Relationships and education lead to higher levels of compliance
by Donna Morrow

"Empower the patient, and success will follow."

Whether treating psychological illness such as depression or addiction or something more physical such as wound care, the most important part of treatment is education and teaching a person to want to care for themselves. When a patient feels that they are not only involved in their care, but also the one driving it, successful outcomes are more likely.

As the medical industry, including insurers, payers and health systems, are looking to reduce costs and rely less on more expensive in-patient care settings by moving to more value-based options, home health care has become an important avenue for treating wound care patients. While the lack of 24/7 direct medical supervision can present caregivers with challenges, at the same time it can actually lead to higher levels of compliance and greater likelihood of long-term success.

Building Relationships

Caring for patients dealing with wounds can become very personal for wound care nurses and clinicians, as we never want to see a patient relapse or be in preventable pain. Developing trust with patients is essential to this type of care. In order to fully heal, patients must feel they are supported, understand the steps of their care and comply with their treatment regimen. In certain patient populations, especially in psychiatric care, these relationships are sometimes the only way to develop a continuum of care.

Education

Education is the single best tool homecare workers can employ to secure successful outcomes. When a wound care nurse visits a homecare patient, education must be a central part of their overall care plan. Wound care patients often do not understand how a wound developed or why a specific product is being used in their care.

However, by equipping them with more information about their wound, they can better understand the behaviors and/or lifestyle factors that have led to the problem.

One step many wound care clinicians overlook is explaining why specific products are being used and how they work. By providing patients with a fuller understanding of this, they begin to become more empowered to continue care on their own, long after a nurse has left. Education also helps patients to feel less embarrassed by their wound and helps to normalize what they are going through, further leading to a sense of empowerment.

Developing these types of individualized care plans—that are highly tailored to each patient with an eye toward educating and empowering patients in their treatment—enables clinicians to better help patients care for themselves.

Challenges and Compliance

Most health care professionals understand and acknowledge that the primary concern when it comes to wound care in the home is the lack of supervision in a controlled setting. Without this controlled setting and without a care provider to come and check, re-dress or tend to wounds at regular intervals, the success of the patient’s treatment is largely dependent on compliance. In 33 years of working with wound care patients, I’ve found that one of the most common triggers of noncompliance is discomfort.

If a patient finds the feel of a bandage or dressing uncomfortable, or if part of their care regimen is painful, they will remove it and/or stop treatment. While this will cause the wound to eventually flare back up and become an issue, in the moment, the patient is happy. This is why relationship building, trust and education are such crucial parts of the treatment plan. When a patient has confidence that short-term pain will lead to long-term healing, there is a much greater chance they will stick to the treatment plan.

Variables that can present challenges to successful management of wound care in the home include patient lifestyle and environment. For example, if there are animals in a home or it is not as clean as it could be, the chance that a wound will become infected becomes more of a concern. Likewise, those patients living busy lifestyles looking to quickly jump back into their regular routine can often unintentionally hinder the success of their care. Consistent pressure on, or contact with, a wound, such as you might experience walking around with a wound on the leg or foot, will cause it to take a prolonged time to heal, if healing is even possible.

Similarly, a strong support system and positive mental state are seen as major boosters of success when dealing with any type of illness or medical condition. Ensuring that patients who are caring for wounds have someone to assist can help the patient feel less alone and reduce the amount of activity they undertake that can impact the wound. If a patient does not have an adequate or reliable support system from family or friends, there are many organizations that offer in-home assistance, in addition to visits from wound care clinicians. This type of support can range from help with daily tasks such as housekeeping or grocery shopping to longer-term care.

Wound care success is a process and does not always happen overnight. Many clinicians find that you can take a step back for every few steps forward, but by sticking with the process, it gets better. When you are able to establish a strong relationship with a patient by fully involving them in the wound care process, through a personalized care plan, education and the creation of a support system, there is a much lower chance of relapse and higher rate of success.