes and obesity. During the conversation with him, my mentor identified several inconsistencies: the patient stated that he was living with his sister, but when he was asked if he has been checking his blood sugar routinely, he said he has been using his brother’s glucose meter. We understand that people with diabetes often have poor circulation which causes slow healing. My mentor suspected that his blood sugar had not been well controlled which was contributing to his poor wound healing process. “No fancy dressing could help his wound, if he doesn’t treat his underlying problem”, my mentor said. Understanding these interlinked causes, a diabetic educator was suggested to facilitate him controlling his weight and to regain control of his diabetes. Successful treatment of difficult wounds requires assessment of the entire patient. Systemic problems impair wound healing, in fact, non-healing wounds may reveal systemic pathologies.
Third, the term 'palliative care' is used to describe care given to patients with advanced, life-limiting illness. The palliative care goals are then transferred to wound care for patients whose wounds do not heal. We had a patient who was 89 year old with a complicated medical history: above the knee amputations on both legs, diabetes mellitus, peripheral vascular disease, dementia, malnutrition, and problems with swallowing. The patient had multiple ulcers staged from I to IV. A couple of her ulcers were undermining and/or tunneling. Based on the patient’s situation, my mentor suggested that the Palliative Wound Management might be more appropriate on this patient. She explained, “With the patient physical condition like this, aggressive wound treatment is not the priority intervention since the healing is not the primary goal. The goals of current wound care intervention (called palliative wound care) are stabilization of existing wounds, prevention of new wounds and symptom management.”
Finally, I discovered that finding new methods to improve wound healing have a great value in the clinical settings. This is another reason that I have passion for wound care since I have many years of research training in cancer biology. Specifically I believe that wound care is a clinical area that requires critical thinking and experimental approaches. Although there are a wide range of topical management options in wound management, choosing the most appropriate dressing makes a huge difference on the process of healing. Moreover, patients with underlying health conditions such as diabetes, stroke, heart disease, paralysis and many other illnesses contribute to wounds development that needs specialized care. “Effective dressing requires a stable “base”, my mentor said, implementation of personalized topical therapeutics guided by molecular diagnosis may result in significant improvements in outcome and my expertise in examining biological problems and finding solutions promotes me to be very interested in the science of wound care.
Overall, my experience in wound, ostomy and continence during the Guided Nursing Electives has given me an opportunity to witness how and what the WOC nurse should be and to understand the importance of treating the whole patient during wound care therapy. Wound care nurses must possess specialized wound care knowledge as well as a solid understanding of general nursing concepts, patient care, anatomy and physiology, and even psychological aspects of the patient. Wound care nurses are an extremely important part of the treatment team who make an enormous difference in the quality of patients’ lives by delivering expert care to individuals with wounds, ostomies and incontinence and by provide continuous care to help patients return to daily life and healthy lifestyles.
By writing this reflection paper, I am sharing how the experience improved my knowledge of wound care, and more significantly how it impacts my belief that nurses can make changes.
Before attending nursing school, I spent 15 years carrying out human disease related diagnostic and preclinical drug development research. This research provided me with a strong medical science background, but also has led to my realization that findings from basic research need translation into practical applications to prevent, diagnose and treat human disease. In my opinion, more than any other healthcare profession, nurses know what patients need, know what to do to meet those needs and how to make a difference. Having now graduated with my BSN, coupled with my previous research training, enables me to apply critical thinking skills to clinical settings. This integration raises me to a higher level allowing me to address complex questions and problems in critical care, especially in improving healthcare outcomes and preventing disease.