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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.

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