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Personal Experience

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Just let it heal.

Maria Kohoutkova
Language: English
Country: Slovakia
Typology: health care professionals
Mrs. Zuzana is 85 years old. For the last few years her family has been taking care of her at home with a help of a 24 hour care taker. Two women are changing in two week terms. Zuzana sufffers of incontinency. She can receive fluids and food only by an internal stomach tube. She is not able to change her position in bed by herself so the nurses position her on regular basis. She lies on an air mattress with a profylactic role of preventing the occurence of bedsores. Zuzana does not speak. Sometimes she expressess herself with groans and paraverbally. Despite the consistent care Zuzana currently has a bed sore in her lower back area. It is the size of a chicken egg, degree 3-4. The doctor ordered VAC system for the wound rebinding with a frequency as needed. Zuzana must handle a difficult rebinding of her deep and painful wound several times per week. Whenever the wound area is contaminated with faeces it is necessary to clean the wound properly and to support the healing with vacuum rebinding. Otherwise it is standardly rebinded twice a week. The vacuum device generates optimal treating conditions in the wound. The bedsore is clean, discharge from the wound and neither the wound surrounding area do not show signs of currently active infection. For Zuzana it is a strenuous and often also very painful procedure despite the fact that her doctor ordered giving her painkillers half an hour beforehand directly to stomach via the tube. The nurse and the caretaker position Zuzana on her side so the nurse can manage the procedure. Zuzana lies on her side facing her caretaker. The nurse stands behind her back so she can have a good approach to the wound as well as to the table with all the necessary material for rebinding. It is a special procedure in which several layers of foil bandages are applied to the wound and its area after its thorough cleaning. Consequently, it is neccessary to protect the wound from entering stool and infection and connect the binding to the VAC device. The rebinding always takes about 30-40 minutes while the cleaning phase is very important. The care taker keeps calming non verbal contact with Zuzana, she reacts toher changed nonverbal expression of surviving this time. The nurse works quickly with a focus, accurately and aseptically with an aim of preventing possible complications and shorten to maximum the time of Zuzana’s discomfort. After the rebinding the nurse and the care taker position Zuzana to a relief position allowing her to rest. Even though Zuzana is not able to communicate verbally, the nurse perceives her non verbal signals and responds to them at all times. OBJECTIVES: Create conditions for healing of Zuzana’s deep chronical wound despite her immobility, incontinence, difficulty with feeding and lacking her ability to talk. Minimize pain, stress and discomfort during the rebinding procedure. Repeat the process exactly and comment on it so Zuzana can get used to what awaits her and learns to recognize the situation. MEANS AND STRATEGY: The nurse always calls the family 15 minutes before her arrival to pre-announce herself so they can administer Zuzana her painkillers at the right time before the rebinding procedure. The rebinding process keeps repeating in a standard way. The nurse tells Zuzana what she is going to do, what is happening at a moment and calms Zuzana with the tone of her voice. When she registers a fright, a jolt or something similar, she always describes what caused it. For example, it was just a disinfection fluid, now we will dry it off. CONCLUSIONS: Zuzana is getting used to a regular unpleasant situation. She is gaining confidence in nurse’s approach, comunicates her experience on the level of her preserved resources. The wound heals optimally.

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