Tag Archives: patient care

Caring for Wounds eBook Series: Pressure Injuries

This e-book is sponsored by Angelini Pharma, Inc.

angelini pharma ebookPatient care teams rely on the wound care nurse alone to implement a pressure injury prevention program; however, a successful program requires involvement from the entire care team and is a 24/7 endeavor.

Learn how your healthcare team can provide better patient care, topics include:

  • Prevention Programs: Where to Begin
  • It Takes a Team
  • Establish a System
  • Empowering Your Patients
  • Prevention Education
  • Pressure Injuries

Balancing the wheels of life

Have you ever ridden a bicycle with a wobbly wheel? The ride isn’t smooth, and you notice every bump in the road. As you focus on your discomfort, you may be distracted from the beautiful vistas you’re riding past.

Think of the bicycle as your overall health, which carries you through life. For most of us, learning how to ride a bike begins in childhood as we learn to control the wheels. But with more wear and tear on the bike, the once-pleasant ride becomes uncomfortable and sometimes out of balance.

As clinicians, we need not just to practice riding our own bicycles gracefully, but also to care for our patients’ worn and hurt bikes. Only by being balanced yourself can you truly help another. Living a balanced, healthy life means finding joy in the journey. Unfortunately, our mortal existence comes with bumps in the road. In our fast-paced society that requires us to juggle family, professional, and other demands, many of us seem compelled to ride faster. But this may not be effective or productive—and it can lead to distress.

The wheel as metaphor

One way to find a balance is to examine the wheels that carry you through life. Each wheel has many spokes; think of the section within each spoke as one of the areas of life that together make up your whole well-being. One section represents your physical health and the others your spiritual, mental, social, environmental, financial, recreational, and emotional health.

Now imagine the center of each spoke is a zero and the outer rim is a 10; from the center to the rim, the numbers increase. How would you rank yourself in each area of life, with 0 representing the lowest ranking and 10 the highest? Put a dot on the number that represents how strong you think you are in each area of your life. Giving each section a numeric value helps you identify problems so you can move toward a plan for improvement. For most people, the numbers will vary from section to section, because most of us feel stronger in some areas of life than in others.

Next, connect the dots around your wheel to see how bumpy the wheel is. If you assigned a 4 to some parts of your life but gave others a 2 or an 8, the connected dots would create an irregular wheel. When you look at your wheel as a whole, you’re examining how bumpy or out of balance  your life may be. With this wheel, would your ride through life be smooth or bumpy? Using this tool can help you identify why your ride seems out of balance and can pinpoint which areas need improvement.

Using SOAP to clean your bike

Clinicians often use the acronyms SOAP and SOAPIER to guide the nursing or patient care process.

SO stands for subjective and objective data—the process of collecting important information about a potential or real problem.

A stands for assessment, the second step. Being able to label a problem helps you recognize the reality of your situation.

With that information, you can create a plan, represented by P, to address the problem.

The additional steps of intervention, valuation, and reevaluation (the IER of SOAPIER) can guide you through the cyclic nature of the process.

Improving the numbers on your wheel

Similarly, we can keep ourselves in balance by using the patient care process on our wheels—and by extension, ourselves. During the assessment step, examine the ratings you gave to each wheel section to gauge the status of each area of your life. Then ask yourself the following questions:

What would it take for me to move from a 4 to a 5, or from a 6 to a 7, in this area?

What one action could I take today to improve this rating?

Am I willing to do this?

What are the barriers to improving my rating in this area?

What resources do I have or need to have to improve the rating in this area?

Joy in the journey

By using the SOAP process on your own wheels that carry you through life, you can make your ride less jarring. When we’re in balance, our ride through life is much smoother and we can enjoy the journey more. When you’re balanced and stable, you can run aside the wobbly bikes of struggling patients—and use the bicycle analogy to help them identify imbalances in their own health and lives.

Holistic practice helps individuals find meaning and balance in their lives. Health is more than just absence of disease. It refers to our emotional, physical, spiritual, social, and environmental well-being. A problem in any one area can affect the whole.

Striving for balance in life is a constant challenge. The terrain changes with the seasons and demands of life. Sometimes just keeping perspective on the road ahead helps you realize that despite the hills and valleys, your wheels are in balance and you just need to keep pedaling. By applying the patient care process to ourselves, we can adjust our wheels and better enjoy the ride. Savor the journey.

A certified nurse educator and certified diabetes educator, Tracey Long is also on the faculty of Nevada State College in Las Vegas.

Selected references

American Nurses Association. The Nursing Process.

Julliard K, Klimenko E, Jacob MS. Definitions of health among healthcare providers. Nurs Sci Q. 2006; 19(3):265-71.

Kimsey-House H, Kimsey-House K, Sandahl P, Whitworth L. Co-Active Coaching: Changing Business Transforming Lives. 3rd ed. Boston, MA: Nicholas Brealey America; 2011.

Luck S. Wellness coaching in integrative health care: a holistic nursing perspective. Integrat Practit.

Seeing healthcare from a new perspective


By: Donna Sardina, RN, MHA, WCC, CWCMS, DWC, OMS

As healthcare clinicians, our world is full of tasks to be completed. Some are new, but many are tasks we repeat every day and thus have become routine—things we could almost do in our sleep.

But what’s routine for us may not be routine for our patients. For some patients, these routine tasks of ours may be their first encounter with a healthcare situation.

When a member of my family needed health care recently, I observed as a family member, not a clinician, and learned what it’s like to be on the other side of the clinician’s routine. What follows are some shareworthy observations.

  • Read health record notes in the computer before talking with the patient. Asking patients about the care they’ve already received or what medications they’ve been given doesn’t build their confidence in your care.
  • Keep the patient updated. If you’re waiting for an order, lab result, or call-back from X-ray, tell the patient this—if possible, more often than once a shift. Think how powerless and vulnerable you would feel lying in a strange bed away from home with no control.
  • Don’t be too cheery and giggly. Remember—the patient is sick and may not be feeling well. Also, you may have great coworkers and a great job, but when you’re conducting the patient assessment, the patient and family don’t want to hear a 20-minute description of the fun you have in your department. This could make them think you’re so busy chatting that you’re not paying attention to detail. Focus on the patient and your assessment instead of trying to become the patient’s buddy.
  • Check bandages at least every shift, even if you’re not going to change them. If you’re checking them with a casual glance or combining this with another task, make sure the patient knows you’re checking.
  • Inspect surgical drains or collection devices at least once every shift, and empty them as indicated. Surgical drains can be extremely scary to patients, who may feel as if their guts or blood are draining from their body.
  • If the patient’s skin is hairy, shave or trim the hair before applying tape or a transparent film dressing. If you don’t feel comfortable removing the hair, ask another clinician for help. Always explain to the patient the reason for hair removal. (Most patients prefer hair removal to the alternative of hair-pulling pain.) A self-adherent elastic wrap is a great alternative to tape for securing bandages on hairy skin, although you still need to use caution when removing it.
  • Before changing a surgical or wound dressing, find out if the patient has seen the incision or wound; if not, ask if he or she wants to see it. When appropriate, it’s best for patients to understand what’s under the bandage. They may be relieved to find out that what they’d been envisioning as a fist-sized wound is much smaller—or, if it’s a large wound, they may be surprised by its size.
  • Don’t complain about the computer or tell patients you have poor computer skills as you’re typing information into their health record.
  • If the patient is required to use a computer stylus to sign something in the health record, make sure to clean it before handing it to him or her. Do this even if the stylus has already been disinfected, because the patient doesn’t know that.
  • Ask visitors to leave the room before you provide care or discuss the patient’s health condition. This way, you spare the patient the burden of having to ask friends or family to leave.
  • Don’t rush discharge. Make sure you’ve reviewed everything, including post-care follow-up and whom to contact for help. Verify that transfer arrangements are in place. Most important,ensure that the patient and family members have received and understand patient and caregiver education. (The teach-back method is a great way to determine their understanding. For more information, visit http://www.teachbacktraining.org.)

As clinicians, we should strive to make every patient encounter special, not routine. Remember—it’s always about the patient.

Donna Sardina, RN, MHA, WCC, CWCMS, DWC, OMS


Wound Care Advisor

Cofounder, Wound Care Education Institute

Plainfield, Illinois

DISCLAIMER: All clinical recommendations are intended to assist with determining the appropriate wound therapy for the patient. Responsibility for final decisions and actions related to care of specific patients shall remain the obligation of the institution, its staff, and the patients’ attending physicians. Nothing in this information shall be deemed to constitute the providing of medical care or the diagnosis of any medical condition. Individuals should contact their healthcare providers for medical-related information.