Nursing and the Wound Care Dilemma

Wound Care in recent years has become big business. As a medical specialty group wound care has grown into a competitive market of the larger medical services provider industry. Wound care has also made a name for itself by providing mobile services. For many at-home patients and institutional clients without in-house debridement doctors, this is a winning solution.

But many patients receiving wound care by such onsite providers have to wrestle with a whole new set of problems. Because of the frequency and the proximity of the new surgeon’s provider visits, this brand-new physician now rules over the patient’s care plan. This random new doctor now is the most influential surgeon in the patient’s orbit.
In the medical world, certain conventions of eminence and integrity are assumed. A physician is generally esteemed by the level of education attained, the prestige of their academic credentials and their source, and the work history performed after graduation. The prestige of the places a physician works after graduation and the relative importance of their work experience determines the opportunities in the medical industry. This also predicates their authority in future patient care giving advice.
The occupational issues the physicians will come up against in the medical community will be a reflection of their formal training. But a position in wound care is due to years spent practicing in the field of wound care medicine. This standing
comes after years, sometimes decades working in professional medical care. Patients receiving wound care services almost never choose the doctor or know anything about them, unlike other types of doctors.
Mobile wound care surgeons analyze the condition of the skin. They measure and record the size depth and breadth of wounds and infected areas. The debridement surgeon can advise new courses of treatment. The wound care surgeon can also discontinue applications if treatments he or she finds detrimental or causeless. They may dismiss effective regimens without a second thought.
Soon the orders for the wound care may bear no similarity at all to the most successful and most impactful wound care regimens the patient has known. No other services can be authorized anymore. The patient is cornered. Then in addition to the discomfort and trauma of heavy infections, the wound care patient is twice over a victim. He or she will be left scratching their head, wondering ‘How did I get here?’

Medical provider services are part of an industry that makes money not doing its job. The more disorders, wounds, lesions, and infection that occur, the more money the hospitals, clinics, and services providers make. Of the gargantuan corporate behemoths that run modern medicine, all of them run on a modern theme: Sickness is an income opportunity.

Wound Care is a segment of an industry that nevertheless subscribes to business drivers that try to curry relationships with their business-to-business clients. In this particular, the patron is the long term care facility or Home Health corporation the patient belongs to. This means that a side contract is attached to the agreement between the physician and the patient. In the B2B world, this means that the interests of the facility and their case management prerogatives come before the wishes of the patient. While the patient may be under the impression that they are in partnership trying to improve their wound care ailments, the real boss of the situation is the facility or Home Health provider management.

This is a dilatory arrangement, as the patient will take consideration of other providers’ advice, including that of the PCP, assuming ongoing wound care success. They may discuss and develop the care plan with a projection of straightforward cooperation from the wound care service. But this assumption may be unwarranted. After making communications with other physicians regarding treatment, medication, and new therapies, the patient may find that the care plan is the victim of a hostile takeover.
Now the patient has heard so many different opinions about her case she feels seasick. After years of listening to persuasive opinions about treatments, the pendulum never rests. There is an endless cycle of wound care referral, the provider’s care initiation, the physician’s kindly bedside manner and befriendment. Then comes the sales pitch, the heavy sell, the isolation from other treatment doctors, and then the coup de gras. The wound care physician announces “It’s my way or the highway”, and the patient wonders how they got into this mess.
Now, all the documentation sets up the wound care provider as the decision-maker of the care plan. Nurses would do well to assist patients in coping and dealing with their doctors double-crossing them. Nurses and counselors should update case managers and family members if the observe patients feeling upset and confused by unsuccessful efforts to make their wishes understood. The concept of respecting resident rights is one that nurses should apply very seriously to all their charges.

The wound care physician now holds the upper hand and if the patient does not obey orders, the doctor can fault the patient for not being compliant. This can discredit the patient with the medical insurer. Documentation like this can risk the patient losing their medical coverage.
All of the assurances and advice that the patients received when other physicians were following the along the case somehow now gets lost. And it is surely a sheer coincidence that the recommendations of the most recent wound care visits dovetail with the least cost scenario for wound care treatment.
Nurses should recognize when patients feel distressed about any treatment they are receiving. But the impetus of hospitals and long term care facilities is to allow the business drivers of any medical care instituion have the last word.
Nurses today must decide whether to honor patient wishes or put the fiscal gains of their employer first.
This is the wound care dilemma for nurses. To step forward, and help, or do nothing, and hinder the situation. Nurses must acknowledge when the transparency and quality of patient care is compromised by the absence of patient consideration. Nurses must also operate with loyalty toward their employer. For nurses experiencing the above referenced type of scenario, serious reflection should ensue. These issues should make nurses everywhere advocate for patients who are getting manipulated by the ‘system.’
And professional nurses will serve their ethics best by obeying traditional standards of nursing handed down by generations. Namely, to put patient health, welfare, and recovery above all other considerations. Monetary and otherwise.

Nurse Treatment of Back Pain

The nurse with a patient complaining of back pain should screen the individual or treatment and therapeutic approach. Back pain, especially in the elderly or the very young, can be a red flag for more extreme disorders or more involved and complicated medical problems. Nurses studying the symptoms of back pain disorders and related conditions should review the list of symptoms and therapies. There is a tendency to medicate back pain, which can shield the patient from being diagnosed with more complex attention to the patient’s more overall health. Smoking and depression, for example, have been linked with diagnosis of back pain.

A nurse’s advice is the first line of defense when back pain strikes or rears up. A nurse should be fiercely protective of any patient complaining of unusual amounts of back pain, especially when they seem to have no basis in normal causes. Backaches after pregnancy and fibromyalgia, for example, would be considered expected. But a nurse will be able to single out over time that a patient has experienced serve back pain during some phases of their condition, and less or none in other stages of their admission. Nurses should be careful to fit the bed positioning to suit the best rest position for that particular patient‘s size and height.

A patient will rely (consciously or unconsciously) on the nurse’s ability to relate this occurrence of symptoms with the physician or other nurses. The nursing staff can plot from the chart when and under what stress the patient reports the most pain. The nurse can review notes from other nurses concerning the most serious incidents of back pain in a patient and analyze the cause. Does the pain result from exercise or inaction? Too much bed rest or not enough in the right position? Too many hours straining over a hot laptop, and not enough restful sleep in a bed meant for the purpose?

A change in bathing habits or a change in the weather could activate arthritis nerves, escalating back pain for a patient who previously only generally complained of it. Turning a mattress or finding a different sort of pillow may be ease the neck tension that cause the surprise of back pain for a patient. The patient may be so used to their particular daily habits in sitting or standing, sleeping and resting, that they have not noticed that these may have damaged best posture or their sleep rhythm. Even temporary daily adjustment to a poorly formed car seat could cause problems over time.

The usual amounts of back pain every adult processes can be due to stress, weight gain in the abdomen, rare syndromes, and poor sitting postures. But unusual pain experienced when the patient is sitting down or lying down can be cause for concern. The spinal cord and related nerves, and the pelvic bones and the sternum area, all come into play. Neck tension and postural neck pain can become the cause of tensed nerve in the lower back, often related to motion in the bed during sleep hours. Nurses should survey the patient upon waking about how their neck and back feels.

Patients with back pain should embrace alternate technologies as well as a consult with e specialty physician. Some habits can be cured, such as reading in bed and poor posture. Homeopathic alternatives for pain treatment have enjoyed a resurgence lately. Such patients should be monitored and the intervention be written for nursing prompts for better posture or “lights out” for less reading in bed, for example. Movement and grooming should be evaluated for best posture and less strain on lower back positioning for long periods of time. Nurses should be particularly attentive to fall/injury risks for back pain sufferers, such as dressing, transitioning from bed to standing without support, and in-bed movement without a rail.

Reflexology, meditation, and acupuncture can give significant relief for back pain sufferers, and many HMOs and insurance types cover these regimens. And massage can often do wonder for back pain victims. Thoracic exercise, lumbar spine exercise, Pilates, and Yoga can contribute to better overall back health. But the conventional medical approach still matters. Surgery and injections may be necessary, depending on the level of the condition. A hybrid approach can work well.

A general physician or custodial doctor may refer the back pain patient for an X-ray, MRI or CT scan. A bone scan or discography may be necessary to evaluate the cause of the back pain. The general physician may refer the patient to a specialty physician. Several physicians may need to be seen before the right one grasps the needs of a specific patient. The pain doctor or chiropractor may direct the patient to multiple modalities, such as stress management, physical therapy, holistic directions, as well as improved posture while sleeping, a better mattress and better neck rest from incorrect arrangement of pillows. And an evaluation of the patient’s coverage can allow for further options.

A nurse should be concerned with an over-reliance on medications to solve these pain problems. Chronic pain can be a condition too often medicated for, and not analyzed enough. Too often, many patients are impressed with commercialized depictions of pain-free lives in pharmaceutical advertisements. A nurse may have to parse these ideals down to simple English for a patient eager to accept the pill path of pain treatment. The dispute over NSAID therapy, more widely advertised drugs, and clinical trial results marches on.

Persons with back pain should be encouraged to try non-pharmaceutical approaches like yoga for strengthening the back, stretching, environment, or focused breathing. The level of attachment a patient has to their back pain can affect their willingness to employ various methods to lessen it or get rid of it entirely. Lifting the tent flap of back pain can reveal unpleasant truths a patient may be unwilling or unable to deal with. Bridging the gap between current pain symptoms and a pattern of anti-pain practices should be the care plan goal of many patient dealing with such issues.

Back pain is also a symptom of tense nerves, chronic stress, and harmful relationships. A watchful nurse can plot a record of just when the patient complains of back pain symptoms and analyze what occurred that might have prompted spasms or a cramped lower back. During times of medical issues and their tendency to create unrelated crises, the relatives and friends of a patient can create havoc with their emotions and concerns “dumped” on the patient. A nurse should observe when a certain phone caller or visitor makes the patient distraught.

Of course, energy vampires suck the energy from an empathic patient who does not have a filter to stop the onslaught of verbal disputes and arguments that occur when medical planning and family conflicts persist. Too often, a nurse will see the patient giving attention to a person who will deflate the and overload them with complaints and problems.

A person suffering from back pain must have a strategy to eliminate harmful inputs that worsen their symptoms. The intervention in the care plan will indicate to a nurse what steps they are authorized to take, such as moving abusive family members on and providing hints for coping.

Student nurses should know that duodenum ulcers, kidney problems, osteoporosis, and inappropriate headrests can cause back pain. Lifestyle choices such as a heavy shoulder bag or handbag, heavy lifting or stooping, or overstuffed pillows can disturb delicate rhythms in spinal function and rest. The causes of back pain and the conditions resulting in untreated back pain should be a regular course of study and a basis for materials review.