Malignant wound management in advanced illness: new insights

"Maintain Professionalism": Nurses' Experiences in Caring for Patients with Malignant Fungating Wounds in Taiwan

CONTEXT

Malignant fungating wounds (MFWs) occur among 5%-15% of patients with terminal cancers, the uncontrollable symptoms result in serious psychosocial issues, thereby reducing the quality of life. Caring for MFWs impacts caregivers, including healthcare personnel. While existing studies are patient-focused, the impact of care experiences and associated support for nurses has not been examined.

OBJECTIVES

To explore the experiences in caring for patients with MFWs among nurses in Taiwan.

METHODS

Qualitative study with a phenomenological approach by thematic analysis was conducted with semi-structured interviews. About 15 nurses who cared for patients with MFWs at local district hospitals in Southern Taiwan.

RESULTS

Four themes were identified to describe the phenomenon: (1) Fear of Unpredictability (2) Maintaining Professionalism (3) Feeling Helpless (4) Rationalizing the Negatives. The themes illustrated the distress of managing physical symptoms and highlighted how nurses strived to promote comfort for patients. Nurses felt helpless about the incurable nature of MFWs but found a way to suppress their feelings.

CONCLUSION

The findings suggested the need for addressing the emotional well-being of nurses who take care of patients with MFWs. Future studies should identify effective coping strategies for nurses' health when caring for this population.

Examination of the Odor-Eliminating Effect of a Deodorizing Spray on the Volatile Odorants of Malignant Wounds

PURPOSE

This study aimed to compare the odor components before and after spraying a deodorizing spray (DS) on volatile odorants in malignant wounds (MWs) in women with breast cancer; a secondary aim was to evaluate the deodorizing effect of the DS.

DESIGN

This is an observational study.

SUBJECTS AND SETTING

We investigated 3 patients who had MWs resulting from breast cancer. Participants were recruited from outpatient clinics in the Breast Surgery Department, University Hospital, Kanagawa, Japan.

METHODS

The target material was exudate-containing dressings collected from MWs. After collection, the odor components (air) were collected into a sampling bag by using a handheld pump. Then, after 5 sprays of a DS, air was collected in the same manner. All odor components were analyzed objectively by gas chromatography-mass spectrometry-olfactometry (GC/MS-O). The concentration in parts per million (ppm) of the main odor components in the air before and after spraying DS was compared, and the residual concentration rate (%) was calculated. Sniffing tests before and after spraying were also conducted to determine the subjective deodorizing effect of DS.

RESULTS

Of the possible hundreds of volatile odorants, 3 to 11 main components of volatile odorants were detected per subject. After DS spraying, the odorants dimethyl disulfide, dimethyl trisulfide, and benzyl alcohol were reduced according to GC/MS-O. The residual concentration of the following main odor components was also reduced: benzyl alcohol (30%), octanal (56%), p-dichlorobenzene (56%), isovaleric acid (56%), propylene glycol (63%), and nonanal (66%).

CONCLUSIONS

DS was effective against some volatile odorants in MWs, but no clear deodorizing effect was observed. Since there are individual differences in the type and number of odorants in MWs, the use of DS needs to be examined and verified in a larger number of cases.

A survey of UK nurses about their care of people with malignant fungating wounds

PURPOSE

To gain an understanding of the nursing professionals who treat people with malignant fungating wounds (MFW) in the UK and their current practices, including perceived barriers and facilitators to providing MFW care.

METHOD

An online anonymous questionnaire was created with questions about the role of nursing professionals who reported caring for patients with MFW, the number of people with MFW they regularly cared for, treatment aims, treatments used, and challenges faced. These questions were developed with professional input and piloted. Using a convenience sampling method, we collected responses from UK nurses by distributing the questionnaire via social media and through relevant professional organisations. The questionnaire was constructed in QualtricsXM software and analysed using SPSS.

RESULT

We received 154 questionnaire responses, with three-quarters from tissue viability nurses and the rest from community and other specialist nurses. The most important treatment aim reported was pain management, followed by odour management. Almost all respondents used antimicrobial and standard dressings for these patients, with a range of products reported. Poor access to MFW care training and lack of local and national guidelines were reported as barriers to providing care for people with MFW. Availability of dressings, access to training, and good communication processes were reported as facilitators.

CONCLUSION

This is the first study to explore MFW wound care practices in the UK. A range of nurses are involved in care delivery with variations in the treatments used. Lack of access to MFW care training, resources, and standardised guidelines may impede care delivery.

Changes in wound symptoms and quality of life of patients with newly diagnosed malignant fungating wounds

OBJECTIVE

This study examined changes in wound symptoms and the health-related quality of life (HRQoL) of patients with newly diagnosed malignant fungating wounds, and explored the factors that impacted the changes in HRQoL.

METHOD

This prospective longitudinal study included patients from three hospitals in China who had been diagnosed with malignant fungating wounds. Questionnaires were used to assess patients' HRQoL and their wound symptoms at the time of diagnosis (T0), as well as at one, three and six (T1, T2 and T3, respectively) months following the treatment period. Factors related to changes in HRQoL were analysed using generalised estimating equation models.

RESULTS

A total of 162 patients were included in the study. The patients reported low overall HRQoL. In three health-related dimensions (functional status, social relations and mental health), patients reported lower functional status at the time of wound diagnosis (T0), which then increased slowly with treatment over time. A lower QoL was associated with odour, exudate, bleeding, pruritus, a low performance status and the need for the dressing of wounds.

CONCLUSION

The HRQoL of patients with malignant fungating wounds exhibited significant changes across different periods. It is thus of great importance to formulate pragmatic, patient and family-centred palliative wound care management strategies.

Malignant wound aetiology, diagnosis and management: a case series and literature review

OBJECTIVE

Malignant wounds develop when neoplastic cells invade the skin either locally or by lymphatic and haematogenous spread. They can present as hard-to-heal wounds and underlying causes include: primary skin cancer; metastasis of extracutaneous primary malignancy; malignant transformation of a hard-to-heal wound; iatrogenic injury; and cutaneous forms of cancers of non-skin origin. High clinical suspicion for a malignant wound should be confirmed with skin biopsy. The aim of this case series is to highlight a combination of both clinically clear cutaneous malignancies and not-so-obvious wounds caused by malignancy.

METHOD

This case series examines patients with malignant wounds of varying aetiology and appearance. For each case, we explain the pathophysiology, atypical features, diagnostic approach and treatment. We also discuss types of wound biopsy and general wound management principles.

RESULTS

Among the 11 cases analysed using descriptive statistics, median wound duration before presentation at our clinic was one year, while median age at presentation was 65 years. Our case series included the following diagnoses: cutaneous metastasis of invasive ductal carcinoma of the breast (n=2); cutaneous metastasis of colorectal adenocarcinoma (n=1); Marjolin's ulcer (n=1), basal cell carcinoma (BCC) (n=2), primary cutaneous squamous cell carcinoma (SCC) (n=1), metastatic malignant melanoma (n=1), cutaneous T-cell lymphoma (n=1), cutaneous angiosarcoma (n=1), Kaposi sarcoma (n=1) and recurrent tonsillar SCC with osteoradionecrosis (n=1); one case had both BCC and SCC.

CONCLUSION

Punch and excisional biopsies were the most frequently used diagnostic techniques. Local wound therapy addressed bleeding, malodour, exudate, pain and infection. However, wound healing is usually achieved once the underlying malignancy is treated. In advanced or metastatic disease, palliative wound care aims to prevent exacerbation of existing wounds and focuses on patient comfort.

Best practices for managing malodorous and infected wounds in advanced cervical cancer

This cross-sectional study was conducted to examine the most effective strategies for managing malodorous and infected wounds in patients who have been diagnosed with advanced cervical cancer. The research was conducted in Liupanshui, China. The study specifically examined demographic profiles, wound characteristics and effectiveness of wound management approaches. The study incorporated the heterogeneous sample of 289 participants who fulfilled the inclusion criteria. Data collection was conducted via structured questionnaires and medical record evaluations. Descriptive statistics and statistical analyses, such as regression analysis, were utilized to evaluate demographic attributes, wound profiles and effects of different approaches to wound management. The findings unveiled the heterogeneous demographic composition of patients, encompassing differences in socioeconomic standing, educational attainment and age. A wide range of wound characteristics were observed, as 65.7% of lesions during the acute phase with diameter between 2 and 5 centimetres, while 41.5% of lesions had this range. The most prevalent types of infections were those caused by fungi (48.4%), followed by bacterial infections lacking resistance (38.1%). A moderate degree of odour intensity was prevalent, affecting 45.0% of the cases. With maximal odour reduction of 80%, a mean healing time of 25 days and patient satisfaction rating of 4.5 out of 5, Negative Pressure Wound Therapy demonstrated itself to be the most efficacious treatment method. Additional approaches, such as photodynamic therapy and topical antibiotic therapy, demonstrated significant effectiveness, as evidenced by odour reductions of 70% and 75%, respectively, and patient satisfaction ratings of 4.3 and 4.2. Thus, the study determined challenges associated with management of malodorous and infected lesions among patients with advanced cervical cancer. The results underscored the significance of individualized care approaches, drew attention to efficacious wound management techniques and identified critical determinants that impacted patient recuperation. The findings of this study hold potential for advancing palliative care for individuals diagnosed with advanced cervical cancer.

Impact of Co-occurring Cancer-Related and Wound-Specific Symptoms on Functional Performance Among Patients With Advanced Cancer and Malignant Fungating Wounds: An Exploratory, Observational Study

PURPOSE

The purpose of this study was to examine the impact of co-occurring symptoms in patients with advanced cancer and malignant fungating wounds (MFWs) on palliative and functional performance, and the feasibility of collecting self-reported data in this population.

DESIGN

This was an exploratory, observational study. Quantitative surveys and qualitative semistructured interviews using a phenomenological approach were employed.

SUBJECTS AND SETTING

The sample comprised 5 adults with advanced breast, oral, and ovarian cancer and MFWs. Participants were recruited from an urban outpatient cancer center, hospice, and wound center located in the Northeastern United States.

METHODS

Demographic and clinical characteristics were collected, and self-reported symptom and functional performance data measured. Descriptive statistics, T scores, confidence intervals, and standard deviation were calculated for quantitative data. One-to-one semistructured interviews were conducted by the first author to gain deeper understanding of participants' symptom experience. Qualitative data were analyzed using an iterative and inductive thematic data analysis method to identify major themes.

RESULTS

The mean cancer-related and wound-specific symptom occurrence was 17 (SD = 5.56) and 4 (SD = 1.26), respectively. Distressing, extensive co-occurring symptom burdens were experienced by all participants; they also reported poor functional performance and diminished palliative performance. Qualitative findings supported quantitative results.

CONCLUSIONS

Findings suggest that co-occurring cancer-related and wound-specific symptoms have incremental and negative impact on functional performance. The use of multiple data collection methods was feasible, including self-reported data in this advanced cancer population.

Fungating Malignancies: Management of a Distinct Wound Entity

GENERAL PURPOSE

To provide information on the surgical management of fungating malignancies as a distinct wound entity.

TARGET AUDIENCE

This continuing education activity is intended for physicians, physician assistants, nurse practitioners, and nurses with an interest in skin and wound care.

LEARNING OBJECTIVES/OUTCOMES

After participating in this educational activity, the participant will:1. Identify characteristics of patients in a study examining the treatment of fungating malignancies.2. Select common symptoms experienced by patients with fungating malignancies.3. Explain issues related to the surgical treatment of fungating malignancies.4. Identify a reason why patients with fungating breast masses may avoid medical care.

Successful Management of Exudate and Odor Using a Pouch System in a Patient with Malignant Facial Wound: A Case Report

Malignant fungating wounds are associated with heavy exudate and malodor, and can thus have a devastating impact on the physical, psychological, and functional health of patients at the end of life. Management is typically limited to the use of more absorbent dressings and frequent changing of dressings. However, this method is associated with a large amount of time needed for wound care, and does not always resolve the problem of malodor. Herein, we report the use of an inexpensive ostomy pouch to manage facial fungating wounds caused by maxillary gingival carcinoma. The pouches are adhered to the skin, and collect a large amount of malodorous exudate for days without leaking. Fewer dressing changes and the absence of malodor result in an improved quality of life for the patient and family.

The Microbiome and Metabolome of Malignant Fungating Wounds: A Systematic Review of the Literature From 1995 to 2020

PURPOSE

Malignant fungating wounds (MFWs) afflict up to 14% of patients with advanced cancer. The bacterial community structures of MFW may influence the development and severity of wound symptoms. The purpose of this systematic review was to evaluate existing evidence regarding the relationship between microbiome and symptoms of MFWs.

METHODS

A systematic review of the published literature from January 1995 to January 2020 was conducted. An established quality assessment tool was used to assess the quality of the included studies.

SEARCH STRATEGY

We searched 4 major electronic databases and retrieved 724 articles; 7 met inclusion criteria.

FINDINGS/CONCLUSIONS

Seven studies were included; the overall quality of the included 7 studies was ranked as adequate. Findings from the studies provided an incomplete characterization of the microbiome and metabolome of MFW; none included modern genomic technologies. Twenty different species of aerobes and 14 species of anaerobes were identified, with inconsistent identification of biofilms and multi-drug-resistant bacteria. Symptom occurrence increased with the number of bacteria species (P = .0003) and the presence of at least 1 anaerobe (P = .0006) in malignant wound beds. Cancer wound-derived odor was associated with dimethyl trisulfide and 4 fatty acid volatiles. Periwound and moisture-associated skin damage were associated with higher putrescine levels in exudates.

IMPLICATIONS

Understanding the role of microbiota of MFW in developing or amplifying the severity of wound symptoms is the first step toward development of more precise and effective topical interventions.

Application of a novel carboxymethyl cellulose-based Mohs sol-gel on malignant wounds in three dogs

The preparation of modified Mohs paste, commonly used for malignant wounds, requires time and effort. Moreover, metal-containing liquid waste is generated when malignant wounds are scrubbed. Therefore, we previously changed the base material of the modified Mohs paste from zinc oxide starch powder to carboxymethyl cellulose (CMC). The novel modified Mohs paste based on CMC (moM-CMC sol) may reduce these disadvantages. In the present study, the moM-CMC sol was applied to malignant tumors in three dogs to manage bleeding and malodor. The moM-CMC sol transitioned into a gel on the tumors within an hour of application and could be easily removed. The symptoms resolved in all cases. The moM-CMC sol could be beneficial for dogs with malignant wounds.

Making the best of multidisciplinary care for patients with malignant fungating wounds: A qualitative study of clinicians' narratives

BACKGROUND

Malignant fungating wounds occur in advanced cancer patients, often in the last 6 to 12 months of life, when malignant cells breach the skin, causing a non-healing wound. Little is known about the perspectives of clinicians who treat these patients or how collaboration is facilitated among different specialties.

OBJECTIVE

To understand the experiences and perceived roles of clinicians who treat patients with malignant fungating wounds from a multidisciplinary perspective.

DESIGN

A qualitative study using narrative interviews was conducted and data was analyzed to identify themes that encompass the experiences of clinicians who treat patients malignant fungating wounds and put these experiences in a temporal context.

SETTING/SUBJECTS

Ten clinicians who treat patients with malignant fungating wounds (n = 10) from various metropolitan research hospitals were interviewed. The clinicians were of different disciplines, including physicians and nurses, and different specialties, including palliative care, oncology, and wound care.

RESULTS

Three themes emerged that described how clinicians of varying disciplines and specialties understood their roles and navigated the transition from curative to palliative care for patients with malignant fungating wounds: (1) making the best of fragmented care (2) collaboration between oncology and wound care (3) transitioning from curative to palliative care.

CONCLUSION

Findings of the study present a timeline of clinical care for patients, with different specialties taking the lead at different points in clinical time. Recognizing when collaboration between specialties is essential, as well as when communication fails, or clinicians have differing perspectives is important to facilitate the best care possible for patients.

Malignant Wounds in Hospitalized Oncology Patients: Prevalence, Characteristics, and Associated Factors

Epidemiological and descriptive research on malignant wounds (MWs) is scarce. The objective of this study was to identify the prevalence of MWs and analyze the characteristics and associated factors of MWs in hospitalized patients at an oncological institution. An epidemiological, cross-sectional, and descriptive study, which was derived from a larger study that collected data on the prevalence of different types of wounds in 341 adults hospitalized in a large oncological hospital, was conducted. The present study comprehensively analyzed data related to MWs. Information was obtained through participant interviews, physical examination, and medical record review. The study was approved by the ethics committee of the institution where the study was conducted. Fourteen MWs were identified in 13 patients, who were primarily married (58%) and men (75%), with a mean age of 60.5 ± 15.1 years. Malignant wounds were predominantly located in the head and neck region (43%) and classified as 1N (50%) according to the Staging of Malignant Cutaneous Wounds instrument. Malignant wounds were characterized as painful (83.3%), with significant pain present during dressing changes (93%). The presence of MWs was associated with the use of antidepressants (odds ratio [OR] = 4.95; p = .012), upper-limb edema (OR = 8.39; p = .003), and infection (OR = 12.16; p = .051). The prevalence of MWs in hospitalized patients was 3.8%. Associated clinical variables were related to the degree of disease progression. This information provides evidence of the need for research identifying and investigating nursing interventions for patients with MW to assist with pain control during dressing changes.

Regenerated oxidised cellulose versus calcium alginate in controlling bleeding from malignant breast cancer wounds: randomised control trial study protocol

OBJECTIVE

Malignant wounds due to breast cancer can present with recurrent episodes of bleeding in the tumour tissue. This study will compare the efficacy of a calcium alginate dressing (Biatain, Coloplast A/S, Denmark) and a regenerated oxidised cellulose dressing (Surgicel, Ethicon, LLC, Puerto Rico).

PROTOCOL

A total of 24 patients with breast cancer and bleeding, malignant wounds will be enrolled in the randomised, controlled, open study, conducted at a hospital specialising in breast cancer treatment and at another hospital specialising in palliative care. Patients over 18 years old, with bleeding and willing to undergo venipuncture for blood collection will be included. All enrolled patients will be randomised for allocation to an experimental group (regenerated oxidised cellulose dressing) or a control group (calcium alginate dressing). The main intervention will consist of the application of the haemostatic product, assessment of digital pressure and estimation of the time required for haemostasis.

OUTCOMES

Key outcome measures will be the percentage of patients with haemostasis within 20 minutes, observation of haemostasis after three, five and 10 minutes, in addition to recurrence of bleeding and the quantity of product used.

DISCUSSION

To our knowledge, this is the first study to evaluate the effectiveness of haemostatic products in malignant wounds. This type of wound is poorly explored in the literature and, among its signs and symptoms, bleeding is poorly studied. The completion of this study will provide a more robust rationale for clinical decision-making related to the control of bleeding in malignant breast cancer wounds in the context of evidence-based nursing practices.

Nursing team knowledge on care for patients with fungating wounds

ABSTRACT Objective: to evaluate the nursing team knowledge of a cancer hospital on care for patients with Malignant Fungating Wounds (MFW) and to analyze associated sociodemographic and educational factors. Method: an observational and cross-sectional study, conducted between September and October 2015, after approval by the Research Ethics Committee. A questionnaire was applied containing sociodemographic, educational and related components to the accomplishment of dressings, dressings choice and orientation. Data were analyzed by using Chi-square, Fisher’s exact test, Student’s t-Test and Pearson’s correlation. Results: 37 professionals participated in the study, most of whom were technicians (56.8%), women (91.9%) and with a mean age of 32 years. The professionals presented 56.5% of correct answers. There were no statistically significant associations between sociodemographic/educational variables and number of correct answers. Conclusion: there was a lack of important knowledge about care for patients with MFW, which should guide strategies for the oncology staff training.

Revisión de las prácticas de enfermería en cuidado paliativo de pacientes con heridas oncológicas

Introducción: Los pacientes con heridas oncológicas o tumorales tienen unas necesidades específicas de cuidado, por dolor, exudado y mal olor; por lo tanto, los profesionales de enfermería deben brindar un cuidado integral y proporcionar confort y alivio de síntomas, a fin de mejorar la calidad de vida del paciente y su familia. Objetivo: Consolidar hallazgos de la literatura sobre prácticas de enfermería en cuidado paliativo de pacientes con heridas oncológicas en el manejo del exudado, dolor y olor. Método: Revisión integrativa mediante la búsqueda electrónica de artículos bajo la pregunta orientadora: ¿cuáles son las prácticas de enfermería en cuidado paliativo de pacientes con heridas oncológicas en cuanto al manejo del exudado, dolor y olor?, en el periodo 2000-2017, idioma inglés, español o portugués, en las bases de datos IdeA, Pubmed, ScienceDirect, SciELO, ProQuest y Dialnet. Resultados: Se identificaron 52 artículos, de los cuales 22 se ajustaban a la pregunta y presentaban información relevante. Esta revisión logró consolidar aspectos importantes sobre las prácticas de enfermería en cuidado paliativo, siendo de utilidad para profesionales de enfermería como un referente de intervenciones dirigidas a esta población con necesidades especiales de cuidado. Conclusión: Se requieren más estudios sobre el manejo de estos síntomas; no obstante, las prácticas documentadas hasta el momento se basan en una adecuada técnica, limpieza de la herida y control de carga bacteriana, elección de apósito atraumático de alta capacidad de absorción y múltiples intervenciones no farmacológicas.

The Microbiome, Malignant Fungating Wounds, and Palliative Care

Malignant fungating wounds present in 5–14% of advanced cancer patients in the United States and are a result of cancerous cells infiltrating and proliferating in the skin. Presentation of malignant fungating wounds often occurs in the last 6 months of life and therefore become symbols of impending death for patients and their families. Due to the incurable and severe nature of these wounds, patients require palliative care until death to minimize pain and suffering. Symptoms associated with these chronic wounds include malodor, pain, bleeding, necrosis, large amounts of exudate, increased microbial growth, and more. Limited research using culture-based techniques has been conducted on malignant fungating wounds and therefore no optimal approach to treating these wounds has been established. Despite limited data, associations between the cutaneous microbiome of these wounds and severity of symptoms have been made. The presence of at least one strain of obligate anaerobic bacteria is linked with severe odor and exudate. A concentration of over 10⁵/g bacteria is linked with increased pain and exudate. Bacterial metabolites such as DMTS and putrescine are linked with components of malignant fungating wound odor and degradation of periwound skin. The few but significant associations made between the malignant fungating wound microbiome and severity of symptoms indicate that further study on this topic using 16S rRNA gene sequencing may reveal potential therapeutic targets within the microbiome to significantly improve current methods of treatment used in the palliative care approach.

Evidence generation for wound care dressing selection: reviewing the issues

In the UK, dressings are categorised as medical devices and manufacturers only have to provide limited evidence of effectiveness before dressings are used in clinical practice. Therefore, evidence based on clinical trial methods is scant. As a direct result, governing bodies in the UK are now recommending that decisions to select one dressing over another could mainly be made on price. Placed within the movement critiquing evidence-based practice (EBP), this paper summarises the main issues surrounding the generation of evidence in selecting dressings for wound care, which is immersed in a context that lacks resources, legislative clarity and freedom to choose methodological alternatives. Dressings are therapeutic medical devices rather than consumables and any rationalisation based on costs may have far-reaching implications for wound care clinicians through purchasing decisions and thus may limit their ability to manage wounds effectively.

The neurosurgical wound and factors that can affect cosmetic, functional, and neurological outcomes

Surgically accessing pathological lesions located within the central nervous system (CNS) frequently requires creating an incision in cosmetic regions of the head and neck. The biggest factors of surgical success typically tend to focus on the middle portion of the surgery, but a vast majority of surgical complications tend to happen towards the end of a case, during closure of the surgical site incisions. One of the most difficult complications for a surgeon to deal with is having to take a patient back to the operating room for wound breakdowns and, even worse, wound or CNS infections, which can negate all the positive outcomes from the surgery itself. In this paper, we discuss the underlying anatomy, pharmacological considerations, surgical techniques and nutritional needs necessary to help facilitate appropriate wound healing. A successful surgery begins with preoperative planning regarding the placement of the surgical incision, being cognizant of cosmetics, and the effects of possible adjuvant radiation therapy on healing incisions. We need to assess patient's medications and past medical history to make sure we can optimise conditions for proper wound reepithelialisation, such as minimizing the amount of steroids and certain antibiotics. Contrary to harmful medications, it is imperative to optimise nutritional intake with adequate supplementation and vitamin intake. The goals of this paper are to reinforce the mechanisms by which surgical wounds can fail, leading to postoperative complications, and to provide surgeons with the reminder and techniques that can help foster a more successful surgical outcome.

Intervenções de enfermagem para pacientes oncológicos com odor fétido em ferida tumoral

Objetivo: identificar intervenciones de enfermería para el diagnóstico de olor fétido en herida tumoral. Métodos: revisión integradora de la literatura a partir de las bases de datos MEDLINE, CINAHL, LILACS e Cochrane, que resultó en la selección de 48 artículos científicos acerca de la temática investigada. Resultados: con base en las evidencias empíricas identificadas en los artículos incluidos en el estudio, se elaboraron 24 intervenciones de enfermería para el control y la reducción del olor fétido en heridas tumorales. Conclusiones: las intervenciones de enfermería presentadas en el estudio posibilitan la promoción de la calidad de vida al paciente con herida tumoral en cuidado paliativo. Como sugerencia posterior al Consejo Internacional de Enfermeros, se deben validar clínicamente para que su inserción se realice en el subconjunto terminológico cuidados paliativos para una muerte digna, de la Clasificación Internacional para la Práctica de Enfermería (CIPE®).

Subconjunto terminológico CIPE® para pacientes em cuidados paliativos com feridas tumorais malignas

Resumo Objetivo Desenvolver e validar um subconjunto terminológico, utilizando a Classificação Internacional para Prática de Enfermagem para pacientes em cuidados paliativos com feridas tumorais malignas. Métodos Estudo metodológico com revisão integrativa da literatura, que busca evidências empíricas relacionadas às feridas tumorais malignas e intervenções de enfermagem para manejo dos sintomas, nas bases de dados MEDLINE, CINAHL, LILACS e COCHRANE, recorte temporal de 2002 a 2015. Após cruzamento das evidências com termos da CIPE® 2013, baseado no Modelo 7 Eixos, foram elaboradas declarações de diagnósticos e intervenções de enfermagem, distribuídas de acordo com necessidades humanas básicas do referencial conceitual de Wanda Horta e avaliadas por peritos. Resultados Das 51 afirmativas de diagnósticos e 134 intervenções de enfermagem, 84,31% e 91,04% foram validadas respectivamente, sendo elaborado o subconjunto. Conclusão O instrumento poderá constituir-se numa referência de fácil acesso para enfermeiros, propiciando um cuidado da ferida baseado em evidências e linguagem de enfermagem unificada.