We are back continuing on the prickly conversations, this time about unhealable wounds. How is the ability to heal determined, and how do clinicians’ factor in a wounded persons goals and priorities, sometimes when there’s conflict with health care recommendations? We discuss if palliative wounds are the same as an unhealable wound and a range of ethical considerations when caring for people with these wounds. These wound types need to be discussed more, we hope you find the content relevant and stimulating for your clinical practice.
Timestamps:
00:00 Introduction
00:37 A big thank you to our audience for connecting
0:37 A big thank you to our audience for connecting
02:53 Love the feedback
03:20 How do the different professions and expertise determine what is unhealable
04:24 When an unhealable is in fact healable
05:24 How is a wound determined as unhealable
06:14 It’s not always about the healability but quality of life and symptom management
07:29 When a person is given evidence-based comprehensive information wounds can be healable
07:42 Once fully informed, despite being potentially healable, people may have different goals and priorities
08:27 Wrong information risks wrong decisions
08:35 Lack of knowledge and skills defaulting to unhealability and a “palliative” wound
08:54 What is a “palliative” wound
12:26 The unethical systemic barriers that result in unhealable wounds
13:16 Is a wound “palliative” when someone is transitioning to end-of-life care
14:23 Dying a dignified death without a wound
14:54 Medical professionals more likely to label a wound as unhealable
16:06 Lack of evidence-based wound diagnostics resulting in a wound being assessed as unhealable
16:17 Many wounds need to be biopsied
16:49 Everything is called a venous leg ulcer due to lack of diagnostics
17:29 Skin failure and the Kennedy Terminal Ulcer. Trombley-Brennan Terminal Tissue Injury
18:14 Barriers to identifying and documenting Kennedy Terminal Ulcer versus skin failure versus pressure injury at end-of-life
19:41 An evidence-based approach to determining if a pressure injury on the foot is unhealable
21:38 Questions to ask to assess if a wound is unhealable
22:44 Why are wound consultants not needed when a wound is unhealable?
22:52 Conversations around healability, capacity and dignity of risk
24:35 Healing not always an endpoint especially when linked to unrealistic claims
26:36 Healing plan vs maintenance vs palliation plan
28:42 The role of hygiene and mobility in the unhealable wound
28:54 Impacts of intersectionality and labelling a wound as non-healable
32:23 Clinical callout regarding unhealable wounds
33:15 Agency and the unhealable and healable wound
35:09 Well-being and wounds
39:04 Ethics of labelling a wound “unhealable” and moral injury
Resources mentioned:
- Kennedy Terminal Ulcer (KTU) and Trombley-Brennan Terminal Tissue Injury (TB-TTI) https://www.caresearch.com.au/Health-Professionals/Nurses/Clinical-Care/Symptom-Management/Skin-Failure-and-Pressure-Injuries
- International Consensus Optimising Wellbeing in people living with a wound https://woundsinternational.com/consensus-documents/international-consensus-optimising-wellbeing-in-people-living-with-a-wound/
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Disclaimer:
The views expressed in this podcast are our own. This podcast is intended specifically for healthcare professionals. Always follow your organisation’s policies and procedures. Please consult your own healthcare provider for individual wound advice.