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Wound care know-how from an expert
Outdated practices can compromise the treatment of wounds
Marcia Frellick
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Nancy Morgan, BSN, MBA, RN, WOC, WCC, DWC, OMS, is co-founding partner of the Wound Care Education Institute. She has more than 20 years of experience as a registered nurse and is board certified in wound care, ostomy and diabetic wound care. We interviewed her about what nurses should know about the specialty and its rewards and challenges.
Why do substandard practices continue?

What do you think all nurses should remember about wound care?

What are some outdated practices?

What are the latest trends in wound care?

If collagen isn’t the first thought, what is?
The No. 1 thing is
keep the wound moist.
That makes wounds heal faster. To keep wounds moist, dressing needs to be sealed down on all four sides so no air can get through. If air comes in contact with the wound bed, it will lower the wound temperature and dry it out. If a dressing falls off, it needs to be replaced fast.
Wet-to-dry dressings, which are considered substandard care in the U.S. This practice involves several times a day saturating gauze with saline, stuffing it into a wound, and ripping the gauze out when it’s dry. But as the gauze dries, it attaches itself to a wound bed and pulling it out creates bleeding and unnecessary harm. However, it’s still being done in practice and taught in schools. Also, putting cytotoxic solutions, such as sodium hypochlorite, in the wound for extended periods of time. We used to do that. They’re OK for a limited time — up to two weeks for infection only. However we see these types of practices going on for months and months, sometimes years.
Using collagen, which has the most evidence behind it in wound care. All of our bodies make collagen, but when a wound stops healing, the wound stops making collagen. It’s as if the wound is sleeping. We use collagen primarily, which is derived from cowhides and we put it into the wound bed and this reminds the body to start making more of its own collagen to heal the wound.
Collagen has been available for years, but it’s always a second thought for clinicians to use and it needs to be one of the first thoughts. Some clinicians and administrators view it as expensive and just don’t understand how it works. Other skin substitutes made from human and animal tissue are like collagen on steroids and we’re seeing good results from that.
Wet-to-dry dressings.
If I could change the world, I would have all the nursing schools teach proper wound care. There are basic things you can do to a wound to get that wound to heal. "
— Nancy Morgan, RN

If you ask any nurse whether they
were taught wound care in school
, the answer is going to be “no.” They were taught to turn the patient every two hours to relieve pressure and keep the skin clean and dry, but they weren’t taught the latest techniques in wound care. Nurses in the field teaching new nurses are teaching what they were taught by their mentors, which was bad wound care. It’s a chronic cycle. Physicians also continue to be taught wet-to-dry dressings in medical school.
Marcia Frellick is a freelance writer.
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How should this change?

If I could change the world, I would have all the nursing schools teach proper wound care. There are basic things you can do to a wound to get that wound to heal. However, we’re not doing those things, and that’s why we have 6.5 million chronic wounds in the U.S. alone.
Why should a nurse consider specializing in wound care?

Skin is the largest organ of the body so it affects all lives. Skin is in! There’s nothing better than the feeling of healing a hole in someone’s body. The skin reflects clinically what’s going on with the patient. We all need to be in tune with the skin. We need more people who are passionate to be healers and make a difference in their patients’ lives.
Why is research important to advance wound care?

Only about 15% of what we do in wound care today is backed up by research. The other 85% comes from people sharing what they’ve been taught or what they see working anecdotally. There’s a lot of room for anyone who wants to get into research.
What would you like to see more research on?  

New dressings or adjunctive-type therapies that can stimulate tissues to grow — accelerate them at turbo-speed. Now, we are very limited on what we can use.
What are the biggest challenges in wound care?

For those confident in wound care, the challenge is getting buy-in from others. Management may not want to buy in to what a nurse wants, such as expanding the products a hospital stocks to widen choices for wound care. The key to overcoming these challenges is education. Recruitment of wound specialists is also difficult because not enough people are certified and ads go unanswered. Wound Care is not a glamorous side of nursing and that could be why.
Are there apps that can help wound care?

We designed a free app for iPhone and Android called
Wound Central
, which has step-by-step videos, an image library of various types of wounds, documentation tips, anatomical reference guides and definitions so nurses can have a reference tool for wounds at their fingertips.