Use of Manuka Honey and Leg Wrapping in Wound Healing

This article discusses the effectiveness of Manuka honey and leg wrapping in wound healing. It includes a background, objectives, clinical question, search criteria, critical analysis, recommendations, and action plan.

Running head: Nursing 1
Nursing
by
Course:
Tutor:
University:
Department:
Date:

Nursing 2
Use of Manuka honey in wound healing of ulcers (Intervention)
1.0 Background
The use of honey as an intervention for the treatment of wounds have historically been used by
indigenous communities across the globe for over a thousand years. Archaeological excavations
and historical records have shown that ancient Egyptians, Romans, Greeks among others used
honey to treat wounds (Roberts, Brown, & Jenkins, 2015). However, with the emergence and
progression in the medical field, antibiotics were introduced in the 1940s causing the cessation of
honey use for treating wounds. But the current increasing trend of antibiotic-resistant bacteria in
addition to the evidence-based research on the effectiveness of honey treating wounds, there is a
re-introduction of honey in clinical medicine. There exist varieties of honey but recent evidence
has shown that some varieties have more beneficial effects than others. An example is the
Manuka honey from New Zealand and produced from the Leptospermum Scopartum shrub.
Studies have found Manuka honey to be effective in wound covering thus keeping the wound
moist and protecting it against bacterial infection due to its multiple antibacterial effects
(Johnston et al., 2018).
2.0 Objectives
Specific – effectiveness of Manuka honey in treating ulcer wound
Measurable – healing of ulcer wound
Attainable – Manuka honey has medicinal properties such as antibacterial
Realistic – availability of the researcher, time and resources
Timely – within 3 months

Nursing 3
1. To determine the clinical effectiveness of manuka honey for the treatment of ulcer wound in
three months
3.0 Clinical Question- PICO
Patient – patients with wounds
Intervention – use of Manuka honey for ulcer wound treatment
Comparison – no comparison
Outcome – fast and effective wound healing
What is the clinical effectiveness of Manuka honey in the treatment of ulcer wound?
4.0 Search Criteria
The researcher conducted limited research on potential resources including PMC and PubMed
databases and a focused internet search. The search was only restricted to articles published in
English language and over the past seven years i.e. from 2012-2019. The specific search terms
used include Manuka honey, wound treatment, wound dressing, wound healing and wound
ulcers. The researcher reviewed the citations, abstracts and titles of the relevant articles and three
articles were included in the analysis. The CASP tool was used for critical analysis. Articles
included in the review were systematic reviews and experimental research
5.0 Critical Analysis
The study by Minden-Birkenmaier and Bowlin (2018) clearly addressed the focused question by
reviewing the current relevant literature on the status of tissue engineering and honey use in
treating wounds. The review also used appropriate papers such as RCTs to address the review
question. Most of the reviewed articles were significant because the study considered in vitro and
in vivo evidence. However, only articles published in English were reviewed and the authors
haven’t revealed how they assessed the quality of the articles. The outcomes of similar studies

Nursing 4
were combined and those with different outcomes compared. The current study is beneficial in
epidemiological studies because it shows the recent technological advancement in the treatment
of wounds using Manuka honey. However, its reliability, strength and validity are relative.
Clark and Adcock (2018) also conducted a literature review to find out the evidence on wound
treatment using honey. The review question was clearly addressed because the study provides a
detailed research methodology used in the study. Moreover, the right papers were used in the
review because the PICO format was used as a selection criterion. The authors assessed the
quality of the studies by subjecting them to a standard inclusion and exclusion criteria.
Moreover, the results have been compared with previous studies. The study was beneficial
because it gave evidence on the benefit of honey in treating wounds. Therefore, the validity,
reliability and strength of the study were high.
An RCT was carried out by Tsang et al. (2017) to ascertain whether Manuka honey was more
useful in wound dressing of a diabetic foot ulcer in comparison with the usual treatment. There
was low-quality randomization during the allocation of patients to treatments and then analyzed.
The treatment was blinded and equal in the two groups and the participants were similar at the
commencement of the study
There is overwhelming evidence on the efficacy using Manuka honey in wound healing because
it fights bacteria, eliminates chronic inflammation, and fosters faster wound treatment. It is more
effective in fighting strains of resistant bacteria where conventional medicine has failed. This is
due to its contents such as MRSA that is responsible for fighting bacteria. It is also important in
most of the tissue engineering templates
6.0 Recommendations
6.1 Practice

Nursing 5
Based on the findings of the review, this study recommends the practice of using honey in
clinical practice in the treatment of different types of wounds. Manuka honey can be used for the
treatment of burns because it hastens the complete healing time of superficial thickness wounds
faster than silver sulfadiazine. Swabs caused by burns were healed within a week when honey
was used (Tsang et al., 2017). Clark et al. (2018) also showed that patients reported reduced pain
when honey was used to dress burns.
Manuka honey can also be used to treat venous leg ulcers based on the findings of Clark and
Adcock (2018). When the use of hydrogel dressing was compared with Manuka honey, it was
observed that the latter was more effective in the treatment of localized wound infection.
Manuka honey should indeed be used in clinical practice because it inhibits bacterial growth. A
diabetic foot ulcer is a common wound that affects diabetic patients and delayed treatment can
cause pain and even amputation. But research has reported the efficacious of honey use in
dressing and wound treatment.
6.2 Further research
Further study is required on the impacts of Manuka honey on immune cells to test for its effects
on neutrophil superoxide output. Moreover, there is a need for further study to determine the
adverse effects of manuka honey in the treatment of acute wounds, and to compare with the
adverse effects when conventional medicine is used
7.0 Action plan
Responsibility Strategy
Leadership Communicate – leadership who understand the
objective of the business should communicate to
the staff on what changes are being made and
why. The benefits of manuka honey should be
well communicated and compared with

Nursing 6
conventional medicine
Collaborate- the employees should be
incorporated into decision making at an early
stage
Commit – the leadership must embrace the
change in the use of manuka honey before the
staff
Communication - Different communication channels such
as internal memo etc can be used to
communicate the changes.
- Meetings can also be used to
communicate the changes
Education - There needs to be education or
awareness on the new treatment
method.
- Can be conducted inform of seminars,
training, bench marking etc.
Organization - The organization should provide the
required equipment to effect the change
- Policy amendments on the change of
wound treatment method and the
corresponding
- Engagement of adequate facilities and
staffing
Section 2 : Scenario 1
1. Area of Practice
Effectiveness of Leg Wrapping in the Healing of Venous Ulcer
2. Background
At least 1% of individuals in the developed countries experience a leg ulcer at some point in their
lives. Most of these ulcers are caused by complications in the veins, leading to blood
accumulation in the legs. Leg ulcers caused by venous complications are referred to as venous
ulcers. The cause for the frequency of ulcer wounds on the lower legs is attributed to gravity.
Compression has been perceived to be the most effective and logical intervention for ulcer
wounds because it works by countering gravity. The failure of compression therapy in most

Nursing 7
cases is not because it doesn’t work but it can be due to poor knowledge and techniques of
application. However, the recurrence of leg ulcers has been reported even after undertaking
compression intervention (Nelson, & Bell‐Syer, 2014). There is, therefore, the need for further
studies to ascertain the effectiveness of compression/leg wrapping in the healing of a venous
ulcer.
3. Objective
Specific – effectiveness of Leg Wrapping in the Healing of Venous Ulcer
Measurable – healing of Venous Ulcer
Attainable – Compression works by countering gravity
Realistic – availability of the researcher, time and resources
Timely – within 3 months
To determine the effectiveness of Leg Wrapping in the Healing of Venous Ulcer
4. Clinical Question
Patient – patients with venous ulcer
Intervention – use of compression for venous ulcer treatment
Comparison – no comparison
Outcome – fast and effective wound healing
Does the use of compression bandages or stockings aid venous ulcer healing?

Nursing 8
5. Search Criteria
The researcher conducted limited research on potential resources including Cochrane Library,
PMC and PubMed databases. The search was only restricted to articles published in English
language and over the past ten years i.e. from 2010-2019. The specific search terms used include
venous ulcer, venous wound, compression, and leg wrapping. The researcher reviewed the
citations, abstracts and titles of the relevant articles and three articles were included in the
analysis. The CASP tool was used for critical analysis. Articles included in the review were peer-
reviewed journal articles, experimental research and systematic reviews.
6. Critical Review
The study by Partsch and Mortimer (2015) does not clearly address a focused question because it
doesn’t identify the study population and the outcome except for citing the intervention.
Furthermore, it is difficult to ascertain whether the types of papers used addressed the review
question because the authors do not mention the bibliographic databases that were used.
Furthermore, the authors did not indicate any process undertaken to assess the quality of the
studies included in the review. The outcomes of the review have been presented under subtopics
and clearly displayed and reasons for variations clearly presented. The overall validity and
reliability of this paper are low, though it's informative regarding the compression of venous
ulcer.
Nelson and Bell‐Syer (2014) conducted a systematic review on the use of compression
intervention in the prevention of reappearance of venous ulcers. The review addressed a clearly
focused question because there is evidence of population studied, intervention and the potential
outcomes. The authors searched for the appropriate papers because they addressed the review
question. all significant studies were included in the study because there is a search criterion and

Nursing 9
the inclusion and exclusion criteria and a list of all electronic databases used. Furthermore, only
RCTs were included in the review. The authors also assessed the quality of the included studies
using the inclusion criteria and Cochrane checklist. The outcome of the study has also been
combined and presented under different subtopics based on the research question. Overall, the
validity and reliability of the article are high.
Zarchi and Jemec (2014) conducted experimental research to determine whether compression is
effectively utilized by homecare nurses in the treatment of venous ulcers. The research question
was focused because it indicated the population, intervention and the potential outcomes. The
population was recruited in an appropriate way using inclusion and exclusion criteria. The
exposure was accurately measured evidenced by the use of objective measure etc. The quality of
the study was high.
7. Recommendations
Recommendations for Practice
Based on the above literature review, this paper makes various recommendations for practice to
ensure the success of the intervention. The pressure is in the hands and not in the material used
for compression. It is important the pulse rate is felt before applying strong bandages. Ankle
blood pressure can also be measured using pocket doppler if there is uncertainty in determining
the pulse rate. During application, the patient should ensure that the toes are fully stretched
towards the nose but over-padding should be avoided completely. The stretch should carefully be
adjusted to the curvature especially in slim legs but the stretch should be strong in fat legs. At the
completion of the compression intervention, the patient should be allowed to walk and to report
back if any pain is experienced. The loose bandage should be replaced or when there are ulcer
penetrations two times per week or once after decongestion.

Nursing 10
Double stockings can also be used and should stay on the leg overnight, however, the basal
stocking should be applied during the day. But still, vector-band devices can still be used
especially when the patient is unable to put on and remove the stockings
Recommendations for Further Research
Future trials should be carried out to incorporate clinical trials unit to offer the maximum
infrastructure for trial design and analysis. Recommendations outlined in the CONSORT
checklist should optimally be used in reporting and the assessments should offer adequate details
on the interventions used.
8. Action Plan
Responsibility Strategy
Leadership The effectiveness and procedure of
compression should be well communicated
and compared with conventional medicine
Collaborate- the patients should be
incorporated into decision making at an early
stage
Commit – the leadership must embrace the
change in the use of compression in venous
ulcer healing
Communication - Different communication channels
such as internal memo etc can be used
to communicate the changes.
- Meetings can also be used to
communicate the changes
Education - Awareness on compression, types of
textiles, and guidelines.
- Can be conducted inform of seminars,
training, bench marking etc.
Organization - The organization should provide the
required equipment to effect the
change
- Policy amendments on the change of
wound treatment method and the
corresponding
- Engagement of adequate facilities and

Nursing 11
staffing

Nursing 12
References
Clark, M., & Adcock, L. (2018). Honey for Wound Management: A Review of Clinical
Effectiveness and Guidelines
Johnston, M., McBride, M., Dahiya, D., Owusu-Apenten, R., & Nigam, P. S. (2018).
Antibacterial activity of Manuka honey and its components: An overview. AIMS
microbiology, 4(4), 655–664. doi:10.3934/microbiol.2018.4.655
Jull, A. B., Cullum, N., Dumville, J. C., Westby, M. J., Deshpande, S., & Walker, N. (2015).
Honey as a topical treatment for wounds. Cochrane Database of Systematic Reviews, (3).
Minden-Birkenmaier, B. A., & Bowlin, G. L. (2018). Honey-Based Templates in Wound
Healing and Tissue Engineering. Bioengineering (Basel, Switzerland), 5(2), 46.
doi:10.3390/bioengineering5020046
Nelson, E. A., & Bell‐Syer, S. E. (2014). Compression for preventing recurrence of venous
ulcers. Cochrane Database of Systematic Reviews, (9).
Roberts, A. E. L., Brown, H. L., & Jenkins, R. (2015). On the antibacterial effects of manuka
honey: mechanistic insights.
Partsch, H., & Mortimer, P. (2015). Compression for leg wounds. British Journal of
Dermatology, 173(2), 359-369.
Tsang, K. K., Kwong, E. W. Y., To, T. S. S., Chung, J. W. Y., & Wong, T. K. S. (2017). A pilot

Nursing 13
randomized, controlled study of nanocrystalline silver, manuka honey, and conventional
dressing in healing diabetic foot ulcer. Evidence-Based Complementary and Alternative
Medicine, 2017.
Zarchi, K., & Jemec, G. B. (2014). Delivery of compression therapy for venous leg ulcers. JAMA
dermatology, 150(7), 730-736.