Post-operative wound care is a complicated process that includes various challenges, which require the application of knowledge to understand how the irrigation of the wound is done. It is a skill on its own that ensures the wounds do not affect the cellular activity and the healing process occurs effectively (Gizaw et al., 2022). As a student nurse attached to the surgical floor as the professional practice setting, I had the opportunity to learn about the normal saline application and wound cleaning in case it was dirty. Again, I learned about accurate measurement and documentation of wound dimensions and drainage output. Together with the key principles of wound healing, complications, and wound dressings, I applied critical thinking and key nursing competence to achieve my learning goals. I will explain wound assessment and documentation, hand hygiene, personal protection, cleaning, irrigation, and patient education in this implementation paper.
The first thing I learned during my practice is post-operative wound assessment and documentation. The aim of the assessment was to determine the characteristics of the surgical wound, i.e., size, depth, and presence of any drainage or infection, and assess the presence of inflammation, redness, or swelling signs in the surrounding tissue (Wound, 2017). I proceeded to utilize the wound score and description to assess the healing and nature of a wound from 0 to 4. The 0 wound score means that the wounds are perfectly healing and the edges are in apposition, while a wound score of 1 means mild redness on or around the wound. 2, 3, and 4 scores are in the red zones as they indicate swelling/discharge/exposed subcutis, partial opening, and the complete opening of the wound, respectively (WVS, n.d). In this assessment, I also explored the factors affecting healing and the preliminary principles of wound management, which are essential to the overall healing process (Yao, Bae, Yew, 2013).
Wounds are part of exposed skin that necessitate that hygiene be paramount to avoid contamination or infection. Apart from patient, hygiene also protects the nurse from cross-contamination of infections. According to Gizaw et al. (2021), post-operative wound infections make part of the major public health concerns that affect the patient’s quality of life. During my clinical practice, I always performed hand hygiene through the decontamination process. When hand washing was not efficient, I sought the use of alcohol gel to complement water and soap (Wound, 2017). I understood that it is the single most important measure that helps avoid transmission of germs to the patient and myself, and therefore, I cleaned my hands more than ten times a day and used personal protective equipment (PPE).
Cleaning and irrigation are critical to the care process surrounding a surgical wound. Usually, a non-toxic wound cleanser or saline solution is recommended (Wound, 2017). I consulted with my preceptor in this process to ensure that no foreign substances like antiseptics were used as their damage could not be estimated. I formed a skill around irrigating the wound with normal saline and substituting it with a povidone-iodine solution to remove exudates and bacteria if the wound was dirty (Gizaw et al., 2021). Therefore, I applied my newly gained knowledge of post-operative wound care to prevent infection, complemented by wound assessment, dressing and monitoring.
Patient education is the time dedicated to developing a patient’s literacy, and thus, a critical element of nursing since it ensures patients are involved in the care. Through my nursing skills, I educated patients and their caregivers about wound care techniques, signs of infection, and the importance of compliance with medication regimens, follow-up appointments, and lifestyle modifications where necessary. By doing so, I helped patients understand their condition and care plan while equipping them with skills in identifying and managing complications, if any, to reduce re-hospitalizations (Cook et al., 2014).
Learning about the key principles of wound healing helped complete the wound care process from assessment to dressing. I learned about dermal wounds and their basic healing mechanisms, i.e., contraction, connective tissue matrix deposition and epithelialization (Wound, 2017). At the basic level, my preceptor educated me on the beginning of homeostasis, followed by cleaning, analgesia, skin closure, and then dressing. Apart from fulfilling my learning requirements, this knowledge is particularly significant to my future practice as a nurse.
This learning process would not have been possible without critical thinking, exercising empathy and compassion, and patience whilst working with surgical patients. As I look forward to being a healthcare professional, I would like to be self-reflective and self-regulating to ensure accountability in my duties and demonstrate my competencies. Nevertheless, I ensured that I met the therapeutic communication requirements set out in CNO (2019) by communicating properly with the clients, involving their families, according to them the necessary respect, and making the communication style as simple as possible. At the same time, I showed empathy on a professional level and compassion for the patients in pain and listened to their concerns. In situations that seemed to be more confusing, I sought help from my learning resources and preceptors to help me stay in line.
In conclusion, the journals and books, clinical preceptors, and nursing skills labs on wound care were important to my learning process as they readily availed information as required. Although learning extended to a wider resource base, I paid attention to specific recommendations from the clinical preceptors, learning journals, and the CNO (2019) standard.
References
Cook, D. J., Moradkhani, A., Douglas, K. S., Prinsen, S. K., Fischer, E. N., & Schroeder, D. R. (2014). Patient education self-management during surgical recovery: combining mobile (iPad) and a content management system. Telemedicine Journal and e-health: the official journal of the American Telemedicine Association, 20(4), 312–317. https://doi.org/10.1089/tmj.2013.0219
Gizaw, M. A., Negawo, M. K., Bala, E. T., & Daba, D. B. (2022). Knowledge, practice, and associated factors towards post-operative wound care among nurses working in public hospitals in Ethiopia: A multicenter cross-sectional study in low resource setting area. Health science reports, 5(4), e677. https://doi.org/10.1002/hsr2.677
Wound, O. (2017). WOCN 2016 guideline for prevention and management of pressure injuries (ulcers). Journal of Wound, Ostomy and Continence Nursing, 44(3), 241-246. https://doi.org/10.1097/WON.0000000000000321
WVS. (n.d.). Post-operative Wound Assessment. WVS Spay-Neuter Protocols. https://wvs.academy/files-static/quick-reference/dog/clinic-downloads/wound-assessment.pdf
Yao, K., Bae, L., & Yew, W. P. (2013). Post-operative wound management. Australian family physician, 42(12), 867-870. https://search.informit.org/doi/abs/10.3316/INFORMIT.740774960890214
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