My first week of simulated placement was a deep dive into wound care. I dove into the intricacies of managing patients with leg ulcers and the various types of wound dressing. A wound, as we know, is a disruption in the continuity of the epithelium. Understanding the normal physiological wound-healing process, which involves four stages—homeostasis, inflammation, proliferation, and remodelling—is crucial. This knowledge is particularly significant when dealing with chronic wounds, where the wound-healing mechanism is often impaired.

I learned the five ways of assessing wound care: wound assessment, wound cleansing, timely dressing change, selection of appropriate dressings, and antibiotic use. I knew pressure sores and leg ulcers were considered chronic wounds. They are slow-healing wounds with a likelihood of reoccurrence, and the pain that a patient feels may be severe and ongoing. The choice of dressing plays a significant role in reducing pain. Using the wrong dressing can cause discomfort when removing it. Therefore, the nurse needs to carefully assess before administering the dressing.

As a nurse, my role in promoting successful wound healing is pivotal. I must use a wound assessment tool to ensure accurate and consistent documentation, and regular reassessment of wounds is necessary to evaluate the effectiveness of the treatment. When conducting a wound assessment, I consider various factors such as the location, cause, tissue type, size, exudate, and the patient’s pain level. Selecting the most appropriate dressing for the wound is a critical decision, but it can be challenging due to the constant development of new dressings. I base my choice on the most current evidence available, and I must assess the wound for slough and necrosis, signs of infection, and malodor. Patient records should indicate the wound’s progress in healing, such as granulation and epithelial growth.

During my community placement, I had the opportunity to apply my theoretical knowledge in a practical setting. I visited a 60-year-old lady who had chronic leg ulcers on both legs. The district nursing team had been attending to her for several years. The lady had swollen legs and limited mobility and sat in a recliner chair, although the chair never reclined. I had visited her several times before, applied her dressings, and documented the procedures and dressings used in her district nursing records. On this occasion, the lady asked me not to apply the K-lite dressing and allowed another nurse to do it. She mentioned that the dressing I had used previously had become loose.

I assessed the wounds and updated the notes to reflect their current size. Then, I washed and redressed the legs according to the care plan. The plan specified washing the legs and applying Aquall Ag Silver, which is used for highly exudating wounds. Atruman was applied, followed by Resorb, Comfiest Yellow, and K-soft layers. I then handed it over to the registered nurse (RN) to use the final layer. While she did that, I documented that the patient’s leg had been washed, redressed, and mapped according to the plan. I also noted a strikethrough on the dressing before removal and recorded the patient’s pain levels before and after the redressing.

Additionally, I pointed out in the patient’s records that the patient had been advised to elevate their legs when resting to aid healing. It shook my confidence when the patient preferred the registered nurse to handle the top layer. The patient had never made this request before and always asked for the dressings not to be wrapped too tight because it made her very uncomfortable. I reassured her that I didn’t wrap them as tight as she had requested and apologised for the falling dressings. I promised her I would ensure they were secure but tight enough in the future. When I left the patient’s house with the registered nurse, she explained that this patient did this to all new nurses and advised me not to worry about it.

The ideal wound dressing should meet the treatment objective and protect the wound from further injury. It should be a moist wound healing dressing that manages excess exudates, prevents the wound from maceration and further breakdown, and ensures the prevention of the exit and entry of organisms. Additionally, it should cause minimal trauma upon removal and be cost-effective. A crucial factor in wound dressings is to ensure that dressings have maximum exposure to the wound bed. This can be achieved using a dressing that decreases the voids and spaces where bacteria can thrive.