Best Practice in Wound Care

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During my placement in the community with the district nurses I had the opportunity to observe at leg ulcer clinic. At this clinic I had the opportunity to observe the dressing of a venous leg ulcer. Wound expert (2006) suggests treatment should consist of keeping the ulcer infection free, absorbing the excess discharge and managing the patient’s medical problems. The aim of the patients care plan is to promote healing. A Zoologist named George Winter (1927 – 1981) studied wound healing in a domestic pig and later became interested in wound dressings. Winter observed that wounds covered with an occlusive dressing healed faster than those left to dry out (Winter 1962, cited in Bale and Jones, 2006). It was from Winters work that the principles of moist wound healing used today was developed. The adoptions of various techniques throughout time to cleanse wounds and promote healing have included topical treatments such as the use of boiling oil, honey, diluted wine and seawater. In clinical practice, the principles of wound cleansing have been misunderstood resulting in the unsuitable and ritualistic use of cleansing solutions (Morison et al, 1997). Nurses sometimes do not question as to why they are cleansing the wound (Bale and Jones 2006). Before Cleansing of the wound is undertaken, the nurse should take into account the natural wound healing involves the bactericidal activity and growth factors present in the wound exudates (Chen et al 1992, cited in Bale and Jones 2006). Removal of wound exudate through inappropriate cleansing and drying may only reduce those vital components for the healing tissue with the principles of moist wound healing. Wound cleansing is also done to remove bacteria (Thomlinson 1987, cited in Bale and Jones 2006). And this is not possible or desirable. Wounds need to be cleansed to remove surplus exudate, slough, debris or necrotic tissue and remnants of dressing material, in order to promote patients comfort (Bale and Jones...
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