Abstract
The management of problem wounds by critical care nurses is a particular challenge in that their primary responsibilities revolve around emergent care and resuscitation of patients. However, with the identification of pressure wound development as a "never event" by Centers for Medicare & Medicaid Services and the escalating costs to more than $5 billion annually for treating chronic wounds in the US population, wound management has become a clinical imperative. The essence of nursing as a healing, caring profession should drive our efforts at reducing and/or eliminating any untoward complication that threatens the very being of our patients. Problem wounds represent such a challenge. This article examines wound management from both the science and art of nursing care. The science comprises advanced wound therapies including hyperbaric oxygen therapy, recombinant DNA growth factor therapy, human skin equivalents, V.A.C. Therapy, advanced support surfaces, and state-of-the-art dressings. The art of wound management resides in the development of a comprehensive wound center with both outpatient and inpatient capabilities including a hospital-based wound team of nursing specialists. The challenge of healing problem wounds requires a multidisciplinary approach, a dedication to measurable outcomes, and a passion for holistic, patient-centered interventions.