Why has wound training to be so hard?

Wound education is supposed to support a professional in answering the question:

What am I going to do next?

In practice, “what next” often appears straightforward.

In the Netherlands approximately 2 to 3% of the Dutch report to their GP with a wound. Obviously, the vast majority of these wounds are not problematic. They will heal regardless, even though a reassuring word from the doctor and a bandage may offer some help.

A small number of wounds close more slowly or not at all. For this, the cause of the wound must be examined, whether it is still present and what can be done about it. But here too, if you remove the cause, the wound will close relatively easily.

Problems can subsequently arise as a result of the wound itself, there may be a bacterial or fungal infection or edema that impairs wound healing. That too requires no rocket science to solve.

Finally, a small group will remain where we cannot (completely) remove the cause or where we do not understand exactly what is happening. Those will be the difficult wounds.

It will be clear that in practice most wounds are easy to heal.

“What now?” is in practice a timely diagnosis and intervention that prevents the development of problems as a result of the wound itself. Over 90% of the wounds at a GP level can be closed within a month or so.

One may almost assume that a badly healing wound cannot occur in the Netherlands. But that is not true, all in all, there are somewhere between 200,000 and 400,000 patients in the Netherlands struggling with a wound.

It is quite possible to reduce this number, but this requires knowledge, skills, and facilities.

These patients occur due to the apparent simplicity of wound treatment. Most wounds are not much of a problem. The question about the cause and thus the treatment of a wound is often easy to answer. The problem arises when the question is not easy to answer, while the practitioner is not aware of it.

False security (IKEA: is a Dutch saying for someone who believes he or she can really close every wound: Ik Kan Echt Alles) is the mother of the problem. As mentioned, most wounds will close by themselves, if there is a cause, even more wounds will close by themselves after the cause has been been removed. After these steps, you may be left with a dirty wound with thickened wound edges, but cleaning and a bottle of iodine will often be sufficient.

So, for these cases you do not really need in-depth wound training, here exudate management will with the help of a bandage and possibly an antiseptic, whether or not integrated into a bandage will be sufficient.

An education where you learn about general causes of a wound and matching dressing to the color of the wound is more than enough. As icing on the cake, you get the stages of wound healing during such training, after which you are allowed to enter the field as a “wound nurse”.

You will be successful because, even with a pack of gauze and a bottle of iodine, you can close at least nine out of ten wounds quickly. If you do not ask yourself too critical questions, you logically think you are doing fabulously. And that’s how the IKEA professional is born.

That single patient who does not heal then is the exception. Unfortunately, an exception affects thousands of Dutch people. An unnecessary problem for which you can arm yourself. But for that, you need knowledge, a lot of knowledge.

Knowledge which enables a practitioner to answer the one simple question on what to do next?

Knowledge about diagnosis and treatment options, but also other knowledge.

Knowledge far beyond the three, four or six stages of wound healing.

Knowledge about more and more in-depth (but still relatively simple because it can be written down in lists) matters such as anatomy, physiology, microbiology, comorbidities, lab values, and medication.

But wound medicine requires more knowledge. Knowledge to reason, to understand what is happening, knowledge about the rules of the game. Knowledge needed to assess your observations in a broader context; to see the analyses in their mutual relationship. Then it’s about wound_levels, math, feedback loops, organizational levels, time scales, and much more.

This will enable you to see what really is happening with your patient. In addition, you will be better able to assess the options available to you. This allows you to take the next step in a more targeted manner.

That knowledge also gives you access to many more options to intervene. Unfortunately, it also creates more impossibilities because you also learn that practice in wound medicine lags the science.

The tricky part is that this knowledge does not seem practical at all to an average practitioner. What are the benefits of growth factors, complement, feedback loops, cell types, immune system, and what not?

There is currently little you can do with that, while in practice the choice of the right bandage actually always works fine.

That is always the tricky part, training people for something they do not consider paramount, but which in the meantime makes the difference for many patients. Difficult knowledge for practitioners who want to understand what they are doing.

Practitioners who know when “What next?” is a bandage and a reassuring word, but also when “What next?” is something completely different.