Activities of Daily Living (ADL)
Here are some things to consider when assessing shared care and activities of daily living.*
Sleeping
Objective:
- Optimising ability to heal.
- Psychosocial Support.
Considerations for shared care:
- Ensure the patient is happy to share the care, sleep is an important part of a patients wellbeing.
- Are they able to get into bed or sleeping in a chair?
Red Flags:
- If the patient is unsure or anxious about sharing the care.
- Pain on climbing stairs, wound leaking too much will soil bedding, wound too odorous to share bed with partner.
How to overcome those Red Flags:
- Spend some time educating and discussing concerns, it may be that shared care is an option later and not right now.
- Review analgesia, OT referral to assess equipment, appropriate absorbent dressing and timely dressing changes.
- Odour absorbing dressings (is it due to infection)
Breathing
Objective
- Optimising ability to heal.
- Risk factor performing shared care task.
Considerations for shared care:
- Will the task affect their breathing?
- Is there something we can ask them to do that will optimise their respiratory function to increase oxygenation for wound healing?
Red flags
- Lower limb wounds where patients are sleeping in chairs.
- COAD can have a negative effect on healing.
- Consider a patient’s mobility if concerns regarding breathing.
How to overcome those Red Flags:
- Education about the importance of going to bed at night.
- Referral or discussion with respiratory specialist team to support and help optimise.
Mobilising
Objective
- Risk factor performing shared care task.
- Optimising ability to heal.
Considerations for shared care:
- Is the patient independent with his/her mobility?
- Mobilisation for patients with a lower limb wound can support the circulatory system and improve the ability to heal. Patients unable to mobilise can perform simple foot and ankle exercises to help.
Red flags
- Will performing shared care put them at risk of a fall?
How to overcome those Red Flags:
- Patients unable to mobilise or at increased risk of falls can perform simple foot and ankle exercises to help the circulation.
- Consider a carer / family member to perform task if falls are a risk.
Communicating
Objective
- Risk factor performing shared care task.
- Psychosocial Support.
Considerations for shared care:
- Can the patient communicate their needs, understand instructions? And will they be able to obtain help when required?
Red flags
- Patient with speech impairment or cognitive impairment that could result in problems not being highlighted.
How to overcome those Red Flags:
- What support network does the patient have?
- Is there a family member or carer who may be willing to take on this responsibility?
Eating & Drinking
Objective
- Optimising ability to heal.
Considerations for shared care:
- Consider the patient’s diet and their hydration, is there any changes your patient can make?
- Does your patient drink enough?
- Consider if the wound is having an impact on appetite or ability to eat.
Red flags
- The risk of putting extra stress on your patient from a financial perspective, increase in food shopping bills, ability to prepare and cook the new diet.
- If the patient drinks more, have they got the ability to get to the toilet?
How to overcome those Red Flags:
- Consider a referral to a dietician.
- Are there any supplements that could be prescribed to support a clinical outcome of wound healing?
- Consider the location of the toilet, can things be moved to make getting to the toilet easier? Or would a commode or urinary device be more suitable / safer for the patient?
Expressing Sexuality
Objective
- Psychosocial Support.
Considerations for shared care:
- Consider the type of dressing / bandaging, is it in line with the patient’s needs?
- Where is the wound and is it having any effects on intimacy?
- The effect the wound may have on body image and relationships.
Red flags
- Does the patient prefer the dressing to be well hidden? Does the dressing impede intimacy and affect their relationships?
- Leaking wound, odour, needing to rely more on partner for help with personal hygiene or wound care.
How to overcome those Red Flags:
- Has the patient discussed their wound with partner / family? With support, could this help to make wound / dressing more acceptable?
- Discuss patient’s concerns and address or seek advice and counselling.
Working & Playing
Objective
- Optimising ability to heal.
- Risk factor performing shared care task.
- Psychosocial Support.
Considerations for shared care:
- Does the dressing impede work or play?
- Clinic appointments means potentially taking time off work, maybe relying on someone to take them.
- Is the wound stopping them swimming or going to the gym or attending their usual clubs?
Red flags
- Does the wound prevent working and social interaction?
How to overcome those Red Flags:
- Can a discussion with work take place to discuss the wound and an area be provided for dressing changes?
- Discuss what social activities can be achieved whilst the wound heals
Controlling Body Temperature
Objective
- Optimising ability to heal.
Considerations for shared care:
- Does excess moisture effect adherence of dressing?
Red flags
- Dressing is difficult to adhere to skin due to excess moisture.
How to overcome those Red Flags:
- Can underlying issue be treated or can products be used to dry area prior to application or to assist adherence?
- Education for the patient on how to achieve a good seal with the dressing selection chosen.
Personal Cleansing & Dressing
Objective
- Optimising ability to heal.
- Psychosocial Support.
Considerations for shared care:
- Can your patient take on the responsibility to wash the affected area e.g. lower limb prior to dressing changes?
Red flags
- If the patient is unable to reach affected area, it may create a risk of falls.
How to overcome those Red Flags:
- Is there a carer or family member that could support?
Maintaining a safe environment
Objective
- Risk factor performing shared care task.
Considerations for shared care:
- Do their home surroundings enable them to complete clean and safe dressing changes?
- Are they physically able to perform the task safely?
Red flags
- Is the dressing going to increase risk of falls or be a trip hazard?
How to overcome those Red Flags:
- Is there an alternative type product that could be used that will improve the patient’s independence.
Eliminating
Objective
- Risk factor performing shared care task.
- Psychosocial Support.
Considerations for shared care:
- Does incontinence effect application of dressing product?
- Ability to apply dressing due to reach and position?
- Is the patient taking regular analgesia?
Red flags
- Patient may not feel comfortable asking family / carer to support.
- Embarrassment in relation to incontinence.
- Will the analgesia cause the risk of constipation?
How to overcome those Red Flags:
- Talk to the patient about the challenges being faced, offer support and solutions.
- Offer support in relation to incontinence understand the issues and align any care plans so it incorporates elimination.
- Could a carer be involved?
- Ensure the patient has the most appropriate analgesia and bowel management regime.
Dying
Objective
- Optimising ability to heal.
- Psychosocial Support.
Considerations for shared care:
- Does patient have known mental health problems that may put them at risk from performing shared care?
- Does the patient understand their diagnosis in relation to there wound?
- Is the patient concerned about dying or is the wound management palliative?
Red flags
- Could the dressing be used to cause harm?
- Patient may be frightened and not fully understanding of their condition
How to overcome those Red Flags:
- Is there an alternative dressing that reduces the risk?
- Consider referral to other service providers for support e.g. mental health teams.
- Ensure clear communication is achieved, so that the patient can freely ask questions and feel comfortable about any concerns or worries they may have.