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EBP article on wet-to-dry dsg and Engel's book

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My patient on Thursday was admitted for I&D of a wound on the bottom of his left foot. He walked outside without any shoes or socks and got a minor cut on the bottom of his foot.The surgeon had to make a laceration of about 4 1/2 inches long to clean it. The wound was cultured and was positive for MRSA. I was able to assist the primary RN in his wet to dry dressing change. He had a wet to dry dsg change daily and it was wrapped in kerlix and ace bandage.

The EBP article I found is based on the many options for wound healing. I like to read research, but I would hate to be doing the research. This is what I found. The study was based on whether or not the traditional dsg is better for wound healing or if the new age dsgs are better. It also evaluated the dressing change tolerance of the patient and pain level. Some of these dressing options I've never heard of and a few I'm pretty familiar with.

1. hydrocolloids are recommended for sloughy, necrotic, granulating wounds but not a reliable choice for wounds with copious drainage. This type of dsg provides a moist environment and seals to prevent the possibility of infection.

2. Foams, such as silicon sponges are highly absorbant and can handle 10x the fluid of it's dry weight. Some studies were found that the foams performed better than the hydrocolloids. The discharge of a patient was not shown to have been speeder than with the standard hydocolliod but it did result in less patient pain and was more cost efficient.

3. Hydrofibres or Aquacel are used as a preventive mean to eliminate bacteria from entering the wound because it traps the bacteria in the gel. The team didn't find any comparable difference in the healing time or tolerance for patient.

4. Wound VAC system was also entered in this article. The evidence showed that the VAC system is used primarily for large, open wounds and it does increase healing time.

Marcus Engel gives pretty good insight to the care that we should give to you patients. Such as saying "I'm Here" or providing privacy when a patient has to the use bedpan or urinal are not things we learn in "nursing school". These are things we learn "on the job" and in clinical. This is a reminder to me that we need to treat our patients as individuals and not just another person we've got to take care of the next 8 or 12 hours.

However, I do have to disagree with him on his view of patients being rude or ugly to us, as healthcare professionals. It's a lot easier for him, as the patient, to say that us, as healthcare providers, need to suck it up and take the rude comments. It does hurt our feelings and takes a toll on our self esteem as healthcare professionals if and when we receive those kind of hasty and rude comments.

But overall, I'm enjoying the book, even if it for school. Smile


I agree that many of the personal aspects of nursing are just something you have to pick up through time. The more people you take care of the better you get at relating to them. It is difficult to have to take rude comments/actions from people, but we also have to try and understand that it is usually not personal and the patient is probably under a great deal of stress.


I agree that most does come along with the on the job training, although when you break it down it is so simple. Like he mentioned: It being a parent-child relationship. I think that was a great comparison to how much the patient's really do rely on us.

4EBP article on wet-to-dry dsg and Engel's book Empty EBP article on wet-to-dry dsg and Engel's book on Mon Nov 21, 2011 10:00 pm


I have also found the book to be a good read. It has made me think about how I take care of the patients and to hopefully be the nurse that eases their pain rather than be the one that they want to throw out the door. I would liek to be the one they remember for the good not the bad. With that being said I think sometimes they stick out in our minds as much as we stick out in theirs. They only get away with saying it to our faces and we must say it behind their backs to under our breath.

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