Wound healing is complex and there are many factors that can interfere with the normal healing process, which can result in an acute wound becoming a chronic, non-healing one. Cigarette smoking is frequently listed as one of the factors which can interfere with wound healing. However, it is one of the potentially modifiable lifestyle behaviours that can reduce the risk of developing a nonhealing wound (Ellis, 2018). Although the precise mechanisms as to how smoking delays healing are currently not clear (Sorensen et al, 2010a, b; Sorensen, 2012), this paper explores the literature on how smoking interferes with the wound healing process at a pathophysiological level, together with how it may be responsible for increased infection rates and delayed healing. In addition, it also discusses how smoking can contribute to infection and wound dehiscence in surgical wounds and delay healing in chronic wounds, resulting in a prolonged recovery time for the patient.
A pressure ulcer is localised damage to the skin and/or underlying tissue, usually over a bony prominence (or related to a medical or other device), resulting from sustained pressure (including pressure associated with shear). The damage can be present as intact skin or an open ulcer and may be painful (NHS Improvement, 2018a). The consequences of pressure ulcers are increased length of hospital stays for the patient, estimated at 4.31 days (National Institute for Health and Care Excellence [NICE], 2005), but also an increase in cost to the NHS, which is identified at around £14-21 billion annually (Nutritional Pressure Ulcer Advisory Panel et al, 2014). Poor nutrition has been recognised as one of the risk factors in the development of pressure ulcers. Improving nutritional intake of patients is thus paramount in reducing patient harm and unnecessary cost. This article looks at the role nutrition plays in the prevention and treatment of pressure ulcers, provides practical advice and signposts readers to the resources produced by the Nutrition and Pressure Ulcer Task and Finish Group.
This article reports on the monitoring of healing rates of fullthickness pressure ulcers at one care provider in the Midlands. This was an agreed measure that was part of the Commissioning for Quality and Innovation (CQUIN) incentive scheme for the CCG. It was an attempt to provide data to support the anecdotal reports that pressure ulcer healing rates had improved after the implementation of a pressure ulcer reduction scheme called the Midlands and East Pressure Ulcer Ambition in 2012. The healing times for full-thickness pressure ulcers were recorded at 40 and 80 days after being reported by the community care provider (a community interest company [CIC], providing NHS funded services). There were 138 patients included in the data collected over a one-year period in 2015. A total of 34% of the patients were healed or healing at 40 days. A total of 55% of patients were healed or healing at 80 days. Of the 138 patients who had a full-thickness pressure ulcer, 56 died (41%), 15% had deteriorating or static wounds at 40 days and 9% at 80 days. This demonstrates that the majority of full-thickness pressure ulcers progress to healing unless the patient is at the end of life. There should be a continued emphasis on preventing as many pressure ulcers as possible to reduce avoidable harm to patients.
Managing moisture to achieve the optimum ‘moist’ wound healing environment is key to facilitating wound healing. Wounds which are dry or have a low volume of exudate need moisture added for hydration. Wounds that are wet with a high volume of exudate need fluid to be removed effectively by dressings with high absorbency. Moisture imbalance can have negative consequences for patients — physically, psychologically and socially.
Welcome to JCN’s learning zone. By reading the article in each issue, you can learn all about the key principles of subjects that are vital to your role as a community nurse. Once you have read the article, visit www.jcn.co.uk/learning-zone/ to evaluate your knowledge on this topic by answering the 10 questions in the e-learning unit; all answers can be found in the article. If you answer the questions correctly, you can download your certificate, which can be used in your continuing professional development (CPD) portfolio as evidence of your continued learning.
Lynfa Edwards and Alethea Foster discuss the complexities of wound management in the diabetic foot and give a joint community nursing podiatric perspective on multidisciplinary care.
Jacky Edwards reviews two dressings from Smith & Nephew Ltd.
Jacky Edwards BSc (Hons), RGN, PGDE, DSPN, ENB 264, 998, 870, N49 is a Clinical Nurse Specialist, South Manchester University Hospitals Trust.
Article accepted for publication: December 2002
Sarah-Jane Hughes discusses the importance of good nutrition for optimum wound healing.
Sarah-Jane Hughes BSc (Hons), MSc, PGDip, SRD is a Senior Dietitian, Royal Hospitals Trust, Belfast. Article accepted for publication: December 2002
