How to do it...Wound care

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1 One of the strongest suggestions involves making caregiving a family affair. Having good ties with family members can only help, most experts agree.

“Dedicate patient education as part of the plan of care. Educate the family along with the resident,” advises Diana Heasley, RN, CWCN, WCC, DAPWCA, CNS, president of Caring Directions Inc. and formerly the vice president of clinical services for DermaRite Industries.

“This can be done one-on-one if cognition allows, and even if it doesn't, the family is now more aware of what is needed, as far as nutrition, hydration, blood sugar control, positioning, etc.”

2 Heasley says it also can be helpful to set up a special diabetic program.

“Diabetes is such an insidious killer,” she says. “If we protect the feet with correctly fitting shoes, socks and encourage foot inspection, this will prevent skin breakdown. We can nip any issues early on.

“Additionally, education can be accomplished on the disease process to aid on the resident participation piece. Family also should be included here. Of course, the plan of care should reflect the education done and resident response, any resistance, etc.”

3 Wound prevention and wound care is an area that is “frequently overlooked” by some providers in resident teaching, notes Tambria Turco, vice president of clinical services for Covenant Care, an eldercare chain with 54 locations.

She said Covenant Care's employees are continually reminded of a handful of good teaching techniques that might be just as effective in other caregiving areas as well.

“Teach directly, face-to-face. Ask the resident to repeat the information back to you,” Turco advises.
“Have the resident do a return demo,” she adds.

4 Taking various “units” of learning slowly enough is also very important. Older people or individuals with compromised cognitive processing abilities never should be rushed with a multitude of information.

“Break the info up into small segments. For example, teach wound cleaning on the first visit, wound observation and monitoring on the second visit, and actual wound treatment on the third visit,” Turco says.

5 Keep the terminology simple enough for the individuals involved.

“Use simple layman's terms for medical facts,” Turco strongly recommends. To that end, she advises caregivers use these terms around residents and their families:

Sore (for wound)
Swelling (for edema)
Sore (for pressure sore)
Germs (for bacteria)
Bandage (for dressing)
Smell (for odor)
Dead skin or tissue (for slough)
New skin (for granulation)

6 Demonstrations and visual means are always a bonus when trying to express ideas or concepts. This includes wound care.

“Use visual material or audio presentations such as YouTube for unique methods of reinforcement of what you have taught,” Turco suggests. “The resident can then view them again and again.”

Repetition is a key to learning  with most people and long-term care residents are no exception.

7 There cannot be enough emphasis on clear, calm communication. Eliminate as much background noise as possible, and while not making the learning environment stifling, try to isolate it so the resident can focus more easily. It also might help to try different periods of the day to discover best learning times.

8 Turco also recommends involving family members in the teaching process. Schedule times to meet with them — with the resident's permission, she reminds.

Mistakes to avoid

--Ignoring the resident, or family members, so they can't assist in the wound care healing process.

--Trying to teach too much, too fast. Remember that these are not only nursing residents but they also could be struggling because of their wounds.

--Using terms that are medically oriented or too complicated for the layman.