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Person-centered care: A win-win for wound management

November 1, 2009
by Tracy Widby, RN, CWCN
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Resident buy-in improves treatment compliance

At a glance…

The “secret” to effective wound prevention and treatment is resident-focused education and care planning. All parties involved-residents, families, and staff-need to buy in to the plan to achieve success.

Many people write articles for magazines about wound care, and I would like to add my own perspective. Long-term care is evolving into a different direction, the direction of person-centered care. One of the age-old questions is how to get residents to adhere to interventions to help reduce the probability of pressure ulcers and to heal pressure ulcers more timely. The quick answer? Let the patient have the choice in the treatment or interventions aimed at preventing or healing pressure ulcers. Buy-in is the key.

This is where person-centered care is the answer. What is person centered care? Person-centered care is allowing a person the right to choose. Don't they have that already, you ask? Let's follow a resident for a few moments from the time of admission. After admission, the resident is taken to a room occupied (usually) by another resident. He or she is put into what is called institutional life. What that means is that a person is put on a schedule: certain shower days, eating meals at a set time, getting medicine at a certain time. The resident is only allowed to bring certain things from home. They basically have no say.

Now let's take newly admitted residents through person-centered care. On admission, they may have a roommate but they can bring in things from home, such as their bed, favorite easy chair, and heirloom chest of drawers along with pictures. They have a choice as to where things are placed in their room, what days and times they want their shower. They are able to decide what they want for their meals. If they do not want a certain meal, such as breakfast, they will be offered something at mid-morning. If a resident wants pizza at midnight, he or she is allowed to have it, or hamburgers and French fries for lunch and supper for a week.

Case study

Let's take things a little further and discuss how person-centered care can have a positive effect on compliance with treatment modalities in relation to wound care. A resident is diagnosed with a stage II pressure ulcer on his coccyx from a recent acute care stay. A plan of care is developed with the resident and family. First, establish everyone's level of knowledge about the wound, starting with an in-depth explanation of how the wound developed, as well as a general discussion of the different types of wounds and types of treatments, not forgetting to explain the often misunderstood subject of how a wound heals.

This is where the buy-in comes in. Talk to the resident and his family about the types of treatment indicated. The resident, his family, and interdisciplinary team develop a treatment plan. The dietician visits with the resident and his family to establish a meal plan high in protein and nutrients to help with wound healing.

A treatment is started consisting of a foam dressing. A treatment order is written consisting of cleansing the coccyx with normal saline or wound cleanser, pat dry, and cover with a foam dressing. Check and change the dressing every three to five days and as needed. Interventions are put in place to include use of a pressure-reducing mattress, gel cushion in a wheelchair or resident's choice of chair. The treatment plan includes the dressing to be done late in the evening or early in the morning at the resident's request. Periods of rest to relieve pressure to area and promote healing are decided upon based on resident preference. The plan of care and resident's preferences are documented and communicated to the direct care staff. The plan of care is reviewed weekly after the wound is measured and assessed.

After the first week of treatment, the wound shows improvement and it shows signs of healing, the resident is compliant with the plan of care, and the family is kept up to date. Within three weeks the wound is healed, and the resident and his family-and the staff-are happy.

What is the secret formula?

When setting up a plan of care where person-centered care is concerned, there is no secret formula. The “secret” is to listen to the residents' and their families' requests. If you can work their requests into the plan of care in some form or fashion, you have buy-in from that point on.

A wise person (my mom) once said, “If you have to give a little, you will get a lot.” She did not mean money, she meant compliance.

Below, in summary, are a few ideas you can use when establishing a plan of care:

  1. Find out just how much the resident and family know.

  2. Explain about the type of wound, treatment modalities and interventions.

  3. Explain how a wound heals.

  4. Talk about nutrition and wound healing.

  5. Ask about resident and family preferences.

  6. Keep the resident and family up to date on how the wound is progressing.

  7. Document and communicate the plan of care to staff.

Conclusion

Person-centered care is not some high ideal no one can achieve. It is a goal everyone can achieve if they think outside the box and be creative. When you combine person-centered care with any realm of nursing or medicine, you can't help but be innovative.

We are about to embark on a new wave of person-centeredness with the baby boomers starting to arrive in continuing care retirement communities and other supportive settings. Are you ready? It will be an adventure.

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