b'TREATMENTWound care Honouring residents wishes when they differfrom clinical best practicesR esidents wishes may not always align with clinical best practices. When it comes to providing long-term care that respects and honours each individuals preferences, however, its those wishes thatcome first. Its about informed consent, says Dr. Karen Campbell, an independent consultant with Primacare Living Solutions. Its helping residents understand the risks and benefits of doing or not accepting a form of treatment or, if theyre not capable, making those options clear to their substitute decision-makers. Thats the direction we need totake in long-term care, and itswhat wed want for ourselves, continues Campbell.Forgoing a form of treatment at the behest of a resident may seem counterintuitive to physicians and nursing staff, even if doing so aligns with a resident-centred model. This is perhaps best exemplified when assisting residents with consistent painIt was an interesting challenge, then,Even still, as a veteran of the long-issues, such as pressure injury. when an 85-year-old woman wasterm care community, she is well admitted to one of the organizationsattuned to the need for staffEasing the pain and discomforthomes with an extensive historyto respect residents wishes andof a pressure injury may requireof pressure ulcers, but ultimatelyseek alternatives.medication or specialized medicaldeclined some of the treatmentequipment, some of which maythat would have accelerated theIn this case, Campbell and the team limit mobility or produce less-than- healing process.attempted to treat a pressure injury desirable side effects. It can be trickyon the residents heel with an off-to balance these considerations whenThis resident was admitted into long- loading heel boot. Compression forming a care plan. In some cases,term care with significant pressuretherapy stockings were also given to there can be instances where little orulcers, but she was also an activeassist with swelling in her legs, and a no treatment is the preferred option. lady who liked to be up and aboutspecial mattress was used to reduce and doing things, recalls Campbell.pressure and shear. While these were A case study Because of that, she didnt want anytextbook strategies, the resident soon In 2018, Primacare Living Solutionskind of aggressive treatment thatfound the boot to be cumbersome Inc. was selected by the Registeredwould take away from her preferredand the stockings too uncomfortable. Nurses Association of Ontario (RNAO)way of life. Therefore, she opted to forgo the to become a pre-designate of itsboot and wear the stockingsBest Practice Spotlight OrganizationDr. Campbell is no stranger to theon occasion. (BPSO) program. The long-termcomplexity of dealing with pressure care provider committed itself toinjuries. She has served on the RNAOsWithout the boots, we werent able implement one of three best practicepressure ulcer expert panel andto keep the pressure off her heels, guidelines, including Assessment andchampioned best practice initiativesand without the compression therapy, Management of Pressure Injuries forthrough her role as President of theit was difficult to keep the swelling the Interprofessional Team. International Skin Tear Advisory Panel.down. But the reality is she found 12 LONG TERM CARE TODAY Fall/Winter 2019'