Wound Rounds: A nurse educator improves wound care

Nurse educator Carolyn Howe-Riddell has implemented a program that improves care and quality of life for palliative patients

Carolyn Howe-Riddell always knew she’d be a nurse. But she had no idea she’d end up in oncology, nor did she see a future for herself as an educator. But she did these things and more, eventually heading up the wound care program at Edmonton’s Cross Cancer Institute.

“I thought I’d be an ICU nurse,” Howe-Riddell says. And she worked in ICU for a little under a year, but it wasn’t a good fit for her. “I ended up coming to the Cross and I loved it.” Howe-Riddell worked at the Cross as a floor nurse before she became the inpatient educator three years ago. It was then she developed a skill and interest in wound care.

Carolyn Howe-Riddell
Photo Dustin Delfs

Despite the seriousness of cancer-related wounds, there’s a lack of research into how best to care for them.

After starting as the inpatient educator, working with staff to get their chemotherapy certification or doing orientation for new hires, Howe-Riddell became aware that she was facing a growing number of questions related to wound care with a limited foundation of knowledge. She set out to learn as much as she could. Those questions from the new hires and others were the foundation of a robust wound care education program at the Cross.

“Once she found out about wounds and wound care, she basically just took off. She was going crazy with the possibilities,” says Nadia Kloc, Howe-Riddell’s supervisor and the nurse manager of inpatients and respiratory at the Cross Cancer Institute.

“Once she came into the educator role, she decided that’s where she wanted to focus her energies.” All this in the face of an absence of funding for the initiative.

Cancer patients sometimes develop pressure ulcers, commonly known as bedsores, from long stays in hospital beds. But more problematic are malignant or fungating wounds that cancer sometimes causes when tumours break through a patient’s skin. These wounds greatly reduce the quality of life for patients, as they drain a lot of fluid, are frequently accompanied by a foul odour and can require up to three or four dressing changes per day. And despite the seriousness of these wounds, there’s a lack of research into how best to care for them.

“We would just have a cart full of supplies for wound care, and nobody would know what to put on,” says Howe-Riddell. “They would provide us with all this stuff, but we didn’t know what to do with it, so we were just slapping anything on. We’ve come a long way.”

CHANGE AGENT: Carolyn Howe-Riddell heads up the wound care program at Edmonton’s Cross Cancer Institute, working in the dual role of educator/learner.
Photo Dustin Delfs

After realizing that wounds were a growing problem for cancer patients, Howe-Riddell and an occupational therapist she works with, Amy Driga, set out to educate themselves, enrolling in relevant courses and trying to develop a wound care team to better care for patients at the Cross. With no funding, the pair took their concerns to management, then started a monthly lunch-and-learn program called wound rounds, where nurses, physicians and other staff could come for educational sessions about caring for wounds. In the past two years, they’ve also held six full-day educational sessions, with industry experts coming in to discuss best practices and new products for wound care. The educational sessions are well attended, with between 30 and 40 people to date from across disciplines coming to lunch and full-day sessions.

Along with the lack of wound care training her team is trying to address, there is also a lack of research around palliative wounds. It’s something Howe-Riddell is trying to change.

Howe-Riddell’s role goes beyond just setting up the wound rounds and full-day educational sessions. She also gives nurses hands-on lessons, teaching them to use new dressings on patients. And despite not expecting to end up in wound care, Howe-Riddell says she finds it incredibly satisfying as it provides her with more meaningful interaction with her patients than she had in the ICU. “Wound care has given me more job satisfaction than any other aspect of nursing,” she says.

She’s passionate about patient care, maximizing comfort for palliative patients by teaching nurses to use better-quality dressing that need fewer changes and allow patients more rest. It’s a quality of life issue, she says. “If these patients only have six months left to live, shouldn’t we be doing everything that we can to maximize that time?” Along with the lack of wound care training her team is trying to address, there is also a lack of research around palliative wounds. It’s something Howe-Riddell is trying to change.

According to Kloc, that dual role of educator/learner is part of what makes Howe-Riddell such an asset. “You have to have some kind of passion for education and learning, and that certainly comes into play with Carolyn,” she says. Kloc points to how animated and excited Howe-Riddell becomes when she talks about the different types of dressings and explaining how the advanced wound care products work.

Howe-Riddell’s passion has also made an enormous difference to patients, some of whom come in from the community and don’t realize that they have other options than changing dressings multiple times a day, or that there are better products available to use. With better care, nurses can control the drainage of wounds, making it possible to change dressings – an uncomfortable, often painful process – only once every other day instead of three or more times per day, and eliminate the odour emitted by malignant wounds so patients can live a more normal life. It also frees up time for nursing staff, but for Howe-Riddell, this is patient care at its most rewarding.

“If you’re working with a healable wound, it’s really nice to see that progress,” she says. “But working with our palliative patients and the wounds that are not going to heal – the amount of difference that you can make for these people is huge. You can change a portion of their life.”

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