Palliative Wound Care

Abstract

Patients with advanced illness may present to palliative care or hospice with unmanaged symptoms that may be exacerbated by the presence of a wound. The wound can be a constant reminder to the patient and caregiver of the underlying illness. Distressing symptoms such as wound pain, odor, bleeding, and/or excessive exudate may impede the patients' ability to spend quality time with loved ones when they need them the most. Although patients may present with wounds of varying etiologies, the most common wounds seen in this patient population are pressure-related injuries. However, there is a shortage of both wound and palliative specialized clinicians. Telehealth and the use of other technology can be a way to address this shortage. This will grant access to a broader number of patients to ensure appropriate wound care plans are in place to meet the goals of care. Although wound healing may not always be possible in this patient population, having access to specialized wound and palliative experts can improve the quality of life for patients and their caregivers.

How do wound care nurses structure the subjective frame on palliative wound care? A Q-methodology approach

“…Given that the majority of patients are end-of-life patients in need of palliative wound care, their wounds are often only treated to stop them from worsening [ 23 ]. To effectively administer wound care to end-of-life patients, nurses must assess and consider such treatment in a holistic manner that include the progression of a patient’s disease(s) as they approach death [ 9 ]. Therefore, since a nurse who provides palliative wound care must also possess an overall knowledge of the patient’s disease, education on this must be done together with wound treatment training.…”

“…Palliative wound care is defined as the integration of strategies relating to the prioritization of symptom relief and improvement of a patient’s quality of life [ 9 ]. Palliative wound care refers to the maintenance of skin integrity and the management of symptoms such as odors, exudates, pain, bleeding, and infections.…”

“…Such care also improves the psychological stability of end-of-life patients, as well as their physical well-being, and facilitates other aspects of terminal care [ 2 , 9 ]. Therefore, with a growing demand for, and importance of, end-of-life care in healthcare systems like nursing homes, there is a growing demand for nurses to perform effective palliative wound care, leading to the continued publication of related studies.…”

“…It is necessary to combine theoretical knowledge with wound care nurses’ experiences for use in clinical practice. Because wound care nurses performing palliative wound care are involved in a patient’s end of life, their empirical knowledge derived from experience extends beyond general wound care [ 9 , 11 , 16 ].…”

Palliative wound care for pressure injuries

“…4 This includes addressing the physical symptoms, psycho social elements, and maintenance care to improve the quality of life for patients and families. 5 As a result, nursing considerations for palliative wound care for pressure injuries involve patient-and family-centered care, prevention, wound care, pain management, and psychosocial well-being.…”