Patient Autonomy, Empowerment, and Self-Management in Wound Care: Are We There Yet?

Introduction

Individuals have the autonomy and right to play a vital role in their healthcare. As they understand their role, this enhances their experience and satisfaction and results in better outcomes and quality of life. With the disparity between the ratio of wound care experts and the rising prevalence of chronic wounds, as well as the challenges of the current pandemic that scale wound care services back, it has become indispensable that patients become engaged and empowered to step forward and helm a vital role in their health care in tandem with scouring the best wound management services.

Now, the question arises; can all the wounds be managed at home? So, to comprehend the paramount role of wound healing professionals, you need first to understand its types.

Wound Healing: Definition and Types

From ancient years till now, wound assessment is a predicament beyond medical society. In most cases, wounds and increased morbidity, as well as substantial mortality, are directly proportional.

Wound healing is one of the most complex processes in multi-cellular organisms, encompassing multi healing phases during the process.  Moreover, it includes the homeostasis/inflammation phase, proliferation phase, and remodeling phase.1 These phases involve a cascade of changes in the body to achieve tissue repair. Yet, there are many factors that if not addressed that can prevent or delay wound healing. While a specialized wound professional is capable of identifying and addressing the many factors to prevent complications and accelerate healing, the individual with wounds also plays an important role by identifying early signs and symptoms of complications and seeking immediate help. In other words, the individual needs to know when their wound is getting better or worse!

Wounds can be of the following types:

1. Acute Wounds:

Acute wounds are linked with the external corruption of intact skin and encapsulation of surgical wounds, abrasions, burns, minor cuts, bites, as well as deleterious traumatic lacerations or caused by crush or gunshot injuries. Such wounds heal within a predictable time irrespective of the type of cutaneous injury.2 If not treated with an appropriate technique and the right dressing these types of wounds may develop infection leading to pain and a long time to heal, which then become chronic wounds.

2. Chronic Wounds or Hard-to-heal Wounds

Generated by endogenous mechanisms due to factors affecting healing (e.g., diabetes, infection, excess of moisture), which can compromise some skin layers such as dermal and epidermal tissue integrity. Types of hard-to-heal wounds are venous or arterial leg ulcers, diabetic foot ulcers, and pressure injuries/sores.2,3 Why they are difficult to heal? Some reasons are impaired arterial supply or impaired venous drainage and metabolic diseases such as diabetes mellitus. Others reasons are malnutrition, excessive pressure on the wound bed (due to being bedridden, wearing inappropriate shoes). These types of wounds are considered complex and therefore, require a wound care specialist, who is knowledgeable and skilled to address the factors affecting healing and create a good wound environment for the patient’s body to accelerate healing.

So, it would be correct to say that such complex wound treatments; should be carried by certified wound care professionals. If you are thinking, how can an individual foster the healing process? Then scroll to the next section.

Patient Involvement: Meaning and Importance

Involving patients in their care is an intricate concept, but it is now widely recognized as a vital aspect of the 21st-century healthcare system. This concept moves away from a biomedical model that was developed for acute disease and therefore does not fit with chronic wounds. And has only contributed to skyrocketing the incidence and prevalence rates of heard-to-heal wounds and limb amputation worldwide.

In the empowerment model, individuals are encouraged to play a more active role in the wound healing process by being on top of everyday self-management practices and decisions. Despite in-depth research, the concept of patient empowerment is not clear for either clinicians or patients.

That is why it is important to clarify what it means for:

Clinicians:

It means taking into consideration the autonomy and rights of their patients to make decisions about their own health and be involved in the development of their own care plan. Clinicians need to develop mutual trust and clear communication that enables the flow of details for both involved parties.

Patients:

It refers to that individual needs to learn about their condition and develop self-confidence to implement everyday self-management practices and managing and make decisions about treatment plans.

Patient empowerment supports a partnership between patient and provider that respects each one role and boosts an individual’s capabilities to implement the care plan designed with the patients, not to them. This allows patients to achieve better outcomes, satisfaction with care, and improvements in quality of life. On the other hand, the healthcare provider will not be frustrated when patients do not follow their instructions. As the care plan was developed in collaboration it is more likely that patients will implement them.

Top Reasons Patient Involvement is a Priority

  • According to the Canadian Home Care Association, nearly 30% of all people receiving home care and living in the nursing home(LTC) have wound care needs and 50% of services provided by home care programs in Canada Involves wound management 5
  • A recent study from the USA, showed that approx. 15% of Medicare beneficiaries (8.2 million)(8.2 million) had at least one kind of wound or skin infection. Surgical infections were the top prevalence category (4.0%), followed by diabetic foot infections (3.4%). 6
  • There is a surge in the number of people living with a wound, due in part to an aging population, and the increased cases of diabetes, obesity, and a plethora of long-term conditions.7  
  • The extent to which an individual is involved in addressing the wound issue impacts the quality of the treatment and the derived satisfaction level.
  • Many individuals with wounds living at home may feel isolated; they may develop symptoms that hinder their day-to-day activity and become anxious about their condition, leading to depression and self-care neglect.

Thus, it becomes indispensable to enhance patient-provider collaboration, connect patients and families to the right services and resources and develop mutual trust, which is reinforced by effective communication between the caregiver and the individual facing the brunt of a wound.

How we at ADVANCED addresses the Challenges in Patient Empowerment

To make patient involvement a reality, our team of certified wound care experts adopts strategies that are aligned with the empowerment model by allowing individuals to take control of their health, make choices, and influence decisions that affect their well-being and health outcomes.

A spectrum of factors can act as challenges to ensure patients are involved in their healthcare. Often this adaptation of the service is delivered to make sure it fits our client’s needs and clarification of roles — not only the roles played by our team.

For decades, the traditional relationship between clinician and patient was more of a paternalistic model, with all decisions based solely on the knowledge and expertise of professionals. At Advanced our approach includes patients at the center of care and decision making. We equip them with knowledge and information about their health issue and provide opportunities for them to ask questions, express their needs, preferences, and concerns. Our collaborative approach is based on the patient-empowered model. Thus, the focus is on two-way communication to back patient involvement. However, sometimes, time-constraint can bridge the gap between the professional and the individual. Our clients can reach out to us at any time through our safe and secure chat-like portal.

As experts of wounds and patients’ needs, our team understands that it is crucial to ask a plethora of questions and get honest and knowledgeable responses. It may encompass a range of issues, including being informed about the risks and pros of all the distinct treatment options. And what this may refer to in terms of expected outcomes. Our team also understands that being unaware of which choices are available and how these can be delivered will impact our clients’ ability to make prudent and informed decisions about their care. In summary, at Advanced we support patients and families with reliable information and they feel capable to make decisions about their care.

Choose the Wound Care Services that Put Patients First

In a nutshell, we can say that living with a sigh of loss, control, or independence can harm an individual’s mental health. Thus, all individuals should have the opportunity to comprehend their condition, be proactively involved in decisions about their treatment, and have the opportunity or option for managing their wounds from the comfort of their home or where they have their needs heard or listened to. It is the core reason; we at ADVANCED offer patient-centered wound care services.

References

1. A.C.de O. Gonzalez, T.F. Costa, Z.de A. Andrade, A.R.A.P. Medrato. Wound healing – a literature review. An Bras Dermatol, 91 (2016), pp. 614-620

2. Whitney JD. Overview: acute and chronic wounds. Nurs Clin North Am. 2005 Jun;40(2):191-205, v. doi: 10.1016/j.cnur.2004.09.002. PMID: 15924889

3. Menke NB, Ward KR, Witten TM, Bonchev DG, Diegelmann RF. Impaired wound healing. Clin Dermatol. 2007 Jan-Feb;25(1):19-25. doi: 10.1016/j.clindermatol.2006.12.005. PMID: 17276197.

4. Eurobarometer Qualitative Study. Patient involvement. Aggregate report, May 2012.  Retrieved from: https://ec.europa.eu/eip/ageing/file/336/download_en%3Ftoken=6-zWlwfx

5. The Canadian Home Care Association. (2012). Evidence-based wound care: home care perspective. Retrieved from: https://cdnhomecare.ca/wp-content/uploads/2020/03/Wound_Management_Home_Care_Perspective_-_English_2012.pdf

6. Nussbaum SR, Carter MJ, Fife CE, DaVanzo J, Haught R, Nusgart M, Cartwright D. An Economic Evaluation of the Impact, Cost, and Medicare Policy Implications of Chronic Nonhealing Wounds. Value Health. 2018 Jan;21(1):27-32. doi: 10.1016/j.jval.2017.07.007. Epub 2017 Sep 19. PMID: 29304937.

7. Sen CK, Gordill GM, Roy S, et al. Human Skin Wounds: A Major and Snowballing Threat to Public Health and the Economy. Wound Repair Regen 2009; 17(6): 763–71. doi:10.1111/j.1524- 475X.2009.00543.x

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