PATIENT TEACHING

It is important that patients be told what to expect during and after wound healing. Some helpful information to give a patient is described below:

• The wound area may tingle, feel strange, or itch. By pressing on the skin or by lightly rubbing it, the feelings can usually be lessened. These feelings may show up for many months, but they should be gone within a year.
• Deeper wounds may have injured some sensory nerves, so there may be numbness or lessened sensation distal to the wound. This problem usually improves on its own within a year.
• All full-thickness wounds, no matter how artfully repaired, leave a scar. Typical scars become darker and redder before they eventually fade. It can be a year or more before they reach their final appearance. Scar mobilization techniques taught by a physical therapist may be helpful.
• Currently, there is limited evidence that creams or lotions can limit scar formation, however Mederma cream can help to improve the overall appearance of the skin.
• If the patient is worried about something seen or felt in the wound or if the patient develops any of the signs and symptoms of an infection, it is important to contact the appropriate healthcare professional.
• If tissue glue has been used, it may cause a mild local inflammatory reaction.
  (WOCN, 2022; Baranoski & Ayello, 2020)

A Patient-Centered Approach

At their first encounter, the clinician begins to develop a therapeutic relationship with the patient, emphasizing that the patient is the most important team member. The clinician explains the steps the patient can take to actively participate in their own care. This is especially important for those with chronic wounds, in which control of blood sugar levels, weight loss, and compliance with compression therapy may play key roles in wound healing.

All information is phrased in plain language that the patient will understand. However, caution is required; what is plain language to one individual may be confusing to another. The age, background, and ethnicity of the patient must be taken into consideration. For instance, instead of referring to “the medial aspect of your leg,” a more easily understood description might be “the inside of your leg.”

Clinicians view wounds from a professional perspective, but that is not how patients see wounds. Wounds are open areas on one’s own body that can, and do, make life miserable. The psychological distress that a wound causes has the potential to impede healing. Patient fears include:

• “Will the wound leave a scar?”
• “Will it come back again?”
• “Can I still work?”
• “How will my partner, family, etc., react to my wound?”

Pain and depression are also significant factors for patients with chronic wounds. For instance, individuals with diabetic foot ulcers often experience intense burning or shooting neuropathic pain that can last for several hours and interfere with sleep. Depression is a common finding among patients with diabetes who have open wounds. It is related to pain, the array of complications they face, and the real possibility of amputation of part of a foot or leg and the resultant deformity.

Wounds with a malodor are particularly debilitating for a patient. They can be a source of embarrassment, shame, and social isolation. Wound care clinicians must practice emphatic listening and give straightforward, honest answers (WOCN 2022; Baranoski & Ayello, 2020).

Discharge Planning

When a patient is transferring to a new level of care or out of a facility, effective communication helps prevent a breakdown in care. All members of the wound care team should be involved in the discharge, with the case manager or social worker normally coordinating the process.

Patient concerns and anxiety about the impending transfer or discharge must be addressed. The patient is told what to expect at the next location of care. For example, a patient being transferred to a nursing home or rehabilitation facility is reassured that staff there will be able to continue the wound care and that a complete record of all treatments and interventions will be provided to the new facility.

Patients being discharged to home are also made aware of the availability of home health care and provided with a list of home health agencies in the area. Once an agency has been chosen, it is incumbent on the wound care team to communicate with the agency and arrange for the following:

• Patient’s projected date of discharge from the facility or clinic
• Date and time when the initial home health intake will occur
• Secure transfer of patient records and treatment plan to the agency
• If possible, a brief telephone conference with the home care wound clinician to discuss the plan of care and address any issues and concerns
  (WOCN, 2022; Baranoski & Ayello, 2020)

Home Care Instructions

Home care plays an important role in wound care, especially for chronic wounds, and the patient and caregivers must feel comfortable providing this care. It is important that the clinician observe the patient or caregiver doing hands-on care and reinforce or correct their technique as appropriate.

A written set of instructions explaining how to care for the healing wound is given to the patient. Included is a list of signs and symptoms of an infected wound and instructions regarding showering, bathing, and swimming. Healthcare facilities generally develop protocol-based, preprinted instruction sheets for each specific type of wound (WOCN, 2022; Baranoski & Ayello, 2020).

CHECKING FOR SIGNS OF INFECTION

Patients are instructed to watch for signs and symptoms of an infected wound. These include:

• Pus or yellow, greenish, or thick whitish fluid in the wound
• Increased redness in the wound
• Redness radiating out into the skin around the wound
• Red lines progressing up an extremity
• Increasing pain or tenderness
• Swelling
• Wound getting warmer than normal skin
• Fever
  (WOCN, 2022)

ELEVATING THE WOUND

Elevating the injured area will minimize swelling, reduce any throbbing pain, and speed up healing. If the wound is on an arm or a leg, patients are instructed to keep the injured area elevated during the first two days. For injuries to the hand or forearm, the patient can consider wearing a sling.

PROTECTING THE WOUND

Patients are instructed that:

• When healing normally, most wounds that have been directly closed will become impermeable to bacteria and water within two days.
• The edges of a directly closed healing wound are held together only weakly for the first five days; therefore, it is important to be especially careful with the wound for the first week. The new scar will then strengthen rapidly over the next month.
• A wound that has been splinted should remain immobilized until the sutures or staples have been removed.
• There is no general reason that most healing wounds need to be kept dry. Beginning on day three, or as ordered by the healthcare provider, patients with sutured or stapled wounds can shower then pat dry the wound and cover with a dressing if there is drainage, or as instructed.

CLEANSING THE WOUND

Patients with wounds will probably be sent home with a protective dressing. Minor wounds and many sutured or stapled wounds will no longer require these coverings after two days. The coverings can then be discarded and the wound left uncovered. However, if there is drainage, the wound is best left covered.

In most cases, patients can be advised that when treating the wound, cleanliness is needed but sterility is not.

A sutured or stapled wound without a dressing can be cleansed gently daily with soap and water beginning two days after the suturing or stapling. A major goal of these washings is to remove the crusting that develops from the wound exudate. Such a wound can remain uncovered starting on day three.

Almost any wound can benefit from being gently cleansed with soap and water in a shower. Taking a shower also cleans the skin around the wound much better than normal saline solution, and clean periwound skin also decreases risk of infection. About the only wounds that should not be in a shower are deep abdominal wounds or foot wounds (because foot wounds may end up soaking in water, which is not desirable).

When the wound is inside the mouth, the patient should rinse the injured area at least three times daily with warm normal saline solution (9% saline).

AVOIDING ALCOHOL

As alcohol may interfere with or interact with some medications, such as antibiotics and analgesics, and may increase bleeding, patients should be informed on an individual basis as to alcohol consumption.