Exploring nurses' and patients' feelings of disgust associated with malodorous wounds: a rapid review

Impact of malodour on health-related quality of life of patients with chronic wounds due to volatile organic compounds

Chronic wounds significantly impact health-related quality of life (HRQoL). Unpleasant wound odour, caused by bacterial colonisation and necrotic processes, is a distressing symptom. Its exact composition is not well understood, but it could be the basis for a personalised odour avoidance strategy. Therefore, this feasibility study explored 92 wounds from 66 patients with the focus on wound odour, bacterial burden and their impact on health related-quality of life (HRQoL). Volatile organic compounds (VOCs) responsible for wound odours were detected at the molecular level, using gas chromatography-mass spectrometry and -ion mobility spectrometry and correlated to the HRQoL. In patients analysed (average age 69 ± 13 years, wound persistence 24.31 ± 70.8 months) 135 pathogens were identified by swabbing including 19% Staphylococcus aureus, 15% Pseudomonas aeruginosa and 35% Enterobacteria. The specific questionnaire 'Wound-QoL-14' showed a non-significant difference in HRQoL in patients with wound odour (2.1 ± 1.0 vs. 1.8 ± 1.0). The latter also had the highest number of VOC detections. The most frequently detected, relevant VOCs from prokaryotic sources were dimethyl-disulphide and diacetyl-(2,3-butanedione). Furthermore, potential biomarkers for specific pathogens were identified, including dimethyl-trisulphide for P. aeruginosa and indole for Escherichia coli. The most prevalent substance groups were ketones and alcohols. In conclusion, the malodour of chronic wounds is caused by a mixture of the intrinsic odour of bacterial products and necrosis. This exploratory study, which combines the analysis of decoded VOCs and the olfactory assessment of odour, could be a novel, targeted approach for identifying potential 'anti-wound odour therapies' that will significantly benefit the HRQoL of patients with malodourous tumour wounds, in particular.

Knowledge, attitudes and practices on diabetic foot care among nurses in Kimberley, South Africa

BACKGROUND

Diabetic foot is a dangerous complication of diabetes and can lead to high morbidity and mortality. As essential team members of the healthcare system, nurses play an important role in diabetic foot management and are indispensable in patients' education to prevent diabetic foot. The study assessed nurses' knowledge, attitudes and practices regarding diabetic foot care in Sol Plaatje primary health care centres in the Northern Cape: Sol Plaatje's 14 district municipality clinics, Kimberley, Northern Cape.

METHODS

This was a descriptive cross-sectional analytical study. A questionnaire assessed nurses' knowledge, practices and attitudes towards diabetic foot care in the above setting.

RESULTS

A total of 128 professionals, enrolled and auxiliary nurses who are providing primary care to patients within the 14 clinics in the Sol-Plaatje sub-district were recruited for the study. Hundred and five participants completed the self-administered questionnaires. The majority (95%) were females and 58.1% knew that South African Diabetic Foot Guidelines existed, while 57.7% had read them. About 57% did not know about the 60-s diabetic foot screening tool, and 67% did not know the 10 g monofilament test. Approximately 29.8% had never attended a class on diabetic foot care and 85.6% required training on diabetic foot care.

CONCLUSION

This study revealed that the majority of nurses working in the Sol-Plaatje sub-district primary health care centres are knowledgeable of the diabetic foot guidelines for primary care. However, there is a need for ongoing education on diabetic foot care.Contribution: The study results will help improve nurses' awareness of the importance of diabetic foot care.

A survey of UK nurses about their care of people with malignant fungating wounds

PURPOSE

To gain an understanding of the nursing professionals who treat people with malignant fungating wounds (MFW) in the UK and their current practices, including perceived barriers and facilitators to providing MFW care.

METHOD

An online anonymous questionnaire was created with questions about the role of nursing professionals who reported caring for patients with MFW, the number of people with MFW they regularly cared for, treatment aims, treatments used, and challenges faced. These questions were developed with professional input and piloted. Using a convenience sampling method, we collected responses from UK nurses by distributing the questionnaire via social media and through relevant professional organisations. The questionnaire was constructed in QualtricsXM software and analysed using SPSS.

RESULT

We received 154 questionnaire responses, with three-quarters from tissue viability nurses and the rest from community and other specialist nurses. The most important treatment aim reported was pain management, followed by odour management. Almost all respondents used antimicrobial and standard dressings for these patients, with a range of products reported. Poor access to MFW care training and lack of local and national guidelines were reported as barriers to providing care for people with MFW. Availability of dressings, access to training, and good communication processes were reported as facilitators.

CONCLUSION

This is the first study to explore MFW wound care practices in the UK. A range of nurses are involved in care delivery with variations in the treatments used. Lack of access to MFW care training, resources, and standardised guidelines may impede care delivery.

Caring for Patients With Malignant Fungating Wounds: A Scoping Literature Review

PURPOSE

The aim of this scoping literature review was to identify current knowledge related to management of malignant fungating wounds (MFWs), gaps in this knowledge, and areas for future research.

METHODS

This was a scoping literature review.

SEARCH STRATEGY

Six electronic databases (Embase, MEDLINE, Cochrane (CENTRAL), CINAHL, Scopus, and Web of Science) were searched spanning the years 1987 and 2022. The initial electronic database search retrieved 6041 studies. The search is based on 60 articles published between 1987 and 2022, along with 14 additional studies were based on search of reference lists of key articles.

FINDINGS

Studies were divided into 2 main domains; the vast majority (65 of 72, 87.8%) focused on symptom impact, measurement, and management. The remaining articles (n = 9, 12.2%) focused on caring for patients with MFW; these studies focused on nursing care experiences and competencies, along with lay caregiver experiences. Findings indicated that instruments have been developed to evaluate symptoms of MFW but only a few have been validated. Most of the studies reviewed evaluated the influence of MFW on physical and psychosocial function. Local and systematic symptom managements such as modern dressings, wound care strategies, surgery, and radiotherapy as well as chemotherapy were found to be effective in alleviating symptoms. Findings also indicated that families and nurses encounter obstacles and burdens when caring for patients with MFW; limited studies were retrieved that investigated the competence and needs of nurses in their caring journey.

IMPLICATIONS

Future studies should focus on: (1) using better designs to evaluate and compare topical agents and dressings to control odor, (2) validating assessment tools specific to MFW, (3) qualitative studies designed to enhance understanding family and nurses' experiences, and (4) improving the nurse's ability to care for patients with MFWs and their responses to managing these challenging patients.

Resigning oneself to a life of wound-related odour - A thematic analysis of patient experiences

AIMS

To determine how patients with chronic wounds describe wound odour, identify what strategies they use to manage it and how effective these are.

MATERIALS AND METHODS

Using a qualitative descriptive approach, semi-structured interviews were conducted between July and August 2021 with seven patients living with an odorous chronic wound at home. Data were analysed using Braun and Clarke's thematic analysis framework.

RESULTS

The results were organised into two main themes: 1) becoming resigned to living with wound-related odour 2) strategies used to manage wound-related odour. Participants were sad, embarrassed and felt isolated but became resigned to living with this odour and accepting of it as a consequence of having a wound. Frequent dressing changes, household cleaning along with the use of sprays were the most frequently used tactics to manage odour none of which were deemed to be very effective.

CONCLUSION

This study highlights the problem of odour management in clinical practice and how individuals develop strategies to overcome odour. Sadly, patients were resigned to living with wound odour and were accepting of it as part of daily life. This highlights the importance for healthcare professionals to recognise, assess for and ensure a better understanding of how people experience wound odour, the impact it can have on them personally. Frequent dressing changes can help manage wound odour from the patient's perspective.

An exploration of public perceptions and attitudes towards maggot therapy

OBJECTIVE

The aim of the study was to explore public opinion and perceptions of maggot therapy (larval therapy), a treatment option for hard-to-heal wounds.

METHOD

The study used a mixed-method approach to obtain quantitative and qualitative data. A focus group was convened to explore opinions and views of maggot therapy with a small group of members of the public. Analysis of emerging themes from the focus group was used to design an anonymised web-based survey, which was made available online to members of the public through email and social media.

RESULTS

The focus group participants identified four key themes concerning the acceptability of maggot therapy. The subsequent online survey was completed by 412 participants, analysis of which revealed some worries and fears. Only 36% of survey participants agreed that they would accept maggot therapy as a first choice for a hypothetical painful wound, although this number increased with wound severity. The most predominant concerns regarding maggot therapy were sensation and a feeling of disgust associated with the therapy. However, participants could see some benefits to maggot therapy.

CONCLUSION

Our study showed that public perception of maggot therapy is varied. Survey participants expressed worries and fears associated with its use. However, positive relationships existed between knowledge scores and potential acceptability of maggot therapy, suggesting that information dissemination and education may be an important factor in public perception and acceptability of maggot therapy.

Something Stinks! Finding Ways to Manage Noxious Odours in the Operating Room and Other Clinical Settings A Randomized Controlled Trial

Objectives: The hospital can be saturated with noxious smells. Anecdotally, medical staff apply products to surgical masks to lessen the impact of these smells. This study aimed to determine the odour-masking ability of 4 inexpensive and convenient products. Methods: A randomized, single-blinded crossover study was conducted in Vancouver, Canada. Participants, 19 to 30 years old, were invited to participate. Participants with active allergies, upper respiratory tract infection, alteration to sense of smell, or failure of olfactory screen were excluded from the study. An experimental odour was used in lieu of a noxious surgical odour. After smelling the experimental odour without barriers, participants were re-exposed to the odour using 5 surgical masks in randomized order. Each mask was lined with a test product (cherry lip balm, tincture of benzoin, Mastisol, mint toothpaste, and control [plain mask]). Participants rated the effectiveness of products at masking the experimental odour from 0 to 100 (0 = completely ineffective, 100 = completely effective). Participants also rated the pleasantness of the products, recorded if the products made them feel unwell, and identified their preferred product overall. Results: Eighty participants were included in the study (33 male, 47 female), averaging 24.2 years of age. Mean odour-masking effectiveness for cherry lip balm was 66.5 (±24.6), tincture of benzoin: 62.6 (±25.0), Mastisol: 61.3 (±23.9), mint toothpaste: 57.5 (±27.4), and control: 21.9 (±21.8). All products performed better than the control (P < .001), but there was no significant difference in performance between products. Cherry lip balm was the most preferred odour-masking product (29 participants), followed by mint toothpaste (22), Mastisol (14), tincture of benzoin (10), and control (5). Conclusions: All tested products demonstrated equivalent odour-masking abilities. If health care professionals choose to use an odour-masking product, they should consider their own olfactory preferences.

[Guideline-based Care for patients with malignant lesions : The new S3 guideline for patients with incurable cancer]

The German Association of Palliative Care developed an evidence-based guideline about the management of malignant wounds in adult patients with incurable cancer. There is a lack of evidence-based guidelines about fungating wounds and a confusing wide range of available wound dressings. The goal of the guideline is to reduce the suffering of patients with malignant wounds and stabilize or improve their quality of life. The guideline is constructed following the German Instrument for Methodological Guideline Appraisal (DELBI): A systematic review was carried out for guidelines and reviews. A wound expert group discussed these research findings and suggested recommendations which were adapted and consented by representatives of 62 medical and health professionals associations.The guideline has 34 recommendations, thereof nine (26%) are evidence based with an evidence level from 2+ to 4 (according to SIGN). The assessment chapter comprises specific assessment tools for malignant wounds, odor and wound-related quality of life. Three recommendations address the psychosocial support of patients and their family caregivers and aim to reduce the impact of the wound on their emotional wellbeing, caregiver burden and social participation. The pain recommendations focus on a preventive atraumatic dressing change, positioning, systemic pain medication (anticipated, rescue and baseline) and local application of morphine or local anesthetics. The guideline gives recommendations on odor management (metronidazole, active coal and antiseptic dressings) and management of exudate (super absorber). The recommendations on prevention and management of bleeding (antifibrinolytica, haemostyptica) are vital for patients and caregivers. This guideline is one of the first evidence-based and consented guideline on malignant wound care and has the potential to improve the palliation of patients who suffer from there malignant wounds.

Investigation of the relationship between nursing students' disgust sensitivity and caring behaviours

AIM

This study aimed to investigate the disgust sensitivity of nursing students, the factors affecting this sensitivity, their caring behaviors and the relationships between these components.

BACKGROUND

Disgust sensitivity has been conceptualized as the degree of disgust felt in response to various stimuli. Nursing students often encounter recognized disgust triggers in clinical practice, such as feces, mucus, urine, foul-smelling wounds and contact with the dead. The nursing students' disgust sensitivity can affect the way they think and may affect their care behaviors.

DESIGN

The study used a descriptive cross-sectional design and was conducted with nursing students in a Turkish university nursing program (n = 577).

METHODS

The study data was collected through the Disgust Sensitivity Scale-Revised Form and the Caring Assessment Questionnaire.

RESULTS

Of the students in the study, 59.6% stated that they experienced disgust while providing care. A negative relationship was found between students' total scores from the Disgust Scale and the Caring Assessment Questionnaire (p < 0.01). The students' disgust sensitivity level was high and the higher the disgust sensitivity, the fewer caring behaviors they exhibited.

CONCLUSIONS

In light of these findings, it can be said that the caring behaviors of nursing students are negatively influenced by disgust sensitivity. Hence, nurse educators need to evaluate students' disgust sensitivity, help students to identify and address their disgust emotions, deal with disgust management strategies together and be aware of when students need support.