The effect of self-treatment of wounds on quality of life: a qualitative study

The Chronic Wound-Related Pain Model: Holistic Assessment and Person-Centered Treatment

Chronic wound-related pain is a complex biopsychosocial experience that is experienced spontaneously at rest and exacerbated during activities. Tissue debridement, trauma at dressing change, increased bioburden or infection, exposure of periwound skin to moisture, and related treatment can modulate chronic wound-related pain. Clinicians should consider multimodal and multidisciplinary management approach that take into account the biology, emotions, cognitive thinking, social environment, and other personal determinants of pain. Unresolved pain can have a significant impact on wound healing, patients' adherence to treatment, and individual's quality of life.

Healthcare interventions to aid patient self-management of lower limb wounds: A systematic scoping review

Chronic lower limb wounds can be described as having the inability to progress through stages of wound healing. Although 80% of lower limb wounds develop as a result of venous insufficiency, other causes include arterial disease and diabetes. In addition to the sustained impact on quality of life, the chronicity of lower limb wounds presents a significant financial burden to healthcare systems. Self-management is a fundamental aspect of the long-term management of chronic illness and its relevance has intensified since the start of the global pandemic. The objective of this systematic scoping review was to define what the self-management of a lower limb wound entails and explore the interventions available to support patients to self-manage. A total of seven articles were evaluated. There was limited consensus regarding the definition and components of self-management in this area. Interventions involved patients participating in additional exercise, wound care, and lifestyle behaviours such as limb elevation and skin care. Only two studies applied theory and only one evaluated participant acceptability of interventions, making it difficult to assess the feasibility of implementation. Although the evidence reviewed provides some insight into the self-management of a lower limb wound, theoretically-guided research is needed in this area.

Surgical wound care preferences and priorities from the perspectives of patients: a qualitative analysis

OBJECTIVE

To explore patients' priorities and preferences for optimal care of their acute or hard-to-heal surgical wound(s).

METHOD

This qualitative study involved semi-structured individual interviews with patients receiving wound care in Queensland, Australia. Convenience and snowball sampling were used to recruit patients from inpatient and outpatient settings between November 2019 and January 2020. Interviews were audio recorded, transcribed verbatim and analysed using thematic analysis. Emergent themes were discussed by all investigators to ensure consensus.

RESULTS

A total of eight patients were interviewed, five of whom were male (average median age: 70.5 years; interquartile range (IQR): 45-80 years). Four interrelated themes emerged from the data that describe the patients' surgical wound journey: experiencing psychological and psychosocial challenges; taking back control by actively engaging in care; seeking out essential clinician attributes; and collaborating with clinicians to enable an individualised approach to their wound care.

CONCLUSION

Findings from this study indicate that patients want to actively collaborate with clinicians who have caring qualities, professional skills and knowledge, and be involved in decision-making to ensure care meets their individual needs.

Description and Utilization of Telewound Monitoring Services in Primary Care Patients with Acute Wounds in Singapore: A Retrospective Study

OBJECTIVE

To describe an inaugural telewound monitoring service (TMS) designed for the remote monitoring of acute wounds to empower primary care patients, and identify factors associated with the utilization of the TMS.

METHODS

Retrospective data were collected from 204 patients who participated in the TMS between June 19, 2016 and August 31, 2017 and analyzed using both descriptive and multiple regression analysis.

RESULTS

The mean patient age was 27.9 years (SD, 12.4); wound area was 7.8 cm2 (SD, 21.2); and duration of healing was 11.7 days (SD, 6.9). A multiple regression model based on patients' demographics and wound factors predicted which patients were likely to have more telewound sessions than face-to-face sessions. The model was statistically significant (F = 2.093 (11, 124), P = .025) with 15.7% of variance explained by the variables. An increase in age (P = .043) and increased days to healing (P = .043) were associated with a reduction in the number of telewound sessions.

CONCLUSIONS

The TMS is a valuable alternative to face-to-face wound care that enables patients with acute wounds to assume the roles of both patient and carer simultaneously. Age and healing duration are predictors for utilization of this service. Prompt attention to these predictors may improve service allocation and utilization.

The "self-treatment of wounds for venous leg ulcers checklist" (STOW-V Checklist V1.0): Part 1-Development, pilot and refinement of the checklist

Patients who have chronic wounds such as leg ulcers should be active participants in their treatment and care. This participation may include self‐treatment of the wound which involves the patient cleaning the wound, applying and removing wound dressings, and/or applying and removing compression therapy. The aim of the study was to develop a Checklist to assist nurses to appraise the conduct of wound treatment when undertaken by the patient. A three‐phase mixed methods study was conducted. A systematic and evidence‐based approach to developing and using structured observations for the study of health behaviour guided the process of developing, piloting and refining the Checklist. The resulting “Self‐Treatment of Wounds for Venous Leg Ulcers Checklist” (STOW‐V Checklist V1.0) can assist the nurse to evaluate the conduct of key self‐treatment behaviours in the areas of equipment and workspace, hand hygiene, wound dressing removal, skin care, wound cleansing and debridement, wound assessment, wound dressing application, and compression therapy application. The growing recognition that patients can benefit when involved in care, the need to enact self‐management because of COVID‐19, and the ever present competition for healthcare funding and resources are compelling reasons for patients, care providers, and healthcare services to afford the self‐management approach, and associated interventions such as self‐treatment, greater consideration. It is recommended that the STOW‐V Checklist is used with patients in a shared‐care model, with nurses and other healthcare professionals providing supervision and oversight of self‐treatment practices whenever this is feasible and acceptable to the patient.

The "self-treatment of wounds for venous leg ulcers checklist" (STOW-V Checklist V1.0): Part 2-The reliability of the Checklist

The “Self‐Treatment of Wounds for Venous Leg Ulcers Checklist” (STOW‐V Checklist V1.0) is an evidence‐based, standardised tool designed to assist nurses to appraise the conduct of wound treatment when undertaken by patients who have venous leg ulcers. A prospective reliability study was conducted to determine the reliability of the STOW‐V Checklist V1.0. Video‐recordings of patients who self‐treated their leg ulcer were obtained (n = 5) and nurses (n = 15) viewed each video‐recording three times and concurrently completed the Checklist. Internal consistency, inter‐rater reliability and intra‐rater reliability were evaluated. Cronbach's alpha for items in the Checklist was 0.792, 0.791 and 0.783 for Occasions 1, 2 and 3, respectively, indicating good reliability. Inter‐rater reliability was 0.938, 0.958 and 0.927 for Occasions 1, 2 and 3, respectively; these results were statistically significant and indicative of excellent reliability. Intra‐rater reliability was 0.403 to 0.999; these results were statistically significant and meeting or exceed adequacy in the case of all except two raters. The study provides preliminary evidence that the Checklist is measuring the concepts that it intends to measure and that there is a high level of agreement among raters. It is recommended that the STOW‐V Checklist V1.0 is utilised with patients in a shared‐care model, with nurses and other healthcare professionals providing supervision and oversight of self‐treatment practices whenever this is feasible and acceptable to the patient.