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Comfort for hospice patients with skin wounds

By Lauri Weiss, RN

This is part three of a series on skincare for hospice patients by nurse Lauri Weiss.

The last time I posted on Caring with Confidence, I talked about causes of skin breakdown in advanced illness that respond to preventive strategies. However, even with the best possible care, we are not always able to prevent skin breakdown. So, today I will talk about treatments that promote comfort and dignity when, in spite of our best preventive efforts, people develop wounds.

People develop wounds at end of life for multiple reasons. The most common causes of wounds at end of life are pressure, moisture, trauma, poor circulation and cancerous tumors. As with all hospice care, wound care at end of life focuses on comfort and overall well-being. On occasion, good wound care may lead to wound healing, even when a person is dying. However, other wound treatment goals take priority at end of life. These goals are:

• Promoting dignity and a sense of well-being
• Alleviating fears related to the wound
• Maintaining function and independence
• Preventing social isolation from embarrassment due to wound odor, drainage and appearance
• Reducing patient and caregiver burden by simplifying and decreasing frequency of wound treatment

Not much reliable information is available on how people feel about having wounds or how wounds impact peoples’ quality of life. However, a recent study of hospice patients with malignant wounds1 showed that the goal of complete wound healing was very low on the list of patient priorities. Instead, patients listed all of the following concerns as more important, in the following order: (1) pain from the wound, (2) odor, (3) amount of drainage, (4) bleeding, (5) appearance of the wound, (6) wound size, (7) location of the wound and (8) itching.

To promote comfort and dignity, the hospice team asks patients and families what is most bothersome about the wound and develops a plan to address modifiable factors based on what can realistically be achieved. The following things can usually be accomplished with the help of your hospice team:

• Controlling pain, odor, bleeding, drainage and itching to promote comfort and dignity and decrease anxiety and fear
• Simplifying and reducing the frequency of dressing changes to maintain independence and reduce patient and caregiver burden
• Minimizing the risk of infection to maintain function and promote comfort
• Improving cosmetic appearance to decrease social isolation and promote a sense of well-being

Be sure to point out any wounds you notice on your loved one so that the hospice team can address them immediately.

This is the third in a series on skin care presented by hospice and palliative care nurse Lauri Weiss. In her first two entries, Lauri talked about how physical changes from advanced illness can alter skin function at end of life and how caregivers can help prevent skin breakdown.

Source:  Emmons. Wounds at the end of life: Wound symptoms and severity, quality of life, and patient reported symptoms and preferences for care. Research Grant: Regenesis Biomedical – WOCN Society Research Grant for Slow Healing Wounds.

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