We are back continuing on the prickly conversations, this time about unhealable wounds. How is the ability to heal determined, and how do clinicians’ factor in a wounded persons goals and priorities, sometimes when there’s conflict with health care recommendations? We discuss if palliative wounds are the same as an unhealable wound and a range of ethical considerations when caring for people with these wounds. These wound types need to be discussed more, we hope you find the content relevant and stimulating for your clinical practice. Timestamps: 00:00 Introduction00:37 A big thank you to our audience for connecting0:37 A big thank you to our audience for connecting02:53 Love the feedback03:20 How do the different professions and expertise determine what is unhealable 04:24 When an unhealable is in fact healable05:24 How is a wound determined as unhealable06:14 It’s not always about the healability but quality of life and symptom management07:29 When a person is given evidence-based comprehensive information wounds can be healable 07:42 Once fully informed, despite being potentially healable, people may have different goals and priorities08:27 Wrong information risks wrong decisions08:35 Lack of knowledge and skills defaulting to unhealability and a “palliative” wound08:54 What is a “palliative” wound12:26 The unethical systemic barriers that result in unhealable wounds  13:16 Is a wound “palliative” when someone is transitioning to end-of-life care14:23 Dying a dignified death without a wound14:54 Medical professionals more likely to label a wound as unhealable16:06 Lack of evidence-based wound diagnostics resulting in a wound being assessed as unhealable16:17 Many wounds need to be biopsied16:49 Everything is called a venous leg ulcer due to lack of diagnostics17:29 Skin failure and the Kennedy Terminal Ulcer. Trombley-Brennan Terminal Tissue Injury 18:14 Barriers to identifying and documenting Kennedy Terminal Ulcer versus skin failure versus pressure injury at end-of-life19:41 An evidence-based approach to determining if a pressure injury on the foot is unhealable21:38 Questions to ask to assess if a wound is unhealable22:44 Why are wound consultants not needed when a wound is unhealable?22:52 Conversations around healability, capacity and dignity of risk24:35 Healing not always an endpoint especially when linked to unrealistic claims26:36 Healing plan vs maintenance vs palliation plan28:42 The role of hygiene and mobility in the unhealable wound28:54 Impacts of intersectionality and labelling a wound as non-healable32:23 Clinical callout regarding unhealable wounds33:15 Agency and the unhealable and healable wound35:09 Well-being and wounds39:04 Ethics of labelling a wound “unhealable” and moral injuryResources mentioned:Kennedy Terminal Ulcer (KTU) and Trombley-Brennan Terminal Tissue Injury (TB-TTI) https://www.caresearch.com.au/Health-Professionals/Nurses/Clinical-Care/Symptom-Management/Skin-Failure-and-Pressure-InjuriesInternational Consensus Optimising Wellbeing in people living with a wound https://woundsinternational.com/consensus-documents/international-consensus-optimising-wellbeing-in-people-living-with-a-wound/If you enjoyed this episode please like, subscribe, leave a comment or share with your colleagues.Connect

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