Reflective Writing 1: Surgical Ward

In this essay I will reflect on a referral case from Éua since August 2023 to surgical ward. The
patient was a 75 years old man with left Diabetic foot sepsis second degree burn. According
to his chart, one of the nursing notes plans was to dress the wound daily. On Monday
morning my second week at the ward, I was allocated to the male side. There were only 2
patients at the male side and this 75-year-old was the one I cared for with the supervision of
the female nurse responsible. After the doctors had assessed the wound, we continued on
with the dressing. During assessing the wound, we were able to identified the wound to be a
stage 4 due to the bones appearance and how deep it was and lots of slough presents. I was
only assessing the wound and helped lift the patient’s leg so that it will be easier for her to
debride the necrotic and slough attached to his tissue. Because the wound was too deep,
she was not able to get the slough all out and there still slough inside after our dressing.

I pity the patient as soon as the nurse starts to apply the courses. At first, I was unsure if I
should question her work but then I had the courage and asked about the slough still left
inside the wound, she said not to worry about it she can’t remove it. I kept thinking about it
the whole day how the dressing was just a waste of time because there was still slough left
inside which means there are still microbes presents and can further cause infections plus
the man is diabetic and wound healing will be slower. According to Woundcaresociety
(2016), a diabetic person immune system is lowered, so their wounds are more prone to
infection.
They have inhibited blood vessels, which cause poorer blood circulation to the wound site
causing the delay wound healing. This should give reason to why it took too long for his
wound to be granulated and heal after months of staying in the hospital.
The incident took place on a Monday it was not until Friday when Dr. Viliami Tangi visits the
patient again that I got to realized why the nurse did not bother to remove the slough.
Viliami after assessing the wound decide to transfer the patient for wound cleansing and
removal of dead skin under his feet. It was then I came to think that the nurse did not
bother to remove all the slough because she knew that this was going to happen.
For further development I believe that seeking help and addressing the issue with other
health workers when facing a situation like this will help find ways to minimize the
vulnerability to infections which can lead to other complications such as fever. Using of
hydrogen peroxide will also remove slough.
According to Angel (2019), slough attracts bacteria to the wound surface, resulting in low
levels of inflammation. White blood cells and plasma infiltrate the wound bed causing peri-
wound oedema, increased levels of exudate and an acceleration in cellular activity 7. Biofilms
are also present in the majority of chronic wounds, contributing to delayed wound healing

Angel, D. (2019). Slough: what does it mean and how can it be managed. Wound Practice &
Research, 27(4). https://doi.org/10.33235/wpr.27.4.164-167