Wound care, a form of palliative care, supports the health care needs of dying patients by focusing on alleviating symptoms. Although wound care can be both healing and palliative, it can impair the quality of the end of life for the dying if it is done without proper consideration of the patient’s wishes and best interests. Wound care may be optional for dying patients. This article will discuss the ethical responsibilities and challenges of providing wound care for surgical wounds, pressure ulcers, and wounds associated with cancer as well as wound care in home health compared to end of life.
Bale, S., Finlay, I., & Harding, K. G. (1995). Pressure sore prevention in a hospice. Journal of Wound Care, 4, 465-468.
2.
Beauchamp, T. L., & Childress, J. F. (1994). Principles of biomedical ethics (4th ed.). New York: Oxford University Press.
3.
Berry, D. E., Boughton, L., & McNamee, F. (1994). Patient and physician characteristics affecting the choice of home based hospice, acute care inpatient hospice facility, or hospitals as last site of care for patients with cancer of the lung. Hospice Journal, 9, 21-38.
4.
Bradley, E. H., Fried, T. R., Kasl, S. V., Cicchetti, D. V., Johnson-Hurzeler, R., & Horwitz, S. M. (2000). Referral of terminally ill patients for hospice: Frequency and correlates. Journal of Palliative Care, 16(4), 20-26.
5.
Brown, G. (2003). Long-term outcomes of full-thickness pressure ulcers: Healing and mortality. Ostomy/Wound Management, 49(10), 42-50.
6.
Cella, D. F. (1994). Quality of life: Concept and definition. Journal of Pain and Symptom Management, 9, 186-192.
7.
Chochinov, H. M. (2002). Dignity-conserving care—a new model for palliative care: Helping the patient feel valued. Journal of the American Medical Association, 287(17), 2253-2260.
8.
Cleeland, C. S., Gonin, R., Hatfield, A. K., Edmonson, J. H., Blum, R. H., Stewart, J. A., et al. (1994). Pain and its treatment in patients with metastatic cancer. New England Journal of Medicine, 330, 592-596.
9.
Colburn, L. (1987). Pressure ulcer prevention for the hospice patient. American Journal of Hospice Care, 4(2), 22-26.
10.
Collier, M. (1997). The holistic management of fungating wounds. Nursing Notes, 14, 2-5.
11.
Community Clinical Oncology Program (CCOP). (2004). Protocols and credit assignments—Community Clinical Oncology Program.Retrieved April 26, 2004, from www3.cancer.gov/prevention/ccop/approved_protocols.html
12.
DeConno, F., Ventafridda, V., & Saita, L. (1991). Skin problems in advanced and terminal cancer patients. Journal of Pain and Symptom Management, 6, 247-256.
13.
Dirkson, S. R. (1995). Search for meaning in long-term cancer survivors. Journal of Advanced Nursing, 21(4), 628-634.
14.
Eisenberger, A., & Zeleznik, J. (2003). Pressure ulcer prevention and treatment in hospices: A qualitative analysis. Journal of Palliative Care, 19(1), 9-14.
15.
Emanuel, E. J., Fairclough, D. L., Slutsman, J., & Emanuel, L. L. (2000). Understanding economic and other burdens of terminal illness: The experiences of patients and their care givers. Annals of Internal Medicine, 132, 451-459.
16.
Epstein, J. B., & Schubert, M. M. (2004). Managing pain in mucositis. Seminars in Oncology Nursing, 20, 30-37.
17.
Grey A. (1994). The spiritual component of palliative care. Palliative Medicine, 8, 215-221.
18.
Hadley, J. S., & Hinds, C. J. (2002). Anabolic strategies in critical illness. Current Opinion in Pharmacology, 2, 700-707.
19.
Hampton, S. (1998). Film subjects win the day. Nursing Times, 94(24), 80-82.
20.
Hanson, L. C., Danis, M., Garret, L. M., & Mutran, E. (1996). Who decides? Physician’s willingness to use life-sustaining treatment. Archives of Internal Medicine, 156, 785-789.
21.
Institute of Medicine (IOM). (1997). Approaching death: Improving care at the end of life. Washington, DC: National Academy Press.
22.
Lynn, J. (1996). Caring for those who die in old age. In H. M. Spiro, M. G. M. Curnen, & L. P. Wandel (Eds.), Facing Death (pp. 90-102). New Haven, CT: Yale University Press.
23.
MacDonald, D. (1989). Non-admissions: The other side of the hospice story. American Journal of Hospice Care, 6(2), 17-19, 40-42.
24.
Mallett, J., Mulholland, J., Laverty, D., Fuller, F., Baxter, A., Faithfull, S., et al. (1999). An integrated approach to wound management. International Journal of Palliative Care Nursing, 5(3), 124-132.
25.
National Institute of Nursing Research. (2002). Long-term care recipients: Quality of life and quality of care research (PA-02-162). Retrieved November 9, 2004, from http://grants.nih.gov/grants/guide/pa-files/PA-02-162.html
26.
National Institutes of Health. (2004). Pathogenesis and treatment of lymphedema and lymphatic diseases (PA-04-071). Retrieved November 9, 2004, from http://grants.nih.gov/grants/guide/pa-files/PA-04-071.html
27.
Naylor, W. (2001). Assessment and management of pain in fungating wounds. British Journal of Nursing, 10(22), 33-52.
28.
Peerless, J. R., Davies, A., Klein, D., & Yu, D. (1999). Skin complications in the intensive care unit. Clinical Chest Medicine, 20(2), 453-467.
29.
Rhymes, J. (1990). Hospice care in America. Journal of the American Medical Association, 264(3), 369-372.
30.
Rockson, S. G., Miller, L. T., Senie, R., Brennan, M. J., Casley-Smith, J. R., Foldi, E., et al. (1998). Workgroup III: Diagnosis and management of lymphedema. Cancer, 83(Suppl.), 2882.
31.
Storey P. (1990). Goals of hospice care. Cancer Update, 86(2), 50-54.
32.
Stromgren, A. S., Groenvold, M., Pedersen, L., Olsen, A. K., Spile, M., & Sjogren, P. (2001). Does the medical record cover the symptoms experienced by cancer patients receiving palliative care? A comparison of the medical record and patient self-rating. Journal of Pain and Symptom Management, 21, 189-196.
33.
SUPPORT Principal Investigators. (1995). A controlled trial to improve care for seriously ill hospitalized patients. Journal of the American Medical Association, 274, 1591-1598.
34.
Sweeney, M., & Bragg, J. (1995). Oral care for hospice patients with advanced cancer. Dent Update, 22, 424-427.
35.
Teno, J., Lynn, J., Connors, A. F., Wenger, N., Phillips, R. S., Alzola, C., et al. (1997). The illusion of end-of-life resources savings with advance directives. SUPPORT Investigators. Study to understand prognoses and preferences for outcomes and risks of treatment. Journal of the American Geriatric Society, 45, 513-518.
36.
von Gunten, C. F., Ferris, F. D., & Emanuel, L. L. (2000). The patient-physician relationship. Ensuring competency in end-of-life care: Communication and relational skills. Journal of the American Medical Association, 284(17), 3051-3057.
37.
Waller, A., & Caroline, N. (2000). Handbook of palliative care in cancer (2nd ed.). Boston: Butterworth Heinemann.
38.
Weissman, D. (2000). Fast fact and concept #03: Syndrome of imminent death. Milwaukee, WI: End-of-Life Physician Education Resource Center.
39.
Wilkinson, A. M., Harrold, J. K., Kopits, I., & Ayers, E. (1998). Endeavors and innovative programs in end of life care. Hospice Journal, 13, 165-180.
40.
Williams, D. T., & Harding, K. (2003). Healing responses of skin and muscle in critical illness. Critical Care Medicine, 31(8), S547-S557.
41.
World Health Organization. (1989). Handbook on palliative care. Geneva, Switzerland: Author.
