SCIENCE, PRACTICE AND EDUCATION an active participant, rather than a passive recipient of care. 2 Person involvement can not only improve wound care outcomes, but also reduce overall health costs and improve quality of life. 3 Under every dress- ing lies a story, and behind every clinical scenario there is a person with a wound waiting to be heard. 4 This case presentation aims to involve the person with the skin tears actively in the presentation of her skin tear journey in her own words. Background Skin tears are common acute wounds found among aging populations and most commonly occur on the extremities. 5,6 The International Skin Tear Ad- visory Panel (ISTAP) defines skin tears as ‘a trau- matic wound caused by mechanical forces, including removal of adhesives. Severity may vary by depth (not extending through the subcutaneous layer)’. 7,8 In Canada, there are only limited studies estimating the prevalence of skin tears across healthcare settings. The prevalence among long-term care (LTC) settings is estimated to be between 14.7% and 22% 9–12 , and it is 30% in palliative care; 13 the burden of skin tears in other Canadian healthcare settings is not known. ISTAP developed a Skin Tear Risk Framework to aid in the risk assessment and prevention of skin tears. 14 The framework indicates important risk factors to consider, including general health, mobility and skin condition, with the presence of one or more factors placing the individual at higher risk and prompting risk-reduction actions. LeBlanc et al. 15 concluded that, within the three risk factors previously men- tioned, individuals with the highest risk of skin tears included those suffering from chronic or critical dis- ease, aggressive behaviour, dependence on others for activities of daily living, history of falls, history of a previous skin tear, displaying skin changes associ- ated with aging and signs of photo damage. Skin changes, including ecchymosis, senile purpura, skin atrophy, photodamage and stellate pseudoscars, ul- timately result in increased skin tear risk. 16 Changes with ageing can also decrease sensation and lead to an increased risk of mechanical trauma. 17 The ageing of the world’s population means that the burden of skin tears will continue to increase; therefore, a focus on awareness, prevention and evidence-informed wound management is imperative. Individuals, caregivers or healthcare professionals’ knowledge, attitudes and practices pertaining to skins tears, their physical environment and local healthcare policies will further influence the incidence of skin tear development. Commonly, the focus for skin tear prevention is centred around the LTC sector, with little attention paid to those living in the commu- nity, as reflected in the lack of Canadian community setting skin tear prevalence data. Individuals in the community need to be educated about the changes associated with aging, the impact of medications, op- portunities for self-management in skin care and skin tear prevention and management. Providing patient education and involving the person with the skin tear in the care plan’s development and evaluation are imperative for supporting wound healing and improving outcomes. 1 Skin tears are often underestimated and trivialised, leading to suboptimal prevention and delayed or in- appropriate management. 18 Although skin tears typi- cally proceed to closure within two to four weeks 17,19 , comorbidities such as diabetes and oedema, in com- bination with aged skin, can put the individual with the skin tear at risk for a delay in wound closure and result in a chronic, non-healing wound. 20 A non- healing or chronic wound can develop due to a vari- ety of reasons, such as modifiable and non-modifiable intrinsic and extrinsic factors 7 , resulting in increased healthcare costs and the human costs of pain, suf- fering and decreased health-related quality of life. 11 Not everyone is aware that living with a complex wound is challenging and affects many physical and psychosocial aspects of lives. 21 Leslie’s Story This is a case study report of a 77-year-old Cau- casian female (Leslie) with a medical history of a right total knee replacement, asthma, hypertension, arthritis, osteopenia and atrial fibrillation. Her cur- rent medications include rivaroxaban, bisoprolol, montelukast, budesonide/formoterol, beclometha- sone dipropinate, ipratropium bromide, telmisartan, cholecalciferol and cyanocobalamin; she is allergic to doxycycline hyclate. Leslie is a retired Registered Nurse (RN) (graduated in 1965) and last worked as an RN in 1980. She has resources to draw on when she needs help. She has a need to know about things, a penchant to ask questions and a desire to be her own advocate. Leslie is a divorced mother of two and now lives with her second husband. She enjoys walking, cooking, baking, reading, painting, knitting, movies and spending time with her children and grandchil- dren. Informed consent was obtained in writing from Leslie, allowing us to obtain and share wound images 53 JOURNAL OF WOUND MANAGEMENT OFFICIAL JOURNAL OF THE EUROPEAN WOUND MANAGEMENT ASSOCIATION
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