Objectives The aim of this study was to retrospectively review the effectiveness of negative pressure wound therapy (NPWT) in sternal wound healing with the use of the validated Bates-Jensen Wound Assessment Tool (BWAT), and explore the role of NPWT over sternal wounds and future treatment pathways.
Methods Data was gathered from patients' medical records and the institution's database clinical management system. Seventeen subjects, who had undergone cardiothoracic surgeries and subsequently consulted the wound care team in one year were reviewed. Fourteen of them were included in the analysis. Healing improvement of each sternal wound under continuous NPWT and continuous conventional dressings was studied. In total, 23 continuous NPWT and 13 conventional dressing episodes were analysed with the BWAT.
Results Among conventional dressing episodes, sternal wound improvement was 2.5–3% over 10 days to 3.5 weeks, whereas 4–5% sternal healing was achieved in 5 days to 2 weeks with sternal wire presence. Better healing at 11% in 1 week by conventional dressing was attained after sternal wire removal. In NPWT episodes, 8–29%, 13–24%, and 15–46% of healing was observed in 2 weeks, 3.5 to 5 weeks and 6 to 7 weeks, respectively. Only 39% wound healing was acquired at the 13th week of NPWT in one subject. With sternal wire present, 6%–29% wound healing progress was achieved by NPWT in 1–4 weeks, and 16–23% wound improvement in 2 to 4.5 weeks by NWPT after further surgical debridement. After sternal wire removal, 6–34% sternal wound healing occurred by continuous NPWT for 1–2 weeks, and maximum healing at 46% after 2.5 weeks of NPWT were observed.
Conclusions Better wound healing was achieved in the NPWT group in comparison to conventional dressings alone. However, suboptimal sternal wound healing by NPWT alone was observed. Removal of sternal wire may improve the effectiveness of NPWT. Successful tertiary closure after NPWT among subjects supports the important bridging role of NPWT in sternal wound healing. Factors causing stagnant sternal wound healing by NPWT alone are discussed.
This article explores wound care nursing interventions and inter-professional collaboration for a patient referred with a stage 3 diabetic foot ulcer (DFU). To the patient’s distress, he had been informed that he may require an amputation due to the severity of his DFUs. On initial presentation, the patient was symptomatic for peripheral neuropathy, infection and hyperglycaemia. The left lower limb was oedematous and there was a DFU at the metatarso-phalangeal joint of the big toe on his left foot secondary to haemorrhagic callus. Progressive healing of the DFU was realised over time by repetitive debridement; incision and drainage of the DFUs; antibiotic therapy; appropriate footwear; dietary instructions; control of the blood sugar levels (BSLs); and patient and family education.
Wound care nursing interventions were applied in conjunction with medical management of the DFUs. The DFUs were managed using a locally made, two-part zinc oxide gauze dressing known as the Unna boot. A family member was instructed how to continue applying the dressings at home in between clinic visits. Complete wound healing was eventually achieved within four months, thus avoiding the need for amputation.
Objective To evaluate the effect of training for enterostomal therapists (ETs) based on Kirkpatrick’sFour Levels of Training Evaluation model. To understand ET trainees' work status after completing the Enterostomal Therapy Nursing Education Program (ETNEP) course as well as the ET students' satisfaction of teachers and studying conditions when completing the Wenzhou ETNEP.
Methods One hundred and sixty-nine students who had completed the Wenzhou ETNEP were evaluated by Kirkpatrick’sFour Levels of Training Evaluation model from four perspectives, namely the Reaction, Learning, Behaviour and Result levels.
Results The overall satisfaction of the Wenzhou ETNEP was high in the Reaction level. In the Reaction Level the average matrix score of training programs and teachers was: >1.4. In the Behavioural level, 103 ETs participated in stoma and wound clinics, with 99.2% of them actively promoting ET nursing knowledge and 18 ETs (13.2%) serving as teachers of ETNEP schools. One hundred and sixteen ETs (85.3%) conducted ET-related nursing courses for other nursing staff and 58.8% of ETs had conducted continued education courses. Of the ETs, 22.8% participated in the hospital’s outpatient or outreach stoma and wound care services. In the Result level, 58.8% of ETs participated in nursing research of the specialty, 29.4% of ETs had obtained scientific research funds and 136 ETs had published papers.
Conclusion Students are satisfied with the ETNEP training they received. Their ability to work and function as ETs has improved on completion of their training. In addition, their professional standing has improved, with all ETNEP participants having achieved good results in the fields of specialised nursing, extended nursing, scientific research and teaching. However, in reviewing the survey results and aligning these with current standards of practice and employment of ETs in China, there is the need to modify parts of the ETNEP (such as raising the degree of ET students' entry criteria), standardise teaching materials and establish communication processes with mechanisms for exchanging ET teachers nationally and internationally, to ensure the quality of teaching and improve the quality of specialised ET nursing.
Spinal cord injury (SCI) patients have a higher risk of developing pressure injury secondary to limited mobility and lack of sensation. The James J Peters Medical Center is one of several regional spinal cord injury centres in the Veterans Affairs System. Veterans with SCI receive comprehensive care. Hospital- and community-acquired pressure injuries (HAPIs and CAPIs) can progressively advance to chronic stage IV pressure injury complicated with osteomyelitis. Chronic wounds that become infected can lead to sepsis if the wounds are not managed properly. The management of chronic wounds represents a significant financial burden for any health care system and a challenge for providers whose goals are to avoid prolongation of hospital stay, avoid complications, and minimise disruption in the patient’s life. A focus of the primary physician is to establish a rehabilitation plan that facilitates the patient to resume activities of daily living post injury and have a productive life in their community. However, despite the collaborative effort of the SCI team, the sudden change in the patient’s mobility can also have a detrimental impact on the patient’s mental status as well.