I am a Registered Nurse and Wound and Ostomy Nurse Manager with an organization that provides an alternative to hospitalization for clients with acute care needs. For me, no 2 days are the same. On the surface, my role may seem like a standard management role. In running our Wound Department, I schedule home visits; review all consults, care, and treatment recommendations; work with other managers and assist in developing treatment plans for our patients. I work on scheduling patient visits across the state of Massachusetts for a team that includes four other wound nurses. I meet periodically with product representatives to keep abreast of new products and treatment options. I also coordinate trialing those products to determine which may best suit our patients. As the wound nurse manager, I regularly conduct audits of our program and meet with our nurses to ensure we maintain high standards of care for our patients. However, the population we work with often requires us to look at care through a different lens.

Our team works primarily with patients who have acute mental healthcare needs and are cared for in their place of residence. One of the most crucial aspects in treating a wound care patient who also suffers from a mental illness-whether it is depression, addiction, schizophrenia, or posttraumatic stress disorder-is establishing a strong and trusting relationship. Without a strong bond patients may feel like the work you're doing with them has little chance of success-or that it will actually harm them. In psychiatric care, these relationships are often the only way to develop a continuum of care. The relationships I am able to build with my patients provide me greater knowledge of their background and insight into their recovery process that other medical professionals who see them less frequently may not be privy to.

A critical step in caring for patients living with mental illness is providing them with the dignity and respect that is often left out of other aspects of their lives. By taking the time to understand their needs and goals, someone in my position can more effectively work with patients and lead them to be the driver of their own care plan. Whether I'm treating a burn, pressure ulcer, a general skin condition, or something more serious, like an ostomy, care must be provided in a holistic manner, with the patient's entire well-being put into consideration.

I once treated a woman in her 50s living with a multitude of health issues-both physical and psychiatric-who had the same wound for more than 3 years when I took on her case. When I walked into her home, she essentially asked me to leave, which is not uncommon with this population. She stated there was no way I could help her. It was clear how discouraged she had become from past experiences. However, after a long conversation with her, in which I listened to her story and concerns, I gained a better understanding of where she was coming from. I told her I was determined to figure out why her wound wouldn't heal, find the right treatment approach, and work closely with her to make sure the problem was solved. It was then that she understood I was there for her and that I would closely follow her progress and stick with her through any setbacks.

Throughout my career, I've learned how important it is that a patient feels supported and trusts you are sticking around. When care plans are built on a strong foundation, the patient is not only driving their care but is also invested in their health, greatly increasing the chance for a successful outcome. Part of this relationship includes educating a patient about their wound. Wound care patients living with mental illness often do not understand how a wound developed or why a specific product is being used in their care. By sitting down with a patient and exploring behaviors and/or lifestyle factors that have led to their health problems, the patient's mistrust of the healthcare system slowly dissipates and they can map out how to avoid detrimental choices that have led them to where they are now.

Although much of what I do is centered on education and relationship-building, we also collaborate with wound clinics, wound care clinicians, home care clinicians, visiting nurse associations, and/or hospitals. We work very hard to develop and employ a true team-based approach that includes the patient as part of that team. Through close collaboration to ensure we are all on the same page in terms of treatment, we are able to achieve much greater success in healing our patients.

Collaboration and a strong nurse-patient bond were critical when I worked with a 58-year-old male patient who suffered from diabetes and had multiple vascular leg wounds. The man had a clinical diagnosis of paranoid schizophrenic disorder and was suspicious and mistrustful of the healthcare system. As a result of his diabetes, he was in renal failure and refused dialysis. Similarly, when it came to treating his wounds, he refused the type of dressing that best fit his situation due to past experience with painful dressing changes. The patient had six open wounds on his left leg and a previous right leg amputation. Not wanting to risk his left leg, our team worked together to come up with a realistic, long-term solution. We found a dressing we knew would not be painful to change and began educating our patient on what to expect. By listening to his fears and doubts, and really hearing him out, a relationship was formed. He began to believe we were on his side and that our most important goal was achieving a positive outcome. Once the bandages were applied, his persistent pain was significantly reduced, which led to long-term compliance. The patient no longer feared a painful dressing change and his six previously persistent wounds healed in approximately 3 months. All of us on the team, including the patient, his physician, and the wound clinic, were greatly relieved that no amputation was necessary.

As a manager I work through the night and am almost always on call. My family knows that what I do is more than just a job; it's who I am. The most valuable lesson I've learned throughout my career is that wound care within complex populations, like those living with acute mental illness, is never an A-B-C-D process. Breakthroughs don't happen overnight, and often includes two steps back for every step forward. But, there is nothing more rewarding than going on this journey with my patients as they work to take control of their own care. At the end of the day, you need persistence and faith and to know that you have helped make a positive difference-no matter how big or small-in someone's life.