The primary importance of wound care in nursing is to reduce or eliminate a patient’s pain and speed up recovery. There is a specialization in nursing where nurses will have to enroll in wound care courses. Certified nurses use certain principles in wound care: wound assessment or evaluation, wound cleansing, dressing change, choosing the proper dressing, and application of the appropriate treatments like antibiotics. Wound care comprises a collection of functions that must follow strict guidelines or protocols to ensure that a patient gets the best possible outcome.
Why wound care is important in nursing
According to the Open Access Government online, wound care is paramount in nursing because improper care can lead to massive health and financial burden on a patient and the government.
In 2009 alone, about 6.5 million people in the US required treatments for chronic wounds costing the government about $25bn. This figure doesn’t include the social burden triggered by people suffering from such wounds. Some social burdens identified with wound care are the patient’s inability to work, mental health challenges, and recurrent wound treatment in individuals.
With all these facts, wound care becomes an essential issue in nursing because it will address many needs of the patients, speed up routine healing, and lower the risks of certain complications.
Some complicated wounds may require collaborative work between nurses and other healthcare professionals. For instance, a patient suffering from diabetic foot ulcers will need the help of nurses in collaboration with a vascular surgeon and sometimes an orthopedic surgeon.
Dressings applied to wounds must be accessed by patients because they are the ones who understand the impact of such treatment. Wound treatment specialists must provide patients with instructions on handling treated wounds and when to raise concerns.
Many patients often tamper with dressed wounds, indulging in actions that can reverse healing or complicate their problems. For this reason, wound nursing specialists should educate patients on wound handling.
Similarly, discharged patients must also be instructed on post-wound treatment care requirements and ways to follow up on recovery.
What is a wound?
In nursing, a wound is defined as a skin breakdown or injury sustained to some tissues, causing disruption to the structural integrity, and leading to some functional losses.
Once a patient suffers an injury that leads to a fresh wound, the skin’s integrity is compromised. In most cases, the mucous membranes may become damaged, and there may be severe risks of infections in nearby organs.
Nurses believe that wounds can be acute or chronic. Some wounds can be closed, which means they may occur underneath the skin’s surface. Open wounds are the commonest ones and are caused by trauma or surgery. Wounds can also be categorized according to cleanliness as follows:
- Class 1 or clean wounds
- Class 2 or clean-contaminated wounds
- Class 3 or contaminated wounds
- Class 4 or dirty-infected wounds.
The class 1 wounds are the cleanest, and they remain uninfected for a while. These wounds are not accompanied by inflammation and are primarily closed. Most clean wounds may occur in the genital, respiratory, or urinary tracts. You can click here to learn more about the Marymount University Online Accelerated Bachelor of Nursing program and see prerequisite courses in wound nursing.
Class 2 wounds that are referred to as clean-contaminated wounds are those characterized by minor contamination that do not pose severe threats to the patients. They can also be found in the urinary tract, respiratory and genital regions of the body.
Class 3 wounds are contaminated wounds that are fresh and open. They occur because of leakages or poor sterile treatment methods that may be caused by incisions that can lead to acute purulent inflammation.
Class 4 wounds are the most infected wounds that require the utmost professional handling. They occur due to poor nursing interventions administered to patients suffering from traumatic wounds. They can also occur due to microorganism proliferation in and around perforated treatment sites on the body.
Leading causes of wound infection
A wound can develop from minor to chronic, depending on how it is managed, when bacteria infiltrate damaged skin and proliferate. This allows microorganisms to break through the patient’s body’s defense mechanism and then overwhelm its defense cells, rendering the immunity system weaker.
Poor aseptic practices may also cause wound contamination, eventually leading to infection. Some pre-existing patient conditions like diabetes mellitus and compromised immunity can also predispose a patient to infection. In most cases, wound infection develops less than seven days after an injury occurs.
Symptoms of an infected wound
Nursing care providers have identified some primary symptoms of wound infection, these are:
- Skin discoloration
- Purulent discharges from the affected part
- Edema or swelling
- Foul smell
- Tender and inflamed skin
- Increased white blood cell count.
Fortunately, wound healing, also known as tissue integrity restoration, is initiated after a skin injury; these healing processes may take four stages, and any disruption to this healing process may lead to wound infection.
Hemostasis, or cessation of bleeding in the wound area, is the first process of natural wound healing. This phase is brought about through platelet aggregation. Inflammation is the second phase of wound healing, and it is triggered by the immune system in the process of controlling or lowering the risks of infection of the wound.
Proliferation is the third stage of the healing process, characterized by scar tissue creation on the affected skin. Scar tissue formation is brought about by granulation tissues filling the wound beds resulting in wound covering.
Maturation is the final natural wound healing process that involves collagen synthesis and final wound covering.
The wound nursing procedures: wounded skin integrity assessment
Wound care typically begins with wound assessment, and the process has four stages:
- Wound assessment with each dressing stage
- Classification of wound type
- The use of risk assessment instrument or tool
- Wound culture collection.
A wound assessment with each dressing phase is the first procedure a nurse usually carries out. In this case, the nurse will inspect the wound size, depth, color, and possible drainage or tunneling to confirm whether treatment is effective.
Identifying the wound type is the next phase; it helps identify the procedures most suitable for wound repair. Nurses often categorize wounds into five types: abrasion, avulsion, puncture, incision, and laceration. Wounds can also be classified based on duration, and these are: chronic or acute, open or closed, and clean or infected.
The third assessment phase uses a risk assessment tool where a patient’s medical history comes into consideration, and the nursing caregiver will conduct physical examinations and laboratory tests. Risk factors for poor wound healing, including diabetes, hypertension, and addiction to alcohol or smoking, may also be investigated.
Obtaining wound culture is the final stage of wound assessment. It involves the application of swabs on the wound, which are then examined for the presence of microorganisms like MRSA. The type of microorganisms identified from the swabbing techniques can help determine the types of wound treatment applicable.
Common wound care interventions
Nurses obtain as much information as possible on a wound during the assessment phase. The type of interventions applicable will depend on the assessment conducted. Nurses will apply the following wound care treatments on most wound types:
- Disinfection of wound site
This is one of the most standard wound treatment procedures. The caregiver applies an antiseptic cleanser to clean the wound. Harsh chemicals and alcohol-based solutions are strictly forbidden for disinfection.
- Wound decontamination
The second phase of wound care is decontaminating the skin injury. You will likely achieve this by removing foreign objects from the wound. This procedure must be done promptly to eliminate necrotic tissues, re-vascularize the wounded part, and prevent infections.
- Eliminate dying tissues
Removing dying tissues, also known as debridement, is essential if you want to eliminate necrotic tissues that can leave room for pathogenic organisms.
- Use the appropriate wound dressing.
Nurse caregivers often apply non-sticky saline wraps alongside the appropriate absorbent material to dress wounds. These wraps will protect the wound from infection and stimulate wound tissue re-epithelialization. You will have to secure these saline wraps with recommended gauze tapes. This is one of the asepsis procedures in wound care that will prevent wound infections.
- Manage the wound
The wound management techniques you will apply will depend on the stage of healing. In most cases, you will have to replace cleansers and dressings at a different phase of wound healing.
- Apply recommended antibiotics or antiseptics appropriately.
Keeping a healing wound moist is essential to maintain hydration, boost blood supply, stimulate collagen formation and speed up wound healing. Keeping the wound moist will also stimulate the destruction of dead tissues, improve wound appearance, and alleviate pain.
As a nurse, you should also be aware of the appropriate antibiotics or antiseptics to apply at different stages of wound treatment. While topical antibiotics will eliminate bacteria, antiseptics will stop the growth and spread of microorganisms in and around the wound. You must apply a secondary dressing with antiseptics or antibiotics and follow directives from a senior nurse or any other healthcare provider.
- Eliminate sutures used for surgical wounds
One of the rules of wound care is that sutures must be removed 14 days after application. Most adhesive glues will naturally peel off in less than two weeks after application.
- Refer patient to wound care specialist for further treatment, if necessary
Under the standard regulations of wound care, you may have to refer a patient to a superior wound care specialist if a patient’s wound doesn’t improve in 14 days.
Why you should become a wound care nurse
The emotional burden on wound care nurses can be huge, especially during natural disasters and catastrophic accidents. Helping people recover from minor and chronic wounds should give you job satisfaction. Also, choosing wound care nursing as your specialization can be financially rewarding.
Many will argue that certifications may be unnecessary to become a wound care nurse, but you will do better if you have them. Obtaining the required certification will validate your commitment to wound care knowledge. It is advisable to become an active registered and licensed nurse with a Bachelor of Nursing degree to become a wound care specialist.
It would be best if you specialized in the traditional or experiential path to becoming an expert in the field. When you decide to specialize in the traditional path, you must complete the Wound Ostomy and Continence (WOCN) accredited courses and have at least 1-year clinical wound dressing experience to practice.
If you decide to specialize in the experiential pathway, you must acquire 50 continuing study hours or a college coursework equivalent. You must achieve this within five years of applying to become a wound care nurse. You must also possess at least 1,500 hours of clinical practice, and you must complete 375 hours of these a year before applying to become a wound care nurse.
You can apply to write for the US national board examination once you complete any of the career paths highlighted above.
According to the US Labor Statistics, the median annual salary for registered nurses was $77,600, though the BLS didn’t differentiate between diverse types of nurses or certified ones. In September 2022, Chicago reportedly paid wound care nurses the highest, with an average salary of $107,903. Philadelphia, Dallas, Houston, and Phoenix complete the top 5 highest paying cities in the US for wound care nurses.
The employment outlook for wound care nurses remains excellent due to higher demands for those with specialty certifications in acute care and home nursing care. The prevalence of chronic diseases and the rise in the aging population are some of the reasons for wound care specialist demand remaining high.
Becoming a wound care nurse requires helping people heal and recover from their wounds. You need to demonstrate compassion and have all the necessary skills to follow wound dressing protocols. You need to be aware of wound nursing regulations and maintain professional quality standards in wound dressing. You must also demonstrate the ability to perform post-care follow-ups on patients until they fully recover from their wounds.
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