EUROPEAN TISSUE REPAIR SOCIETY
NEWS FROM FINLAND |
EUROPEAN TISSUE REPAIR SOCIETY NEWS FROM FINLAND |
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WOUND HEALING
AND MANAGEMENT IN FINLAND In Finland, as in many other countries, the care of wounds is one of the main challenges for health care. Patients with wounds are cared for in all health care organisations, in primary as well as in specialised health care. Wounds are divided into two groups: acute and chronic. The acute wound wound group consists of surgical wounds, traumas, burns, etc. The chronic wounds are the real challenge for health care, because the care of them can be expensive for patients and for the national economy. In addition to the costs, chronic wounds cause pain and stress for the patients and they have problems in coping with daily activities. The incidence of the chronic wounds in Finland varies within the population according to age and health status. Older people have a higher risk of developing chronic wounds compared to people of working age. Also, those people with other chronic diseases – like diabetes, cardio-vascular and neurological diseases, such as paralysis – have an increased risk of developing a chronic wound. The main chronic wounds are pressure sores, venous leg ulcers and diabetic wounds. In 1995 leg ulcers as a main medical diagnosis required over 35,000 bed days while the pressure sores needed/occupied 19,000 bed days (ask nurses). The average number of days spent in hospital in one care period was twenty days with leg ulcer patients and thirty-eight days with pressure sores. (Eriksson, et al, 1999). In 1998 the prevalence of chronic wounds in the total outpatient population was studied in eleven hospitals and five home care units in the Helsinki district. The study showed that 6.4% of patients had chronic wounds. The patients with chronic wounds were elderly with an average age of 74 years and only 3% of them were still employed. The hospitals cared for 80% of the wound patients and only 20% were cared for in home care units (Eriksson, et al, 1999, Eriksson, et al, 2000). The trend in the Finnish health care system is to shorten the care periods, and transport more and more patients with chronic diseases in the primary health care sector. In future the patients with chronic wounds will be more often cared for in outpatient clinics and home care units. This has set demands for health professionals to increase their knowledge and skills in the daily management of wounds, while the staff have a responsibility to keep up-to-date with wound treatment methods so that they can select the best care for each patient. Wound healing is described in the literature in Finland as a biological process comprising three phases: inflammation, proliferation and maturation. (Ahonen, et al, 1992; Ahonen, et al, 1993; Iivanainen and Seppänen 1998; Laato 1999). The terms PPI (the first intention) and PSI (the second intention) are also used in Finnish wound care practice. The main issue in the daily management of the wounds is to assess properly the healing of the wound. The documentation of the wound healing on the patient’s chart varies considerably among the Finnish health care organisations. Some wards and home care units have developed forms for the documentation of the wound healing. However, far too often the written documentation of wound healing and management on the patient’s chart is ‘wound is managed, it looks OK’ or ‘No changes’ or ‘the wound looks better’. The observed signs of healing or symptoms of prolonged healing are not documented to validate the assessment of wound. In clinical practice the key question from the professional’s point of view is how to choose the best wound care product for this wound when the number of registered wound care products in Finland is over 400. The basis for selecting a wound care product is an appropriate assessment of wound. To help in the assessment of wounds the Finnish Wound Care Association has developed a tool, called ‘Helper’. It is based on the RYB classification of the wound. To the colours red, yellow and black is added the colour pink, which describes the wound in the epithelialisation phase, when the wound is almost healed (Flanagan, 1997). The ‘Helper’ also includes instructions for the daily management of wounds according to the classified colours: black – remove; yellow – debride; red – safe; pink – safe. On the other side of ‘Helper’ the signs of wound infection is described. The ‘Helper’ also has a measurement in scale of mm/cm, which reminds professionals that part of the assessment of wound is measuring. The ‘Helper’ is laminated and can then easily be cleaned by alcohol or other antibacterial substances. The principle in the daily management of wounds is to create an optimal healing environment. This includes a warm, moist and acid environment, which can be provided by a correctly-selected wound care product. The removal of devitalised or contaminated tissue is the base (is important) for wound management. Highly exudating, infected wounds are washed by tap-water and liquid soap using a sponge, brush, etc. The debris, slough and necrotic tissue are removed by scissors, forceps and surgical knife. Surgical debridement is probably used in Finland more often than in many other European countries. Sharp dissection of devitalised tissue in partial surgical debridement can be done by those health professionals who do the wound management (practical nurse, nurse, doctor). Total surgical debridement, revision is done by doctors in the operating theatre. However, bed-side revision is also frequently done in the wards and in some cases it can be done by specialised nurses. Autolytic and enzymatic debridement (Iruxol®, Iruxol Mono®) is also used, but sharp debridement is preferred in many cases such as wide wounds while the aim is to promote the healing of the wound. In the treatment of wounds also the aspects of trauma and pain need to be taken into the consideration. The patient’s experience of pain should be minimised. Pain increases the secretion of stress hormones and in this way prolongs the time required for wound healing. Local anaesthetics, together with systemic medication, are recommended before the treatment of a wound. The management of the wound should not cause trauma in the wound bed or in the surrounding area. If the binding adheres to the wound bed, or to the periwound skin, it breaks down the new vital tissue and prolongs the healing process. The daily management of wounds is an art. Each patient is an individual and you cannot have a recipe book for the treatment of wounds. To deliver high quality wound management requires that the professionals involved in the treatment of wounds have a multi-scientific theory base and ongoing education in wound management. The challenge for the Finnish health care system is to increase the knowledge and skills the wound as a basis for its management. For this we need good co-operation between professionals and between education and clinical practice. References:
Further information may be obtained from: Helvi Hietanen |
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