The science and art of holistic wound care
Wound care used to be more of an art than a science, but thanks to contributions from different disciplines, wound care is now firmly based on science and clinical evidence using a holistic view of the patient. This means not only focusing on the specific wound that needs to be treated, but also trying to observe and understand the patient’s overall health. Such an approach requires a range of skills from medicine to physiology, psychology, clinical engineering and patient care.
The management of the patient with skin lesions, a subject that is often underestimated, requires targeted and timely interventions through the creation of specialised and multidisciplinary teams. These teams can accompany the person throughout their treatment journey, ensuring effectiveness of treatment and equanimity of access to care.
Skin lesions include all conditions of loss of dermo-hypodermal substance and they can affect all age groups, from newborns to older people. They can be the result of trauma, accidents, complications and consequences of vascular or metabolic diseases, or chronic autoimmune pathologies. Skin lesions can also result in hard-to-heal wounds following post‑acute and postoperative surgeries.
The incidence of pressure ulcers (PUs) in hospitalised patients of all ages ranges from 4–9%, increasing to 10–25% in older people.1,2 Hard-to-heal wounds consist of ischaemic ulcers, diabetic ulcers and venous ulcers by PUs that do not re-epithelialise. The magnitude of the phenomenon is important because of the number of patients involved and resources needed to treat the problem. PUs are debilitating, painful and reduce the patient’s quality of life. They affect more people over 65 years of age, and their risk is increased in patients with comorbidities (diabetes, hypertension, respiratory disease, chronic obstructive pulmonary disease) but also in younger patients with neurological and post-traumatic injury.
Patients with hard-to-heal PUs are among inpatients and home care patients. The problem concerns general practitioners, hospital and community care nurses in the home and nursing home, and family. Thus with increasing life expectancy and an aging population, there is further evidence of the need for health professionals with the appropriate skills and abilities to manage a PU.
Hard-to-heal wounds represent a major public health challenge, not only in Italy, but also in other European countries where health and care professionals and organisations face the same critical issues: ● Heterogeneity of tools ● Criteria and monitoring of surveillance systems ● Assessment of appropriateness of choice and treatment ● Diagnostic and therapeutic pathways and continuity of care ● Ways to develop and maintain expert and specialised skills ● Creation of multidisciplinary teams and access to medical devices. The situation in Italy is heterogeneous and citizens from different regions often do not have the same access to care. Comparing the different care pathways for patients with skin lesions allows us to highlight the lack of equity and accessibility of care in the national context, and to raise awareness for the implementation and improvement of services.
Various associations and societies aim to develop expertise, improve care pathways, develop research and disseminate evidence-based best practice in collaboration with institutions, professional bodies and patient groups.
AISLeC (the Associazione Infermieristica per lo Studio delle Lesioni Cutanee) is the first scientific nursing interdisciplinary Italian society dedicated to the study and research of skin lesions recognised by health professionals and by institutions as a scientific society committed to promoting evidence-based practice.
AISLeC’s aim is to promote the value and importance of science in the training of health professionals as a guide to clinical and organisational decision making, and to pursue the development of integration of expertise and multidisciplinarity as essential in the management of skin wounds.
AISLeC—which is celebrating its 30th anniversary— is a point of reference that aims to develop the skills of health professionals by giving priority to innovation and research, and by promoting appropriate dissemination among professionals, institutions and citizens.
It carries out scientific activities aimed at training, information, popularisation, education and the development of scientific research suitable for improving clinical practice.
Among its various initiatives, in addition to face-to-face and distance learning (FAD) training interventions, is the ‘Wound Care Pill’, which allows for the discussion of a clinical topic of interest, based on evidence combined with expert opinion, on a clinical practice topic or question. In other words, ©
JOURNAL OF WOUND CARE VOL 32, NO 5, MAY 2023