Minimizing factors that impair wound healing: a nursing approach.

Chronic wounds present tremendous challenges to the healthcare team. Unlike acute wounds that usually progress neatly in a timely manner through the inflammation, proliferation and maturation phases of the healing process, chronic wounds deviate from the predictable sequence of regeneration and repair. To aid the healing process, there are five questions a nurse should ask when assessing a wound: "What is it?" "At what stage in the wound healing process is this wound?" "Is this wound healing at the expected rate?" "What local factors exist that may be delaying the healing process of this wound?" and "What systemic factors exist that may be delaying the healing process of this wound?" At various points in the process, specific concerns then need to be targeted. Initially, prevent or control infection. Then optimize exudate control and remove foreign bodies. Finally, prevent premature wound closure or contracture, especially in infected or undermining wounds. When the five assessment questions are answered and specific concerns have been addressed, the wound should proceed through the normal phases of the wound healing process. Throughout the process, attention to factors such as nutrition, systemic conditions, and perfusion is essential if healing is to be optimized.