Malodorous fungating wounds: uncertain concepts underlying the management of social isolation

Defining palliative wound care: A scoping review by European Association for Palliative Care wound care taskforce

BACKGROUND

Deciding whether to transition to wound palliation is challenging for health care professionals because there is no agreed definition or understanding of palliative wound care, including the goals, core elements and differences from general wound management.

OBJECTIVES

To conduct a scoping review with qualitative synthesis to define palliative wound care in terms of its conceptual framework, goals, principles, components, and differences from general wound management, and provide a new definition of palliative wound care based on this scoping review.

ELIGIBILITY CRITERIA

Published literature that refers to the definitions, concept, goals and core elements of palliative wound care using any methodological approach, without any time limits, published in English.

SOURCES OF EVIDENCE

The searches were conducted in CINAHL Complete via Ebsco, Medline via Ovid, Cochrane Library, Scopus, and Google Scholar.

CHARTING METHODS

A data extraction form was developed by the review team and used independently for data charting purposes. Braun and Clarke's six phases of thematic analysis guided the qualitative synthesis.

RESULTS

A total of 133 publications met the inclusion criteria. Three main themes were developed to define palliative wound care and understand its differences from general wound management: 1- Healing potential of wounds and patient vulnerability, 2- Understanding the impact on individuals and family to address needs, 3- Towards new goals and perspectives in approach to care.

CONCLUSIONS

Palliative wound care focuses on symptom management, comfort, and dignity, but does not always target the healing of the wound, which is the goal of general wound care. The needs of the individual and their family must be addressed by clinicians through the provision of care and support that takes into account the true meaning of living and dying with a palliative wound.

PROTOCOL REGISTRATION

A review protocol was developed but not registered.

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®).

Social interactions, body image and oral health among institutionalised frail elders: an unexplored relationship

OBJECTIVES

This paper draws on theories of ageing, body image and disfigurement, to explore the potential for relationships between oral health, body image and social interactions between institutionalised elders.

BACKGROUND

Social relationships are important at all stages of life. A positive body image increases confidence in social interactions, which contributes substantially to health, well-being and quality of life. Body image can be negatively impacted by oral conditions, particularly those that are appearance related and do not meet cultural ideals.

RESULTS

Typically, the oral health of frail elders in long-term care facilities is poor, but to what extent poor oral health and dysfunction influence body image, and social behaviours is unclear.

CONCLUSIONS

We conclude that there is the potential for poor oral health conditions to contribute negatively to the social well-being in this population, but suggest that it requires further investigation.

An intense and unforgettable experience: the lived experience of malignant wounds from the perspectives of patients, caregivers and nurses

Malignant wounds occur infrequently, but are typically described as devastating and overwhelming. However, there has been little formalised research, and the vast majority of existing malignant wound literature comprises reports of health care professionals from their management of the physical symptoms. Few studies have investigated the lived experience from the perspectives of patients and nurses and none have investigated the experiences of lay caregivers caring for a patient with a malignant wound. As a result, there has been little mention in existing literature of the non physical issues associated with malignant wounds or how they might be addressed. The purpose of this study was to address this gap in knowledge by investigating the lived experience of malignant wounds from the perspectives of those living it. In-depth interviews were conducted with patients, caregivers and nurses. The data were analysed thematically within a hermeneutic phenomenological methodology to show four themes: (i) malodour; (ii) new mode of being-in-the-world; (iii) still room for hope and (iv) enduring memories. Although this study confirmed previous findings that malodour was one of the worst aspects of malignant wounds, it was significant that the other three themes occurred in the previously largely overlooked psychosocial domain.

Malodorous fungating wounds: how dressings alleviate symptoms

Fungating wounds are unlikely to heal and therefore, the prime consideration should be the treatment and, where possible, the elimination of symptoms such as malodour. Malodour is the byproduct of bacteria and the fatty acids that are part of necrotic tissue. Application of dressings that block the odour, such as charcoal, or dressings that are antimicrobial, will reduce or remove the malodour that has such a negative effect on the patient's quality of life.

Management of malignant fungating wounds in advanced cancer

OBJECTIVE

To review the pathophysiology and assessment of malignant wounds and management techniques aimed at controlling pain, odor, exudate, and local bleeding.

DATA SOURCES

Current research and published literature.

CONCLUSION

Assessment of malignant wounds, selection of appropriate dressings, related symptom management, and patient and family support are vital aspects of cutaneous wound management in advanced cancer.

IMPLICATIONS FOR NURSING PRACTICE

A thorough understanding of the care of malignant wounds will assist oncology nurses achieving palliative goals of care including optimal symptom management, odor and drainage control, and emotional support.

Home Health and Wound Care: An Interdisciplinary Research Opportunity

This article reviews the role of the social worker in home care, briefly describes the literature concerning the psychosocial impact on wound care patients, and suggests opportunities for expanding this area of inquiry. The literature suggests that patients who have leg, foot, or pressure ulcers experience quite a number of psychosocial problems related to the presence and treatment of the wounds. The author is of the opinion that wound care research should include more disciplines, specifically social workers.