Editorial: Good wound care: What is it?

Advances in Skin & Wound Care,  Sep/Oct 2000  by Salcido, Richard

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Nearly every article, clinical practice guideline, and lecture on the subject of wound care discusses the major attributes of wound care. For the most part, these are principles and practices that are thought to achieve positive outcomes. One of the most commonly cited attributes of wound care is good wound care.

What is good wound care? As wound care practitioners, how do we recognize it? Do we know it when we see it? Is good wound care qualitative? Or can it be quantified?

Recently I did a search on the Web, MEDLINE, and the National Library of Medicine using terms and key words that included good and wound care. I found numerous abstracts and articles that contain good wound care as part of a general recommendation to practitioners, usually in the conclusion of the document. Good wound care also appears in the methodology section of many clinical research papers, usually without adequate definition or clarification.

Qualitative or Quantitative

The term good wound care is qualitative and, therefore, subjective in nature. To my knowledge, no standard metrics exist that differentiate the degrees of goodness of wound care. As practitioners and researchers, we are then obligated to clarify the issue based on this premise. The task is how to convert this largely subjective term to a method that will allow us to measure good wound care.

When we think of measuring something, we usually look for a tool that meets commonly accepted characteristics of measurement. The penultimate goal in scientific measurement is to gain accurate, precise information that is reproducible, valid, and generalizable to the clinical environment.

From a methodologic point of view, the term good wound care is classified as a nominal measurement. A nominal measurement or nominal scale is described as an ordered naming process accounting for specific attributes. This could include, for example, certain wound characteristics or perhaps a scale to measure goodness of care. Thus, we can conceptualize good wound care as a nominal phenomena (qualitative), meaning soft data, descriptive, or impressions that are subjective in nature.

Adding Order

Nominal scales cannot be measured with statistics. We can, however, compliment nominal data or a list of attributes with an ordinal scale. Ordinal scales, as the name implies, are related by order-for example, (1) good wound care, (2) better wound care, or (3) best wound care. Ordinal scales imply ordering of numbers. An example of this used in clinical practice is the visual analog scale for pain. Pain is real but subjective in nature; it is what the patient tells you it is. The qualities of pain have been described as sharp, stabbing, lancinating, dull, or aching. Clinicians have attempted to quantify these subjective phenomena by using the visual analog scale.

To operationalize this concept for wound care, we could construct a hypothetical scale entitled Scale of Good Wound Care. On one end of the spectrum could be good wound care and at the other end of the scale could be best wound care. To refine this concept, we could also add numbers to measure the degree of goodness of care, giving it a score. The addition of numerical values would attempt to quantify the degree of goodness of wound care. We can compliment or improve the likelihood of quantification if we also use ordinal data.

Measuring Good Wound Care Now

Until we have a scientific method to define and measure good wound care, we must rely on traditional methods. Wound care professionals and the quality of wound care they deliver can be measured by qualitative methods currently used in the field. Professional organizations and certifying bodies are charged with the responsibility of evaluating cognitive and professional competencies for wound care providers, ensuring these professionals achieve minimal standards and, thus, have the professional qualifications to provide wound care. Other methods of measuring good wound care include the accepted standards of care documented in the literature and the use of clinical practice guidelines that have been peer-reviewed.

Ultimately, good wound care is measured by the best possible outcome for the patient-a set of positive circumstances that produce the desired outcome.

Richard Sal" Salcido, MD, is the Editor-in-Chief of Advances in Skin & Wound Care. He is Professor and Chairman, Department of Rehabilitation Medicine, at the University of Pennsylvania Health System, Philadelphia, PA.

Copyright Springhouse Corporation Sep/Oct 2000
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