Written by Janis Harrison, RN, BSN, CWOCN, CFCN
Palliative care (pronounced pal-lee-uh-tiv) is specialized medical care for people living with a serious illness. This type of care is focused on relief from the symptoms and stress of a serious illness.
The goal is to improve the quality of life for both the patient and the family.
Both palliative care and hospice care provide comfort. But palliative care can begin at diagnosis and at the same time as treatment. Hospice care begins after treatment of the disease is stopped and when it is discerned the person is not going to survive the illness.
Principles of Palliative Care
1. Affirms life and regards dying as a normal process.
2. Neither hastens nor postpones death.
3. Provides relief from pain and other distressing symptoms.
4. Integrates the psychological and spiritual aspects of care.
5. Offers a support system to help patients live as actively as possible until death.
Palliative care is meant to optimize the quality of life, and the goal of wound healing may not be realistic. This type of care is centered around the patient and family and how aggressive they want to be in the act of wound care.
Making sure the wound does not cause the patient increased discomfort and is a choice to improve the patients’ quality of life. Palliative care focuses on the quality of the life the patient has left not on the last days of life.
Palliative wound care is defined as the strategy it takes to relieve symptoms and focus on wound improvement, rather than wound healing. We focus on the management of symptoms such as the odor, exudate management, bleeding, pain, and infection. The goal is to keep the skin intact if possible.
Palliative care for wound care may be due to a terminal illness, several comorbidities that overwhelm the patient and caregiver, or patient choice to continue or to stop as it is interfering with the patient’s lifestyle. Pressure Ulcers are a high risk for the palliative care patient and all guidelines and policy should be in place for comfort and prevention as voiced by the patient.
Selecting Wound Dressings
The goal when selecting to select the right dressings to manage the odor and exudate of the wound. Odor control is accomplished with sodium impregnated gauze, antimicrobials, and use of charcoal dressings. Exudate control can be contained with foams, alginates, hydrofiber dressings, absorptive powders, and wound drainage pouches.
Protection of the periwound skin is important with use of hydrocolloids, therefore non-traumatic tapes, skin barriers and sealants should be considered carefully.
Debridement should be autolytic with use of hydrogels or enzymes. Hydrocolloids can also be used. I have used Dakin’s solution to decrease the bioburden, odor, and debride the wound, but in a wet to moist environment so as not to cause pain with dressing changes. Other dressings to use are antibacterial dressings and creams, sodium impregnated gauze, and absorptive dressings.
Control bleeding with the use of hemostatic dressings, non-adherent gauze, and alginates. Wet the dressing before removal so as not to debride good tissue with the dressing and prevent unnecessary bleeding.
It is important to reevaluate the wound(s) the needs of your patient on a regular basis. Finding out what your patient’s concerns are may be different than when you started this venture with them. Maybe at first the patient did not want to have to change their dressing more than every 3 days. Now the odor is of more concern thus causing them to prefer changing the dressing 3 x daily to control the odor.
On a personal experience note, my mother recently endured a large blood-filled blister on her heel.
She has suffered several Cerebral Vascular episodes and is not moving on her own. She is presently on palliative care. I decided to use a foam dressing with non-stick silicone-backing, as the blister was not intact and was leaking a small amount. I did not want to debride the blister because of the pain she would have. We added a heel protective boot to her in- bed regimen and changed the foam dressing every 3 days. We placed her in a stocking, but no shoes were allowed. She was much more comfortable, and the blister fluid reabsorbed. I was able to remove the old tissue once it dried out and the epithelial tissue covered the new skin. We continued the heal protectors for prevention.
Halo Wound Solutions is a national DME supplier for wound care supplies shipped to patients at home that are reimbursed by most insurance plans.
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Janis Harrison, RN, BSN, C.W.O.C.N & C.F.C.N. is the owner of Harrison WOC Services, L.L.C. in Thurston, Nebraska. A graduate of Morningside College, Janis works as an independent contractor of Wound, Ostomy, Continence, and Foot and Nail Care services for medical entities throughout Northeast Nebraska. With over 30 years of experience as a nurse and 12 years as a CWOCN and CFCN, she found her passion for wound care when her spouse was afflicted with many complications from four consecutively failed surgeries that involved his ostomy. Through this experience, it became obvious that rural Northeast Nebraska was in need of wound and ostomy nursing care.