Wound Care Management for Nurses

A one day course for Nurses on wound care in practice. This is a didactic and hands on course which will cover topics on how wounds heal, what prevents healing, acute wounds, chronic wounds, infection and antiseptics. Wound and patient assessment, and decisions of what and how to dress wounds. This includes the demonstration of products, as well as the role and use of bandages and compression therapy.

Learning Outcomes

  • To understand the biology of healing.
  • To identify the factors that impact on wound healing.
  • To understand accurate wound and patient assessment.
  • To clarify wound infection and the role of antiseptics.
  • To identify and treat acute and common chronic wounds seen in practice.
  • To clarify and examine dressings their type and functions.
  • To understand and demonstrate bandages and their role in retention, support and compression.

Topics

1. Introduction

An overview of the current state of play with wounds, the ageing population and the rapid increase in Diabetes and its consequences. The uses of Inexpert “experts”, Eminence-based practice not evidence-based practice Industry only training, Too many dressings. What is the burden of chronic wounds in today’s society. Dressings don’t heal wounds Good dressings optimise local environment for healing. Chronic wounds need a diagnosis (i.e. why wound is not healing) AND do something about it , Do not swab chronic wounds as a matter of course often leads to unnecessary antibiotic use & not addressing underlying problem.

2. Wounds Biology

Wounds go through a structed process to heal There are three phases of wound healing inflammatory (destructive),proliferative (regenerative),maturation (reparative) During all of these phases there are a number of cells that are essential to the process of the healing including platelets, neutrophils, macrophages and fibroblasts. Just as some of the cells which you may think are only present for one particular phase are there from the very beginning of the wound, through to the ultimate healing of the wound. The critical thing is that the phases of healing are a continuum, each phase continues on in a steady process merging with the next phase. In fact, one wound may be in more than one phase at one time. Knowledge and understanding of wounds, tissue and healing have grown rapidly over the past 30 years, resulting in a major change in the method of wound management.

3. Factors impacting on wound healing

Most wounds heal without a problem however others are slow or remain unhealed for a considerable length of time. There are a number of factors which affect wound healing, intrinsic factors including: health status, immune function, diabetes, age factors, body build, nutritional status and extrinsic factors including: mechanical stress, debris, temperature, desiccation / maceration, infection, chemical stress.The effects of systemic medications on the healing wound vary greatly, medications are prescribed for conditions which may be unrelated to the wound, but which may have effects which could either inhibit or stimulate healing.

4. Practical Wound Assessment

When assessing the status of the patient, the areas to be addressed should include a general health status, medication review, nutritional status assessment and an evaluation of the awareness and involvement of the patient’s family concerning wound care. The first step is assessment of the patient's general health status, especially cardiorespiratory function. Any disease that disrupts or diminishes circulation and perfusion can interfere with the normal delivery of cell nutrients and the constituents of the immune response. A review of medications nutritional status then carefully assessing the wound. Wound assessment includes the wound's aetiology, its location and its size and depth. A thorough wound assessment also includes evaluation of the wound bed in terms of type of tissue present; observation of the quality and amount of exudate; and determination of the presence or absence of infection. It also involves assessment of the condition of the peri-wound area and evaluation of any past and current treatments. Careful assessment and planning will actually save time spent on inappropriate or ineffective treatments. We will look at simple methods of patient assessment covering all of these areas.

5. Acute Wounds Cuts, Grazes, Burns and Skin Tears

Most wounds resulting from trauma can be managed and treated as part of everyday practice. The critical aspect of emergency first aid is to be aware of your own limitations and know when to refer on to a hospital. There are some simple rules for the management of such wounds, covering decontamination, cleansing, haemostasis, wound closure, dressings bandages. The types of wounds fall into the following categories: Lacerations cuts and Grazes minor lacerations Major lacerations. Bites Insect animal. Burns, sunburn scalds, superficial burns partial thickness full thickness. Post-operative wounds hospital setting home setting. The major objective is to facilitate optimal healing that is, with as little scar tissue as possible, with a good cosmetic appearance.

6. Leg Ulcers and their management

A large proportion of wounds seen in clinical practice are chronic in nature. The studies indicate that one percent of the population has a chronic wound, and of that group some twenty percent have had the wound for more than two years. More recent studies indicate that the level of chronic wound particularly in older patients is considerably higher than that percentage. Chronic wounds may be classified into the following groups:

  • leg ulcers
  • pressure wounds
  • post-operative wounds
  • chronic infected wounds
The difficulty in the management of any chronic wound is that there is always an underlying physiological cause of the wound which must be treated, but many patients have multi-factorial issue and co-morbidities. For best results the basic cause of the problem must be attacked

7. Wound Infection and Antiseptics

The use of topical antiseptics and antibiotics in acute wounds is entirely different from that used in chronic wounds. In a traumatic wound the risk of infection from contamination at the time of wounding is very high. The aim is to use antiseptics and antibiotics prophylactically in order to reduce the level of bacteria in the wound, and then to allow the body's own mechanisms to destroy the rest. The use of some less toxic antiseptic products are appropriate in the early management of acute, traumatic wounds. The use of products like silver dressings in burns is part of the early management of this type of wound. We will examine the best antiseptics to use and how to use them.

8. Dressings What to use and When

For many years the products used were of the 'passive' or the 'plug and conceal' concept including gauze, lint, non-stick dressings, tulle dressings and fulfil very few of the properties of an ideal dressing very limited (if any) use as primary dressing, but some are useful as secondary dressings. It is clear that there are a number of negative aspects in the use of gauze. The non-absorbent passive dressings are Paraffin gauze (tulle) dressings are among the earliest modern dressings.

Interactive dressings help to control the micro-environment by combining with the exudate to form either a hydrophilic gel, or by means of semipermeable membranes, controlling the flow of exudate from the wound into the dressing. They may also stimulate activity in the healing cascade and speed up the healing process. There are SIX classes of Interactive dressings and are classified according to their functionality. There are a small number of specialised dressings for use in particular wound types. In addition there are a number of specialised products that are antibacterial and are used in both acute and chronic wounds. We will look at a range of different dressings available and discuss the best ones to use in particular wounds.

9. Bandages and How to apply them and when to use them

When choosing and applying a bandage, it is important to differentiate between the traditional and the ritual on one hand and what is best and most cost effective for the patient on the other hand. Bandages may be used for a number of purposes. Keeping a dressing in place (retention), supporting an injured joint (support) and assisting venous return in the lower leg (compression), providing a pressure gradient to encourage the flow of blood back to the heart and reduce oedema and swelling by compression, as a prophylactic in sports to prevent injury, as a pressure bandage to help control bleeding and post-surgically to help control venous-oozing. Compression bandages are used as one of the main treatment in the management of venous disease, especially where there’s an association between venous ulcers and varicose veins both to aid the healing of the ulcer and ultimately in the management of the venous return to help prevent reformation of a venous ulcer. Compression bandages come as either High Stretch Compression Bandages, Tubular bandages, Short Stretch Bandages or Multi Layer Bandages. We will demonstrate the method of bandage application of the range of different bandage types.


This workshop is endorsed by Australian College of Nursing (ACN) according to our Continuing Professional Development (CPD) Endorsed Course Standards. It has been allocated 8 CPD hours according to the Nursing and Midwifery Board of Australia – Continuing Professional Development Standard.


This activity has been endorsed by APNA according to approved quality standards criteria.
Completion of this educational activity entitles eligible participants to claim up to 8 CPD hours.


Timetable 2017

TimeTopic
7:45 - 8:00 Registration
8:00 - 8:30 Tea and coffee on arrival
8:30 - 10:00 Topic 1: Introduction and overview (15min discussion on current wound care practices)
Topic 2: Wounds Biology (45min Q&As)
Topic 3: Factors Impacting on Wound Healing (20min Q&As)
10:00 - 10:30 Morning tea
10:30 - 12:30 Topic 4: Principles of wound assessment (45min hands-on demonstration and Q&As)
Topic 5: Wound Infection and Antiseptics (30min Q&As)
Topic 6: Acute Wounds ( 45min Q & A ) 
12:30 - 1:30 Lunch
1:30 - 3:00 Topic 7: Leg Ulcers and Their Management  (60min case study discussion and Q&As)
Topic 8: To Dress or Not to Dress (part 1 Lecture 30 min)
3:00 - 3:15 Afternoon tea
3:15 - 3:45 Topic 8: To Dress or Not to Dress (part 2 Demonstration 30 min)
3:45 - 4:30 Topic 9: Bandaging and compression therapy (45min hands-on demonstration and Q&As)
4:30 Evaluation & Finish

Course Director

Geoff Sussman

Associate Professor of Wound Care

Associate Professor Geoff Sussman  holds a position in  the Faculty of Medicine, Nursing and Health Sciences  Monash University and he has been a faculty member at St Anne’s College Oxford University and  Auckland University . He has been involved in wound management for over 30 years in clinical research and clinical practice and teaching  and  has over 100 publications. He is a board member of Wounds Australia, an executive board member of the Australasian Wound and Tissue Repair Society and International Wound Infection Institute. He was the inaugural  Secretary of the World Union of Wound Healing Societies and is president elect of the Asia Pacific Association for Diabetic Limb Problems. He is associate editor of the International Wound Journal, a member of the editorial board of Wound Practice and Research, Chronic Wound Care Management and Research  and is a member of the advisory committee for Post Graduate Wound Care education at Monash University. He was awarded an OAM in the Queens birthday Honours in 2006 for his work in wound care as a researcher, educator and clinician. He was recognised at the 2008 World Wound Healing Congress in Toronto with a life time achievement award for his work in wound management.