Margaret Heale

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Wound Research Data Review Including Outliers

by Margaret Heale RN, MSc, CWOCN

When looking at randomized controlled trials one of the first things you read is a one liner, "subjects were matched," and there may be a list that includes stage of pressure injury, size of wound, age, sex, and a myriad of other things somebody decided to include. There may also be exclusion criteria such as uncontrolled blood sugar, obesity, and being over 60 years old. It makes sense to do this, and there is no doubt that once you have got homogenous groups and compare the outcome of one with another, after whatever intervention you wish to discover the worth of, the result may look gratifyingly convincing.

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home care nurse with patient

By Margaret Heale RN, MSc, CWOCN

I watched a short PowerPoint DVD on the "bag technique" as part of our regular in-servicing the other day. The presentation started with the most important way to prevent cross infection—wash hands—which is fine. Then came the bag technique. I have no problem with the fundamentals of keeping your bag off the floor, only getting anything out of it after decontaminating your hands, and wiping before you store. I do have a problem with having to place the bag on a Chux or water-resistant wipeable or disposable surface, however.

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dressing removal

By Margaret Heale RN, MSc, CWOCN

Wounds are dressed every day, and much goes into the choices that are made to properly apply wound dressings. The condition of the periwound skin should be a major factor in the decisions made, as injuring this area can extend the wound and cause considerable pain. Tape removal is one of the most painful areas of wound care.

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Medical supply waste

Margaret Heale RN, MSc, CWOCN

It is truly shocking how much plastic we use and how much medical supply waste there is. From gloves that we wear to touch a patient's skin, to the sterile packed scissors that we are meant to dispose of into the sharps after use.

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patient repositioning for pressure injury prevention

by Margaret Heale, RN, MSc, CWOCN

This past fall, I attended the New England WOCN Society regional conference. While I am still processing all the great information that I absorbed there, I'd like to share with you some of the important discussions that came up on the topics of pressure injury staging and patient compliance with repositioning protocols.

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wound care terminology

by Margaret Heale, RN, MSc, CWOCN

Looking back on a previous New England WOCN Society regional conference I attended, it strikes me that there where several impressive items discussed relating to the topic of pressure injuries. In listening to Dr. Joyce Black give a little background on the NPUAP rationale for the recent changes made to pressure injury staging, it was clear that much thought had gone into changing the term "pressure ulcer" to "pressure injury".

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advancing wound care nursing skills

by Margaret Heale, RN, MSc, CWOCN

I was not at the April National Pressure Ulcer Advisory Panel (NPUAP) meeting, but I do think some of critical commentary that has followed the announcement of the pressure injury staging system changes is flawed. Clearly designating the thickness of an injury to a defined stage makes sense and communicates a severity. All the NPUAP have done is clarify some detail that clinicians have had to manage previously, within a gray area. It is not the responsibility of the NPUAP, researchers or clinicians at the bedside to make up definitions to fit coding or legislators. It is important that researchers and bedside clinicians provide CMS and legislators with research demonstrating how and why pressure ulcers occur.

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delivery of high quality bedside care

by Margaret Heale, RN, MSc, CWOCN

Stepping forward into a model of care that is quantitative and objective is essential and most definitely the way we are headed in wound care and beyond. Using the word "care" in the same sentence with "quantitative" and "objective" may sound like an oxymoron, but care does not have to be fluffy and old-fashioned. What it must be is kind, gentle and authentic. My question is: how can the care we provide be kind, gentle, and authentic when the emphasis is so obviously on cold, hard measures and stark black and white comparisons with little value placed on the people who are the care providers?

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nurse transporting patient in wheelchair

by Margaret Heale, RN, MSc, CWOCN

It has become quite easy to look at pressure ulcer prevention in most health care settings. From acute care, through the ED and on to the OR and ITU, then to the various floors of med surg, orthopedic, not forgetting rehab and community nursing. Pediatric and neonatal units have better defined pressure ulcer risk assessment tools to utilize that have made assessment and planning care much less haphazard for those patients than in the past. The prevention and treatment of pressure ulcers does not lay with any one of the above areas but all of them, all the time for every patient at risk.

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Accountability

by Margaret Heale, RN, MSc, CWOCN

Most of the residents here are elderly, though some of the more acute rehab patients are quite a bit younger than me. We actually have five women over a 100 out of 116 people, quite impressive with the eldest being 105 years old. As for me, I am a retired British matron just doing a little volunteer work near where my granddaughter works.