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Contributors
ElizabethA.Ayello,PhD,RN,ACNS-BC,CWON,MAPWCA,FAAN Faculty
Excelsior College Schoolof Nursing
Albany, New York
ClinicalAssociate Editor
Advances in Skin & Wound Care
Executive Editor Emerita
Journalof the World Councilof EnterostomalTherapists (WCET)
Senior Adviser
The John A Hartford Institute for Geriatric Nursing President
Ayello, Harris & Associates, Inc.
New York, New York
SharonBaranoski,MSN,RN,CWCN,APN-CCRN,MAPWCA,FAAN
President
Wound Care Dynamics, Inc.
Nurse Consultant Services
Shorewood, Illinois
Symposium Director
ClinicalSymposium on Advances in Skin & Wound Care
EditorialAdvisory Board
Advances in Skin & Wound Care
NursingAdvisory Board
Rasmussen College
Romeoville/Joliet, Illinois
Councilof Regents & NursingAdvisory Board
Lewis University
Romeoville, Illinois
DanR.Berlowitz,MD,MPH
Co-Director
Center for Healthcare Organization and Implementation
Bedford Virginia Research Hospital
Bedford, Massachusetts
JonathanS.Black,MD Fellow Physician
PaulaErwinToth,MSN,RN,CWOCN,CNS
Director Emerita, WOC NursingEducation
Cleveland Clinic
Cleveland, Ohio
Caroline E.Fife,MD,UHM,CWS
MedicalDirector
St. Luke’s Wound Clinic
Chief MedicalOfficer
Intellicure
The Woodlands, Texas
Professor of Geriatrics
Baylor College of Medicine
Houston, Texas
SusanGallagher,PhD,MSN,MA,RN
Senior ClinicalAdvisor
Celebration Institute, Inc.
Houston, Texas
SusanL.Garber,MA,OTR,FAOTA,FACM
Professor
Department of PhysicalMedicine and Rehabilitation
Baylor College of Medicine
Houston, Texas
MaryJoGeyer,PT,PhD,CPed,FCCWS,CLT
Program Director
Indian River State College
Fort Pierce, Florida
KeithHarding,MB,ChB,FRCGP,FRCP,FRCS
Dean of ClinicalInnovation
Head of Wound HealingResearch Unit
Schoolof Medicine
Cardiff University
Cardiff, Wales, United Kingdom
WendyS.Harris,BSHS,BSN,RN
Hollis Hills, New York
SamanthaHolloway,MSc,PGCE,FHEA,RN
Senior Lecturer
Wound HealingResearch Unit
Schoolof Medicine
Cardiff University
Cardiff, Wales, United Kingdom
CarolinaJimenez
Research Assistant
Queen’s University, Schoolof Nursing
Kingston, Ontario
PaulKim,DPM,MS,FACFAS
Associate Professor
Director of Research
Division of Wound Healing
Department of Plastic Surgery
Georgetown University Hospital Washington, District of Columbia
Robert S.Kirsner,MD,PhD
Professor, Vice Chairman, and StiefelLaboratories Chair
Chief of Dermatology
University of MiamiHospital
University of MiamiMiller Schoolof Medicine
Miami, Florida
CarlA.Kirton,DNP,RN,MBA
Chief Nurse Executive
Lincoln Hospital& MentalHealth Center New York, New York
RonaldA.Kline,MD,FACS
Chief Division of Vascular and Endovascular Surgery
MedicalDirector of Wound Care
Carondelet St. Joseph Hospitaland Tucson Kindred Hospital Tucson, Arizona
StevenP.Knowlton,JD,RN
Partner
Locks Law Firm, PLLC New York, New York
JavierLaFontaine,DPM,MS
Associate Professor Department of Plastic Surgery UT Southwestern MedicalCenter
Bethesda, Maryland
MaryEllenPosthauer,RDN,LD,CD,FAND
President
MEP Healthcare Dietary Services, Inc.
Evansville, Indiana
SandyQuigley,RN,MSN,CWOCN,CPNP-PC
ClinicalSpecialist in Wound, Ostomy, and Continence Department of Nursing
Boston Children’s Hospital Boston, Massachusetts
KarenRavitz,Esq.
Nusgart Consulting, LLC
Silver Spring, Maryland
PamelaScarborough,PT,DPT,CDE,CWS,CEEAA
Pamela Scarborough Doctor of PhysicalTherapy
Certified Diabetes Educator
Certified Wound Specialist
Certified Exercise Expert for AgingAdults
Director of Public Policy and Education
American MedicalTechnologies Irvine, California
GregorySchultz,PhD
Professor of Obstetrics & Gynecology Institute for Wound Research University of Florida Gainesville, Florida
R.GarySibbald,BSc,MD,FRCPC(Med,Derm),MACP,FAAD,M.Ed, MAPWCA,D.Sc.(Hons)
Professor of Medicine and Public Health University of Toronto
ClinicalEditor, Advances in Skin & Wound Care
Course Director IIWCC & Masters of Science, Community Health (Prevention & Wound Care)
Past President World Union of Wound HealingSocieties Mississauga, Ontario, Canada
MaryY.Sieggreen,APRN,CNS,NP,CVN
Nurse Practitioner, Vascular Surgery
Foreword
Itis mypleasure to write the foreword for the fourtheditionof Wound Care Essentials: Practice Principles,editedbytwoofthemostrespectedpeople in the field of wound care, Dr. Elizabeth Ayello and Sharon Baranoski. As always, these editors have done a superb job of makingimprovements to a text that is already outstanding. The changes they have made are relevant and timely, and they have brought together an inimitable teamof experts to write each chapter. Over half of the chapters in this edition have either entirely new authors or additional experts added to a team of authors to assurethemostup-to-date,accurate,andpertinentcontent.
This edition follows rapidly on the heels of the recent release of the 2014 NPUAP/EPUAP/PPPIA clinical practice guidelines and systematicallyincorporates these into all appropriate chapters. Readers can be assured that clinical recommendations incorporated fromthe guidelines have been subjected to structured and deliberate scientific scrutiny to evaluate the strength of the evidence. In addition, clinicians can depend on the expertise of the authors to deliver the best in clinical decision making whenevidenceislackingbutactionisnecessary.
High-resolution color photos, so important to understanding the nature of various types of wounds and treatments, are no longer confined to the center pages ofthe bookbutare integrated throughoutthe textand placed in proximity to the content that is germane to the type of wound or type of treatment under discussion. In addition, Chapter 24 has a wound photo galleryof39differenttypes ofwounds withquestions for readers toanswer andconsider.
Several topics have expanded coverage in this edition. There is an entirelynew chapter onQualityofLife issues for patients withwounds that lays a sound foundation of theoretical issues before moving on to clinical concerns related to quality of life. Skin tears have been more thoroughly addressed, and the update includes the work of International Skin Tear AdvisoryPanel (ISTAP).Also,inthisnew andimprovededition,thereader will find the chapter onwound bioburdenhas beenrewrittenand expanded and fistula management has been added to the chapter on tubes and drains. These are but a few examples, but because of the many chapters that have new authors or coauthors, many other changes will be evident to those
familiar withthethirdedition.
As in the previous edition, a general emphasis on knowledge management remains. Knowledge management involves gatheringdata from a variety of sources, organizing it so that patterns become apparent, providing context that is relevant to understanding the principles related to action(inthis case, professional practice) and deliveringall ofthese things to the end user in timely fashion and in a format that expedites rapid assimilation.Thesearethe“bones”aroundwhichthethirdeditionof Wound Care Essentials: Practice Principles was built and the fourth edition retains this structure. New authors, new content, and new sources of evidence have been added. Context is provided with patient scenarios and case discussions as well as anexpanded use ofcolor photos withinthe text. Questions are provided atthe end ofeachchapter as a self-assessmentwith answers provided at the end of the book. All are in a format that supports rapidassimilationofcontent.
Congratulations to the editors and the authors on producing a book that will help clinicians, whether novices or experts, to manage the complex knowledgesurroundingwoundcareinatrulysubstantiveway
BarbaraBraden,PhD,RN,FAAN Dean Emerita, Graduate School and University College
Creighton University Omaha, Nebraska
QualityofLifeand ChronicWoundCare
KevinY.Woo,RN,PhD,FAPWCA
ElizabethVanDenKerkhof,RN,DrPH
CarolinaJimenez
We gratefully acknowledge the contributions of Mona Baharestani, PhD, ANP, CWON, CWS, for her work on previous editions of this chapter.
Objectives
Aftercompleting this chapter, you’ll be able to:
describe how wounds and those afflicted by wounds are viewed identify the impact of quality of life on patients with wounds and their caregivers
describe ethicaldilemmas confronted in wound care identify issues and challenges faced by caregivers of patients with wounds
describe strategies aimed at meetingthe needs of patients with wounds and their caregivers
Wound healing involves complex biochemical and cellular events
Chronic wounds do not follow a predictable or expected healing pathway, and they may persist for months or years.1 The exact mechanisms that contribute to poor wound healing remain elusive; an intricate interplay of systemic and local factors is likelyinvolved. Withanagingpopulationand increased prevalence of chronic diseases, the majority of wounds are becoming recalcitrant to healing, placing a significant burden on the health system and individuals living with wounds and their caregivers. Although
imageandself-concept,andlossofindependence
4. PrUsymptoms: managementofpain,odor,andwoundexudate
5. HealthdeteriorationcausedbyPrU
6. Burdenonothers
7. Financial hardship
8. Wounddressings,treatment,andother interventions
9. Interactionwithhealthcareproviders
10. PerceptionofthecauseofPrU
11. Needfor educationaboutPrUdevelopment,treatment,andprevention
Diabetes is one of the leading chronic diseases worldwide.13 Persons with diabetes have a 25% lifetime risk of developing foot ulcers that precede over 80% of lower extremity amputations in this patient population.14,15 The 5-year mortalityrates have beenreportedtobe as high as 55% and 74% for new-onset diabetic foot ulcers and after amputation, respectively; the number of deaths surpasses that associated with prostate cancer, breast cancer, or Hodgkin’s disease.15 Individuals with unhealed diabetic foot ulcers share some unique challenges. Due to problems using the foot and ankle, patients with foot ulcers suffer from poor mobility limiting their ability to participate in physical activities.16 Mobility issues may also interfere with their performance at work resulting in loss of employment and financial hardship. Increased dependence can lead to caregiver stress and unresolved family tension. High levels of anxiety, depression, and psychological maladjustment may affect patients’ abilities toparticipateinself-managementandfootcare.16,17
It is estimated that approximately 1.5 to 3.0 per 1,000 adults in North America have active leg ulcers, and the prevalence continues to increase due to anagingpopulation, sedentarylifestyle, and the growingprevalence of obesity.18 Chronic leg ulcers involve an array of pathologies: 60% to 70% of all cases are related to venous disease, 10% due to arterial insufficiency, and 20% to 30% due to a combination of both.19 Although venous leg ulcers are more common in the elderly, 22% of individuals develop their first ulcer by age 40 and 13% before age 30, hindering their ability to work and participate in social activities.20,21 To understand the experience of living with leg ulceration, Briggs et al.22 reviewed findings from 12 qualitative studies. Results were synthesized into five categories, similar tothoseidentifiedaboveinindividualswithPrUs:
1. Physical effectsincludingpain,odor,itch,leakage,andinfection
patient with a wound. Standardized wound care plans often fail because they do not promote patient adherence/coherence. Patients may be labeled “noncompliant” when the real problem is that the care plan has not been properly individualized to their specific needs taking into account their perspectivesonQoL.
