This is the first of my many blogs that will be produced for Nursing in Practice. My interest in wound care began while I was on my final management placement as a student nurse.
During my time as a student nurse I had come across stage-2 and small stage-3 pressure ulcers but was particularly shocked and overwhelmed by the experience of nursing a lady with a horrendous stage-4 pressure ulcer which was all across her buttocks following a fall at home. She was being nursed on a bright yellow ‘pegasus’ dynamic mattress. These dynamic mattresses were all we had back then. Every day this poor lady pleaded with me to be nursed in the bay of the ward because she felt clostrophobic and lonely being nursed in a sideroom. Being nursed in the bay was not an option as the odour from this lady’s pressure ulcer was so offensive that a lot of the staff looking after her would smear balm under their noses to mask the odour before they entered her room. Sadly, some nurses avoided her room all together. By looking after this lady I was fortunate to meet my first tissue viability nurse.
There were not many tissue viability nurses back in the 1990’s, and back then very few nurse specialist roles existed. I remember being inspired by the way this tissue viability nurse approached this patient and spent time listening to her. The nurse almost appeared not to be interested in the actual pressure ulcer, but more in the patient’s wishes not to be locked away in a sideroom. I remember the nurse asking me and another student nurse to help wheel her out into the hospital garden. I felt unsure as it seemed a bit unconventional and the ward sister was not too pleased this was happening. On reflection I realised that the tissue viability nurse had made a holistic assessment of the patient. She knew the pressure damage was so severe that the patient would not survive. What she identified as important was not the actual ulcer itself, but that this patient should be able to have her wishes met in the short time she had left in this world. Meeting this lady and the tissue viability nurse left an impression on me that I will never forget, and it is the main reason I became a tissue viability nurse. This story emphasises the importance that it is not the ‘hole in the patient, but the whole patient’ which as nurses we should focus on. Many times while working in the community I have seen patients with a spare room full of boxes with different dressings that have been used to try and heel a wound without success. It is only when a holistic assessment has been carried out that it could be something as simple as a low Hb or poor diet that is stopping the wound from healing.
MSc, BA(Hons), Dip N, RN, non medical prescriber
Sandra Lawton and Stuart Thompson-McHale are the expert bloggers for the Nursing in Practice dermatology and wound care resource centre. They work together as expert bloggers; Sandra Lawton produces all dermatology blogs while Stuart writes the wound care pieces.
Dermatology: Sandra Lawton
OBE, MSc, RGN, OND, RN Child (Diploma), ENB 393, QN
Sandra Lawton is the blogger for the Nursing in Practice dermatology and wound care resource centre; her focus is dermatology.
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