Detailed Reflection on Wound Dressing Skills and Knowledge: A Report

This report is a reflective analysis of a nursing student's experience in wound dressing, specifically focusing on a case involving a diabetic foot ulcer. The student utilizes Gibbs' reflective cycle to critically evaluate the situation, detailing the initial description of the event, the feelings experienced, and an evaluation of the positive and negative aspects. The analysis stage explores the reasons behind the ineffective treatment, particularly the inappropriate use of hydrocolloid dressing for a wound with heavy exudates and potential infection. The report concludes with a discussion of alternative approaches, such as silver-impregnated dressings, and outlines the actions the student would take in similar situations in the future. The student's reflection emphasizes the importance of accurate wound assessment and the selection of appropriate dressings to promote effective wound healing and prevent complications.

Running head: REFLECTION ON WOUND DRESSING SKILL AND KNOWLEDGE
REFLECTION ON WOUND DRESSING SKILL AND KNOWLEDGE
Name of the student:
Name of the university:
Author note:

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REFLECTION ON WOUND DRESSING SKILL AND KNOWLEDGE
Introduction:
Every healthcare professionals working in the diabetic ward are well aware of the
occurrence of different types of foot ulcers in diabetic patients. Different types of foot ulcers are
presented by the clients that require different intensity of treatments depending upon the nature
of the wound, depth of the wound and others (Frykberg et al. 2017). Providing proper dressing
after the treatment of the wounds are an integral part of the wound management of such patients
as it initiates the time for healing procedures. Researchers have recognized that maintaining a
moist environment is indeed necessary for the maintaining the healing process. Dressings have a
huge role in maintaining the environment of the wound while at the same time, controlling the
growth of different types of microorganisms, allowing of the different gaseous exchange and for
thermally insulating the wound that allows a-traumatic removal (Game et al. 2016). Researchers
are also of the opinion that that dressings should be such that it can accommodate different
practical issues that should include allowing of the observation of the wound, providing
mechanical protection as well as conformability, cost effective dressing and others
(Yazdanpanah et al. 2015). This assignment will mainly help me to reflect on my wound
dressing skills helping me to identify the areas where I went wrong. Through effective reflection,
I developed knowledge of proper dressing that should be applied in different of the cases. Gibbs
cycle will be used for effective reflection.
Description phase:
The first stage of reflection is called the description phase where the event that took place
needs to be discussed. I was alone at the ward on that night when a patient was admitted to the
diabetic ward. She was having a deep wound on her foot that was releasing exudates and had a

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foul odor. She was suffering from pain and wanted the nurses to attend to her immediately.
Therefore, as there was no senior nurse on ward, I had to conduct the mechanical debridement
where I provided wet dressing and then pulled of the dressing resulting in damaged tosses to
come out. After that, I provided hydrocolloid dressing to keep the wound moist and asked the
patient to rest the night. Later in the early morning shift, the senior nurse arrived and was
shocked to see the condition of the wound. The dressing had been filled with exudates and
maceration of the skin had taken place. The wound had bad odor suggesting that there has been
microbial infection again. The patient complained to the senior nurse stating that she does not
want any care from me as I could not provide her relief.
Feeling phase:
The next phase is called the feeling phase where individuals need to reflect what they
were thinking and feeling. This incident affected my self-confidence and I was feeling
embarrassed about my action. Although, I was feeling very low, I was also confused at the same
time where I could not understand what went wrong in the treatment as hydrocolloid dressings
are considered the best form of dressings. I did not understand what else I could have done in the
situation and was feeling helpless. Moreover, I also felt down that me, as a nursing professional
should provide the best care that would follow non-maleficence. However, I could not provide
the best practice and in turn, my intervention caused suffering and pain to the patient. I was
broken down and could not develop courage to conduct any more activities on ward.
Evaluation phase:
The next stage is called the evaluation stage where good and bad aspects of the
experience would be reflected. The negative part of the entire incident is that inappropriate

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nature of dressing had affected the health of the patient where she had suffered massively in
pain. The healthcare centers which promise to provide the best evidence based care has failed
miserably in meeting the patients’ needs die to my inappropriate knowledge of dressing of
wounds. This had affected the fame of the healthcare center also. However, the good part of the
incident was that it helped me to release that I am not competent enough to handle wounds. I
need to develop more practical skills and evidence-based knowledge of wound dressing so that
no such incidences occur in future. Therefore, the incident helped me to understand my
incompetency and urged me to develop my skill efficiently.
Analysis stage:
The next stage is called the analysis stage where the individuals need to discuss what
sense can be made from the entire situation. After the incidence took place, I discussed the event
in details with the senior nurses and even undertook evidence based studies so that I can
understand the mistakes made by me. I came to develop the knowledge that hydrocolloid
dressings are designed in ways that makes them occlusive and helps in trapping exudates within
the dressing. This induces hydration of the wound. However, in case of this patient, heavy
exudates were coming out for which the dressing was not appropriate. It is designed to create
ways by which the wound remains moist and heavy exudates are therefore not controllable by
this dressing (Game et al. 2016). High exudation of the wounds had thereby lead to maceration
of the wounds in the patient. Moreover, researchers are of the opinion that hydrocolloid gels are
suitable for clean wounds and are intended to keep for long periods like weeks. However, the
patient’s wound were not clean but had infection for which hydrocolloid dressings are not
appropriate as they increase the risk of infection. Researchers are of the opinion that this type of

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REFLECTION ON WOUND DRESSING SKILL AND KNOWLEDGE
dressing is helpful in preventing infection but are not suitable for already infected wound (Rupert
2016).
Conclusion stage:
In the conclusion stage, the individuals should decide what else they could do for
providing the best care to the patients. I have developed knowledge that in such situation, silver
impregnated dressings would have provided the best outcome. The antimicrobial effects of the
silver are quite complex and includes direct inhibition of the different types of bacterial cell
respiration, alterations of the cell membranes and inactivation of the intracellular enzymes
(Schaper et al. 2016). Silver-coated dressings are seen to se elemental silver that provides more
effect at killing bacteria like silver sulfadiazine or silver nitrate (Bakker et al. 2016).
Therefore, I should have applied the dressing that should have prevented the
further growth of infection and would have helped the patient to develop quality
life.
Action stage:
In this stage, the individuals should decide what actions they would take if
such situation arose again. I should first observe the wound properly and try to
analyze the depth and nature of the wound. I would also provide importance to
observation of the presence of infection as that would help me to decide the type of
dressing. Depending upon these entire factors, I will decide which type of dressing

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I should apply. This would help in providing best service and safest care to
patients.
Conclusion:
With the help of reflective cycle of Gibbs, I could successfully evaluate and
analyze the event and developed new information. I could develop my skills and
knowledge in wound dressing which would help me to provide best care to patients
in future.

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References:
Bakker, K., Apelqvist, J., Lipsky, B.A., Van Netten, J.J. and Schaper, N.C., 2016. The 2015
IWGDF guidance documents on prevention and management of foot problems in diabetes:
development of an evidence‐based global consensus. Diabetes/metabolism research and
reviews, 32(S1), pp.2-6.
Frykberg, R.G., Gibbons, G.W., Walters, J.L., Wukich, D.K. and Milstein, F.C., 2017. A
prospective, multicentre, open‐label, single‐arm clinical trial for treatment of chronic complex
diabetic foot wounds with exposed tendon and/or bone: positive clinical outcomes of viable
cryopreserved human placental membrane. International wound journal, 14(3), pp.569-577.
Game, F.L., Apelqvist, J., Attinger, C., Hartemann, A., Hinchliffe, R.J., Löndahl, M., Price, P.E.
and Jeffcoate, W.J., 2016. IWGDF guidance on use of interventions to enhance the healing of
chronic ulcers of the foot in diabetes. Diabetes/metabolism research and reviews, 32(S1), pp.75-
83.
Game, F.L., Apelqvist, J., Attinger, C., Hartemann, A., Hinchliffe, R.J., Löndahl, M., Price, P.E.
and Jeffcoate, W.J., 2016. Effectiveness of interventions to enhance healing of chronic ulcers of
the foot in diabetes: a systematic review. Diabetes/metabolism research and reviews, 32(S1),
pp.154-168.
Rupert, P., 2016. Human acellular dermal wound matrix for complex diabetic wounds. Journal
of wound care, 25(Sup4), pp.S17-S21.
Schaper, N.C., Van Netten, J.J., Apelqvist, J., Lipsky, B.A. and Bakker, K., 2016. Prevention and
management of foot problems in diabetes: a Summary Guidance for Daily Practice 2015, based

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on the IWGDF Guidance Documents. Diabetes/metabolism research and reviews, 32(S1), pp.7-
15.
Yazdanpanah, L., Nasiri, M. and Adarvishi, S., 2015. Literature review on the management of
diabetic foot ulcer. World journal of diabetes, 6(1), p.37.