Boersema GC, Smart H, Giaquinto-Cilliers MGC, Mulder M, Weir GR, Bruwer FA, Idensohn PJ, Sander JE, Stavast A, Swart M, Thiart S, Van der Merwe Z. Management of Nonhealable and Maintenance Wounds: A Systematic Integrative Review and Referral Pathway.
Adv Skin Wound Care 2021;
34:11-22. [PMID:
33323798 DOI:
10.1097/01.asw.0000722740.93179.9f]
[Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
GENERAL PURPOSE
To synthesize the evidence regarding nonhealable and maintenance wound management and propose an interprofessional referral pathway for wound management.
TARGET AUDIENCE
This continuing education activity is intended for physicians, physician assistants, nurse practitioners, and nurses with an interest in skin and wound care.
LEARNING OBJECTIVES
After participating in this continuing professional development activity, the participant will apply knowledge gained to:1. Identify the ideas from the authors' systematic review that could prove useful in understanding nonhealable and maintenance wound management.2. Select evidence-based management strategies for nonhealable and maintenance wound management.
ABSTRACT
OBJECTIVEThis systematic integrative review aims to identify, appraise, analyze, and synthesize evidence regarding nonhealable and maintenance wound management to guide clinical practice. An interprofessional referral pathway for wound management is proposed.
DATA SOURCES
An electronic search of Scopus, Web of Science, PubMed, Academic Search Ultimate, Africa-Wide Information, Cumulative Index of Nursing and Allied Health Literature database with Full Text, Health Source: ConsumerEdition, Health Source: Nursing/Academic Edition, and MEDLINE was conducted for publications from 2011 to 2019. Search terms included (nonhealable/nonhealing, chronic, stalled, recurring, delayed healing, hard-to-heal) and wound types most associated with nonhealable or maintenance wounds. Published studies were hand searched by the authors.
STUDY SELECTION
Studies were appraised using two quality appraisal tools. Thirteen reviews, six best-practice guidelines, three consensus studies, and six original nonexperimental studies were selected.
DATA EXTRACTION
Data were extracted using a coding framework including treatment of underlying causes, patient-centered concerns, local wound care, alternative outcomes, health dialogue needs, challenges within resource restricted contexts, and prevention.
DATA SYNTHESIS
Data were clustered by five wound types and local wound bed factors; further, commonalities were identified and reported as themes and subthemes.
CONCLUSIONS
Strong evidence on the clinical management of nonhealable wounds is limited. Few studies describe outcomes specific to maintenance care. Patient-centered care, timely intervention by skilled healthcare providers, and involvement of the interprofessional team emerged as the central themes of effective management of maintenance and nonhealable wounds.
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