Page 9 - Wound Care at End of Life Content: A Guide for Hospice Professionals - DEMO

Care Team & Patient/Family Education

EDUCATION:
Evidence‐based medicine is a requirement for wound care. Clinicians are demanding evidence
before changing a wound care regimen or introducing new products. Evidence‐based wound
practice is “the integration of best research evidence with clinical expertise and patient
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values.”

Lack of knowledge is one of the most common barriers associated with a failed plan of care.
Pressure ulcer incidence increases if clinician knowledge is insufficient. Clinician training should
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be repeated at regular intervals to address both staff changes and guideline modifications. The
clinician must assume responsibility for self‐education and recognize it is not a one‐time event.
Best education practices also help patients and families formulate realistic expectations about
their wound treatments, risks, and healing.

Patient education begins with an assessment of the patient’s knowledge base and then
BUILDing on this foundation. Just as BUILDing the goals of care are patient‐centered, education
must also be patient‐centered. Printed materials are time‐savers; however when developing
them, carefully consider patient/caregiver educational level, health literacy, cultural and
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language sensitivities. BUILD on the patient and caregiver’s knowledge of the wound and
wound care. Take into consideration the emotional and psychological impact the wound has on
the patient and family. Wound pain, odor, and exudate have the potential to cause significant
social isolation and embarrassment for both the patient and the family. Often, wound care falls
to a single caregiver, which may result in that caregiver feeling isolated. If the wound
deteriorates, the caregiver may be criticized by other family members even though the
deterioration is related to disease process rather than inadequate care. Patients are often
embarrassed by the odor, leakage of fluid from the wound, and the unpleasant appearance of
the wound. Consciously or subconsciously, wounds are often perceived as a failure on the part
of patient or caregiver to provide adequate care. The wound may be perceived as a betrayal by
one’s own body. The wound is a constant reminder of the presence of disease and the dis‐ease
it creates.

Provide education for the patient and the patient’s circle of care. This may include family,
caregivers in the home, or care facility staff (e.g., extended care facilities or assisted living
facilities). Hospice interdisciplinary team members may facilitate communication, assist in
collaboration, and provide education in managing the patient’s skin care needs.

Chapter 2 References
1. Sibbald RG, Woo K, Ayello E. Increased bacterial burden and infection: NERDS and STONES. Adv
Skin Wound Care 2006:19(8):447‐461
2. Ayello EA, Capitulo KL, Fowler E, Krasner DL, Mulder G, Sibbald RG, Yankowsky KW. Legal issues
in the care of pressure ulcer patients: key concepts for health care providers: a consensus paper
from the International Expert Wound Care Advisory Panel. J Palliat Med 2009;12(11):995‐1008
3. Nix DP, Peirce B. Noncompliance, nonadherence, or barriers to a sustainable plan? In Bryant RA,
th
Nix DP, eds. Acute & Chronic Wounds: Current Management Concepts. 4 ed. St Louis,
MO:Elsevier/Mosby. © 2012, p408‐415

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