The importance of nutritional risk factors in wound healing; a comparative study of opinions between wound care nurses and dieticians

Wounds that heal poorly cause a significant burden on the wound care patient and on the United States healthcare system¹. Wound healing is a complex process with many complicating factors.  One significant factor is nutrition².  Malnourished wound care patients have a higher risk of being hospitalized and they also have a high mortality rate³.  There are several nutritional screening tools, however, Biscardi⁴found that there is not a single nutritional screen that will provide a full nutritional status and none are specifically geared to wound healing.  

In working to develop a tool, we wondered if there would be a difference between the factors that dieticians and wound care nurses (WCN) think are important for wound healing.            

Our IRB approved project was a qualitative survey of 54 dieticians and WCN’s.  We gathered demographic information including: age, education level, years of experience and national certification.  We listed 16 nutritional factors to rank “in order of importance when considering a patient’s nutrition and wound healing”. The choices included items related to: weight, swallowing, oral deformities, medications/supplements, comorbidities, nutrients, blood sugar levels, assistance needed for ADL’s, and alcohol.   

After the survey items were statistical analyzed, we found that most rankings were similarly. Highly important to both groups were: diabetes and >2 servings/day of protein.  Moderately important to both were: ADL’s, chewing problems, fruits/vegetable and >10 medications.  Less important were amount of dairy, herbs/supplements and alcohol consumption. Our biggest surprise was that 80% of dietitians ranked “gained/lost 10 or more pounds without trying” as first or second while only 25% of WCN’s ranked it at that level. The highest ranking for WCN’s was presence of co-morbidities.

In retrospect we would change some of the risk factors to include appetite changes and BMI.  We would also widen settings, in our study 90% worked in acute care.