Holistic assessment of chronic wounds: a concept analysis

The term “holistic assessment” is widely used but there is no accepted definition of what this means in context of chronic wound assessment. This is surprising since chronic wounds absorb £285.5 million annually of Irish... [ view full abstract ]

The term “holistic assessment” is widely used but there is no accepted definition of what this means in context of chronic wound assessment. This is surprising since chronic wounds absorb £285.5 million annually of Irish healthcare budget; an expenditure predicted to escalate due to increasingly ageing population and increased incidence in co-morbidities. The aim of this concept analysis was to build on existing knowledge and expand the understanding of “holistic assessment” in the specific context of chronic wound assessment. Rodgers evolutionary cycle of concept analysis is appropriate because it focus’ on clarifying, describing and explaining concepts. To locate the literature relevant databases were searched using the keywords: holistic, assessment, chronic, and chronic wound. The search extended over a ten-year period to capture the historical evolution of the emerging concept of interest. Literature retrieved on palliative wound management was excluded. Key findings in the analysis identified the concept as a dynamic process having multiple references and interpretations, all of which attributed the ‘person’ as central. Chronic wounds are characterised by chronic co-morbidities including suppressed immunity,and multiple influencing health factors. Recurring surrogate terms “well being” and “person-led” express the humanistic element of the concept and recognise the ‘whole’ person as the sum of parts and therefore, unique. The concept is driven by the most relevant antecedent identified; ‘communication’ considered from clients and nurse perspective. To conclude, “holistic assessment” is highly complex, an evolving and dynamic process demanding specialist knowledge in context of chronic wounds. Building a therapeutic relationship driven by communication and trust is pivotal to the successful application of the concept. Importantly, this analysis highlights the importance of specialist clinical skills and knowledge in chronic wound assessment. This paper will describe the concept and explore the implications for practice.