PR14-092 Using a Pictorial Guide for Complicated Abdominal Wounds

Rosie Argo, BSN., RN., COCN., CWCN, BEMC, Phoenix, AZ
Each person processes and learns new information in different ways. There are three main cognitive learning styles: visual, auditory, and kinesthetic. Common characteristics such as visual objects, graphs, charts, and pictures assist in the learning process (VARK, 2013). Using this conception, the WOC nurse has assembled a step by step pictorial dressing change guide to assist the floor staff in managing a complex abdominal wound with an ileostomy and fistula.  

The WOC nurse took pictures of the bedside table with the preparation equipment. As the WOC nurse was changing the dressing, step by step pictures were taken of the complex wound and specific instructions were written at the bottom of the page. This included how to cleanse the wound, create and utilize a pattern and apply the fistula management pouch.

Prior to using a pictorial guide, the patient’s dressings were being changed on an average of once a day, with an approximate cost of $40.00 per dressing change. After implementation of this pictorial guide, frequency of dressing changes decreased, decreasing costs and maintaining a physiological wound environment.  When the patient was transferred to a Medical-Surgical unit where formal instruction of the use of the pictorial guide did not exist, the frequency of dressing changes increased. After identifying this barrier, the WOC nurse quickly provided education to this unit’s staff.

Identified barriers were patient compliance, discrepancies in the shift to shift report (pictorial guide not handed off to the oncoming nurse) and misplacement of the pictorial guide. In addition to written instructions, the visual guide provided an additional learning style for the staff and the patient.

The pictorial dressing optimized the process of changing a complex abdominal wound, empowered the nurses to provide excellent patient care and decreased dressing costs.