Why it’s Time to Look Closer at Wound Healing & Nutrition

Wound healing has never been more important. In Canada, an alarming 7 per cent of home care patients have compromised wounds. Luckily, there are steps that nurses can take to prevent infection and help patients make progress. Promoting proper nutrition is an important example.

Unfortunately, nutrition has frequently been overlooked in the past. But things starting to change. Now, more than ever before, the many factors that contribute to wound healing are being considered together.

As care becomes increasingly patient-centred, practitioners are working collaboratively to achieve positive wound outcomes. In Ontario, care coordinators are well positioned to help patients develop plans to meet wound-related goals. Often, nutritionists are also a big part of the equation.

But while a number of practitioners may play a role, wound care nurses have the unique insight to predict how many different factors will come together to impact healing.

Of course, it isn’t just other professional care team members who base actions on the knowledge of wound care nurses. As patients are becoming more active in their own care, the involvement of specialists affects their efforts, too. And nutrition is a key healing factor that is (in most cases) largely under the control of patients.

This post will explore the increasingly important connection between wound healing and nutrition.

Nutrition: One of the Keys to Wound Healing

What makes nutrition such an important component of high-quality wound care? Diet is one of the few factors that has the potential to improve outcomes for all wounds. Whether a patient has a pressure ulcer or a burn, taking in the right nutrients can be beneficial.

As a wound care nurse, you’re well aware of the potential healing power of protein, fats, carbohydrates, and vitamins. From improving immune function to boosting collagen production, nutrients contribute to positive wound outcomes in many different ways. And today, diet has taken on a new level of significance.

Chronic wounds are presenting a bigger challenge to the health care system than ever before. There’s also a growing awareness that patient engagement is one of the keys to achieving positive wound management outcomes.

For these reasons, practitioners may want to think carefully about how best to help patients understand the link between wound management and nutrition.

But it’s not only those receiving care who have much to learn. Even if you’re the most experienced wound care nurse in the world, there’s information out there with the potential to impact the way you provide treatment.

It wasn’t so long ago that new evidence on the effectiveness of moist wound healing changed the way specialists practice. Now, new studies are turning up new information—and much of it is related to nutrition.

As just one small example, a recent study of children with burns turned up surprising results. Researchers believed that those who received early aggressive nutritional support wound have a limited hypermetabolic response compared to those who received the same support later. They found that opposite was true.

The takeaway for those who treat wound care patients is that the relationship between wounds and nutrition is complex.

Wound care is a rapidly developing field. Now, more than ever, it’s time for wound care practitioners, home care nurses, and patients to consider the role of nutrition in wound management.

Helping Patients Adjust Their Mindsets

Nutrition is often overlooked by patients, who aren’t always aware of the active role they can play in their own healing. This type of thinking usually stems from past experiences with the health care system.

Whether you’ve been practicing for decades or a few short months, you’re aware of some of the biggest recent shifts in Ontario health care. Chronic disease rates are on the rise, and acute care isn’t always the best solution for patients. Increasingly, care is being provided in the home. And in many cases, ongoing self care is part of the key to patient success.

Shifting care into a new environment is a massive undertaking—one that’s occurring at a rapid pace. So it’s no wonder that many patients still see themselves as the passive recipients of care. The messages they’ve received during past doctor and hospital visits have reinforced this idea.

As a wound care specialist, you do so much more than provide evidence-informed treatment. Whenever possible, you provide patients with the tools to engage in their own care.

Providing these tools may mean teaching a diabetic to test her blood sugar. It may mean offering resources aimed at helping patients prevent foot ulcers. Often, these efforts are going to include dietary guidance.

There’s no doubt that proper nutrition can promote wound healing and prevent wounds from worsening or becoming infected. Through diet, patients have a real opportunity to contribute positively to their own care. But this opportunity only exist for those who understand it.

As methods of care delivery change, wound care patients must be made aware of the importance of nutrition. Adhering to dietary plans may be a major key to achieving good outcomes. A vocal wound care nurse can help a patient—and her circle of care—take positive steps in this direction.

The Need for Plans that Work

Many patients need help understanding the role that nutrition—and dietary choices—play in wound healing. But of course, they’re not the only ones involved in their wound care.

In addition to becoming patient-centred, wound care approaches are becoming far more multidisciplinary. This is especially true in Ontario, where leaders have stressed the importance of coordinated, interconnected care in recent years.

If you’re a wound care nurse, you’ve probably seen the difference that multidisciplinary care can make. Consider the treatment of pain.

Given your area of expertise, you’re well suited to understand a patient’s wound-related pain. But you also know that the knowledge of pharmacists, psychologists, and other practitioners has the potential to improve the care you provide. It all depends on circumstances.

Needless to say, the same is true when it comes to nutrition. On its own, your expertise is highly valuable. And when it comes to necessary nutrients and healing, you may have a very strong grasp of the basics. But this knowledge isn’t always enough.

Think of how much better outcomes can be when you work with a patient’s care coordinator, nutritionist, and primary care physician.

Back when chronic wounds weren’t as common, some care components frequently went unexplored. Nutrition is a prime example. Today, it’s more important than ever to align all of this component—and to do it right, the first time.

When patients receive care at home, there’s always the risk that a subtle complication will go undetected. There’s a chance that, outside of relatively controlled hospital environments, care won’t be carried out exactly as planned. Collaborative multidisciplinary wound care helps mitigate this risk.

Bringing it All Together

As home care has evolved, approaches to treating wounds have followed suit. No longer is a one-size-fits-all approach acceptable. A patient’s unique circumstances need to be considered. Nutrition planning and support is a critical piece of the wound healing puzzle.

This holistic ideal can only be achieved when a patient’s entire circle of care is involved in her care. From nurses and specialists to the person receiving care and her family members, it’s best for those involved to understand a patient’s nutritional needs.

Feature image courtesy of Marco Verch

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COPD Education – Onboarding


To complete a thorough needs assessment / initial evaluation for a COPD patient of an outpatient clinic

Patient, Educator (Nurse, RT, the Physician could also be the educator)

One 60-90 min session with the Educator

  • This protocol should be established for all COPD patients from a given clinic, independently of whether they are new patients or they are known to the clinic. This protocol is the basis to engage the patient into other protocols such as education, exacerbation follow-up, etc.
  • We need to identify patient goals/concerns to guide the interventions
  • A thorough evaluation is carried on, with the objective of understanding where the patient is on their disease journey and follow-up treatable traits: dyspnea, exacerbation or dyspnea and exacerbation.
  • It includes the use of objective questionnaires such as the mMRC, CAT, HADS, Frailty Scale, etc.
  • Identify if the patient needs to be referred to other resources (e.g. Physiotherapist, social worker, occupational therapist)
  • Once Onboarding is completed, the patient continues to the COPD Education workflow
COPD Education – Continuous Maintenance


To cover in depth all the necessary elements of self-management education as per the LWWCOPD, with priorities based on patient goals and identified treatable traits

Patient, Educator (Nurse, RT or Physician)

A number of “Core” educational modules have been identified which cover the basic COPD education from the LWWCOPD program. Additionally, optional modules can be used to respond to patient needs. The timeline (frequency, number of modules to be covered at a given education session) is fully customizable, although we recommend to have education sessions every 2-weeks during the “active” phase of education. Once this is completed, the patient continues to the Maintenance Mode (see below).

  • Launched at the onboarding protocol
  • Provide basic overview of COPD self-management based on LWWCOPD (medication adherence, inhaler techniques, PLB technique & energy conservation) up to the development of an Action plan for early exacerbation recognition and management.
  • Prioritize self-learning by the patient (e.g. watching videos, reading educational materials, completing homework) in addition to live sessions with the Educator. Educational materials are sent to the patient directly via the platform, and become the patient’s own library. The Educator can customize which “homework” the patient receives.
  • Educators have access to “User guides” to standardise their educational intervention. These user guides include: objectives, interventions, suggested questions, evaluation of self-efficacy, and learning contracts for each module.
  • Once the core education is completed, the patient can continue to the Respiratory Status Follow-up Workflow (run in parallel)

The Maintenance Mode
  • As soon as the maintenance mode is engaged, the frequency of visits Educator/Patient is reduced to once every 6 months.
  • During the Maintenance Mode sessions, the educator has access to all the education modules and can choose any piece of content that needs to covered with the patient. 
  • A streamlined evaluation (similar to the initial eval.) is done during each “maintenance” visit to identify any substantial changes on the patient’s needs that will require some adjustment. The patient could come back to an “active” education mode (more frequent education sessions, e.g. every 2 weeks).
COPD Respiratory Status Follow-up


Monitoring of stable patients from a clinic in order to identify early any aggravation of symptoms (exacerbation) and implement an action plan

Patient, Educator (Nurse, RT or Physician)

Scheduled regular automated follow-up to the patient symptoms. Intensity/Frequency can be adjusted by the Educator depending on patient needs (e.g. daily, every week, etc.). Ongoing through the year.

  • Launch: Patients who have completed the Core Educational including setting-up an action plan.
  • Regular automated questions allow to identify any change in patient’s symptoms and severity.
  • If an exacerbation is detected the patient gets a reminder to engage their self-management strategies while waiting for the Educator to call back.
  • An alarm is generated for the Educator, so they immediately call back the patient. At this call they will evaluate any further intervention required and schedule additional follow-up.
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