Palliative Would Care
Nursing aspects of palliative wound care are driven by patient and family goals, integrated with three components of wound management: the management or palliation of the underlying cause of the wound, management of wound-related symptoms, and management of the wound and peri-wound skin, including lymphoedema. Wounds most commonly found include pressure ulcers, fungating malignant wounds, and fistulae. Patients with blistering skin conditions, inherited and acquired, have extensive longstanding wounds and palliative care needs. In addition, meticulous skin care for patients of all ages with debilitating long-term conditions is crucial to prevent unnecessary skin breakdown. The symptoms and psycho-social aspects and local problems associated with broken skin and wounds include odour, exudate, excoriation, maceration, bleeding, pain, and pruritus. Key clinical interventions include the application of wound dressings and skin care products. Unless these wounds and related problems and symptoms are managed effectively and consistently, body image and feelings of self-worth are affected together with the ability to socialise and maintain employment with associated loss of dignity and distance from social contacts.
Skin problems are prevalent in patients with advanced disease who are receiving palliative care. Nursing aspects include the management of skin breakdown and wounds together with related symptoms, and promoting patient comfort and dignity, thereby enhancing the quality of life of patients and families. Palliative wound care encompasses the care of patients, of all ages, with a weakened skin barrier together with the management of wounds caused by advanced and intractable diseases and conditions.
Palliative wound care acknowledges the psychosocial impact of wounds on the individual concerned, their family and friends, and also their clinicians. It is driven by patient and family goals, which are integrated with three wound management components to reduce the impact of wounds on all concerned:
- management of palliation of the underlying cause of the wound
- management of wound-related symptoms including physical, psycho-social and existential aspects
- management of the wound and peri-wound skin.
The difference between curative and palliative wound care, in our view, has more to do with patients quality of life, goal setting and outcome measures than radically different clinical interventions. For example, palliative wound care goals include the management of odour, exudate, bleeding, pain, and the maintenance of an intact dressing system, which are interim goals towards wound healing by secondary intention. Wound healing may also be achievable, demonstrated by a study from Canada where the potential for complete healing of pressure ulcers of grade II and above, skin tears, and diabetic and venous ulcers increased the longer the patients lived.
Aims and Objectives:
To conceptualise palliative wound care in terms of its definition, core elements, and any differences with general wound care management.
To develop, through consensus, an agreed set of core outcomes for reporting intervention studies in palliative wound care.
To agree the core elements of an undergraduate and post-graduate curriculum on palliative wound care.
To provide recommendations for optimal advanced wound care management in this population, for policy initiatives, to promote palliative wound care and areas that need research.
The Task Force is chaired by Georgina Gethin, Senior Lecturer, School of Nursing and Midwifery, NUI Galway, Galway, Ireland.