Empowerment in chronic wound care—exploring the scope for patient contribution†
, und | 26. März 2024
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Article Category: Review
Online veröffentlicht: 26. März 2024
Seitenbereich: 1 - 16
Eingereicht: 27. Dez. 2022
Akzeptiert: 31. Juli 2023
DOI: https://doi.org/10.2478/fon-2024-0001
Schlüsselwörter
© 2024 Benedikt Hackert et al., published by Sciendo
This work is licensed under the Creative Commons Attribution 4.0 International License.
Figure 1.
Figure 2.
Figure 3.
Primary control strategies during wound care.
| Item | Strategies |
|---|---|
| Wound cleansing | Washing of wounds |
| Choose type of washcloth and water temperature | |
| Decision over who does the washing | |
| Choose start time for bathing and bath toys (when patients are children) | |
| Remove splints | |
| Debridement (not recommended anymore according to medical standards) | |
| Pace | Time-out/patients pace procedures |
| Tell nurses how fast to go | |
| Dressing change | Dressing change |
| Remove dressing | |
| Reapply dressing | |
| Choose dressing together with health professional | |
| Hold bandages | |
| Collecting dressing materials (when patients are children) | |
| Patient decides body positioning | |
| Pain medications | Patient-controlled analgesia |
| Choose type of pain medications | |
| Other | Conversation: ask questions, tell nurse which are most sensitive areas |
| Decision which family members are present at dressing change | |
| Self-massage | |
| Singing | |
| Decide which limb or area to start with (in case of several wounds) | |
| Risk assessment (e.g., signs of infection and when to seek professional help) |
Categories of patient empowerment and its frequency of occurrence in the literature.
| Category | Number of occurrences | Example |
|---|---|---|
| DOF | 17 | “Encourage individuals to request a ‘time out’ during any procedure that causes pain…” |
| Shared decision making/educated patient | 38 | “Every patient has the right to receive relevant information, support and encouragement from the nurse which will permit him/her to make informed choices” |
| Adherence to self-care behaviors | 44 | “This study developed and piloted a patient-centered pressure ulcer prevention care bundle for adult hospitalized patients to promote patient participation in prevention. The care bundle had 3 core messages: (1) keep moving, (2) care for your skin, and (3) ensure a good diet” |
| Control/responsibility | 8 | “Empowerment is a collaborative approach□the patient’s potential to adapt to the disease, to change its course, and to extend individual responsibility for dealing with the disease is considered and emphasized” |
| Abstract descriptions of patient empowerment | 7 | “The clinician should endeavor to involve and empower patients to optimize pain management.” |
Secondary control strategies (during dressing change).
| Item | Strategies |
|---|---|
| Distraction | Reading; TV; conversation; virtual reality; interactive stories on a video game device; headphones |
| Comfort | Holding something (side rail); extra blankets; repositioning; warm blanket; presence of a benign and caring adult; ask (verbally or non-verbally) for comfort |
| Communicative acts | Social support (e.g., sharing and discussing emotions and experiences with other patients); hold hands; influence a patient’s perceived pain and stress through effective communication; parental visiting |
| Relaxation/stress reducing strategies | Breathing exercises (e.g., deep breathing); music; (visual) imagery (e.g., imagine to be on a beach); pictures; massage; progressive muscle relaxation; touch; aromatherapy; multi-modal stress management; biofeedback |
| Cognitive techniques/coping mechanisms | Appraisal/cognitive reframing/reinterpretation of the context; positive evocation to focus on recreating a pleasant memory and to create a positive emotional state, imaginative transformation of sensation or imaginative lack of attention (delivered by psychologist); focus on positive aspects of wound management (e.g., improved health, removed pain); cognitive attribution: benign meaning to pain (gaining information about reasons for pain, avoid catastrophizing); minimization;coping skills intervention; use euphemisms for painful stimuli; mental focus on physical sensations |
| Environment | Calm environment (e.g., no mobile phones); minimize sensory input (e.g., from open windows) |
| Predictability | Education about dressing change procedure and pain relief strategies; health professionals state what they are doing while treating the patient |
Primary control strategies.
| Item | Strategies |
|---|---|
| Autonomy/predictability | Take off bandages for a short time to reduce itching |
| Reduce dependence on caregivers | |
| Input into daily schedules and routines | |
| Schedule dressing change according to patients wishes/when patient feels best | |
| Planning: seeing a nurse to check the wound should fit working hours of patient | |
| Possibility to refuse treatment | |
| Environment | Change personal environment (e.g., mobile bathtub for better hygiene) |
| Create familiar environment (e.g., in hospital) | |
| Pain medication | Initiative in using or not-using pain medication |
| Ask for pain medications | |
| Patient-controlled analgesia | |
| Communicative acts | Speak up for oneself |
| Remind nurse when she/he forgot something | |
| Interaction with other patients or health professionals: Music and dancing with health professionals | |
| Talk and share their thoughts; communicate concerns, feelings, etc. | |
| Ask questions | |
| Direct requests (e.g., ask for pain medications) | |
| Empathetic conversations between patients and health professionals | |
| Inform patients about wound dressings and treatments to empower them to participate in their care | |
| Negotiating care between patient and nurse
Synchronize role expectations Requests for patient’s permission (e.g., to remove items from medicine box) Dispute over responsibility for carrying out or deciding on care decisions; patients stating their actions, then seeking permission Give patients feedback about their care performance in a sensitive, empowering way |
|
| Express feelings and thoughts | |
| Dictate how to treat the wound (patients can become assertive when they have the impression the care is not executed to professional standards) | |
| Social support | |
| Social closeness (with a person having a similar wounding-experience) | |
| “Laugh and a joke” (p. 558) |
|
| Emotional disclosure | Expressive writing about a traumatic event |
Categories of DOF and their frequency of occurrence in the literature.
| Degree of freedom | Number of occurrences | Example |
|---|---|---|
| Primary control during wound care | 21 | Time-out: Patient can pace procedure |
| Secondary control during wound care | 14 | Relaxation |
| General techniques (not restricted to wound care) | 25 | Talk and share thoughts |
| Abstract descriptions of freedoms | 10 | Autonomy support to increase power and responsibility |
| Beliefs (about empowering behaviors) | 5 | Self-efficacy beliefs about to apply bandages |