Episode 8: Wound Care

This transcript was generated automatically. Its accuracy may vary.

Cara Lunsford

Oh, hey, nurses. Welcome to the Nurse Dot podcast. Giving nurses validation.

Tracy Lynn Rodgers

Resources and hope. One episode at a time. So today on Nurse Dot podcast.

I know that patients healed in spite of what we were doing for them and not because of what we were doing for them. Our bodies are fundamentally geared to heal. You and I are not the healer. Only a body can heal. I can't build new tissue in a wound. I cannot build new skin on a patient. But I can facilitate an environment to help the body do what it does best.

Joining us today, Tracy Rogers, a registered nurse with over 33 years of experience and a comprehensive background in wound care, long term care and writing standards of practice and quality assurance. Tracy continues to teach for Wound Care Education Institute and relies as well as sits as an expert witness and consultant in legal and malpractice cases. On today's episode, Tracy goes into detail about a tragic accident that forced her to experience the world through the eyes of a patient who.

Cara Lunsford

Tracy Rogers. It is a pleasure to meet you. How about we just kick it off with just a little bit about, like, who you are, what you do, and then we'll talk a little bit more about what we're going to dig into on this episode specifically, which is this kind of experience you had around this horrific car crash and wound healing and all of that.

Tracy Lynn Rodgers

I'm saying I am coming up on my 11 year anniversary, 12 year anniversary of my car accident. Really learned a lot. It's different being a patient than being a nurse. And you learn that there are good and bad health care professionals just like everything else we approach in life, right? Much of what we where we go and where we come from, that is attitude and what you do with it.

So I'm happy to share any and all of that with you today.

Cara Lunsford

Well, I really appreciate that. But yeah, tell me you've been a nurse a long time.

Tracy Lynn Rodgers

Also super long time. I hate to say this, so I turned 53 this year. I've been a registered nurse for 34 years and it's so weird to say that because when I was 19 and I can tell you, I tell my students when I'm teaching classes, I know that when I was looking at 40 or 45 year old nurses and you're 19 and 20, you're like, Ooh, wow, they're super old, they're ancient.

And now I'm one of those. I'm there. I'm one of those. When we talk about things in wound care, like doing sugar dying and wet to dry and drying things out and using fans and all of the old stuff that when I see wounds healed in spite of what we were doing for it and not because of what we were doing part, it was from that whole realm.

And I think there's a lot to be said for coming up through the ranks and seeing everything from old old fashion to where we're at now. I went into nursing, knew from a very young age that I wanted to be a nurse. One of my best friends and I graduated top of our class, so we got into nursing school.

She was 17. I was 18 when we got here, and she turned 18 during that summer and we were babies. I don't even know how I look back now. I'm like, I don't even know how they let us in. But we were smart and she was one of those. I was always really jealous because she was a very smart, naturally smart, just where things seemed to come easy for her.

Now, she may tell you different, but in my my view, my vision of what I saw with her was that it came easier. I had to work for everything that I had really. I developed really, really good study skills when I was younger, and it has paid off for me my entire life. It was either that or be a bus driver.

So that was my five year old girl. So when somebody said, What do you want to be when you grow up? I said, A nurse or bus driver?

Cara Lunsford

Well, those are two very different. Those are two very different careers.

Tracy Lynn Rodgers

Everybody on the planet is glad that I'm not a bus driver because everything I drive is like middle and fast and I would probably be in an orange jumpsuit somewhere, you know, if I had to drive a middle school bus because I wouldn't have the tolerance for those for those kids. But the reason why I bring that up is because people leave an impression in our life in one way or the other.

And when I was in kindergarten or kindergarten bus driver, his name was Lee. He and his wife used to come on and they would always make such a big deal about when you would get on the bus. It would be like, Oh, Tracy, you look so cute today, or nice to have you a wonderful day and take your seat.

You know, and it was just kindergartners. And from the time I was little, my view of a bus driver was that person who every single day, twice a day, made you feel like you were the best person on the face of the planet. You know, so much so that I would want to be a bus driver. Now, I had never had any health care issues, so I literally have a huge paper that says, What do I want to be when I grow up?

And it was written when I was in kindergarten when our parents night was and they got to come, they got to see it, said the number one thing was the bus driver. Second thing was the nurse. I am so glad today that I chose the path of becoming a nurse because I've always had it me like I love taking care of people.

I love seeing progress, I love seeing things heal. And I think that's one reason why wound care specifically was a really good natural fit and a natural draw for me. So yes, I've been in it from what seems like dinosaur times until where we're at now today, to say.

Cara Lunsford

Hey, you know, I've heard 60 is the new 40. I that was just on a text thread the other day.

Tracy Lynn Rodgers

We and every age that we get, we're going to keep changing that number. You know that when we turn 70, this group that we're in, we're going to be like, what is this where they cause Gen X or whatever we are that we are going to be? Whatever it is that is that point in that year of our life will be the super cool.

We are rocking it. We are not going down. We are fighting this age thing hard. So anyway, yeah, loving every bit of it. I was just made a grandma. My oldest son, I have two boys. They are both kind of in the, if you will, health care area. My youngest son is an EMT and he's graduating rookie school with the Clark County Fire Department.

My oldest son is a dentist and he's in his residency for orthodontics. And then his wife, his starring role wife is has her doctorate of physical therapy that she just graduated with. So they just had their first born last a week ago Sunday. So it's weird. I'm officially in the grandma. I say, grandma group. So lots of fun, exciting things going on in this time of my life.

Cara Lunsford

Oh, this is this is a very exciting time in your life. I think there was one of the things that I, I take away from what you were just saying when you were talking about the whole bus driver thing, the whole being a bus driver. But then you were hit by a bus, weren't you?

Tracy Lynn Rodgers

I know. I know. Somewhere in this universe, in this world, there is some weird irony of that that all understand later on, I had never been in a car accident. I had never broken bones and then in good Tracy fashion, like I told, my car wasn't actually my fault. There was a tour bus that made an illegal U-turn in front of me on the freeway and they were trying to turn in the dirt median that says, No, you turn to go the other way.

I was literally the epitome of when they say stay in your own lane. I was literally like, center in my lane, like just in my lane. And this tour bus made this turn right in front of me and broke everything from the neck down my neck in nine places, my lower back, both arms, both legs. Traumatic brain injury fracture in my skull, collapsed lung.

Yes, 22 broken bones. And it wasn't any of the small boats? No, no fingers, toes or ribs. It was all big stuff, you know. So I am here to tell you. I tell my students, I tell every time I have a speaking engagement like our bodies are meant to heal and how we get them there. And what you do with it is going to be up to you.

One of my surgeons told me the first because I was in and out. I think I've had probably 37 surgeries. I'm what I call the $1.6 million Woman. That is with your PPO discount rate. That's what my insurance paid in. After all of the discounts are doing, I have no magical powers. I can tell you when it's going to rain tomorrow or if the weather's going to drop.

That's the only thing I can tell you, because my left hand and my left knee will start to eight pretty good. But I don't have I can't I don't have X-ray vision. I made a metal and all kinds of fancy parts, but there was a lot that I learned from that. I was really grateful that I had my background in nursing, because I can tell you, for all the numerous facilities that I went to, all the surgeries that I had, that my sister, who's also a nurse, she's a wound care nurse as well, she was with me for a lot of this.

In fact, they said a room up at their home instead of say me to a rehab center, they my insurance case manager, authorized for me to have a room at my sister's home where they brought all the equipment and so that I could be there and just had home help. All of those things, you know, personal carried everything.

And I was really grateful because that made it possible to my kids, because they were in high school there and they were a freshman and senior in high school, that they were able to come and be able to stay with me on weekends when they weren't in school. And, you know, And where is that a rehab center? They wouldn't be able to stay overnight there or even, you know, visiting hours were limited.

This was back in 2011. And so my whole experience was very different than what a lot of people would experience. And my primary surgeon said, well, the first time that I went home, because they kind of put me together in part of bits and pieces, like they couldn't do everything at one time. It would be it wasn't even a reasonable thought, you know, it was kind of like they stabilized the big stuff and would send me home and then bring me back in a few days later and put something in and take something out, send me home, bring me back.

It's so much so that when I would go into pre-op, you know, I go to the pre-op center that I had most of my surgeries at University Medical Center, because that's where most of my surgeons were for the trauma center. They were kind of like assigned to you, Right? And so I stayed with many of my original surgeons and my primary surgeon, Ortho.

He said the first time I went home, he said, Now is when the real work begins, like us doing your surgery, giving you through that, that's about 40% of your recovery. What you do with this on the till and how much you put into it is going to be what you get out of it at the end. And it was a long, hard like four years.

It was a lot a lot more than I had anticipated. It was very difficult to be so incredibly independent, doing my own thing, running a business, having a legal nurse, consulting business. I was single, I had two children go, go, go volunteering, doing all kinds of fabulous things, you know, And to have it just removed so quickly and to be I mean, I was cast to my fingertips.

I they had to put my call light around my big toe on my right foot to get the nurse because I couldn't even hit a call button. And they transferred me using like a large device sheet. They would lift me from the bed to a recliner and recliner to a bed because I couldn't stand on either leg. I didn't even know up until that point that you could be non weight bearing on your arms.

Like they didn't even want me pushing on my elbows to help adjust or because both arms were significantly broken. And so it was a real there was a lot for me to have to learn as far as being a patient, how to be able to let other people take care of me where I was so used to. I'm just going to say it and I'm not even embarrassed by it.

Yes, I have control issues. I'm used to being in control of my I like being in control of my life. Whether or not it is a true thing or not. I like being the one who is giving care rather than receiving. I can tell you for a lot of nurses that may feel or anybody going to any job that they may feel like I'd give anything not to be able to have to go to work today.

I spent three months non weight bearing I transferring from a bed to a recliner, having somebody feed me an open water bottle, wash your teeth, brush your teeth, wipe your bottom like the epitome of everything at age 40, you know.

Cara Lunsford

That's that's learning some gratitude. I mean, that's definitely an opportunity for gratitude.

Tracy Lynn Rodgers

It was really humbling for me. Yes. And and grateful. I remember laying in bed thinking I would give anything to be able to vacuum. I of course, I like cleaning, though, but to be able to do just anything that had some resemblance of normalcy. And the worst part was it wasn't like my brain. I mean, my kids will still joke about this, like, remember when mom had that traumatic brain injury and she doesn't remember everything like, there's a lot of truth to that.

But for the most part, my head was there, but my body was completely broken. And to have to go through that healing process and maintain really to your point, that every single day it was bringing it down to the most kind of intimate level. I'm grateful that there is air in my lungs. I'm grateful that I'm still here as a mother.

I'm grateful that I at least get to continue this life journey, you know, with my children, even though it's going to be hard for the next little while. And when my doctor has said now's when the real work starts, like when I went home, he wasn't kidding that was when it got really hard. The surgeries are one thing coming out of surgery with a chest tube in because you ended up with a collapsed lung or, you know, I'd had catheters and all kinds of things that I wasn't used to having as a person that very much used to taking care of as a nurse.

It was very humbling. And it was one of those experiences in my life I learned a lot from. I wouldn't knock on wood, I would never want to go back and repeat it. But even my kids, my children, I see my children, they're young adults, but they grew a lot from that experience because they had to you know, they grew up in a way that I don't think they would have grown up that was back in the day where we use checkbooks still, you know, this back in 2010 where stuff wasn't all online, 2011 and my oldest son would go to the post office and get my mail and bring it up and I would

show him how to write checks and balances the checkbook. I learned things like my kids Greatest fear was when they were at school. They were staying with my ex-husband and and his wife, and they were great with them. I'll be forever grateful for their support during all of that as well. You know, making sure that my kids were able to get up to see me and whatnot.

But my kids learn things on life skills that I don't think they would have learned any other way. And even though those were things that young kids should not have to learn to do at that age, I feel like it better prepared them for where they're at in their lives today. Even though there was a lot of hardship that came out, there was more good than bad.

Cara Lunsford

Certainly, Definitely. It's the hard times where we do the most growing. It's so rare that in the easy times is when you're making these like huge periods of growth in your life or, you know, emotionally, mentally, spiritually. It doesn't usually happen during the easy you know, it times, you know, it's new when it's smooth sailing.

Tracy Lynn Rodgers

The refiners fire can be really rough. And you always have to think. I always call it that ring of fire. Right. What I worked labor and delivery. We always say right at the end when that baby is pushing through that ring of fire, there's something wonderful on the other side. You just have to get to the other side.

You have to be patient and get through that. So.

Cara Lunsford

So did you do late labor and delivery as well?

Tracy Lynn Rodgers

I did early on. And then that was my when I was 19 and 20, in fact, I delivered my first baby. One of our patients walked in and it was baby number six for her and she went so fast. The doctor came in as the baby was literally like, I don't think she was in the hospital for 20 minutes.

This lady, we barely got her in bed and that was the first time that I had an opportunity to basically deliver a baby early. Early on, My my background was trauma flight for life. I see you. I used to run on the code team. Loved that. I used to love that high adrenaline kind of thing. The older that I've gotten, you know, when you fly in a plane and and I do a lot of travel for work and there's always somebody who is going to take their list inoperable and have two small little bottles of drinks on a plane.

And then they're lightheaded and dizzy. And the flight attendants, like if they're a doctor or a nurse on this plane, I'm like, oh, my goodness, this has got to stop. People have got to be smarter. Everything like going into Vegas is party central, right? That's where I based out of it. So it's just I don't miss any more.

The older that I've gotten, I really like I said, I've really enjoyed and embraced the legal nurse consulting and the expert witness and being able to work and teach in the wound care. And I don't miss that early trauma. And but I did to answer your question, I did stay on with my labor and delivery skills for a number of years because I was able to deliver my younger sister, both of her two youngest boys.

And so I kept those skills up at a critical access hospital in Sierra Nevada because that's where she was going to be delivering. And so, yes, I like most nurses, we are doing usually three or four or five things, right? We always have a couple of things going on. But I love nursing as a profession because of that, because there is so there's so much flexibility in what you can do and and skills that you can really put to the test.

And I really did. I loved I loved being a nursery nurse, you know, that was like the best of all is just sitting there holding these little babies that just listening to their brand new little squeaks and snorts and little lip smacks. There's not anything better than that.

Cara Lunsford

I used to want to do that. I did pediatric oncology for many years. And then also to what you were saying, I've done a variety of different nursing over the years, anywhere from home health, Hospice Director of nursing, entrepreneurship, the whole thing. But I actually I really love wound care and I recently just the other day interviewed Cheryl Hines from Curb Your Enthusiasm, which is now available on the podcast as of yesterday and today.

And her daughter spent like three months in the hospital for a golf cart accident where the golf cart flipped on top of her and landed on her. And she had these terrible, terrible burns and wounds on her legs. And I was one of her home nurses who took care of her and was doing the wound vacs and everything like that.

And of course, in hospice, we also do like tons of wounds. All the cubit is ulcers, that form and everything like that. So you work in wound care, you teach about wound care. How did you get into that?

Tracy Lynn Rodgers

So originally, when I was 19 years old, 18, I did want to be a pediatric oncology nurse. And I think being exposed to young children who were dying, usually it was cancer or terminally ill. Whatever it was that they had was a lot that was a lot to take in as like a 19 and 20 year old. And I was really fortunate when I was doing my preceptorship for my bachelor's degree that I had my preceptor, saw something in me that I don't even think that I knew was there.

I mean, I ran on the code team. I was one of those nurses at the hospital, albeit very young. My process was, you give me an algorithm, I can go buy that right? Things weren't intimidating for me when it came to popping an idea and there wasn't an idea I couldn't put in anyone, whether it was an on.

We used to put them in even baby's heads at that time. In their feeds on people are bariatric patients where you couldn't palpate, you know, the end of it, but you knew by location where it should be. And those kind of things came very easy for me. And she really created an avenue for me during my preceptorship for me to be able to go.

That was the first time she was a flight nurse and she was able to get me on under the preceptor ship, this being now mind you, this was 30 years ago, 33 years ago that I was able to do flight for life with her, go into ICU. She had with one of those nurses at the hospital who had an in everywhere.

And so if there was anything really newer, exciting going on, she would be like, Oh, you've got to run down to surgery. They've got this or we have this coming in the E.R. It would be really great exposure for you to see that. And so she was the one who kind of encouraged me to go into that trauma icu e.r.

And is where my early onset was. And then i had a friend who was doing home health at the time, and she said, oh, you should do home health. You know, the pay is great. And you go out and see five or six patients or something and when I hear nurses that tell me home health is an easy job, it was honestly one of the hardest jobs I ever had.

And I tell students all the time, if you want an I.V. to stay in or you want negative pressure to stay on, you ask a home health nurse to do it because we don't want to be called out at 2 a.m., right? Tell me that I'm wrong.

Cara Lunsford

Exactly.

Tracy Lynn Rodgers

You have backup. If you go out to put an idea in it for home health, there's just you. So you get really good at that and you make sure that things stay in that they're taped down. Well, that that negative pressure isn't going to be pulled off because usually the person that has to go out and fix that, if that is the case, like Home Health had its own set of challenges, but it made me a better nurse.

I feel like like every avenue, every component of nursing that I've been to, every facet that I've been able to work in has really helped develop me into the person, the nurse that I am today. But it was through home health. That was where my early start for wound care really started, because that's where the nurse, you know, our director of nurses or whoever assigned you a patient would say, Oh, you've got to go out.

You've got these five patients today. Three of them have went well. I was, you know, 23 you're 23 years old. And that was before we actually had we put unit boots on everybody, right? They had a lower extremity wound. We didn't get advised. You kind of went in the supply room and looked and said, Oh, this looks good.

It's a moderate, draining wound. I will put an alginate on. It was almost like we were guessing There wasn't anybody who really taught us how to do wound care, like we were wound care has been its own little entity until about the last I would say ten or 15 years is where wound care really started developing some what we would call more standards.

We don't have everything in wound care is not evidence based that we do have. We're understanding wounds better. Everybody, every type of wound, whether it's diabetic, pressure, injuries, burns, whatever that is, plastic surgery type, things that are done. At least everybody's finally getting on the same page when it comes to how do you wound seal? How does the skin heal?

What are the stages? It was so disjointed before everybody was kind of doing their own thing when it came to wound care. But that was really my early start into that and I loved it. I think the thing that I loved the most about it was you could see progress, you know, much like physical therapists take somebody like me who was literally broken from the neck down to watch the improvement of I literally had to learn how to walk again.

Three different times. Right? Use that left leg three different times when they would do something and I was non weight bearing for three months on it. So even my therapists like they said when we get to see people progress or heal or find increased range of motion those kind of things, they love that progress. I feel the same a lot when it comes to was most of the wounds that I do like you.

I have a pretty strong background in home health and hospice, so not all wounds. We know they're not all. Our goal may not be to heal that wound. It might be for pain management or odor management, or to help prevent it from getting an infection or getting worse. But predominantly, as far as recognizing the patients who are high risk and treating those wounds appropriately.

That's where I have really spent the last probably about 2018 years of my career, has predominantly been in wound care. Now in there, also like delivered my two nephews and things like that. But predominantly it's been in wound care and in the legal aspect as well. Again, going into an area I would have never thought if somebody would ask me when I was 19 years old, would I be putting maggots on a patient's wounds and would I sit in a courtroom or go to a deposition where an attorney is going to chew you up and spit you out?

My answer would have been a hard, fast no. And you know, down your career, years later, you find that you do have tools that are in you. That was one of the things that my preceptor like I was saying, I'll be forever grateful for somebody who saw things in me that I didn't even see in myself. And then she helped me develop those.

She served as a really great resource to me. One of the reasons why I think I love teaching so much, being able to help others either answer questions that they have or develop a new skill set or hone a skill set that they already have. I love seeing people grow in their perspective fields, whatever that may be.

Cara Lunsford

I think I've seen a lot of wounds. I've been a nurse maybe half the number of years that you've been a nurse, but for you, like, do you have a specific experience that you look back on and you're like, Wow, that was a that was a really, really challenging wound.

Tracy Lynn Rodgers

This many years in. I tell a lot of doctors that I work with when I got into wound care and when I decided my sister and I brother in law, we decided we would open a women's center in this smaller town. It was when you talk about profiling, it happens for when we choose business. This was a great place to put a business.

They had a critical access hospital. There was no wound care center within an hour, and you had to have out-of-state insurances, either Utah, Nevada, for Nevada, it was an hour and a half away. We have a lot of what's called snowbirds there. So before we opened this one center, I realized even though I was a CCW, see that I still had a nurse, regular wound care certified.

We were all debridement certified. We had six wound care nurses and a physical therapist. We had a fabulous medical director who most doctors will tell you that many wound nurses know more than they do when it comes to wound care, how to appropriately treat wound care. We're seeing more and more physicians in in our classes and our groups because they're taught so very little.

And what they were taught was from a book written 20 years ago, and it was basically wet to dry. Right? We know that we've gone away from those. But that being said, I sometimes say to doctors, I'm really impressed when it comes to they'll say, Oh, I've got a really impressive work for you to see. There are probably five that I remember frequently.

One of them was not even our patient originally. It was a gentleman who was in his early fifties. He looked like he was in his seventies. He drank a lot. He had a lot of addiction issues. He had had a traumatic brain injury at one point. And so he actually lived with his parents who were in their eighties and his mother was the one that I was seeing.

So his father had brought the mother into our women's center. And we I just remember she had a wound on her lower extremity because we had certain rooms and she was in our room that where we would treat lower extremities. And there was an odor in this room. Now the the father and the son had come in and there was an odor.

And when I took the dressings off, nothing in her wings had an odor to it. And I'm thinking, where is that odor coming from? It's definitely an infection smell. And and it wasn't her, you know, she wasn't she was incontinent, but she was clean and it was kind of doing a check over of her and the father at the end had asked me, he said, Would you mind looking at my son's head?

He's got some sutures that I think need to come out. And I said, Oh, when where they put in? And he said, six months earlier. So he had.

Cara Lunsford

Oh, my gosh.

Tracy Lynn Rodgers

He had fallen through a literally it was like he was looking at a TV, a store that had TVs in the window. I don't know what led to it, but he has had gone through the window of these TV and into a TV. And so the whole back of his head, about a six inch piece, like a large cap on the very top of his whole head, had been stitched down and he had never gone in to have the stitches removed.

So when I went over to him, I lightly pressed on the top of that hair because I could see scabbing and all around the edges and it was black. It was like just black scar on the top. It was weird. There was hair that was still grown over top of that at one point that was now died of this big flat piece of scar right on the top of his head.

I barely pushed on it and it was like green yellow girl came out from the sides, all the sides. It was the most pure violent smell, just rancid. I can't even explain. I have a very, very strong stomach. Most people who do well care. We rely on our sense of smell to help us. Right? So I even have to say I was like, wow.

My niece who was applying for nursing school at the time, she was one of my medical sisters were standing right by me and she had a pair of gloves on and she just looked at me. I said, There she went, three shades of white that almost was white green. And she said, I think I better step out of the room.

I said, Yes, you need to go out because I don't need them any more. So what we did is our offices were connected to the hospital where we practiced as well. But I just started taking some scissors and cutting that those sutures apart. They were already pulling apart. And when I lived, there was just a skull, just his entire skull and this creamy green, gooey, thick purulent drainage.

And it was literally his skull right there. So I put I just barely cleaned it up. I said, we're going to put you in a wheelchair and walk you down to the E.R. because the year needed to see this. So I put a saturated ceiling because I took him down by myself. I'm telling the doctor in the E.R. who he was a fabulous doctor.

I said, Now you're even going to be impressed by this. I lifted up the back of the ceiling because then he could see the skull on that and he said, we're going to put him in the ascending flight for life down to Vegas. I said, You do realize they're going to send him right back with an order for negative pressure to go on that.

He said, Oh, they're going to keep him this and that, that I don't know how we walked around and wasn't dead because of an infection, but in any event, that was a pretty impressive thing. And sure enough, like 7 hours later, they sent him down a flight for life and I get a referral back from the hospital he got sent to to put negative pressure on.

And so we killed him. We shaved his head, healed him with negative pressure. I mean, it was impressive to see the things that you can heal when even coming from somebody who he still drank a lot. He smoked his dietary was bad. Like our bodies are meant to heal, right? Even in the worst of circumstances, our bodies are meant to heal.

I can only imagine how much better he would have held if he would have been doing things right. But in spite of that, that was one of those very impressive that just it was kind of we worked so hard to get him healed. And, you know, it was kind of one of those things that he actually ended up dying in a car accident and drunk driving.

It was a single about a year and a half after we got to Estadio. You know, there's been some very graphic ones, some burns patients that have had significant burns. This all kinds of wounds over the years. The body is an amazing thing and you have to learn how that body heals because everybody, even now, the way a body heals, the way cells work, all work in the same way, but the way that everybody bought, every person's body is going to heal is going to be different.

And so learning to be kind of what I call like a wound whisperer, like you have to understand that patient on every end. And I honestly feel like some of the very best nurses and clinicians I've ever worked with have been wound care clinicians, because we always say, you have to treat the whole patient, not just the home, the patient.

If their blood sugar stabilize, the wound won't kill. If they're in pain, the wound won't help. There's an infection. The wound. What if they're nutritionally compromised? The wound right here. In order to get that wound to heal, you've got to have all of your parts in place. So we get really good at looking at the whole patient. And it's not a one time look at them once it's continuous, week after week after week after week and another.

Cara Lunsford

And noncompliance stuff, Right. Like the psychosocial, the psychosocial part. You know, my psych instructor in school said it's all psych. And it's so true because you're always dealing with people. And I had a guy once who had a terrible dick. Hubert is on the back of his heel where you could see his Achilles tendon all the way through because he fell asleep in his recliner and he had poor circulation and, you know, some diabetes and stuff like that.

And and he had this terrible wound on the back of his heel. But man, try to get him to stop walking around with his wound back. You know, he just you couldn't get him. He was like 80 years old. We couldn't get him to sit down one day. He was like driving the car with his wound wound back on.

And I like, What are you doing, man?

Tracy Lynn Rodgers

I tell you, it's. It is The struggle is real when it comes to non-adherence and noncompliance with wound care. And so we we always say try to meet them halfway or part way. That's one of the biggest litigated. The things that lead to litigation. Surprisingly, in wound care. We know the two biggest litigated areas in long term skill, there are falls and mismanagement with age, identify wounds that treat women correctly, but that non-adherence, that noncompliance is a it's a real deal.

And the problem is the patient could be noncompliant. And yet the families the when that comes at you two years later saying why did mom or dad lose their leg, they got septic. And to your point, you're saying they weren't doing anything that we were asking them to do, and why am I having to defend appropriate care and treatment when the patient they absolutely have a huge component.

There is a huge component as to what they put into it, right?

Cara Lunsford

Yeah. It's that whole class that you can lead the horse to water. You can't make them drink. And a lot of times you like you just said, you know, we look at the whole situation, especially in home health, right? Not only are you looking at the whole patient, but you're looking at the house, you're looking at the family, you're looking at like what kind of access they have to, you know, medications or to food or, you know, how they are from a socioeconomic perspective, what kind of support they have at home.

And you look at all of that in home health. And, you know, that same guy, the one that was walking around with his wound back on and we couldn't get him to sit down. His wife had this fascination for Persian rugs and she had literally about 20 Persian rugs everywhere. And I was like, this is like a risk for falls.

He's walking around with a wound back. I just kept shaking my head like every time I'd walk in, I just say, Can we just, like, pull up these rugs just for next couple of months? Like pull up the rugs and, you know, just if you could just sit down.

Tracy Lynn Rodgers

Like that, you people, you get a real feel for somebody when you're in their home. And we know as a home health nurse, you know, you're a guest in their home. And so we always to approach those things. Some of those homes that are just seriously hoarders are a real thing, or they've got cats and dogs and there's urine and stool and stuff.

They're walking. You can't even sit down. You know, there were homes that you would save that patient for very last because you knew when you went in they would have nine dogs and you'd have dog and cat hair all over you. And that's the one end that people in a hospital, long term scale, you don't really know where that person came from.

Right? In home health, you know, you get a different view and a different picture of that whole entire family. Just to your point, everything the resources, they have somebody to present to the hospital and that whole big picture isn't even really addressed. It's never seen we don't really know what brings a person to into an air launcher. Right.

Unless it unless they come with an ambulance and you've got a good ambulance crew that gives you a detailed history of what that environment was like that. Yes, certainly lots of struggles on that end.

Cara Lunsford

So I had a question for you when you were talking about the negative pressure prior to Wound VAC being in existence. Was there another more so when I first went to nursing school, went to dry, was still or moist to dry was still the standard. That was what they taught us in county hospital was this moist to dry type of thing.

And for debridement purposes and all of that. But then right around that time was when I saw my very first wound vac, which was about 16 years ago. Now, how long have wound backs actually been around?

Tracy Lynn Rodgers

You know, I, I can tell you now, I know that the concept and theory behind negative pressure was that much earlier than this. But in-home help, I did my first negative pressure in 1994, and I remember that because I was pregnant with my oldest. That was when I did my very first. And in 19, I want to say 97, our home health, our director of nurses was fabulous.

She wanted four or five of us nurses to be able to go down. There was a particular company and back then and I guess I'd say sales, it was Casey. They were one of the pioneers with using the negative pressure. And so they were putting on a big one day seminar where my company paid for several businesses to go down and we got to be what they called wound back champions.

I still have my certificate from that. That and the concept behind negative pressure has not changed a lot. It's been in this last probably year or two that they've finally come out with a hybrid drape that is forgiving. So like when you go to put something down, if it doesn't suck down, there's this weird gratification that happens when you put negative pressure on, and especially if it's a hard location or a hard spot and it sucks down immediately and it doesn't there's no air leak.

I know that sounds so crazy, the things that we get excited about, but we want to do like this happens so that it's like, Look what I did. Oh my gosh. First try. We didn't have to tape. We didn't have to use ostomy paste. We weren't having to everybody. That's the negative pressure logging, you know what I'm talking about.

But the concept, the theory behind a lot of that, at one point it was foam. Then they had the gauze and they were using it. Now it's predominantly, I would say most of us probably are most familiar with the gauze type of negative pressure. And like I said, there's the newer hybrid drape where we don't have to border around the wound.

You can put the drape down, you can lift it up and put it back down. There's all kinds of fabulous things that have come out. The Vera flow where it kind of irrigates it. And those are in acute or like stepdown units. We've got those PICO, which are the ones that they can be sent home with a surgery type this disposable.

So negative pressures come a long way but went to dry and fortunately stayed in there up until about the last probably five or six years is really where they started saying no more went to dry. It isn't a great form of mechanical debridement. It cools the wound off. It doesn't do anything really for a debridement. They're painful. It first of all, it cools it down and then it dries it out.

And those are like two of the worst things that we can do at a cellular level for cells, for wound healing. And I'm a negative pressure fan like I am when I first learned to use them. I'm so grateful that our director of nurses that they saw the importance in being trained appropriately because there's a lot of them.

From a legal standpoint, I probably get six negative pressure cases a year of in appropriate application of negative pressure that have resulted in usually access to the femoral artery or retained foam or sponge. Those are the two big things where we've seen adverse events with negative pressure. And generally speaking, it's because nurses are trying to train other nurses now, like with any wound care product, these manufacturers, they want you using their product and more so they want you using it appropriately.

They are more than happy to come wherever you're at and teach your team of health care professionals. And we know that wound care isn't exclusive to nursing anymore. You know, there's I mean, it could be LPN, LPN and P TDOT physicians. But that being said, whatever the product is, and speaking of negative pressure especially, they want you using it and they want you using it correctly.

They would love to teach you to use their product. I'm always telling them, call them, they'll come to you. They will teach you how to use it, apply it, teach you the tricks of the trade. I personally, if I have if it's an option to use negative pressure, I'm on it like I will use it if that is available because of how fast they heal.

When nurses tell me they don't like negative pressure, I and it's my theory, it's my opinion. I think it's because they're not comfortable in the application of it. Right. Like maybe they've had a couple of bad experiences. And so because once you learn how to use it and use it right, there's like no going back. We're talking aljunied, hydro fibers, foam, all these things are fabulous, but nothing takes the place of negative pressure in the wound care end.

Right now, not all hands are appropriate for negative pressure, but I am. I'm a fan.

Cara Lunsford

Yeah, I agree.

Tracy Lynn Rodgers

Yeah. Negative pressure has really been it's been around a while. I wish that the hard part is is the cost of it. You know it is Those units are anywhere between 20 and $35,000 a piece. And so it's a pretty pricey unit to have. And I always say you have to be selective about your patients. If patients are non adherent non-compliant, not going to leave it on, turn it off, aren't good with it.

They lose their right to have the good fancy stuff. You know.

Cara Lunsford

I was thinking like prior to there being like the fancy wound backs, I could just picture somebody with like you know, cupping, you know, like where you do cupping. I could just picture somebody like, well, this could work.

Tracy Lynn Rodgers

So I guess like in wound care, unfortunately, I think there was a lot that's it's weird to say we used to put my lanta baited. I'm with sugar in wounds. I don't even know what the theory was behind that. But we did all kinds of crazy, weird stuff. And people still are holding to those things that there is no legitimate reason why you should be using talcum powder.

And I mean, I'm just I mean, like cornstarch, right? Like that's meant for baking. That is not meant for food. And that's where people really get themselves into trouble is like, well, my great great grandmother use this. And if it were good enough for her and I always say this example because in wound care is the one area where people don't want to advance.

We want to stay with old stuff like, oh, no boots for everything or wet to dry or those things. It seriously makes my head want to spin around three times when I see that's still being done in charts. But that being said, I always tell them if you start having pain in your right upper quadrant and every time you eat something fatty or whatever and you're like, Oh, I might have a bad gallbladder.

So you go to your doctor and he refers you to a surgeon. They get a high risk and they say, Yeah, you've got a little bit of a fatty gallbladder. Let's go ahead and get that out. And the first surgeon you go to tells you we're going to open up about four or five inches. We're going to put a down drain bag in there.

You'll have an energy tube, you'll be in the hospital four or five days. We're going to take your gallbladder out. You going to be like, hold the fun. I thought if there weren't large gallstones, I could have it out with a laparoscopy. Right? Like everybody else. I'm in and out. Same day surgery, my recovery. The only pain I really have is where in my scapular area where they blow that gas into you.

I didn't think I had to be in the hospital that long. Well, this older doc is like, Nope, I've always done it this way. This is way. My grandpa did it. That was it. That's what I feel about wet the dry dressings and some of the stuff that these people don't want to give it up. I'm like, You wouldn't go have your gallbladder out the old fashioned way, just like people are entitled to have.

We have fabulous wound care products on the market. We have fabulous things to help, wounds to heal, and people need to get on board with that and start practicing what would be more the standard of care and get away from that old fashioned stuff. It drives me nuts.

Cara Lunsford

Yeah. It's okay to, like, evolve and to to grow and to change with the times. And hey, look, I went and I did like a medical mission to Haiti. If you ever want to get crafty with stuff and you don't have a lot and you want to use that ingenuity, there's lots of places you can go where you can do that.

I had a kid who had an inch infiltrated Ivy, who was just a baby and I was like, Do we have any warm packs? Do we have what do we have here? And they're like, We have some boiling water. And I was like, What am I going to do? And I poured boiling water, well, not boiling, but hot into a diaper.

And then I took the dry side of the diaper and I put it on the kid's arm. And then I wrapped it with the sticky sides of the diaper. That's all I had. So, like, did I feel like MacGyver? Sure. Totally felt like MacGyver. And that can be a fun feeling of like, I was resourceful. Being resourceful is one thing, but completely turning a blind eye to things that are, you know, so much better than what we've done historically, right.

That's being, you know, kind of shortsighted and not looking out for the greater good.

Tracy Lynn Rodgers

What is in the best welfare of the patient. And we know wound care can be expensive and it takes a while to heal. And so people think that going cheap on your dressing is, for example, went to dry. Well, it's very inexpensive dressing to put on the premise it's going to be take longer to heal, harder to heal, the manpower, the time to put in on it.

I always say add your time up, your salary time or your hourly time, plus the cost of that, doing twice the day dressing and then versus putting a dressing on three times a week. That might be a $10 dressing. There is a huge cost savings in that in and of itself when you look at it for manpower, for what goes into it, but also a risk for infection, they're slower to heal.

You know, there are just there are things that we did that I look back and that's why I always say I know that patients healed in spite of what we were doing for them and not because of we were doing for them. Our bodies are fundamentally geared to heal. It's what they do. Our job is to and I always say we're not honestly, as nurses, we kind of embrace this like I am the healer.

You and I are not the healer, okay? Only a body can heal. I can't build new tissue in a wound. I cannot build new skin on a patient. I cannot build a new epidermis, dermis, granulation tissue. But I can facilitate an environment for that body to help the body do what it does best. And that is make sure the patient's eating.

Make sure I have an appropriate dressing on, make sure there's no infection, Get rid of any dead tissue, suffer scar like I can facilitate an environment and then let that body do what it is supposed to do. And that's why I always say we're facilitators of wound healing. And I'm not trying to take away from the importance of where nurses are in the health care paradigm.

But the fact of the matter is this we don't actually heal. The body heals. So Your job is to facilitate an environment where the body can do what it does best, and that is where we're facilitators of healing.

Cara Lunsford

Well, first of all, I think such an amazing thing to end on because what a great statement for people to take away from all of this, because not only did you have to experience healing on your own because of your own very, very traumatic injuries that you went through, that you now have the ability to have compassion, to to empathize with patients.

And just you just brought so much to this episode today. It was just so full and rich with information, just with personal story. And you're clearly just an expert in your field. So I'm just I'm so grateful for you for coming and spending this time with me.

Tracy Lynn Rodgers

Well, I appreciate you having me. It's certainly my pleasure. Thank you for the invite.

Cara Lunsford

Absolutely. We will have you on again. I have no doubt I will likely see you at the Wild on Wounds convention. I am guessing.

Tracy Lynn Rodgers

You will see me. Yes. I'm going to be there with bells on. I love it there. I want everyone to care. I think that it's such a great way just to feel a part of that one. Care community and to be able to rub shoulders with some of the best and learn continually to learn in your wound care journey.

So and have fun. Why we're doing it. It'll be great. I look forward to it.

Cara Lunsford

So if you like. GROSS Things come to the Wild on Wounds conference, where they'll be plenty of gross pictures for you to look at.

Tracy Lynn Rodgers

There we go. I love that one. It is true. Most most of us are weirdly most wound care people. I think we're a little bit we are just a little weird. I'm going to say that we we like weird stuff and we like to see we take the challenge on.

Cara Lunsford

Absolutely. Well, it's been a pleasure. Traci, thank you for for this hour that you spent with me and all my love to you.

Tracy Lynn Rodgers

Thank you. I appreciate you.

Cara Lunsford

Talked. You said.

Tracy Lynn Rodgers

Okay, bye bye.

Cara Lunsford

Bye.

If you were a nurse who enjoyed this episode and you have an idea for future episodes, you can connect with me by downloading the nurse dot com app. Nurse dot is a nurse dot com original podcast series Production music and sound Editing by Dawn Lunsford, Production Coordination by Rhea Wade, Additional editing by John Wells. Thank you to all the listeners for tuning in to the Nurse Dot podcast.

Until next time, keep spreading the love and the care.