Wound Management: Using Levine’s Conservation Model to Guide Practice

author: 

Matthew J. Leach, BN(Hons), ND, PhD

Levine’s conservation model,¹ initially constructed as a teaching framework for medical-surgical nursing,² is based on the belief that nursing interventions should be aimed at conserving function.^3,4 Roberts and Taylor⁵ and Fawcett⁴ state that nurses currently use Levine’s model in practice by acting to preserve client energy and integrity — encouraging bed rest, maintaining pressure area care, and preserving privacy. To clarify the relationship between Levine’s conservation model and wound management, each of the four principles of Levine’s model will be examined. To enhance understanding of the context in which Levine’s conservation principles are presented, the underlying assumptions, definitions, and limitations of the model are discussed.

Definitions

Levine’s conservation model¹ consists of four major principles. The principles are defined as follows:

  • conservation of energy — balancing energy output and input to avoid excessive fatigue⁴

  • conservation of structural integrity — maintaining or restoring the body structure by preventing physical breakdown and promoting healing⁵

  • conservation of personal integrity — maintaining or restoring the patient’s sense of identity and self-worth⁵ and…acknowledging uniqueness⁴

  • conservation of social integrity — fostering awareness that the patient…is a social being who interacts with others⁵ in their social environment. read more...

An Overview of Tissue Types in Pressure Ulcers: A Consensus Panel Recommendation

author: 

Joyce Black, PhD, RN, CPSN, CWCN, FAPWCA; Mona Baharestani, MD, PhD, ANP, CWON, CWS; Steven Black, MD, FACS; Jamie Cavazos, RN, MSN, CWOCN; Teresa Conner-Kerr, PhD, PT, FACCWS, CWS, CLT; Laura Edsberg, PhD; Benjamin Peirce, RN, CWOCN, COS-C; Evelyn Rivera, RN, CWOCN; and Greg Schultz, PhD

 

Abstract: Pressure ulcer assessment is usually performed at the bedside by a clinician with minimal training in wound assessment. A multidisciplinary panel of United States’ wound experts was assembled to provide anatomically accurate and practical terms associated with pressure ulcer assessment, healing, and nonhealing in order to help clinicians identify and describe tissue types and pressure ulcer stages. Specifically, anatomical markers and/or structures within the wound are described to facilitate tissue type identification and pressure ulcer staging. The panel agreed that the provision of a common language facilitates quality care across settings. Although some research has been conducted, additional studies to determine the validity and reliability of wound assessment and healing terms and definitions, as well as pressure ulcer staging systems, are needed.

Accurate physical and psychosocial assessment is imperative to determine an appropriate plan of care for the patient with a pressure ulcer.¹ Chronic wounds occur in 2.8 million people in the US and cost billions of dollars to treat.² However, Patel and Granick³ examined 50 medical school curricula and found that medical students receive an average of only 4 hours of instruction on wound-related topics (including anatomy and physiology of wounds and wound healing) during their entire medical school training. Nurses receive similar minimal training. Vogelpohl and Dougherty⁴ reviewed 10 nursing textbooks and reported that on average only 200 lines of text and 10 tables were presented on wounds, some of which were inaccurate. Many nurses learn human anatomy using only textbook descriptions and pictures and lack a thorough knowledge of the appearance of human tissues in either a cadaver or surgical specimen. The lack of wound and pressure ulcer training also has an impact on practice. Subsequent inaccurate assessments of ulcer size, stage, and visible tissues may affect payment and processes of care needed to support healing can be developed in error. At times, these inaccuracies can lead to fines and litigation. read more...

KEMANA ARAH PERAWATAN LUKA DI INDONESIA

Saldy Yusuf, S.Kep.Ns.ETN.

Luka merupakan masalah global, bukan hanya di negara berkembang tapi juga di negara maju. Permasalahan luka bukan hanya pada "rusaknya integritas integumen" tapi lebih dari itu. Luka menimbulkan berbagai permasalahan yang kompleks dan terkait satu sama lain. Pasien dengan luka akan mengalami berbagai gangguan mulai dari hal yang sederhana seperti gangguan pola tidur hingga gangguan yang tidak kita perkirakan seperti gangguan body image bahkan gangguan interaksi sosial.

Saat ini yang menajdi fokus perhatian 'wound care expert' adalah luka kronis. Decubitus. Luka Diabetes, dan Luka Kanker menyita perhatian para ahli di berbagai belahan dunia. Issue-issue seperti biofilm, wound infection, wound diagnostik, bioenginering skin hingga biomolekular akan menjadi topik yang hangat dalam dekade ini.

Hal ini memberikan gambaran kepada kita di Indonesia bahwa kita tertinggal 20 tahun dari negara Eropa dan Amerika termasuk Jepang dalam teknologi perawatan luka. Ketika di tahun 2000-an kita hangat membicarakan modern wound dressing, moist concept, TIME concept, ternyata di luar hal ini sudah dibicarakan 20 tahun yang lalu.

Memang fokus perhatian pemerintah di bidang kesehatan terutama di wound care boleh saya katakan tidak ada. Belum ada kebijakan dan program untuk menurunkan insidens luka decubitus, belum ada program nasional pencegahan amputasi diabetik, dan belum ada anggaran untuk paliatif care bagi pasien dengan luka kanker.

Fokus pemerintah masih pada masalah klasik; menurunkan angka kematian ibu dan bayi, meningkatkan cakupan imunisasi dll. Aspek itulah yang dijadikan indiaktor peningkatan derajat kesehatan masyarakat. Bila kita bandingkan dengan Pemerintah Jepang (sebagai contoh), melaksanakan screening decubitus dimana Pemerintah memberikan reward $ 400 US bagi perawat yang mendeteksi dan mencegah decubitus, walhasil insidens decubitus di Jepang hanya 1 digit yakni 3 % bandingkan dengan Negara kita dimana insidens decubitus sebesar 33%.

Memang sulit mengikuti jejak Pemerintah Jepang, untuk tahap awal yang paing penting adalah menyiapkan ilmu dan keterampilan perawat dalam perawatan luka, syukur-syukur kalau dalam 1 bangsal ada perawat terlatih untuk perawatan luka dan minimal ada 1 ET Nurse untuk setiap rumah sakit, saya yakin akan ada perubahan besar. Minimal bau eksudat tidak berhembus lagi di sudut-sudut bangsal Rumah Sakit.