Team Approach to Wound Care
It takes a village to treat a chronic wound. A chronic wound is one that does not progress to healing at the expected rate. Almost any wound can become chronic, however common chronic wounds can include neuropathic foot ulcers, pressure ulcers, leg ulcers, and diseases.
Due to their chronic nature, and the multitude of factors that impact wound healing, no one is positioned to impact wound healing without the help of other team members. This team includes the patient, family, and various healthcare professionals.
Who’s on the team?
The composition of the team will change in relationship to the client’s needs and goals. First and foremost on every team is the client. Ultimately it is the client’s goals and values that drive the direction of the team. Treatment plans that are negotiated with the client, and are in line with their values and priorities tend to foster adherence to these plans. Thus the healthcare providers need to know the other individuals whom the patient considers to be on the “team”. The family is an important part of this group and will also influence the treatment plan. Treating the cause of the wound alone may involve several healthcare professionals. Knowing the role of each team member will help with the formation of an appropriate team for each individual as well as appropriate referrals:
A Registered Nurse is often involved in assessing the client and determining the factors that may be contributing to the development of the wound. As the healthcare provider who may have the most regular contact with the client (through dressing changes and other treatments) they can be an invaluable source of information regarding the true impact of that wound on the client’s quality of life.
Dieticians are incredibly important in the care of people with chronic wounds, especially those with diabetes because the client’s diet has a direct influence on wound healing. They will help to ensure that the client has an appropriate intake to include all essential nutrients, and maintain good glucose control.
Orthotists are important to help with the offloading of the foot through the use of customized orthotics and footwear adaptations. Until the wound is offloaded, the pressure redistributed and shearing reduced, the wound will not progress to healing.
Prosthetists are critical to ensuring the proper fit and funding of prosthetic devices such that the client’s gait does not cause an increase in pressure/forces on the client’s remaining foot.
Physical Therapists have expertise in gait analysis and the prescription and use of ambulation aids. Through the prescription of an appropriate ambulation aid, stressors on the foot can be reduced. In addition, the physical therapist may be able to prescribe alternative forms of exercise to help with glucose control without increasing the stress on the client’s feet.
Occupational Therapists have expertise in the prescription of assistive devices including wheelchairs and scooters. This can be an important part of the strategy to offload the client’s foot. In addition, their knowledge in promoting independence with activities of daily living helps clients to become independent by inspecting and caring for their feet on a daily basis.
A Social Worker is a critical team member who can address the psychosocial components such as the loss of role/identity (i.e. being the breadwinner), fear of amputation, cultural concerns and fostering a readiness for change. Social workers are often also able to assist the client in finding funding for devices, and income replacement.
The Physician may function as a “quarterback” in the team, ensuring appropriate referrals for the client, providing prescriptions as appropriate, and promoting the overall health of the client. Other specialists such as a wound care specialist, infectious disease specialist, vascular surgeon, endocrinologist, orthopaedic surgeon, gerontologist, etc. may also need to be involved.
Finding a team of healthcare professionals with a common goal can be a challenge in some settings. It’s important to recognize however, that teams do not need to be formed within one organization or facility – it is possible to have a team without walls.
Regardless of who is on the team, the healthcare team must engage, empathise, educate and enlist the client. Engaging the client involves finding out about the person and who they are beyond being a person with a wound. Empathizing is demonstrating a true understanding of the client’s concerns and how the wound may be affecting their life. Then the healthcare professionals provide education for the client so that they are able to make informed choices about their treatment plan. Finally the healthcare providers enlist the client and gain commitment to the treatment plan.
Linda Norton OT Reg. (ONT), MScCH
National Education, Shoppers Home Health Care; Faculty, University of Toronto
Patricia Coutts RN
Toronto Regional Wound Healing Clinics; Faculty: University of Toronto
An excerpt from Alignment 2013, Official Publication of Orthotics Prosthetics Canada