Wound care rewards outweigh challenges for home health nurses

The science of wound care has been evolving ever since Florence Nightingale and her nurses treated soldiers’ wounds under dire and challenging circumstances in battlefield hospitals during the Crimean War. Now, more than 150 years later, wound care has become an important and growing — but still challenging — nursing specialty.

Eileen P. Williamson, MSN, RN

Eileen P. Williamson, MSN, RN

Home care nurses are never sure what they’ll find when at a patient’s home. Frequently they begin their assessments at the curb before they even meet the patient, looking over the outside home environment for safety and other potential issues. That assessment often leads to a laundry list of problems that becomes a to-do list of solutions. Once inside the home, they perform a full assessment that makes the list longer — and wound care is often on it.

Home care patients can suffer from various types of wounds that range from the serious traumatic or surgical ones to simpler early-stage pressure ulcers. Although the nurse is the one who takes charge of wound care, every member of the home care team understands that any break in skin integrity requires immediate attention and must be reported promptly. When wound care involves a patient who is on home care, the job is a different and more complex one for the nurse.

Comprehensive care plans are essential, as are complete, accurate and consistent communication, documentation and follow-up with everyone involved in the patient’s care, including the family. Ongoing surveillance of the wound is crucial, and regardless of the home’s sanitary conditions, everyone must maintain clean technique at all times. Also, a patient’s home is not part of a large organization. Each home is unique and comes with its own risks and potential problems that are different from those encountered in traditional hospital settings.

Home care nurses don’t have safety, risk management, dietary, central sterile or environmental services departments to turn to, so everything — from a lack of equipment, heat or hot water, to poor lighting or sanitation, slippery rugs or empty pantries — ends up on their to-do lists.

Wound care for patients at home requires a team of players from various disciplines. The nurse oversees, directs and delegates all aspects of care to each team member. Nurses are leaders and teachers, and their practice is collaborative as well as autonomous. Because of the diverse groups they serve and work with, home care nurses need excellent people skills and must be culturally competent.

Culture plays a role in every patient care setting and interaction, but the role is more important in home care. The patient’s cultural background, beliefs and practices need to be recognized and considered in the patient’s home and in the care plan for that patient. Along with the challenges, there are many rewards in caring for patients at home for nurses and their team members. Those who have chosen it as their specialty say they love what they do and who they do it with. And maybe that love is the real home team advantage — especially for the patients they serve.

Earn CE credit! Take one of our wound care CE modules at http://ce.nurse.com/RCourseSearch.aspx?SearchT=wound.

For more stories on wound care, visit http://news.nurse.com/article/20150123/NY02/150123003#.VMZIRS59YeF.


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