Evaluating And Adapting An Integrated Wound-care Service To Local Population Needs: A Mixed Methods Review
Jennifer Mackey – Mid Yorkshire Teaching NHS Trust
Aim
The author is a specialist wound care practitioner working across both primary and secondary care settings, having qualified in 2007. Their clinical background includes experience in spinal injuries and district nursing, providing a broad foundation for managing complex patient needs. The author is part of an Integrated Tissue Viability Specialist Team compromising of nine clinicians ranging from Band 6 to Band 8a, delivering services across three hospital sites: Pontefract, Dewsbury and Pinderfields as well as the surrounding community.
The local population presents a diverse demographic profile, with 44.8% of residents identifying as Christian, 37.3% reporting no religious affiliation, and 11.5% identifying as Muslim. The author recognises the importance of understanding these demographic factors, as they can influence health beliefs, patient engagement, and approaches to care delivery.
Socioeconomic challenges also significantly impact the area, particularly high levels of unemployment, with approximately 70,025 residents currently out of work. This context can contribute to health inequalities, delayed presentation, and challenges in treatment adherence.
Method
The clinician sought to obtain valid data from service users regarding the wound care services they had received. Data collection was conducted using Microsoft Forms (Fig. 2), which included the following questions: the type of wound, the number of dressing changes required per week, whether the wound affected the patient’s activities of daily living, and the patient’s overall experience of the wound care service.
The collected data were subsequently collated and analysed using Microsoft Excel. The questionnaire was intentionally kept concise, and the terminology was simplified to ensure clarity and ease of understanding for all participants. In addition, the author aimed to track the journeys of three patients in greater detail, including photographic documentation. To maintain patient confidentiality and anonymity, these individuals were referred to as Patient 1, Patient 2, and Patient 3.
Fig. 2
Results
Patient 1: Right Knee Dehisced Surgical Wound The patient presented with four separate wounds to the right knee, all with a sloughy base resulting from surgical wound dehiscence. During recovery, the patient experienced significant psychosocial stress, as they were not receiving wages while off work and were at risk of job loss if unable to return promptly. This financial and occupational uncertainty contributed to increased psychological pressure and social withdrawal, with the patient reporting reluctance to leave the house, negatively impacting their mental health. A multidisciplinary approach was implemented, involving the community nursing team. Sharp debridement was carried out, which the author supports when performed appropriately and within clinical guidelines. Wound management included a variety of dressings, such as medical-grade Manuka honey, to promote healing. Complete wound resolution was achieved over a four-month period.
6/3/25. Referral from orthopaedics regarding dehisced surgical wound right knee
16/4/25. Wound improving. Continue with Negative Pressure Wound Therapy (NPWT) applied reduce to weekly
16/4/25. Continue with TNP as wound improving
Patient 2: Debridement of Left Perianal Gangrenous Tissue The patient was referred to the Tissue Viability team for management of a surgical wound affecting the perineum and left buttock, following debridement of gangrenous tissue. NPWT was initially applied to support wound healing. Ongoing management included the use of medical-grade honey dressings in combination with secondary superabsorbent dressings, alongside other appropriate wound care products. Exudate levels were high, presenting a significant management challenge. To address this, superabsorbent dressings were utilised to effectively control moisture and protect the surrounding skin. Due to mobility limitations associated with the wound, the patient temporarily relocated to a downstairs living arrangement .Episodes of bleeding from the wound led the author to proceed with cauterisation. This intervention demonstrated some benefit, particularly following the second application, contributing to improved wound stability. Over time, the wound progressed and plastics was requested but declined by the patient. A personal goal for the patient was to go to his caravan however before the wound could heal, sadly he received a new cancer diagnosis and is now palliative and receiving support from relevant healthcare professionals.
9/11/24. Debridement of left perianal gangrenous tissue and lower half of both scrotum NPWT applied
24/12/24 (Image taken from rehab unit)
26/1/25. Medical grade honey applied primary with a super absorber as a secondary dressing
18/7/25. Wound continued to improve
Patient 3: (Left above knee amputation site) Patients main issue was pain.
Left above knee amputee, The patient is an ex-smoker, has type two diabetes and was assessed as being overweight. Patient went from a below knee amputation (BKA) to an above knee amputation (ABA) and suffered with high levels of pain. The author devised a plan to instigate Oramorph pain relief prior to the dressing change to reduce pain felt during dressing changes. The maximum depth of the wound was 2-3 cm deep. 70% slough and 30% granulation was present on assessment by the tissue viability team. After the application of medical grade honey and super absorbent dressings the odour reduced. The dressing regime supported the reduction of pain and 90% of the sloughy tissue present had been removed.
Full dehisced surgical wound to left stump. Surgical history 30.10.24 revision of left BKA to AKA with dehiscence afterwards
Wound had a depth of 2cm, medical grade honey applied
Tissue viability team utilised Sharpe debridement
Wound healed
Results From Questionnaire
Discussion
Wound care management is inherently complex, requiring clinicians to address not only physiological healing but also the psychological, social, and economic factors that influence outcomes. This case study highlights how patient demographics, including religion and unemployment, play a significant role in shaping care needs, health beliefs, and engagement with treatment. Understanding these factors can support more effective patient education and promote improved adherence to care plans.
The author’s role as a Tissue Viability Nurse within a multidisciplinary team enabled a holistic approach to patient care, integrating clinical expertise with an awareness of wider influencing factors. questionnaire findings indicated that wounds had a considerable impact on patients’ activities of daily living, reinforcing the importance of addressing not only wound healing but also overall quality of life.
Across all three patients, individualised care planning was essential. Patient 1 demonstrated how psychosocial factors, including financial stress linked to unemployment and social isolation, can negatively impact recovery. Consideration of personal beliefs, including religious perspectives, may also influence how patients perceive illness and treatment. Clinical interventions such as sharp debridement and appropriate dressings, including medical grade honey, supported wound healing, while highlighting the importance of incorporating holistic support alongside physical care.
Patient 2 presented with a highly complex wound characterised by excessive exudate and bleeding. Effective exudate management through superabsorbent dressings and the use of topical negative pressure therapy were key interventions. The decision to use cauterisation further demonstrates the importance of clinical judgement in managing complications. This case also illustrates how reduced mobility can significantly affect a patient’s living situation and independence., impacting not only the patient but their wider support network
Patient 3’s experience underscores the importance of pain management in wound care. The introduction of Oramorph prior to dressing changes improved patient tolerance and engagement with treatment. Additionally, the use of appropriate dressings, including medical grade honey, contributed to reduced slough and odour, promoting a more favourable healing environment. Consideration of individual beliefs and personal circumstances, including religious practices, may also support improved communication and patient centred care.
The data collection process using Microsoft Forms and Excel provided valuable insights into patient experiences and treatment effectiveness. Keeping the questionnaire simple ensured accessibility and encouraged participation, supporting the collection of meaningful patient-reported outcomes. However, expanding the survey to a larger patient group would enhance the reliability and depth of findings.
Overall, these cases demonstrate that successful wound management requires a patient centred, multidisciplinary approach that integrates clinical expertise with an understanding of psychosocial, cultural, and socioeconomic influences, including religion and unemployment. Tailored interventions, effective communication, and ongoing evaluation are essential to optimise healing and support patients in returning to their normal activities of daily living.
Conclusion
This case study demonstrates that effective wound care extends beyond clinical intervention alone, requiring a holistic, patient centred approach. Across the three cases, positive outcomes were achieved by the author through the integration of evidence based treatments such as debridement, NPWT, medical grade honey, other dressing selection, and effective pain management within a multidisciplinary framework.
However, the cases also highlight the significant impact of psychosocial and socioeconomic factors on healing, including pain, mobility limitations, financial stress, and reduced quality of life. Addressing these alongside physical wound care was essential in supporting recovery and promoting engagement with treatment.
Overall, the findings reinforce the importance of individualised care planning, strong multidisciplinary collaboration, and the inclusion of patient reported experiences in evaluating service effectiveness. By adopting this comprehensive approach, clinicians can optimise healing outcomes and better support patients in returning to their normal activities of daily living.