Reflection on the understanding of Wound Aetiology

locution on the sympathy of Wound AetiologyWhilst on Community placement, an accompaniment occurred which en commensurated me to reflect on how important it is to understand the aetiology of exasperate criminal maintenance in order to practice holistically when delivering c atomic number 18 to affected roles. In order to wait on the reflection process the Gibbs (1988) Reflective Cycle go forth be employ which encompasses 6 stages description, thoughts and feelings, evaluation, analysis, conclusion and action plan which impart supporter me to continually develop and improve my breast feeding skills and companionship through evidence found learning whilst developing my self confidence in coincidence to affectionateness for new(prenominal)s (Siviter 2008). To maintain confidentiality and comply with the NMC Code of Conduct (2008) all names afford been changed.DescriptionMy mentor and I had trim backed a patient, who will be cognise as Mary (NMC 2008) in her own home. M ary is an aged(a) lady, who lives but and had been dumbfounding with degenerative leg ulcers for a number of months which had not installn any signs of improvements for a number of months. The purpose of the visit was to take down the alive dresss, assess any improvement or deterioration in the s sessdalises and to dole out and redress the injures in accordance with the current c are plan. As predicted thither was no funda psychical improvement in the break. Therefore I debrided the vexs, utilize an emolument and redressed with NA dressings, gauze and applied a 4 social class bandage which is recommended in the study by ( ) under the supervision of my mentor. later on leaving a patients house my mentor and I discussed the visit and raged near roughly the importance of not just treating the obvious problems but taking an holistic approach. During this discussion my mentor asked me to assess Marys sustainmentary status and if required talk to her about the impo rtance of bring tothy eating and the positive implication it may leave on affront better during our next visit.Thoughts and feelingsI agree always been interested in the importance of nutrition in celebrate of health and was had a vague conscious that it had an effect on wound meliorate. (DH 2010). As we visit a number of patients with chronic leg ulcers I thought it would be a great advantage if I understand the aetiology of wound heal and what effect nutrition had on the process, I also entangle that if people could be empowered to improve their nutritional status and maximise to maximise their healthy outcomes then this would be a very powerful tool. Although in that location are many factors wound tell on to heal and a holistic approach should be taken. This assignment will focus on wound healing and nutrition.EvaluationI felt empowered that I could affect peoples health in providing quite simple knowledge in terms of health promotion to people and was able to del iver holistic care to mary in accordance with the NMC mark of professional conduct (2008).If Mary had been given entropyrmation sooner on the effect good nutrition may arrive at on her would healing then she may be in a position where her legs would obligate been improved sooner.AnalysisThere are many definitions of a chronic would with one of the simplest perhaps organism described by as a skin defect persisting longer than 6 weeks or snitch recurrence of the defect.Wounds, especially chronic wounds are amongst the major unresolved aesculapian problems which digest affect quality of life and are a significant burden on health care costs (Thomas 2006). In the UK, in that location are around two hundred thousand suffering from chronic wounds at any one time. The healthcare cost for these patients is estimated to be 2.3-3.1 one thousand million per year (Posnett and Franks 2008).Infection, poor nutrition and impaired organ function are the main reasons many wounds fail to he al (Johnson et al 2005). until now to optimise effective wound healing a holistic approach should be taken and therefore these reasons should not be reviewed in isolation.The process of wound healing is a series of cellular and biochemical events which can be categorised into three stages of inflammatory, proliferative and maturation. The healing process is complex these stages can lots overlap and result in the healing process moving transport and backwards in response to various factors (1). Whilst a wound is healing there is a significant growing in cell proliferation, protein tax deduction and enzyme activity which demands vitality which would normally be released from protein reserves and energy stores (1). The corpse mainly uses glucose to provide this energy during cellular activity much(prenominal) as protein synthesis, cell division and secretion (Bray et al 1999).When dust tissue is damage the hypothalamous responds by releasing the stresss hormone catecholamine s which in turn increases the bodies glucose levels (Morrison et al 1999). testify suggest that wounds can increase the bodys metabolism which, if not addressed will result in weight loss, a particular problem with antique people (Lal et al 200- and DeSanti 2000). Clark 2002 also states that a lack of sufficient energy sources can inhibit wound healing resulting in body round out being broken down and used as a substitution for glucose to assist the healing process. Morrison et al (1999) also confirms that in nice nutrition can reduce the effect of the ashesic response and consequently delay the wound healing process. (1).Landsdown (2004) says that although wound healing is an individual process which varies from patient to patient due to factors such as age, sex, health status, socioeconomic, racial and geographical influences, position identification and treatment of chronic wounds is paramount to successful would healing. What is agreed is by many that to promote the best p ossible wound healing opportunities the body will demand energy and requires nutrients for proliferation and maintenance (sev references).Nutrition is recognised as the cornerstone of good health by the World Health ecesis (WHO) and The National Service Framework for Older People highlight nutrition as an important area for nurses to assess properly, observe for malnutrition and taking action, such as advice and place upright if nutritional requirements are inadequate ( DH 2001).There are many studies which have concluded that nutrition plays an important part in the process of wound healing. In particular many acknowledge the merge between the inflammatory stage and nutrition (Sobotka and Meguid 2010). Many chronic wounds prevail in the inflammatory stage. Casey (2003), states that the healing process can be prevented or significantly delayed when patients regimen does not contain essential nutrients. brownness et al (2010) agrees with this and suggests that whilst nutritiona l requirements vary between patients a lack of adequate nutrients cause delayed wound healing.However, there is much research to show that nutrition is crucial in a holistic approach to wound healing(Todorovic 2002).According to Bryant (2000) the importance of adequate nutrition for good wound healing should not beunderestimated. Williams and Leaper (2000) concur stating that whereas good nutrition facilitates healing, malnutrition delays, inhibits and complicates the process. If a patients nutritional status is compromised, and they are unlikely to meet their requirements for recovery (Collier, J., 2006)However Sobotka and Meguid (2010) point out there is still a lack of bottom wound healing studies due to a number of reasons such as design and execution, and lack of full understanding of the pathphysiology of wound aetiology and understanding of the more complex wound healing issues. They also suggest there are many rituals and myths surrounding wound healing which delays the pro cess and affects the advances and draw near of wound healing therapies.Nutrition deficiencies have been found in close to patients with wounds. However, evidence suggests nutrition is not an contract science in relation to wound healing and is relatively unexploredProtein, vitamins and some aminic acids are all important factors in the effectiveness of wound healing. Proteins are the key for tissue growth, cell renewal and repair. They have a significant dissemble many stages of the wound healing process. Continuous protein malnutrition compromises the immunity system and has a detrimental effect on the skin which constrains thinner and wrinkled (Brown et al 2010).In particular Vitamin B is found in meat, dairy, vegetables and fish and cereals. Vitamin b helps to promote cell proliferation, maintain health skin and muscle tone, support and increase metabolic rate and enhance immune and nervous system functions and therefore deficiencies in this vitamin can hinder wound heali ng (Landsdown 2004). Studies have shown that elderly patients with chronic wounds have consumed less than two-thirds of the recommended daily allowance for vitamin B. divide on amino acidsThe elderly in particularly can compel nutritionally vulnerable. 30% are at a high jeopardy of being malnourished in the UK and a further 70% at moderate risk. Malnutrition is a major cause for concern in elderly people, whether they are hospitalised or live in the community. It is important for nurses to be aware that sub-optimal nutrition has a detrimental effect on the bodys skill to heal wounds. Nutritional deficiency also impacts on a persons well being such as muscle function, immune response, respiratory function, rehabilitation and mental status (Kirshbaum 2009).There are many reasons older people suffer with malnutrition which include decreases appetite, psychosocial factors such as isolation and depression, impaired cognition, teeth and jaw problems, help with eating, poor positioning and acute illnesses which effect gastrointestinal soaking up and requires higher nutritional input (Harris 2004). During short periods of starvation the body can lose 60-70 grams of protein. However severe trauma or sepsis can increase this loss to 150-250 grams per day (Wild et al 2010).To compensate for this loss, in addition to standard food intake, nutritional supplements containing protein and energy are often prescribed which would have the appearance _or_ semblance a logical way to replenish nutrients and supply additional nutrients to advocate wound repair(Wild et al 2010) (Schols J et al 2009). However Brown et al (2010) states nutritional supplements in the context of wound healing is a relatively unexplored area suggesting this may be because nutrition is not an exact science. To further add to this argument Krishbaum (2009) says that detailed information on supplements and their ability to help with wound healing is not available. Williams and Barbul (2003) confirms that controversy surrounds the area of wound care and nutritional supplements.A patients nutritional requirements are a primordial aspect in the provision of holistic care and it is important for nurses to trust this when carrying out a nursing assessment to formulate a wound management plan. Together with other health professionals it is the nurses responsibility to gain knowledge in nutritional support to be able to offer help and advice and if necessary counsel undernourished patients in ways to improve their diet (Johnstone et al, 2005)..According to(Hopkins, 2001)nursing assessments, particularly of wounds, can be inclined to cargo hold down on physical aspects of wound management, for example the use of appropriate dressing and infection control. This was also evident fromobservation and participation of practice nursing work experience. There is evidence that poor nutritional status adversely effects wound healing (Haydock and Hill, 1986), delays healing and increases th e risk of wound dehiscence (Ruberg, 1984), and that dietetical intervention can improve or accelerate wound healing. mop upNutrition is important in wound healing although it is impractical to reach nutrients in isolation, several nutrients appear particularly important for wound healing. Proteins and amino acids are vital for tissue growth, renewal and repair after injury.several(prenominal) studies have found deficiencies in various wound patients. Most studies have been small in size and of short duration.From the research many of the info has come from America and not so much been done in the UK. However, I still think that the importance of nutrition is still a vastly underestimated and ignored issue in primary care, not just my general practice. I at the beginning of this module knew little about nutrition and healing and feel that perhaps other health professionals could become better informed. On reflection incorporating teaching sessions for other healthcare stave may hav e addressed this concern. I intend to now keep myself informed of advances in nutrition and healing and continue to assist patients and colleagues understanding.From the sight of a General Practice Nurse (GPN) it was considered that they may be ideally suited to act as facilitator to aid nutritional assessment and preparation of those in the practice population with wounds.AssessmentAction PlanI am still going to visit this lady twice a week and am going to ask at each visit if she is still eating healthily and what she has had to eat and offer simple suggestions in ways to eat food which will promote her wound healing, which in turn should improve her lifestyle. And I am going to look for other opportunities to teach and promote health whilst clinically treating patients.