Taking care of wounded patients and its efficacy depends on the processes followed as well as documentation. In this regard, the concept of Hospital in the Home (HITH) mentioned by Tran & Taylor (2009) will be useful while reviewing and discussing wound care and documentation as the range of conditions treated by HITH and the evidence supporting the efficacy of wound care can be compared. Moreover, in the HITH system, documentation is important for the doctor or nurse to know the condition of the patient and give necessary treatment (Tran & Taylor, 2009).
The documentation in wound care can help nurses treat the patients at home and medical review to be taken at a parent hospital. Though every wound care is not treated at home, the review and documentation of the treatment are also useful in wound care taken for fungating malignant wounds. According to Patricia Grocott, Natasha Browne, Sarah Cowley (2005) the management of these types of wounds is palliative in nature to optimise the quality of life. As this type of care depends on physical symptoms as well as psychosocial needs the treatment mixed with documentation can give good results and can also conceptualize the quality of life (Patricia Grocott, Natasha Browne, Sarah Cowley, 2005).
Along with the subjective assessment of wound care documentation, the importance of treatment and documentation will find a place in the review. According to Carolyn Buppert (2000), the documentation depends on the nurse’s medical visits to the patient in the absence of a doctor. One of the requirements that allow the nurses to visit the patients is the documentation of subjective assessment of the patients suffering from wounds and should meet the documentation guidelines for evaluation and management from health care financing administration (HCFA) (Carolyn Buppert, 2000).
The evaluation of HCFA can result in pay for performance strategies and thus can result in reimbursement strategies as well and demands the documentation of clinical results with healing rates. This type of study by William J. Ennis, Emily Fibeger, Katie Messner, Patricio Meneses (2007) is an example of an ontological study that explains the existence of wounds and their healing rates. The authors state that the healing rates have become both clinical and marketing tools for the hospital that offers treatment for wounds. They recognise that the recording and reporting of clinical results regarding wound care are imperative, but the stratification of patient’s risk is important and this aspect should find a place in documentation. In this regard, William J. Ennis et al., (2007) cite an example of a patient with venous leg ulceration of one-year duration, who was unsuccessfully treated when he approached a primary care doctor clinic. The absence of documentation in the primary care resulted in debridement, and he was treated with moist dressings and compression. It took eight weeks for him to be an outpatient and at this juncture, the documentation at the hospital about his treatment helped the nurses visit him at home (William J. Ennis et al., 2007).
The documentation of treatment as mentioned above leads to characterize the changes in concentrations in the case of the tumour necrosis factor. Regarding this aspect, the study of Deepak V. Kilpadi, Joyce K. Stechmiller, Beverly Childress, Linda Cowan, Melissa Comerio, Kristine Kieswetter, Gregory Schultz (2006) examines the development of pressure ulcers and the care given to the patients suffering from them and thus gives rise to a philosophical study of wounds. The type of wounds observed and treated by the authors are the ulcers that are developed due to persistent pressure on soft tissue over a bony site in the body. This results in obstruction in capillary flow thus leading to tissue necrosis. Deepak V. Kilpadi et al., (2006) observed that physiological response to tissue injury gives rise to a surge of events that last for several days. Depending on the severity of the wound, this may last for some months also. After observing the key regulators that obstruct wound healing, the authors found that pro-inflammatory cytokines are the reasons for it. The growth factors, proteases, and protease inhibitors also played a role in obstructing the healing. Hence, the researchers used negative pressure wound therapy (NPWT). This promoted the healing by reducing the effect of pro-inflammatory cytokines. This is due to the established fact that the NPWT shows an effect on inflammatory cytokines within a few hours of application. However, debridement, treatment compliance, nutritional support in-patient settings help to avoid the effect of pro-inflammatory cytokines in the context of regulated healing of the wound (Deepak V. Kilpadi et al, 2006).
The regulated healing of a wound further initiates the discussion on venous ulcers that are directed at lowering venous hypertension. According to Oscar M. Alvarez, Mayank Patel, Juanita Booker, Lee Markowitz (2004) this further increase fibrinolytic activity in the wound thus increasing the vascularization or oxygenation of tissue from blood. This treatment is mixed with compression, and this makes leaked fluid back into circulation so that the wound healing can be hastened. This type of study by Oscar M. Alvarez et al., (2004) can be termed as ontological study as the existence of the methods during wound treatment and care are studied. The authors discuss compression and then turn to skin grafts as well as dressings when the ulcers need further treatment after compression. However, the wound should be ready for these grafts or human skin equivalents as well as dressings to carry them. Thus it is important to heal the wound up, to a certain extent, to apply skin grafts and human skin equivalents (Oscar M. Alvarez et al., 2004).
Despite the mention of skin grafts and human skin equivalents, the pain in chronic wounds has not been discussed in this paper until now. In this regard, Patrica Price (2005) mentions the need of treating the patient suffering from a chronic wound as treating a whole person. This refers to holistic care, and Price documents a philosophical study of the treatment of chronic wounds. The study of Price (2005) draws evidence from recent years which experienced persons living with a chronic wound that affected the quality of life of patients. Price states that after qualitative research, it was found that the aspect that affects the quality of life of a patient and makes him/her prone to distress is pain. Price also cites a Canadian study by Nemeth KA, Harrison MB, Graham ID, Burke S (2003) about the debate that exists about pain, which is undeniably subjective. The researcher further takes refuge under Gate theory that acknowledged the role of the brain process in pain perception and thus takes the treatment from a wound to the body and from there to the brain thus supporting the necessity of holistic treatment necessary for patients with chronic wounds (Patrica Price, 2005).
The holistic treatment put forward by Patrica Price (2005) demands accurate and reliable wound measurement that is only possible with documentation and wound assessment as part of the treatment. Marco Romanelli, ValentinaDini, Lee C. Rogers. Catherine E Hammond, Mark A. Nixon (2008) mentions alerts to a clinician to evidence of deterioration and enhancement of communication between health care providers and patients. The documentation regarding the interventions of the practitioners also can help to have a robust rationale in deciding the further treatment when the wound healing is slow or if there is no change. The documentation should include the clinical evaluation of the extent of tissue, which will be useful in wound assessment for further treatment. The skin lesions if any should also find a place in the documentation and the equipment used to treat wounds also should find the place in documentation (Marco Romanelli et al., 2008).
The documentation of wounds is for subjective assessment, and that is useful for the treatment of wounds caused due to pediatric burns. According to Ingo Jester, Ingo Bohn, Throsten Hannmann, Karl-Ludwig Waag, Steffan Loff (2008) the dressings containing silver and cream containing silver sulfadiazine are effective in the treatment of burn wounds. Ingo Jester (2008) found that the silver dressings are effective for even acute and chronic wound care. The authors further state that the silver sulfadiazine impregnated with hydrocolloid wound dressing has been found antibacterial for 48 hours and content Ag which is a polyurethane foam was also found useful to maintain antimicrobial standards for weekdays in the treatment of wounds due to paediatric burns. Thus, the researchers opine that these treatments decreased the mortality of children due to wound infection (Ingo Jester et al., 2008).
Thus, decreasing wound infections is to make them aseptic. There are widespread aseptic techniques, during vaginal birth as well as caesarean birth. Even then the infections may result in terminating a pregnancy. This may even cause maternal morbidity in a few cases. Regarding this aspect, Nell Tharpe (2008) mentions infection in these wounds. He estimated that as the second highest cause for maternal deaths and not diagnosed in such a way in the United States. Hence, the researchers found it important to avoid infections that make worse the effects of wounds. Though they mention the wounds in the genital tract, the aspect of nullifying the effects of infection on any wound is suggestible as they quote that with the advent of enhanced sterile practices and use of antibiotics, morbidity, as well as mortality, has been decreased significantly (Nell Tharpe, 2008).
Use of Antibiotics
The use of antibiotics and sterile practices are growing mature with time. According to research done by William J. Ennis, Claudia Lee, Mary Vargas, Patricio Meneses (2004) randomized controlled trials are replacing case reports. As a result, clinicians at present are focussing on outcome data instead of experience. In this regard, the authors made research on hospital-based wound clinics and wound aetiology, wound measurement, vascular assessment, lab testing and Imaging were done on the patients. They followed LCD, CWATS and their treatments included electrical stimulation, ultrasound, negative pressure therapy and compression therapy as well as surgical debridement. Three years of data have been captured in this system, and then they turned to the sub-acute unit and the patients in this unit were visited by authors weekly once. They observed that the patients in hospital settings found fast recovery than the ones in sub-acute units (William J. Ennis et al., 2004). This emphasizes the need for holistic treatment as mentioned in the above subchapters.
As per the above review, the outcome measures of wound treatment can be divided broadly into three categories. The first one is about measures of clinical efficacy, and the second one is about health-related quality of life. The third one is health economics. The second aspect may also be generic or condition specific (Seaver L. Soon, 2004).
The review also considered the wounds of burns, and these can be categorized under epidermolysis bullosa (EB) which is a chronic genetic blistering skin disorder. Carol Schober-Flores (2003) term EB as an extreme skin fragility and blister formation, in this case, can be compared with wounds that are caused due to burns as treatment of EB has different levels, and they will be useful in treating different wounds (Carol Schober-Flores, 2003).
The study limitations are regarding the lack of practical work done by the researchers as this is a literature review. The research done by different doctors with the assistance of nurses are found and their methods, interventions and results are reviewed according to the need.
As per the review, the fact observed by Richard Bamberg, P.Karen Sullvan, Teresa Conner-Kerr, (2003) can be concluded. The authors interviewed AAWC members to respond about types of wounds in clinical practice and their culturing. They also recorded the responses on the purpose of culturing as well as lab tests. It was found that culturing of wounds will be a source of clinical information. It can be observed that this information has been underutilized in health care and thus the documentation can be used to avoid such mistreatments (Richard Bamberg, P.Karen Sullvan, Teresa Conner-Kerr, 2003).
Carol Schober-Flores. (2003). Epidermolysis Bullosa: The Challenges of Wound Care. Dermatology Nursing. 15(2). Jannetti Publications, Inc. Web.
Carolyn Buppert. (2000). Can I Prescribe Wound Care Therapy for Home Care Patients Under Medicare?. Medscape nurses. 2(2). P… Web.
Deepak V. Kilpadi, Joyce K. Stechmiller, Beverly Childress, Linda Cowan, Melissa Comerio, Kristine Kieswetter, Gregory Schultz. (2006). Composition of Wound Fluid From Pressure Ulcers Treated With Negative Pressure Wound Therapy Using V.A.C. Therapy in Home Health or Extended Care Patients: A pilot Study. Wounds. 18(5). P. 119-126. Health Management Publications, Inc. Web.
Ingo Jester, Ingo Bohn, Throsten Hannmann, Karl-Ludwig Waag, Steffan Loff. (2008). Comparison of Two Silver Dressings for Wound Management in Pediatric Burns. Wounds. 20(11). P. 303-308. HMP Communications. Web.
Marco Romanelli, ValentinaDini, Lee C. Rogers. Catherine E Hammond, Mark A. Nixon. (2008). Clinical Evaluation of a Wound Measurement and Documentation System. Wounds. 20(9). P. 258-264. HMP Communications. Web.
Nell Tharpe. (2008). Postpregnancy Gential Tract and Wound Infections. J. Midwifery Womens Health. 53(3). P. 236-246. Elsevier science, inc. Web.
Oscar M. Alvarez, Mayank Patel, Juanita Booker, Lee Markowitz. (2004). Effectiveness of a Biocellulose Wound Dressing for the Treatment of Chronic Venous Leg Ulcers: Results of a Single Center Randomized Study Involving 24 patients. Wounds. 16(7). Health Management Publications, Inc. Web.
Patricia Grocott, Natasha Browne, Sarah Cowley. (2005). Quality of Life: Assessing the Impact and Benefits of Care to Patients With Fungating Wounds. Health Management Publications, Inc. 17(1). P.8-15. Web.
Patrica Price. (2005). An Holistic Approach to Wound Pain in Patients With Chronic Wounds. Wounds. 17(3). P.55-57. Health Management Publications Inc. Web.
Richard Bamberg, P.Karen Sullvan, Teresa Conner-Kerr. (2003). Diagnosis of Wound Infections: Current Culturing Practices of US Wound Care Professionals. Wounds. 14(9). Health Management Publications, Inc. Web.
Seaver L. Soon. (2004). What are Wound Care Outcomes. Wounds. 16(5). Health Management Publications, Inc. Web.
Tran, A., & Taylor, D. M. (2009). Medical Model for Hospital in the Home: Effects on Patient Management. Australian Health Review, 33(3), 494+.
William J. Ennis, Emily Fibeger, Katie Messner, Patricio Meneses. (2007). Wound Healing Outcomes: The Impact of Site of Care and Patient Stratification. Wounds. 19(11). P. 286-293. HMP Communications. Web.
William J. Ennis, Claudia Lee, Mary Vargas, Patricio Meneses. (2004). Wound Outcomes from a Single Practice at a Subacute Wound Care Unit and Two Hospital-Based Outpatient Wound Clinics. Wounds. 16(5). Health Management Publications, Inc. Web.