What is wound care? Learn about the procedures, steps, risks, and requirements for providing wound care.
Wound care covers every stage of the wound management process. It’s a critical component of healthcare and one that may require special nursing skills. The wound care nurse is responsible for determining the proper treatment to promote healing and continually assess their patient’s skin.
This article focuses on the art and science of wound care, one of the most vital tasks for nurses and other medical staff. Healthcare professionals who master this skill can help prevent infection and potentially save lives!
(Click here to see our full list of the most common nursing duties and responsibilities).
Wound care can be exciting yet daunting among new healthcare professionals. Registered Nurses (RNs) are required to learn the proper techniques for this procedure in a medical environment.
Wound Care Definition
What Is Wound Care?
When caring for a wound, there are numerous factors to consider. These elements include the type of wound, the healing process, and the proper treatment for wound management.
Once the wound is appropriately diagnosed and all elements have been considered, the best treatment options can be determined. Stitches are often included, as well as bandages and medication.
Common types of wounds:
- Pressure injuries (i.e., pressure ulcers) contain localized damage to the skin or underlying soft tissue. This may present as intact skin or an open ulcer.
- Venous ulcers are linked to the incompetence of the valves of the lower extremities, allowing blood to reflux into the superficial venous system and causing edema.
- Arterial wounds result from severe tissue ischemia, which is a deficiency of blood in the tissue.
- Diabetic foot wounds (i.e., neuropathic ulcers). Neuropathy encourages ulcer formation by changing both pain sensations and pressure perception in the foot.
- Skin tears are a traumatic wound caused by mechanical forces (shear, friction, or blunt force). Skin tears are typically classified into one of three categories:
- Type 1: No skin loss.
- Type 2: Partial loss of the skin flap.
- Type 3: Total loss of the skin flap.
- Moisture-associated skin damage (MASD) is the inflammation and erosion of the skin that comes with exposure to all kinds of moisture, such as urine, perspiration, or wound drainage.
Who Performs Wound Care?
The amount of wound care that nurses perform can depend entirely on their location, specialization, and experience level. Registered nurses have the opportunity to become specialized in wound care. These nurses are known as Certified Wound Care Nurses (CWCN), and they can specialize in treating wounds, continence care (CCCN), ostomies (COCN), or all three, which would make them a fully Certified Wound Ostomy and Continence Nurse (CWOCN).
These nurses tend to fill central roles in hospitals, nursing homes, and home health agencies. Wound Care Nurses typically manage various wound-care programs, provide consultations for treating wounds, and provide direct patient care and education.
(Click here to learn how to become a nurse).
What Does a Wound Care Nurse Do?
Wound Care Nurses use several techniques to assess, treat, and care for patients with wounds. This usually includes wound debridement, cleaning, bandaging, and working with the doctor or care team to determine if other treatments are necessary (i.e., surgery, antibiotics, etc.) CWCNs also educate patients and their caretakers on caring for their wounds at home, preventing infections, and avoiding further injury.
Typical roles and duties of a Wound Care Nurse:
- Assessing and monitoring wounds
- Debriding, cleaning, and bandaging wounds
- Working with the care team to determine if other treatments are required
- Caring for ostomies, diabetic foot care, and more
- Educating patients and caretakers on wound care, infection and injury prevention, and pressure ulcer care
- Completing documentation for Medicare reimbursement
- Writing orders to promote wound healing and avoid skin breakdown
Training Requirements for Wound Care
Once you have earned your degree and passed the NCLEX-RN exam, you may want to pursue additional training and education to become specialized in wound care.
Some RNs enter this specialty after treating patients with chronic wounds in other areas (think oncology, critical care, etc.) Keep in mind that it’s uncommon for a new graduate to be hired into a wound-care position without gaining prior experience.
Many Wound Care Nurses have obtained a Bachelor of Science in Nursing (BSN) degree or higher. Requirements for Certified Wound Care Nurse (CWCN) include a BSN degree, an active RN license, and supplementary training.
The Wound, Ostomy, and Continence Nursing Certification Board offer four different wound care certifications:
- Wound, Ostomy, Continence
- Foot Care
- Advanced Practice
- Wound Treatment Associate
You can also pursue certification through Vohra Wound Physicians. They offer a Vohra Wound Certified Nurse (VWCN™) certification.
Where Do Wound Care Nurses Work?
Wound care nurses typically work within hospitals under various units, such as:
- Operating Room (OR)
- Critical Care
- Inpatient settings, where patients are bedridden
They may also find employment with home health care agencies, nursing homes, hospices, and public health agencies. There’s also an increasing need for WOCs in long-term care settings.
Necessary Equipment for Wound Care
The suggested supplies for wound care may include the following items:
- Gauze sponges
- Non-woven sponges
- Medical tape
- Alcohol pads
- Face masks
- Bandages and dressings:
- Suture removal kits
- Medical gloves
- Gauze rolls
- Cotton-tipped applicators
- Medical drapes
- Cotton balls
A Detailed Guide to Wound Care
By reviewing the following steps, you can begin to learn more about the process of wound care. Like any other skill, wound care requires a lot of time and practice to master. Try not to feel disheartened if you don’t get it right the first time, and don’t hesitate to ask your instructor for help.
Here are some of the general guidelines you should follow when administering wound care in a controlled setting.
Part One: Assess the Wound
Wound management should start with a comprehensive assessment of the wound. It should also include the following:
- Location on the body. Location often provides information on possible causes of the wound.
- Type of tissue damage. Determining the amount of tissue damage in a wound will guide the plan of care and provide possible clues for the healing timeline.
- Wounds may be described as partial-thickness—damage is limited to the epidermal and dermal layers—or full-thickness, with apparent damage in both the subcutaneous layers and below.
- Class of tissue. The tissue in the wound may be noted as “viable” or “nonviable.” For instance, viable tissue may look like a meaty red or light pink.
- The appearance of necrotic tissue varies. It can appear to be black, brown, or tan.
- Size of the wound. Use linear dimensions to ascertain the size of a wound (i.e., length times width). It’s best to measure a wound’s length from head-to-toe, whereas you can measure the width from side to side.
- Tip: For wounds with depth, you can measure from its deepest point to the surface.
- Keep an eye out for sinus tracts. These will sometimes appear in full-thickness wounds. Abscesses may form within this dead space.
- Don’t miss signs of undermining, either. Indicators include tissue devastation on the border of the wound. It creates a “liplike” effect.
- Observe wound edges. The edge of a wound may tell you how long it has been present. It might even help you determine the cause of injury.
- Wounds covering bony areas with sharp or clear edges can be connected to pressure.
- An irregular shape and undefined edges often signify venous ulcers on the patient’s leg.
- Look for infection. Signs of local infection—redness of the skin, pain, swelling, and wound odor, to name a few—should be noted during your assessment.
- Note pain levels. The amount of pain linked to the wound can provide vital information regarding its cause and potential duration.
Part Two: The Eight Objectives
After you have assessed the wound, you can initiate topical therapy. Topical dressings encourage the normal healing process in wounds.
- Combat the infection. If an infection is apparent, wound cultures should be considered. Also, be sure to discuss topical antiseptic products with the overseeing physician.
- Clean the injured area. Clean the wound during each dressing change. Important: Use products that will be compatible with the wound’s tissue.
- Remove damaged tissue from the wound. If you spot necrotic tissue, you will likely need to remove this tissue.
- Ensure there’s a degree of moisture in the wound. A moist environment can lead to wound healing, less pain, and lower infection. The key word here is appropriate—only ensure there’s an appropriate degree of moisture.
- Clear the dead space. Wounds with depth must be packed. Some typical packing agents are normal saline and hydrogel-impregnated gauze.
- Manage odor. Speak with the overseeing physician to ascertain wound cleaning protocol and the frequency of dressing changes.
- Limit pain. These wounds should be carefully assessed for the possibility of infection or other causes and treated immediately.
- Safeguard the periwound skin. Sometimes, the incorrect use of a moist dressing can cause Heavily draining wounds, or the improper use of a moist dressing can lead to damage of the periwound skin.
Part Three: Take a Step Back
Wounds don’t occur in isolation. This means that you need to look at a number of factors. They may very well impair healing or contribute to wound development.
Think about components like the below:
- When it comes to pressure injuries, minimizing pressure should be a critical element of the treatment plan.
- It’s imperative to crease the risk of further injury for neuropathic ulcers.
- Use compression in your treatment plan to manage swelling in patients with venous ulcers.
- In patients with skin tears, protecting the skin is a priority. This particularly applies if they have fragile skin or carry other risk factors.
- If your patient has a history of diabetes, glycemic control is another essential factor to consider.
- Nutrition should be part of the treatment plan. Both nutrition and hydration are essential to normal cell function and wound healing.
- Document everything in detail. This is a vital communication tool for the healthcare team.
This process will depend on the patient’s health as well as the type of surgery. For healthy children and adults, most wounds heal within two weeks. However, healing will likely take longer if they have health issues, take certain drugs (i.e., steroids or chemotherapy drugs), or have a weakened immune system.
Patients who leave with a dressing on their wound will need to change it every one or two days. They should also inspect the wound for redness, weeping, swelling, or other problems. Some people experience discomfort or numbness around the wound at first, which is normal; their surgeon will prescribe medicine to keep them comfortable.
Potential Risks or Complications of Wound Care
Serious wound care risks or complications can include various conditions. If the patient experiences any of the following, they should contact their doctor or surgeon immediately.
- Chills or fever over 101degrees Fahrenheit
- Warmth, swelling, redness, or more pain at the wound
- Puss, a bad smell, or more drainage than usual from the wound or drain
- Sudden, excessive bleeding from the wound or drain.
- A feeling of hardness or fullness around the wound or any opening of stitches or staples.
Pro Tips for Mastering the Art of Wound Care
The following are some pro tips for advanced students of wound care.
- The degree of pain may not indicate the extent of your patient’s injury. For example, skin tears can be incredibly painful. This is because damage to superficial skin can expose nerve endings.
- You can remove damaged tissue from a wound using several methods:
- Autolytic debridement is attained through moist topical dressings.
- Enzymatic debridement is accomplished by applying the prescribed topical agent to the wound.
- Sharp-wound debridement may be performed at the patient’s bedside or in the operating room.
- Wounds that are necrotic with signs of infection need to be treated with sharp-wound debridement ASAP.
- Follow critical principles and guidelines. Wound care performed by the nurse should be guided by the nurse’s scope of practice and institutional policy.
- Treating wounds usually requires a multidisciplinary approach. The frontline nurse is a vital member of this team.
- Wound Care Nurses may treat several complex wounds. Here are some examples:
- Pressure ulcers may form in patients who have impaired mobility. Treatment will typically depend on the stage. For instance, a Stage I might only require relief of pressure. A Stage III, on the other hand, requires a more aggressive approach.
- Diabetic patients may develop skin ulcers—typically in the feet or legs—due to impaired circulation. Wound nurses should reduce swelling to aid the healing process.
- CWCNs also treat burn wounds. They may be responsible for cleaning the wound, changing the dressings, and sometimes, even managing skin grafts.
- Wound nurses manage several wounds. Other examples include lacerations, gunshot wounds, knife wounds, and animal bites.
- Look at the following resources for helpful organizations, societies, and agencies. Also included are websites with more information about wound care.
- Wound, Ostomy and Continence Nurses Society
- American Professional Wound Care Association
- Association for the Advancement of Wound Care
- Organization of Wound Care Nurses
- Journal of Wound Care
- Journal of Wound, Ostomy and Continence Nursing
- International Diabetes Federation
- International Skin Tear Advisory Panel
- National Pressure Ulcer Advisory Panel
- World Council of Enterostomal Therapists
Why Should Nurses Learn How to Perform Wound Care?
Like other tasks they perform, proper wound care is vital for the nurse’s patient’s health and safety. In this specialization, you will be responsible for performing wound care, facilitating the healing process, and promoting patient comfort. These crucial steps can help prevent infection or other complications.
Becoming a Certified Wound Care Nurse can open doors. This career path might receive more job opportunities, higher pay, professional prestige, and personal satisfaction. Plus, the job outlook for CWCNs is excellent! This is likely due to high demand for the profession in acute care, nursing homes, etc. The prevalence of obesity and diabetes all but guarantees a certain degree of stability in this unique specialization.
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