My Scope of Practice: Keeping Wound Care Simple

When work, commitment, and pleasure all become one and you reach that deep well where passion lives, nothing is impossible. — Anonymous

     Sarah Kuser, BA, BSN, MSHA, is the Wound Care Coordinator at Kindred Hospital, a long-term acute care facility in Tucson, Arizona. “My job is all about wound care,” she explains. “I work directly with patients and educate staff. It’s exciting being in charge of a wound care program and working to make it the best it can be.”

     Sarah hails from a large family of four brothers, a sister, and a multitude of pets. She recalls playing nurse at a young age. “Someone always needed a band-aid or splint,” she says. “If they didn’t, I’d give it to them anyway.” After college, Sarah discovered her degree in anthropology didn’t translate into a job. She soon pursued a nursing degree and served as an ICU nurse for 13 years before becoming a wound care coordinator, over the years finding wounds more and more fascinating. “When [a wound] heals, it’s just amazing,” she says.

     Ronald Kline, MD, a vascular surgeon with whom Sarah works, once told her there are five basic categories of products with five purposes in wound care: absorb moisture, provide moisture, debride, fill in dead space, and address infection. Obviously, it is important to choose the most appropriate product. “When I’m inundated with sales reps and hundreds of products, Dr. Kline’s advice has helped me focus. Another important point is to optimize the body’s ability to heal the wound. You can’t get sidetracked by a bunch of fancy, expensive products. Just take good care of the patient and the wound will improve.”

     Sarah’s has four tips of the trade that have served her well. “First, smelling a wound is an important part of the assessment,” she says. “Second, when a patient has had their sternum removed, it is crucial for the caregiver to pack the wound gently, so as not to cause cardiac tamponade. Also, you must be attentive to the timing of your patient’s respirations when you are packing the dressing so your hand doesn’t get caught in the ribs. Third, remember nutrition is vital for wound healing. Without good protein intake, the wound doesn’t have the building blocks to repair itself. Last, you need a tough stomach but the reality is that wound care nurses can eat while they watch or listen to graphic patient details!”

     Sarah’s fulfillment regarding consistent healing outcomes is enhanced by the personal relationships and bonds formed in the world of wound care. “Sylvia, one of my favorite patients, was in my care during her multiple cardiac procedures, including cardiac valve replacement. Ironically, she has in many ways taken care of me — listening to my problems, giving me advice, helping me keep my life in perspective, and providing lots of laughter. For the past 10 years she has been my surrogate mom.”

     In addition to her work at Kindred, Sarah researches depression and its effect on wound healing and the patient’s recovery. “If patients are hospitalized for a prolonged period and they’re depressed, they spiral downward clinically,” she says. “As a result, I am more proactive in requesting psychiatric consults; sometimes, antidepressants are effective in hospitalized patients. Sarah also is interested in wound prevention. She believes good nursing care can prevent pressure ulcers in most cases but acknowledges sometimes the patient’s condition prohibits following the gold standards — for example, blood pressure and heart rate may prohibit patient turning. She also notes that when a patient is in the dying process, the skin dies, too. “You have to weigh what is available against what is best for your patient,” she says.

     Sarah’s also pleased with the recent emphasis on evidenced-based research. “I like knowing my practice is founded in evidence-based science,” she says. “When a physician, patient, or family member asks why we are choosing a specific plan of care, I can state it’s the national standard for wound care nurses and provide research articles that show the benefits of our regimen.

     Sarah’s nonwound-related activities include spending time with her husband and 18-year-old daughter, four cats, three dogs, and five horses. She enjoys horseback riding, camping, and reading (she just finished The Kite Runner and is looking forward to The Secret Life of Bees). With the help of her new blackberry, she is starting to get her news on the go. “I can now read The New York Times whenever I want to!” she says. She tries to keep up with a bevy of wound care and nursing journals because she is a proponent of education. She tells soon-to-be nurses to keep going when it comes to learning. “If you’re an LPN, get your RN,” she says. “If you’re an RN, get your BSN. You can’t go wrong with education.” Sarah also insists that if any professional is burned out, he/she, should change what they are doing before it has an impact on care.

     Looking ahead, Sarah hopes to have an established program for pressure ulcer prevention in place at Kindred and to become more involved in evidence-based research to improve patient quality of life. If possible, she would like to blend these two goals. Her professional philosophy is to be “kinder than necessary” to patients and co-workers. Her daily goal is to “hopefully, make patients’ lives easier and more comfortable.” Passion, honesty, and quality define this wound care coordinator — they are the perfect combination of traits for keeping it simple in her scope of practice.

This article was not subject to the Ostomy Wound Management peer-review process.