Ask the care expert ... about end-of-life wound care

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Sherrie Dornberger, RNC, CDONA, FACDONA, executive director, NADONA
Sherrie Dornberger, RNC, CDONA, FACDONA, executive director, NADONA

I work on a floor in a skilled care facility where most residents are on hospice or at the end of life. Some have wounds that will never heal. How should we care for these?

First, one never knows what will heal and what will not. Having been in long-term care for almost 40 years,I've found that improving or declining of a resident's condition is unpredictable.

There are more than 300 million residents worldwide, and about 3% need wound care while also receiving end-of-life care. Curing the wounds may not be a realistic goal, but a more palliative approach may be the best course of action.

Expert Aletha Tippett, M.D., has written about involving both humanity and compassion, and states that goals should include prevention and management of skin breakdown, enhancing comfort and controlling odor.

To this end, your team (including all disciplines) should develop compressive treatment plans to manage the symptoms. 

Wound treatment should enhance quality of life by stabilizing the wound, using appropriate dressings, managing infection, and protecting the peri-wound area. Pain control might include a pressure-relieving mattress; selecting dressing for fewer changes; medication prior to the dressing changes; and individualized turning and repositioning to relieve pain.

If the resident is taking no nourishment, consider higher protein, enriched drinks provide benefits while taking less in orally. That is why it is essential to include the entire interdisciplinary team, such as dietary, in the effort.

Keep in mind, too, when you are changing a dressing more than needed (because of improper dressings) it not only can cause discomfort but it also lowers the wound temperature, which can infringe upon healing.