Abstract
This study was necessitated by the international recognition of wound‐related pain (WRP) as a must‐address issue and patient‐centred concerns. The aim of this study was to assess patients' WRP experiences at rest and in relation to dressing change. This descriptive study utilised a WRP questionnaire which incorporated a visual analogue scale of 0–10 for data collection. A total of 109 patients participated in this study; 95·4% of the participants experienced wound pain at rest and during performance of activities of daily living, which were moderate (47·1%) and severe (30·8%) in intensity. Also, 91·7% of the participants experienced wound dressing change‐related pain, mostly as moderate (47·0%) and severe (28·0%) pain. The major factors that worsened WRP experiences were touch/handling, change in position/movement, wound cleansing, removal of dressings and usage of honey as a dressing agent, while the use of analgesic and brief rest between dressing change were considered the major strategies that can relieve WRP. WRP experiences have been reported by patients at rest, during performance of activities of daily living and at wound dressing change. A need to incorporate WRP assessment has been observed, which is vital in improving wound care outcome.
Keywords: Wound dressing change‐related pain, Wound pain, Wound‐related pain, Wound‐related pain assessment
Introduction
Associated with wound and its management is the issue of pain, the experience of which is unique to every individual with wounds. Pain is a significant problem with all types of wounds and the pain that patients experience may be associated with the wound themselves, dressings or dressing changes 1. Addressing patients' wound‐related pain (WRP) experiences, which is being described as an unpleasant sensory and emotional experience associated with wound and dressing change 2, 3, should be an utmost priority for clinicians in charge of wound care, but this often seems not to be the case 4, as pain is often ignored in wound care or passed over as a symptom of the type of wound involved 5 or bound to occur as a result of the wound dressing procedure, with the patient compelled to endure or live with it as the case may be. As observed, patients who undergo wound dressing change are often worried about WRP; in anticipation of this procedure, they often exhibit feelings of fear, anxiety, palpitation, elevation in blood pressure, and urinary and bowel urgency. Patients with intense negative feelings and signs usually resort to uncooperative behaviours to avoid or resist wound dressing changes when due.
WRP‐induced behaviours are often responsible for the delay in wound healing as the wound could have become macerated and infected, which in turn leads to increased pain, emotional breakdown, uncooperative attitude to wound dressing change procedures and subsequently wound trauma. This continues in a vicious cycle of pain in the patients, which goes a long way to influence their overall quality of life 6. WRP has become a professional and humanitarian concern, which will change only if all health care professionals actively engage in care strategies to minimise trauma and pain in wound care 7. As proposed by Cooper, ‘the first step in treating pain is to recognise that pain exists and is unique to each individual, before ascertaining when it occurs and what is the cause’ 8. Systematic and rational approach to the assessment and management of WRP is fundamental to a patient‐focused and holistic wound care, and it is hoped that this study will contribute to this quest.
Method
This descriptive study was carried out at the University College Hospital (UCH), Ibadan, Nigeria, which offers primary to tertiary health care service including wound care. The management of wound involves a multidisciplinary team which includes the nurse, physician, nutritionist, pharmacist and other health care professionals whose interventions can directly improve patients' wound care outcome with the nurse as the ‘nerve’ centre coordinating the activities of others. In the UCH, wound dressing change is primarily the duty of nurses and mostly carried out in all the wards and clinics using aseptic techniques. As a national referral centre and a centre of excellence in the provision of health care services in Nigeria, UCH was purposively selected as the study setting.
WRP in this study was categorised into wound pain and wound dressing change‐related pain. Wound pain is defined as the pain felt at rest when no wound manipulation is taking place, and during performance of activities of daily living, while wound dressing change‐related pain is the pain that may be experienced in anticipation, during and after wound dressing change. A WRP questionnaire was used to collect data and it contained 37 items on participants' demographic data and wound history, experience of wound pain (background/incident pain), and experience of wound dressing change‐related pain. Some of the items on the questionnaire were adapted from the patient wound pain questionnaire 9 and the WRP at dressing change assessment tool 10. Visual analogue scale (VAS) of ‘0’ to ‘10’ was used to rate WRP intensity. The wound size was determined through the use of two‐dimensional linear method for all the wound types except that of burn/scald injury which was estimated through the use of Lund and Browder chart. In order to effectively assess wound dressing change‐related pain, some specific pain behaviours/expressions were observed by the researchers during dressing change.
Ethical approval for the study was obtained from the University of Ibadan/UCH Ethics Committee (UI/EC/12/0206). As part of the procedure for data collection, an interaction between the participants who met the inclusion criteria and the research team took place within 24 hours prior to data collection for inpatients and 30 minutes to 1 hour for outpatients at surgical outpatient (SOP) clinic to achieve the following:
Inform the participants of what the research is all about (objectives, benefits and risk).
Assure confidentiality of information obtained from the participants in the course of data collection.
Obtain participants' written consent.
Teach the participants on how to use the visual analogue scale (VAS) to rate the intensity of WRP at rest and in relation to wound dressing change.
At the end of the proposed 1‐month duration of data collection, a total of 121 patients were purposefully selected from the surgical wards, medical wards, neuroscience wards and the SOP clinic. The data were analysed using Statistical Package for Social Science (SPSS) version 16, which was used to calculate descriptive statistics and generate relevant frequency distribution tables and graphical charts that were used to draw inferences from the data.
Result
Response rate
A total of 121 questionnaires were administered and retrieved, of which 109 were found to be valid for analysis. Hence the response rate was 90·1%.
Demographic characteristics and wound history
The participants' gender distribution was 63 males to 46 females. The average age of participants was 43·7 years [minimum age = 18, maximum age = 80, SD (standard deviation) = 1·6]. The highest patients' age category with wound in this study was 36–50 years (n = 37, 33·9%). Majority of the participants (53·2%) were self‐employed (demographic characteristics of the study participants are presented in Table 1). The wound history of the participants is summarised in Table 2, with the average wound age/duration as 13 weeks (SD = 3·8). The average size for burn/scald was 26·6% Total Body Surface Area (TBSA) (SD = 13·9), and for the other wound types was 72·5 cm2 (SD = 138·1). A total of 57 participants (52·3%) had infection in their wounds, which had signs such as exudates/drainage (n = 44), friable granulation tissues that bled easily (n = 13), unpleasant odour from wound (n = 35), delay in wound healing (n = 22), increase in wound size (n = 17), maceration of wound edge (n = 9) and necrotic tissue on the wound surface (n = 23).
Table 1.
Participants' demographic data (N = 109)
| Variable | Frequency | Percentage |
|---|---|---|
| Sex | ||
| Male | 63 | 57·8 |
| Female | 46 | 42·2 |
| Age (years) | ||
| 18–25 | 15 | 13·8 |
| 26–35 | 21 | 19·3 |
| 36–50 | 37 | 33·9 |
| 51–64 | 22 | 20·2 |
| 65–80 | 14 | 12·8 |
| Occupation | ||
| Civil servants | 25 | 22·9 |
| Self‐employed | 58 | 53·2 |
| Students | 10 | 9·2 |
| Pastors | 6 | 5·5 |
| Military | 3 | 2·8 |
| Unemployed | 2 | 1·8 |
| Retired | 5 | 4·6 |
Table 2.
Participants' wound history
| Variable | Frequency | Percentage |
|---|---|---|
| Type of wound | ||
| Pressure ulcer | 14 | 12·8 |
| Leg ulcer | 7 | 6·4 |
| Diabetic foot ulcer | 14 | 12·8 |
| Surgical wound | 15 | 13·8 |
| Cellulitis | 9 | 8·3 |
| Burn/scald | 17 | 15·6 |
| Traumatic wound | 32 | 29·4 |
| Scrotal ulcer | 1 | 0·9 |
| Wound age/duration (weeks) | ||
| 1–4 | 53 | 48·6 |
| 4·1–24 | 48 | 44·0 |
| 24·1–52 | 3 | 2·6 |
| 52·1–76 | 1 | 0·9 |
| 76·1–312 | 4 | 3·7 |
| Wound size | ||
| Burn/scald | ||
| 1·5–14% TBSA | 2 | 1·8 |
| 15–28% TBSA | 8 | 7·3 |
| 29–42% TBSA | 3 | 2·8 |
| 43–59% TBSA | 2 | 1·8 |
| Other wound types (cm2)* | ||
| 2–50 | 64 | 58·7 |
| 51–100 | 17 | 15·6 |
| 101–300 | 9 | 8·3 |
| 301–600 | 2 | 1·8 |
| 601–900 | 2 | 1·8 |
| Wound location | ||
| Neck/head | 4 | 3·7 |
| Upper limbs | 9 | 8·3 |
| Lower limbs | 65 | 59·6 |
| Trunk | 22 | 20·2 |
| Upper/lower/trunk | 4 | 3·7 |
| Upper/trunk | 3 | 2·8 |
| Head/upper/trunk | 2 | 1·8 |
| Presence of signs of wound infection | ||
| Yes | 57 | 52·3 |
| No | 52 | 47·7 |
Other wound types represent traumatic wound, surgical wound, Cellulitis, pressure ulcer, leg ulcer, diabetic foot ulcer and scrotal ulcer. Also, the ‘.1’ in the wound duration category means plus ‘1 day’.
Wound pain experience
Majority of the participants (n = 104) experienced wound pain (Table 3). The pain experienced by the majority of participants (57·7%) was localised in both the wound and the surrounding wound area. In rating the level of wound pain experienced, majority of the participants (n = 81) experienced moderate to severe wound pain (average = 5·09, SD = 2·39).
Table 3.
Participants' wound pain experience
| Research item | Frequency | Percentage |
|---|---|---|
| Experience of pain in relation to the wound | ||
| Yes | 104 | 95·4 |
| No | 5 | 4·6 |
| When wound pain is experienced | ||
| At rest | 27 | 26·0 |
| On movement | 59 | 56·7 |
| At night | 27 | 26·0 |
| At performance of ADL | 81 | 77·9 |
| During the day | 22 | 21·2 |
| Location of wound pain | ||
| In the wound alone | 34 | 32·7 |
| In the surrounding wound area alone | 10 | 9·6 |
| In both the wound and surrounding wound area | 60 | 57·7 |
| Duration of wound pain | ||
| <2 weeks | 23 | 22·1 |
| 2–4 weeks | 39 | 37·5 |
| 1–2 months | 20 | 19·2 |
| 3–4 months | 10 | 9·6 |
| >4 months | 12 | 11·5 |
| Quality of wound pain | ||
| Sharp | 35 | 33·7 |
| Stabbing | 17 | 16·3 |
| Throbbing | 26 | 25·0 |
| Aching | 46 | 44·2 |
| Burning | 22 | 21·2 |
| Stinging | 9 | 8·7 |
| Tingling | 8 | 7·7 |
| Frequency of wound pain | ||
| Constant/continuous | 24 | 23·1 |
| Intermittent | 71 | 68·3 |
| Radiating | 9 | 8·7 |
| Rating of wound pain on a scale of 0–10 | ||
| No pain (0) | 5 | 4·8 |
| Mild pain (1–3) | 23 | 22·1 |
| Moderate pain (4–6) | 49 | 47·1 |
| Severe pain (7–10) | 32 | 30·8 |
| Intake of analgesic for relief from wound pain | ||
| Yes | 81 | 77·9 |
| No | 23 | 22·1 |
| Effectiveness of analgesic used to relieve wound pain | ||
| Yes | 77 | 95·1 |
| No | 4 | 4·9 |
ADL, activity of daily living.
A total of 81 (77·9%) participants were on analgesic for relief from their wound pain. The analgesics used by the participants were single analgesic therapy: tramadol (n = 31), paracetamol (n = 14), diclofenac (n = 4), ibuprofen (n = 1), DF 118 (dihydrocodeine) (n = 1); and combined analgesic therapy: tramadol and paracetamol (n = 8), tramadol and diclofenac (n = 7), pentazocine and tramadol (n = 4), pentazocine and paracetamol (n = 3), oral morphine and paracetamol (n = 1), paracetamol and diclofenac (n = 1), diclofenac and pentazocine (n = 1), DF 118 and diclofenac (n = 1), aspirin and paracetamol (n = 1), tramadol, pentazocine and paracetamol (n = 1).
Wound dressing change‐related pain experience
Majority of the participants (n = 100, 91·7%) reported the experience of pain at/in relation to wound dressing change (see Table 4), 23% of the participants had analgesic as a premedication prior to wound dressing changes, namely: tramadol (n = 10), intravenous pentazocine (n = 7), diclofenac (n = 3), paracetamol (n = 2); which they all reported as being effective in relieving their wound dressing change‐related pain. At the end of dressing change, 57% of the participants experienced WRP with an average duration of 31·1 minutes (minimum = 5 minutes, maximum = 24 hours, SD = 4·91). Wound dressing change was carried out on alternate day/daily basis with mostly gauze‐base dressings and honey as dressing agent (Table 5).
Table 4.
Participants' wound dressing change‐related pain experience
| Research item | Frequency | Percentage |
|---|---|---|
| Experience of pain in relation to wound dressing change | ||
| Yes | 100 | 91·7 |
| No | 9 | 8·3 |
| Frequency of wound dressing change | ||
| Twice daily | 5 | 4·6 |
| Daily | 47 | 43·1 |
| Alternate days | 52 | 47·7 |
| Twice weekly | 5 | 4·6 |
| Once a week | 0 | 0 |
| Intake of analgesic as a premedication prior to wound dressing change | ||
| Yes | 23 | 23·0 |
| No | 77 | 77·0 |
| Effectiveness of analgesic in reducing wound dressing change‐related pain | ||
| Yes | 23 | 100·0 |
| No | Nil | |
| Experience of wound‐related pain after the wound dressing change | ||
| Yes | 57 | 57·0 |
| No | 43 | 43·0 |
Table 5.
Products used for wound dressing change
| Product | Number of patients |
|---|---|
| Cleansing solution | |
| Normal saline | 109 |
| Dressing agent | |
| Honey | 66 |
| Povidone iodine | 26 |
| Povidone iodine + honey | 8 |
| Bactigras* | 6 |
| None† | 3 |
| Dressings | |
| Gamgee‡ | 63 |
| Plain gauze | 40 |
| Bactigras* | 6 |
| Securing material | |
| Cotton plaster | 79 |
| Crepe bandage | 30 |
Bactigras is a topical prepared paraffin‐based gauze dressing with chlorhexidine.
None is a dry dressing.
Gamgee is a gauze dressing lined with cotton wool for retention of wound drainage.
As a way of determining the level of wound dressing change‐related pain experienced by the participants, the aggregate score in all the seven stages of wound dressing change was calculated for each participant (range = 1–70, average = 31·5, SD = 1·84). The aggregate scores were categorised into no pain (score total of 0), mild pain (score total of 1–21), moderate pain (score total of 22–42) and severe pain (score total of 43–70). Out of the 100 participants who reported the experience of wound dressing change‐related pain, 25 had mild pain, 47 had moderate pain while 28 had severe pain (detail results presented in Figure 1). The rating of the pain in all the stages of wound dressing change range from VAS of 0–10 except during wound cleansing which ranges from VAS of 1–10. The average/mean of the rating of the wound dressing change‐related pain in all the dressing stages are: prior to dressing change 3·79 (SD = 2·69), during removal of old dressing plaster/bandage 4·42 (SD = 2·94), during removal of old dressing 4·74 (SD = 2·93), during wound cleansing 5·13 (SD = 2·99), during application of dressing agent 4·98 (SD = 3·03), during application of new dressing material 4·43 (SD = 2·99) and after wound dressing change 4·10 (SD = 2·81).
Figure 1.
Patient's rating of pain experienced at each stage of wound dressing change on a visual analogue scale (VAS) of 0–10. A, prior to dressing change; B, during removal of old dressings' plasters/bandage; C, during removal of old dressings; D, during wound cleansing; E, during application of dressing agent; F, during application of new dressing; G, after wound dressing change.
In response to wound dressing change‐related pain, striking pain behaviours/expressions were observed during wound dressing change, 41% of the participants demonstrated pain behaviours. At the stage of removal of dressing, wound cleansing and application of honey as a dressing agent, some of the participants cried, groaned, moaned, called names of their loved ones, sweat profusely and asked fundamental questions such as ‘why me?’. In most of the participants (n = 34), these observed pain behaviours/expressions were noticed during the application of honey to the wound.
In addition, the questionnaire also determined the participants' area of most concern in the light of other problems associated with wound and its management that could affect patients' quality of life such as odour, difficulty in wound healing and so on. As presented in Figure 2, majority of the participants (73·4%) agreed that WRP is their area of most concern.
Figure 2.
Wound‐related pain as the area of most concern to patients affecting their quality of life (N = 109).
WRP alleviating and relieving factors
Touch/handling and wound cleansing/removal of dressing were regarded as the most common factors that alleviate the experience of wound dressing change‐related pain, while touch/pressure was considered to be the most common factor that alleviates the experience of wound pain (Table 6). In both wound pain and wound dressing change‐related pain experiences, the use of analgesics was considered a major factor that could improve WRP experiences; this was followed by assuming a comfortable position and use of distraction method for improving wound pain experiences while brief rest between dressing change as indicated by the patient, soaking of wound and the use of non‐adherent dressings reduced wound dressing change‐related pain experiences (Table 7).
Table 6.
Factors alleviating the experience wound‐related pain
| Wound pain experience | Wound dressing change‐related pain experience | ||
|---|---|---|---|
| Alleviating factors | Frequency | Alleviating factors | Frequency |
| Touch/pressure | 60 | Touch/handling | 53 |
| Change in position | 46 | Wound cleansing | 50 |
| Movement | 45 | Removal of dressings | 50 |
| Night‐time | 15 | Application of honey as dressing agents | 28 |
| Tight wound bandaging | 6 | Use of gauze‐based dressings | 12 |
Table 7.
Factors relieving the experience wound‐related pain
| Wound pain experience | Wound dressing change‐related pain experience | ||
|---|---|---|---|
| Relieving factors | Frequency | Relieving factors | Frequency |
| Pain‐relieving medication | 62 | Pain‐relieving medication | 75 |
| Assuming comfortable position | 57 | Brief rest between dressing change | 28 |
| Distraction method | 24 | Soaking of wound | 26 |
| Listening to music | 11 | Using of non‐adherent dressings | 14 |
| Cool bath | 5 | Removal of dressing by self | 13 |
| Praying to God | 4 | Warm cleansing dressing solution | 10 |
| Dressing change by a preferred nurse | 10 | ||
| Dictating the pace of activities during dressing change | 8 | ||
| Presence of relatives during dressing change for support | 5 | ||
| Distraction method | 1 | ||
Discussion
Minimising WRP is an essential part of wound care that starts with the assessment of patients' experiences of WRP. The overall study results revealed that the participants experienced WRP at rest, during performance of activities of daily living and in relation to dressing change. Pain associated with wound has been identified as a key threat to healing, as patients are unable to participate fully in activities that promote healing, such as wound dressing change and exercise 11. The worst aspect of having a wound is the pain that it causes, rather than the other aspects which affect quality of life such as exudates, odour and restricted mobility for many patients 6. To this effect, WRP has been identified as the area of most concern to majority of the study participants (73·4%), which is quite similar to the findings of Price et al. who reported that 40·3% of the patients indicated that the pain at dressing change was the worst part of living with wounds with 63·8% agreeing that pain at other times was the worst part of living with an ulcer 12.
Most of the participants experienced moderate to severe wound pain (incident/background pain) which have been categorised as mostly pain of nociceptive origin with its frequency as intermittent and constant in nature. The reported intensity and frequency of wound pain in this study could have an implication on the individual's quality of life and the need for effective pain control. Majority of the participants (n = 81, 77·9) were on a prescribed regimen of analgesia to obtain relief from their wound pain experiences, with 95·1% of the participants reporting the effectiveness of the analgesics in relieving their wound pain. Adequate pain control is important for wound healing and promotion of patients' quality of life 13, 14. Importantly, the combination of analgesic with other non‐pharmacological interventions such as patients' education about expectation of pain and coping strategies for pain have been shown to be more effective 15.
Wound often requires the application of dressings to promote healing, facilitate protection and enhance body comfort; however, as important as this process is, the patients' experiences of pain has been identified as a major issue in the management of wound 7, 16. Participants in this study (n = 100, 91·7%) experienced pain in relation to wound dressing change as mostly moderate to severe pain in intensity; this is quite close to the findings of Mahé et al. 17, which revealed that pain at wound dressing changes was treated in 89% of the patients (n = 624) and Meaume et al., who found that 79% of patients experienced moderate to severe pain episodes during wound dressing changes 18. The highest level of pain was experienced by the participants during wound cleansing, application of dressing agents and at removal of old dressings. These findings support the growing awareness of pain associated with the cleansing part of wound dressing procedure 12.
The method of wound cleansing, the use of honey as a dressing agent and the use of gauze‐based dressing in the study setting accounted for the highest rating of wound dressing change‐related pain during wound cleansing, application of dressing agents and removal of dressing. The frequency of dressing change on alternate/daily basis can also be linked to the use of gauze‐based dressings, due to its poor capability in retaining fluid. In literature, gauze‐based dressings cause significant pain and trauma to tissue on removal 2, 19. The cleaning of wound bed and its surrounding was done through the use of a dressing forceps with a soaked cotton wool in normal saline at its tip repeatedly until the wound was assumed clean. As documented by Hollinworth ‘the cleansing of wounds with cold fluids is an unpleasant and potentially painful experience for patients, and the direct contact of the dressing forceps in wound and the continuous wiping across the wounds are painful which can damage delicate tissues and cause more pain sensation by the patients’20.
Honey is also used in the study setting in the treatment of infected wounds and to promote the formation of granulation tissue in deep wounds; this is because of its osmotic effect, hydrogen peroxide activity, phytochemical component, increased lymphocyte/phagocytic activity, anti‐bacterial potency 21, local availability and affordability. However, as observed, the majority of the patients who had their wounds treated with honey reported a very painful localised stinging sensation, which made some to cry, moan, groan, call out names of their loved ones, sweat profusely and/or ask fundamental questions. These patients' experiences of pain in relation to honey usage calls for prompt intervention, as this can affect patients' concordance with wound treatment plan, thereby leading to a delay in wound healing. However, no adverse reaction is associated with the clinical usage of honey as a dressing agent other than a localised stinging sensation which has been linked to its acidity, and allergic reaction that may result from the presence of pollen; as a result of these reactions, honey used as dressing agents should be processed and standardised for clinical usage 21. As observed, the honey used in the study setting is not specially processed for wound dressings as physical observations show some particles in them. It is worth noting that various brands of honey with standardised antibacterial activity are commercially available in developed countries. However, the usage of these brands of honey in a resource‐poor clinical setting such as the study setting may be difficult.
One of the key elements in the assessment of WRP is the identification of factors that could worsen and improve its experiences 22, 23. A lot of factors influence a patient's pain sensation, therefore health care professionals need to take time and listen to patients, and this is because understanding the patients' pain experience, factors that worsen and improve its experiences, and its effects on their daily lives, is essential in identifying the most appropriate means for managing WRP and providing supportive measures 24. Brief rest between dressing change as dictated by the patients and removal of dressing by patients themselves can help in improving their perception of being in charge and in control of their dressing change. Atraumatic dressings have been identified as standard method of reducing WRP experiences; since its development, soaking of dressings has been considered an outdated method of relieving pain during dressing removal 2, 25. Atraumatic dressings are not so common in Nigeria and when available, cost is a major limitation as most of the patients may not be able to afford it. The advocacy for the use of atraumatic dressings as the best choice of avoiding pain and trauma during wound dressing change is on the increase 26. Therefore, there is a need to resolve the major challenges confronting the usage of atraumatic dressings in Nigeria, which can go a long way to improve patients' concordance with wound treatment plan and the overall wound care outcomes.
Conclusion
WRP experiences have been reported by participants at rest, in the performance of activities of daily living and in relation to wound dressing changes.
Touch/pressure, change in position/movement, wound cleansing, removal of dressings and application of honey as dressing agent were reported to be the major factors that worsen the experience of WRP.
The use of analgesic in the control and management of wound‐related pain in patients has been highlighted.
Therefore, effort should be geared to regulate clinical practice of wound care and management of related pain issues, so that each individual will be treated according to the assessment findings of causative factors which will help to improve clinical outcomes.
Minimising WRP should be the central focus of wound care practitioners, which can be achieved through the implementation of patient‐centred wound care plan that implements strategies that holistically address the sensory, affective, cognitive and physiological components of pain.
Implication for clinical practice
WRP assessment must be implemented in the Nigerian clinical setting, with a focus on identifying its causes, and how the experience can be improved.
Optimal patients' wound care must combine advances in wound dressing change techniques with non‐pharmacological interventions and appropriate pharmacological interventions.
A change in clinical practice of wound care practitioners towards patients with wounds, especially in the area of control and management of WRP experience is hereby proposed.
Recommendations for future research
The available reports on patients' WRP experiences are mostly internationally biased. Therefore, there is a need for further research in the below areas:
Determination of the incidence and prevalence of WRP in Nigeria.
Assessment of wound care practitioners' knowledge and attitude to the assessment and management of WRP in clinical practice.
Clinical trials to identify cost‐effective atraumatic dressings.
Acknowledgement
Benneth Chijioke Obilor provided writing assistance and was involved in the proofreading of this article. Joel Ojo Aluko contributed to the analysis and interpretation of data.
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