THE USE OF WET-TO-DRY DRESSINGS By LINDA JOYCE COWAN A THESIS PRESENTED TO THE GRADUATE SCHOOL OF THE UNIVERSITY OF FLORIDA IN PARTIAL FULFILLMENT OF THE REQUIREMENTS FOR THE DEGREE OF MASTER OF SCIENCE IN NURSING UNIVERSITY OF FLORIDA 2004 Copyright 2004 by Linda Joyce Cowan ACKNOWLEDGMENTS Many thanks go to my husband Bill for many dinners out and dinners at home with the one dish he knows how to cook (spaghetti). Many thanks go to my son Josh, who said he did not mind me starting back to college the same year he started college (as long as I was not in any of his classes). Many thanks go to my daughter Debbie for helping me study, reading words that she didn’t know how to pronounce, much less what they meant (most of which she said she’d rather not know what they meant). Many thanks go to my parents, sister, extended family and church family for their prayers, support and constant encouragement of my going back to school after 20 years. Many thanks go to my friends Ruthie Jo, Elaine, Pricilla, Katherine, Kathy, Shari, Marion, Liz, Karen, Seleeta, Sylvia, Bonnie, Cindy, Veta, Judy, Candice, Bev, and Tara, who never seemed to doubt me, even when I doubted myself. Special thanks go to my thesis advisor, Dr. Joyce Stechmiller, who was an endless source of wisdom, encouragement, mentoring, advice and guidance. She has opened so many opportunities outside of the classroom to learn an enormous amount about research and helped me to grow a real enthusiasm and love for research. She has also been one of my biggest cheerleaders. I have been very blessed by each member of my advisory committee and have been fortunate indeed to have such wonderful researchers on my thesis committee. I would like to sincerely thank Dr. Susan Schaffer, who is one of the most meticulous editors I have ever met. She has been very encouraging to me and was the first to spark my interest into iii the possibilities of continuing with the Ph.D. program. I would also earnestly like to thank Dr. Meredith Rowe, who was the best and most valuable research professor I ever had. She made research methods come alive and made me realize that I really could do research that may make a difference in clinical practice. Each of their contributions to my thesis supervisory committee has been beyond measure. I could not end my acknowledgments without recognizing that ultimately it has been by the grace of God that I have successfully completed my studies. I most gratefully submit my thanks and praise to Him alone for any good that comes out of my life. May I keep my main goals in life as my motivation for all that I do (to serve God by helping my fellow man, and to please and honor my Savior, Jesus Christ, by utilizing the gifts He has given me to the fullest extent possible). May I always trust that through His strength and help, I can do more than I think I can. iv TABLE OF CONTENTS page ACKNOWLEDGMENTS ................................................................................................. iii LIST OF TABLES............................................................................................................ vii LIST OF FIGURES ......................................................................................................... viii ABSTRACT....................................................................................................................... ix CHAPTER 1 INTRODUCTION ........................................................................................................1 Statement of the Problem..............................................................................................1 Scope of the Problem....................................................................................................5 Purpose of the Study.....................................................................................................8 Research Questions.......................................................................................................8 Significance of the Study to Nursing............................................................................8 Description of Terms ..................................................................................................10 2 REVIEW OF THE LITERATURE ............................................................................11 A History of Wound Care...........................................................................................11 Moist Wound Healing.................................................................................................16 Wet-to-Dry dressings..................................................................................................17 The Physiology of Wound Healing ............................................................................19 Wound Healing Considerations..................................................................................22 3 METHODOLOGY .....................................................................................................27 Purpose .......................................................................................................................27 Setting and Sample .....................................................................................................27 Design of Study ..........................................................................................................27 4 RESULTS...................................................................................................................32 Sample Characteristics................................................................................................33 Research Questions.....................................................................................................34 What Is the Incidence of Wet-to-Dry Dressings?.................................................34 v What Types of Wounds Are Wet-to-Dry Dressings Being Used for? ................36 What Specialties of Health Care Providers Are Most Frequently Ordering Wet-to-Dry Dressings? ....................................................................................38 When Wet-to-Dry Dressings Are Being Ordered, Do Clinical Data Suggest the Need for Mechanical Debridement? ..........................................................39 5 DISCUSSION AND CONCLUSIONS......................................................................41 Discussion of Findings ...............................................................................................41 Data Review................................................................................................................41 Dry Gauze...................................................................................................................42 Surgical Wounds.........................................................................................................43 Cytotoxic Solutions ....................................................................................................44 Mechanical Debridement............................................................................................45 Limitations of the Study.............................................................................................46 Conclusions.................................................................................................................47 Implications for Future Research................................................................................49 Implications for Practice and Education.....................................................................50 Summary.....................................................................................................................53 LIST OF REFERENCES...................................................................................................54 BIOGRAPHICAL SKETCH .............................................................................................63 vi LIST OF TABLES Table page 4-1 Sample Characteristics and Wound Characteristics.................................................33 4-2 Types of Dressings and Amounts of Granulation Tissue ........................................34 4-3 Amounts of Granulating Tissue Noted in the Wound Beds.....................................39 4-4 All Dressings by Wound Type ................................................................................40 vii LIST OF FIGURES Figure page 1-1 Cost Comparison of Wet-to-dry vs. Collagen Gel Dressings (HHRN = Home Health Registered Nurse, BID = twice a day, QD = once daily) ...............................4 3-1 Wound Data Collection Form ..................................................................................31 4-1 Incidence of Wet-to-dry Dressings in a Sample of 202 Wound Care Patients .......35 4-2 Dressings by Wound Type by Number of Subjects .................................................36 4-3 All Wet-to-dry Dressings by Wound Type ..............................................................37 4-4 Wet-to-dry Dressings by Type of Healthcare Specialist..........................................38 4-5 Breakout Data for Dry Gauze Dressings, Wet-to dry Dressings and all others.. .....39 viii Abstract of Thesis Presented to the Graduate School of the University of Florida in Partial Fulfillment of the Requirements for the Degree of Master of Science in Nursing THE USE OF WET-TO-DRY DRESSINGS By Linda Joyce Cowan December 2004 Chair: Joyce Stechmiller Major Department: Nursing Wounds represent a major health problem, as well as