WOUND CARE: SUTURE / CLIP/DRAIN REMOVAL             26/07/2024.

 

The lesson started with the introduction of the topic, the learning outcomes, and the structure of the skin.

The skin is divided into three:

• Epidermis ( this is further described as the epidermis – it is composed of 5 layers, it has a protective barrier, contains melanin, and a new epidermis every 25 – 45 days).
• Dermis (this layer contains – hair follicles, capillaries, sweat glands, nerve endings, iol glands, collagen and elastin)
• Hypodermis – this is also known as a subcutaneous layer ( this acts as a shock absorber, regulates temperature, connective tissue connects bone and muscle to the layer of the skin, nerves and blood vessels here connect to those in the dermis layer).

Note: the skin protects our bodies. The skin is a physical barrier,  when the skin wounds the barrier is open to infection. The PH of the skin is 5.5 and it is acidic to kill bacterias. The skin is sensitive to pain.

 

We described a wound as an injury that breaks the skin or other body tissue. Or a wound is a break in the continuity of the skin, through injury or surgery.

The stages of wound healing is as follows:

• Hemostasis
• Inflammatory
• Proliferative
• Remodelling.

 

Hemostasis ( vascular constriction, platelet aggregation, fibrin formation to create thrombus.

 

The inflammatory – inflammation attempts to rid the wound area of any foreign material, microbes or toxins. This prepares the site for tissue repair.

This phase is characterised by:

• Swelling
• Redness
• Heat
• Pain.

 

The proliferation (angiogenesis, collagen synthesis, reepithelialization, extracellular matrix formation).

 

The maturation and remodelling ( collagen remodelling, vascular maturation, edge contraction, scar tissue.

 

The following are abnormal healing. Failure to heal at least 40% within the 4 weeks:

• Infection.
• Devitalised tissue.
• Chronic wounds.
• Overgranulation.

We continued with wound assessment and the TIMES model. The learning outcomes were also discussed.  The types of wounds are as follows:

• Traumatic injury, eg skin tear, laceration, burn, abrasions.
• Pressure ulcer
• Legs ulcer/ diabetic ulcer
• Surgical, eg incisional, skin graft, ostomy, flap reconstruction.

 

TIME(S) is an acronym used to support a standardised approach to wound assessment and outline key considerations in the process.

T – tissue

I – inflammation/infection

M – moisture

E – edges. And the additional ‘s’ is to assess surrounding skin.

 

Note: we should make TIME to assess and manage a wound effectively.

 

The tissue can be: 

• Necrosis,
•  slough, 
• granulated, 
• hypergranulated.

 

Infection, the location.  

• (Wound bed only – treat the wound topically).

• Systemic (swab to be taken if a patient is  presenting with a systemic infection or a deteriorating condition. In these cases, oral antibiotics may be advised.

• odour

 

moisture(exudate) 

• Volume (low, moderate, high)
• Type /consistency (serous, haemoserous, purulent)

 

Edge 

• Rolled, fragile, hypergranulated

 

Surrounding skin

• Excoriated, macerated, oedematous.

 

                                         

 

                             KSB ADDRESSED

 

                       KNOWLEDGE.

 

K1: Understand the Code: Professional standards of practice and behaviour for nurses, midwives and nursing associates (NMC, 2018), and how to fulfil all registration requirements. 

K2: Understand the demands of professional practice and demonstrate how to recognise signs of vulnerability in themselves or their colleagues and the action required to minimise risks to health.

K4: Understand the principles of research and how research findings are used to inform evidence-based practice. 

K5: Understand the meaning of resilience and emotional intelligence, and their influence on an individual’s ability to provide care. 

K6: Understand and apply relevant legal, regulatory and governance requirements, policies, and ethical frameworks, including any mandatory reporting duties, to all areas of practice.

K7: Understand the importance of courage and transparency and apply the Duty of Candour.

K8: Understand how discriminatory behaviour is exhibited.

K9: Understand the aims and principles of health promotion, protection and improvement and the prevention of ill health when engaging with people. 

K10: Understand the principles of epidemiology, demography, and genomics and how these may influence health and well-being outcomes. 

K11: Understand the factors that may lead to inequalities in health outcomes. 

K12: Understand the importance of early years and childhood experiences and the possible impact on life choices, mental, physical and behavioural health and well-being .

K15: Understand human development from conception to death, to enable delivery of person-centred safe and effective care. 

K16: Understand body systems and homeostasis, human anatomy and physiology, biology, genomics, pharmacology, social and behavioural sciences as applied to delivery of care. 

K17: Understand commonly encountered mental, physical, behavioural and cognitive health conditions as applied to delivery of care. 

K19: Know how and when to escalate to the appropriate professional for expert help and advice. 

K20: Know how people’s needs for safety, dignity, privacy, comfort and sleep can be met.

K21: Understand co-morbidities and the demands of meeting people’s holistic needs when prioritising care.

K22: Know how to meet people’s needs related to nutrition, hydration and bladder and bowel health 

K23: Know how to meet people’s needs related to mobility, hygiene, oral care, wound care and skin integrity 

K24: Know how to support people with commonly encountered symptoms including anxiety, confusion, discomfort and pain 

K25: Know how to deliver sensitive and compassionate end of life care to support people to plan for their end of life 

K26: Understand where and how to seek guidance and support from others to ensure that the best interests of those receiving care are upheld 

K27: Understand the principles of safe and effective administration and optimisation of medicines in accordance with local and national policies 

K28: Understand the effects of medicines, allergies, drug sensitivity, side effects, contraindications and adverse reactions 

K29: Understand the different ways by which medicines can be prescribed 

K30: Understand the principles of health and safety legislation and regulations and maintain safe work and care environments 

K31: Understand how inadequate staffing levels impact on the ability to provide safe care and escalate concerns appropriately 

K32: Understand what constitutes a near miss, a serious adverse event, a critical incident and a major incident 

K33: Understand when to seek appropriate advice to manage a risk and avoid compromising quality of care and health outcomes 

K34: Know and understand strategies to develop resilience in self and know how to seek support to help deal with uncertain situations 

K35: Understand own role and the roles of all other staff at different levels of experience and seniority in the event of a major incident 

K36: Understand the roles of the different providers of health and care 

K37: Understand the challenges of providing safe nursing care for people with complex co-morbidities and complex care needs.

K39: Understand the principles and processes involved in supporting people and families with a range of care needs to maintain optimal independence and avoid unnecessary interventions and disruptions to their lives 

K40: Understand own role and contribution when involved in the care of a person who is undergoing discharge or a transition of care between professionals, settings or services 

K41: Know the roles, responsibilities and scope of practice of different members of the nursing and interdisciplinary team, and own role within it 

K42: Understand and apply the principles of human factors and environmental factors when working in teams 

K43: Understand the influence of policy and political drivers that impact health and care provision Skills.

 

                                       SKILLS

S1: Act in accordance with the Code: Professional standards of practice and behaviour for nurses, midwives and nursing associates (NMC, 2018), and fulfil all registration requirements 

S2: Keep complete, clear, accurate and timely records 

S3: Recognise and report any factors that may adversely impact safe and effective care provision 

S4: Take responsibility for continuous self-reflection, seeking and responding to support and feedback to develop professional knowledge and skills 

S5: Safely demonstrate evidence-based practice in all skills and procedures required for entry to the register: Standards of proficiency for nursing associates Annex A & B (NMC 2018) 

S6: Act as an ambassador for their profession and promote public confidence in health and care services 

S7: Communicate effectively using a range of skills and strategies with colleagues and people at all stages of life and with a range of mental, physical, cognitive and behavioural health challenges  

S8: Recognise signs of vulnerability in self or colleagues and the action required to minimise risks to health 

S9: Develop, manage and maintain appropriate relationships with people, their families, carers and colleagues 

S10: Provide, promote, and where appropriate advocate for, non-discriminatory, person-centred and sensitive care at all times, reflecting on people’s values and beliefs, diverse backgrounds, cultural characteristics, language requirements, needs and preferences, taking account of any need for adjustments 

S11: Report any situations, behaviours or errors that could result in poor care outcomes 

S12: Challenge or report discriminatory behaviour 

S13: Apply the aims and principles of health promotion, protection and improvement and the prevention of ill health when engaging with people 

S14: Promote preventive health behaviours and provide information to support people to make informed choices to improve their mental, physical, behavioural health and wellbeing 

S15: Identify people who are eligible for health screening 

S16: Promote health and prevent ill health by understanding the evidence base for immunisation, vaccination and herd immunity 

S17: Protect health through understanding and applying the principles of infection prevention and control, including communicable disease surveillance and antimicrobial stewardship and resistance 

S18: Apply knowledge, communication and relationship management skills required to provide people, families and carers with accurate information that meets their needs before, during and after a range of interventions 

S19: Recognise when capacity has changed recognise and how a person’s capacity affects their ability to make decisions about their own care and to give or withhold consent 

S20: Recognise people at risk of abuse, self-harm and/or suicidal ideation and the situations that may put them and others at risk 

S21: Monitor the effectiveness of care in partnership with people, families and carers, documenting progress and reporting outcomes 

S22: Take personal responsibility to ensure that relevant information is shared according to local policy and appropriate immediate action is taken to provide adequate safeguarding and that concerns are escalated 

S23: Work in partnership with people, to encourage shared decision making, in order to support individuals, their families and carers to manage their own care when appropriate 

S24: Perform a range of nursing procedures and manage devices, to meet people’s need for safe, effective and person-centred care 

S25: Meet people’s needs for safety, dignity, privacy, comfort and sleep 

S26: Meet people’s needs related to nutrition, hydration and bladder and bowel health 

S27: Meet people’s needs related to mobility, hygiene, oral care, wound care and skin integrity 

S28: Support people with commonly encountered symptoms including anxiety, confusion, discomfort and pain 

S29: Give information and support to people who are dying, their families and the bereaved and provide care to the deceased 

S30: Recognise when a person’s condition has improved or deteriorated by undertaking health monitoring, interpreting, promptly responding, sharing findings and escalating as needed 

S31: Act in line with any end of life decisions and orders, organ and tissue donation protocols, infection protocols, advanced planning decisions, living wills and lasting powers of attorney for health 

S32: Work collaboratively and in partnership with professionals from different agencies in interdisciplinary teams 

S33: Maintain safe work and care environments 

S34: Act in line with local and national organisational frameworks, legislation and regulations to report risks, and implement actions as instructed, following up and escalating as required 

S35: Accurately undertake risk assessments, using contemporary assessment tools 

S36: Respond to and escalate potential hazards that may affect the safety of people 

S37: Participate in data collection to support audit activity, and contribute to the implementation of quality improvement strategies 

S38: Prioritise and manage own workload, and recognise where elements of care can safely be delegated to other colleagues, carers and family members 

S39: Recognise when people need help to facilitate equitable access to care, support and escalate concerns appropriately 

S40: Support and motivate other members of the care team and interact confidently with them 

S41: Monitor and review the quality of care delivered, providing challenge and constructive feedback when an aspect of care has been delegated to others 

S42: Support, supervise and act as a role model to nursing associate students, health care support workers and those new to care roles, review the quality of the care they provide, promote reflection and provide constructive feedback.

S43: Contribute to team reflection activities to promote improvements in practice and services.

                        

 

                                 BEHAVIOURS

 

B1: Treat people with dignity, respecting individual’s diversity, beliefs, culture, needs, values, privacy and preferences 

B2: Show respect and empathy for those you work with, have the courage to challenge areas of concern and work to evidence based best practice 

B3: Be adaptable, reliable and consistent, show discretion, resilience and self-awareness.