Skin Issues In Nursing

Opinion

Working night shifts, I do not see doctors and therapists, thus I go by what was written on the resident’s chart. When it comes to therapists working with residents, I could say that they follow the reporting guideline of skin issues observed to the nurses in-charge of the resident. Doctors are made aware of the skin issues and sometimes they would give orders to change the treatment of the wound and lab tests when they deemed necessary.

Based on my interview of the nursing staff, I have learned that nurses’ aides have not seen nor read the wound assessment guideline. They do not know where to find it either. This is the same with the nurses. Nurses’ aides are quick to report to their respective nurses whenever they find skin

One of the nurses, KR, voiced that it is a hassle to write up bruises and sometimes she would not write it up especially when her shift gets busy (Personal communication, March 1, 2018). ANA’s Code of Ethics (2015) has stated that “the nurse has authority, accountability, and responsibility for nursing practice…takes action consistent with the obligation to promote health and to provide optimal care” (p. 15). The nurse’s decision not to follow through with the resident’s skin issue is a failure when our ultimate goal is to provide optimal care. I have observed these attitudes towards bruises more often because most of the time I was the receiving nurse and consequently was the one to write up the bruise. When it comes to wounds, nurses differ in their opinions as to what appropriate treatment and dressing needs to be used. In the wound assessment guideline, it only states that we need to follow the facility’s wound treatment protocol, which I have not found when I searched for it. I believe that this leads to confusion amongst the nurses. They tend to treat wounds the way they were practiced before. Aside

This is applicable to all residents and staff. There were no references or evidences included in the guideline. Wanda, the director of nursing, has stated they consulted a local wound care specialist, pharmacists, wound supply carriers, and a standard nursing wound care protocol. I can say that these references are not in the highest level in the hierarchy of evidence. Most of them are level VII and experts agree that evidence in this level is not reliable. Although staff are held responsible, most of the nurses have not seen nor even read the guideline. Aside from that, nurses are not unified when it comes to the documentation of the wound assessment. These may be due to lack of knowledge of the guideline and also their attitudes towards skin issues, especially bruises. Some nurses do not like to write an incident for bruises because they consider it a hassle. However, nurses need to perform their duties as mandated by the ANA’s Code of Ethics (2015), “the nurse has authority, accountability, and responsibility for nursing practice…takes action consistent with the obligation to promote health and to provide optimal care” (p.