Clinical Uncertainty in Nursing Assignment by Subject Academy

Introduction:

The main clinical uncertainty discussed here is an inconsistency in the matter of wound dressing, where some nurses have been found to use the sterile dressing method, and some other nurses have used the method of clean dressing for the purpose of wound healing. The sterile dressing consists of covering the wound by a bandage or a tape for stopping any further injury and avoiding contact with the air for healing. On the other hand, clean dressing is washing the wound from time to time, and keeping it in the open for the healing procedure. The main research question that is answered throughout the research is whether clean wound dressing is a safer option for surgical wounds or not. The research question has been formulated by comparing the two options for the treatment of surgical wounds, which is the sterile procedure and the clean dressing procedure. The intent of the research was finding out the better or, the safer option, and hence, the aforementioned question has been formulated.

The research strategy that is used for answering the question is that it is action-based research where the information in relation to the research question has been collected from six specific journal articles, and the specific information related to the surgical wound care has been considered. The research strategy has been developed by searching for those articles, which are within the last seven years, from 2013 till 2020 for the research strategy to focus on the latest information. The paper that has given both qualitative and quantitative evidence has been selected for the research study. The approach of research helps in deriving the inference at the end of the research, and it is of two types, inductive and deductive. In the present research, the only deductive approach has been chosen for the research because it is directly related to the development of understanding about the answer to the question of research, and generates one inference at the end.

The selected studies for the research are:

The first study is related to the comparison of sterile and clean dressing technique for postoperative surgical wound infection within Chinese Healthcare. It helps in understanding how far wound healing is possible by using both the techniques related to operational wounds.

The study mainly focuses on the use of clean or sterile dressing technique for wound infection. The study mainly focuses on the subject of infection and helps in understanding which technique is better to stop the infection from spreading.

This study is based on wound dressing and compares the data concerning its effectiveness. The focus of the article is on whether the wound dressing in a sterile method is more effective or the clean dressing method.

The study focuses on the acute surgical wound dressing procedure, which involves the description that involves validation and development in relation to an observational metric. The study has helped in the creation of an observational metric that is useful for measuring whether the clean dressing or the sterile dressing technique is suitable.

The study is mainly dependent on the practice and principles of wound dressing, and the way by which the practice and principles of wound dressing are managed. It helps in furthering the answer to the question by understanding whether the clean dressing principle is better than the sterile dressing principle.

The study is mainly related to the treatment of wounds and the wound healing process. This study is chosen because it investigates about healing the chronic wound and managing the caring of the wound treatment process.

Main Body:

The paper, (Huang, Zhang, Guan, & Liang, 2016), says that with the increasing antimicrobial resistance, it is always required to have suitable techniques for wound dressing for decreasing the process of infection, and for decreasing the time of healing to consider the factors of patient safety. In order to achieve this, the paper had chosen a population of 130 patients, within which 70 are males, and 60 are females. It has been found to be important for the surgery in the Affiliated Hospital of China, and their wound healing process is observed. It has been observed that 12 patients who had got their wounds treated by the sterile process have got an infection; however, the size of the wounds was larger. On the other hand, for the wounds of smaller size, it has been found that the sterile treatment of wounds is more effective as the covered wound is treated faster than the clean dressing procedure.

In the paper, (Kent, Scardillo, Dale, & Pike, 2018), it is seen that the use of clean dressing technique is an effective medical intervention in the case of chronic wounds for reducing the infection. The search strategy that is used in the research is done by the trained librarian of a university, which had helped in the extraction of information from 473 articles from different sources. However, it is also seen that the research cannot conclude the type of dressing technique that is the best for chronic wounds due to the lack of evidence for the entire process. Hence, it has been inferred from the article that the research shows sterile wound treatment is suitable for chronic wounds, and the clean dressing process is suitable for the smaller wounds.

The paper, (Sood, Granick, & Tomaselli, 2014) is focused on collecting the data about the effectiveness of various wound healing techniques. It has found that the clean wound dressing has been more effective for chronic situations rather than the sterile wound dressing. It has also been found that there are other methods of clinical wound dressing from the journal like hydroconducive dressings, biological dressings and skin substitutes. The journal helps in understanding the methods of clinical dressing processes and helps in understanding that the future direction of clinical wound dressing is mainly related to the clean dressing rather than the sterile dressing process

The paper, (Hegarty, et al., 2019), states that this study was mainly for developing the observational metric, which can be used for understanding the practitioner’s performance for completing the right wound dressing process by using the aseptic non-touch technique (ANTT). The research is conducted by the help of a group of medical practitioners, researchers and academics that came together for developing the observational metric by means of a six-step method that culminated into a Delphi panel. The final metric constitutes three different phases, which has 31 steps, 18 mistakes and 27 errors in the sentinel. It has been shown from the research process that the sterile would treatment procedure is more effective in reducing infection, but it is expensive. On the contrary, it is also found that the clean dressing process is comparatively cheaper for the dressing of wounds.

The paper, (Vowden & Vowden, 2017), focuses on the practice and principles that are related to the cost-effective technique of wound dressing and clinical management. The journal has helped in understanding whether the sterile wound dressing or the clean wound dressing is more cost-effective. The journal has been able to evaluate that it depends on the type of wound that is in process, and the researchers inferred that in the case of smaller wounds, the clean wound dressing method is required to be followed because it has helped in reducing the amount of infection. On the other hand, it has been found that in the case of larger wounds, the sterile method is more suitable because the plaster over the wound gets it healed faster.

The paper, (Powers, Higham, Broussard, & Phillips, 2016), mainly focuses on wounds resulting from the treatment of chronic ulcer operations, and the wounds that take time to heal for the diabetic patients. It always leads to significant morbidity and mortality of the population. In this study, it has been found that a mix of sterile wound healing and the clean wound healing process helps in avoiding infection. It has been found that when the wound is highly infectious, or during the initial stage, the sterile process is followed, which leads to avoiding the infection. However, the clean wound healing is done at regular intervals for the sake of avoiding infection from non-exposure and cleans the wound for another plaster.

Conclusion:

The study concludes that the wound healing process is clinically always applied when the bruises or wounds cannot be healed automatically, and it requires antiseptic for healing and avoiding infection. It has also been found that the sterile wound healing is covering the entire wound by plaster for avoiding infection. On the contrary, the clean wound healing is exposing the wound to air, washing it, and applying antiseptic from time to time. When the research question focuses on which one is safer, it is found that no conclusion can be reached because it depends on the type of wounds. When the wound is large, it is found that the sterile process of wound healing is useful to avoid infection. On the other hand, for treating smaller wounds; the process of clean dressing is useful.

It has also been found in the study of six journals that for a person who is going to stay out of the hospital in relation to the treatment of wounds, the sterile dressing is more effective because it stops the dirt and dust from entering the wound. On the contrary, for long hospital stays in case of chronic wounds, the clean dressing method for wounds is more effective.

References

Hegarty, J., Howson, V., Wills, T., Creedon, S., Mc Cluskey, P., Lane, A., et al. (2019). Acute surgical wound‐dressing procedure: Description of the steps involved in the development and validation of an observational metric. International wound journal , 16 (3), 641-648, DOI: 10.1111/iwj.13072.

Huang, X., Zhang, J., Guan, S., & Liang, W. (2016). Comparison of sterile and clean dressing techniques in postoperative surgical wound infection in a Chinese healthcare facility. Tropical Journal of Pharmaceutical Research, 15 (2), 415-419, DOI: 10.4314/tjpr.v15i2.27.

Kent, D., Scardillo, J., Dale, B., & Pike, C. (2018). Does the use of clean or sterile dressing technique affect the incidence of wound infection? Journal of Wound, Ostomy and Continence Nursing, 45 (3), 265-269, DOI: 10.1097/WON.0000000000000425.

Powers, J., Higham, C., Broussard, K., & Phillips, T. (2016). Wound healing and treating wounds: Chronic wound care and management. Journal of the American Academy of Dermatology, 74 (4), 607-625, DOI: 10.1016/j.jaad.2015.08.070.

Sood, A., Granick, M., & Tomaselli, N. (2014). Wound dressings and comparative effectiveness data. Advances in wound care, 17 (7), 511-529, DOI: 10.1089/wound.2012.0401.

Vowden, K., & Vowden, P. (2017). Wound dressings: principles and practice. Surgery (Oxford) , 35 (9), 489-494, DOI: 10.1016/j.mpsur.2017.06.005.