Why wound care?
My first hands-on exposure to wound care was during my third clinical rotation in an outpatient setting. I had a blast performing pulsatile lavage on a lower extremity wound and went home that night trying to make sense of the world of wound care. Alas, I found that world to be an extremely convoluted system of indications for future research and, of course, the overpowering conclusion to all questions during physical therapy graduate school, “it depends.” What I wanted was a black and white, concrete answer for when to use one of the many dressing choices that are available. I wanted to know why my CI was covering a wound with a foam dressing rather than a hydrocolloid dressing. Researching these specific basics was very difficult. If you are a practicing clinician with experience, the research is expanding and very useful in terms of indications and contraindications of a given treatment method. But to a rookie wanting to know the basics, this was no easy feat.
Developing experience…
The time came to choose our elective during that next semester, and I chose to create my own independent study in a full-time wound care clinic that treated both inpatients and outpatients. I knew the only way to make sense of all of this was to dive into it and get hands-on experience; and what an invaluable experience it was! I’ve always known I wanted to be an acute care physical therapist after I graduate, and I wanted to be able to independently manage an entire caseload that also includes patients needing wound care. I wanted a skill set that was a bit unique to the generalist education, and deep down I really just wanted to fully understand what I was introduced to during that third rotation. At the conclusion of my independent study, I created a powerpoint for my peers at UNC that shared the basics regarding evaluation procedures, treatment techniques, dressing options, management of compounding factors, indications for various modalities, and documentation of wound care. This became the basis for the extensive Wound Care Module I have created as my capstone project. To further assist students and/or clinicians, I also created an evidence table for various dressing options as well as a user guide that indicates the optimal dressing for all stages of pressure ulcers based on how the wound presents.
Several other endeavors have further added to the clinical knowledge necessary to complete this project. My PICO question during the Evidence-Based Practice II course focused on the optimal debriding modality for stage III and IV pressure ulcers. I also presented an inservice to medical providers at the Tyrrell County Medical Clinic during a service-learning trip in March of 2013. This inservice focused on evidence-based treatment of diabetic foot ulcers, venous leg ulcers, and pressure ulcers. I created supplementary patient education pamphlets for each of these conditions, and these are still being used in their clinic today. Click each of these hyperlinks to see each two-page pamphlet: DFU patient pamphlet, VLU patient pamphlet, PrU patient pamphlet.
The finished product
Wound care has been identified as a weakness for many of the students; therefore, a part of this module was created for use as a part of the Musculoskeletal I course. I created ten multiple choice and short answer test questions for academic use, and two UNC professors provided feedback on all of the final products of my capstone, Mike McMorris and Mike Gross. A wound care PT from the site where I completed my independent study, Tara Marshall, also provided feedback, all of which confirmed the value of this education module. Please Click Here to view the musculoskeletal I module and here to view the extension that is targeted for a more experienced audience.
I would like to thank you for visiting my capstone site, exploring the tools I have created, and hopefully learning a bit about wound care in the world of physical therapy! Please post any comments or questions that you may have.
10 Responses to “Wound Care Education Module”
Mike Gross
Michelle- You certainly have done a lot of work here and produced some valuable resources for clinicians, students, and patients with all of your outcome products. The content on your slides really should be referenced on the actual slides with either “Name, Year” or supercripts. Mike Gross
llemmons
Everyone please keep posting comments to my capstone! I will be in Guatemala April 23rd-May 1st on a PT service learning trip where I will be providing intervention as well as inservices regarding proper handwashing and cost-effective treatment of pressure ulcers. I will attempt to monitor my site as able, but I will absolutely answer all feedback after my return. Thank you!
llemmons
Hi Brandon,
Thanks for the feedback. I’ll just go through your questions one-by-one. The four degree temperature difference does indicate an inflammatory process underlying the epidermis; could or could-not be infected, but something is going on under the surface. Regarding a pressure ulcer of the ear, the oxygen tubing is referring to supplemental oxygen via nasal cannula. Protecting the outer tissue of the ear with foam prevents pressure on that one surface that can lead to skin breakdown. So basically you just make a sandwich of ear, foam, then oxygen tubing. Prevention of ulcer recurrence depends on what type of wound that patient presents with. This mainly comes back to the initial slides in Part I of the module concerning causes/barriers to wound healing. So if the wound is due to pressure, a patient must relieve the source of pressure. If a patient has a diabetic wound, then proper glycemic control and foot protection is key. Thank you so much for appreciating my end products; indeed it was a lot of hard work! But it was really enjoyable to make sense of such an elaborate facet of PT. Hope this helps!
Tara Marshall
I am impressed with the level of research and detail you have put in to this project. As a practicing PT in the wound care field, I was pleasantly surprised to learn some new things from your materials! I especially like the evidence tables for dressing selection – it provides me with evidence to back up my commonly used practices and evidence as to why I might use other dressings that I don’t commonly use.
Your wound type specific patient and provider handouts are great! Single page information that cuts to the chase of what one needs to know about a wound with language for both the lay person and the health care practitioner.
I have never heard of the dermal infrared thermometer. Again, I learned something and it may be something that I should learn more about!
Overall, very complete and well done project. I look forward to you coming back to WakeMed Wound Care to give our staff an inservice to share all of this wonderful information!
blindqui
Wow! What an undertaking that you executed very well! I would have never even thought of many of the considerations you presented in your PowerPoint for wounds. For example making sure that adequate ventilation is available in a persons home to prevent overheating of a motor on a pressure relieving mattress system, when indicated to prevent ulcer formation. Also, I am always impressed by the significant savings over time when the best quality care is used for wounds, even though the upfront cost appears as though it may not.
I did have a few questions. It looks like you have had quite a few comments on your capstone already, so hopefully they won’t overwhelm you. 1) I was curious about the dermal infrared thermometer and the fact that if there is a 4 degree difference from one side to the other that the patient should inform their doctor. Is the cause of a difference like this from infection? 2) When it comes to preventing pressure ulcer of the ear, when you use a foam pad do you just insert the oxygen tubing into the foam for delivery to the wound? 3) For prevention of ulcer recurrence, what recommendations do you have for adequate skin care?
Also, I was reminded of a few patients on my last clinical rotation who suffered dehiscence of surgical wounds. I watched the wound care nurse perform dressing changes on these, and I found the wound VAC dressing so interesting. What an awesome intervention! Genius even!
Anyways. Thanks for all the hard work you put into this! It really shows. I am very impressed with your initiative in visiting clinics and really helping educate yourself in this content.
llemmons
Hi Kim, thanks for the positive feedback! I think that is a great idea to add pictures. I didn’t do that initially because I didn’t want to “gross out” the students/audience before they got a chance to learn the basics. Personally, during burn lectures, the pictures distracted me from listening to the ideas presented. Perhaps a solution to this could be adding pictures and more specific examples at the end of Part I of the module. Thanks!
I have seen the Wagner Scale utilized for Diabetic Foot Ulcers, but I do not have any other experience with objective outcome measures, nor did I come across others in my literature review that stand out in my mind. The best way to objectively assess a wound is taking pictures and measurements every time you see a patient. And of course, you may utilize these resources I’ve created. Pass the knowledge along to help improve patient care! That’s the point of this module! Thank you Kim.
Kim
Michelle,
Your project is AWESOME! Not only do I know that you learned a ton, but I think that so many therapists and colleagues can benefit from the information and products you put together as part of this project. I know I did! I completely agree with you and Natalie that wound care can be a weakness for many entry-level students. I know I speak for multiple therapists who are not so enthused by wound care when I say I am glad there are people like you in our profession who have such a passion! From your patient education materials to your informative module, you’re products are extremely helpful. I wish I would have had something to refer to like this prior to my first clinical rotation in acute care and so I’m glad that first year students in the future will have access to this.
Have you considered adding more pictures of actual wounds to the musculoskeletal I module? I know sometimes it is beneficial to look at a picture of a wound and try to figure out its cause (venous vs arterial) and try to describe it (exudate classification, staging, etc). Perhaps this will give the students an opportunity to self reflect on their skills and abilities following the module in a realistic manner.
I love how you created an “extension” for more experienced therapists/students to delve further into specific conditions with practical tools, patient education, and intervention techniques from a multidisciplinary and comprehensive approach. I have never heard of a some resources such as a dermal infared thermometer and am excited to add this to my toolbox of things I can bring to the table and offer my patients! I know that you brought up the Braden Scale for pressure ulcers but I was curious if in your research you found other wound care outcome measures that are most recommended or frequently used aside from standard numerical measurements for other wound types (diabetic, venous, arterial).If you have, is there one you found more prevalent in clinical use or a “gold standard” I should know about for various practice settings? Thank you so much for all of this amazing information and for putting it in PRACTICAL formats to truly help our own education and our patients. With your permission, I’m excited to provide these materials to some of my own patients on my next rotation!
llemmons
I was not able to personally utilize the materials with any patients, but I left them in the clinic. The nurse that normally performs diabetic education was very thankful! Coincidentally, this nurse also worked in the neighboring hospital and was ecstatic about the pressure ulcer guide. She laminated it that day!
Anon
Wow! This is very helpful!
nclawler
Michelle-
I really enjoyed looking through your Capstone materials! Wound care is one area of the curriculum I felt was lacking in content and overall emphasis. In reality, some PTs are primarily wound care therapists, so it is a huge part of practice! I really enjoyed looking through your evidence table for dressings, as well as the dressings based upon pressure wound staging. It seems like you left Tyrell County with a lot of great resources. Were you able to actually share these pamphlets with patients personally or did you leave them in the clinic for future use? If so, how did they receive the information? I remember the presentation on Tyrell County a few years ago, discussing the lower health literacy levels in the area, and was curious about whether the information was well-received or not.
Also I really appreciate the module for wound care you created for the Musculoskeletal I course. I would have loved to have my hands on this a few years ago. Especially after having a wound-care heavy rotation myself, I think a little more prior knowledge would have been helpful! Thanks so much for sharing!