June Skin & Wound Awareness Series: Week 5-Skin and Wound Care Works Best When Everyone Knows Their Role

Why residents and families need to understand the interdisciplinary team

Skin and wound care can become very complex.

There are diagnoses, medications, nutrition concerns, mobility limitations, moisture issues, pressure risks, circulation concerns, infection risks, documentation requirements, treatment orders, equipment needs, family questions, resident preferences, and provider follow-up. But successful skin and wound care awareness does not begin with complexity. It begins with clarity.

Residents and families need to know that skin and wound care is not the responsibility of one person, one department, or one weekly wound round. It is an interdisciplinary program. That means multiple people bring different skills, different observations, and different responsibilities together for one shared goal: protecting the resident’s skin, comfort, dignity, healing, and quality of life.

That is why role-based awareness matters.

Skin and wound care is a team approach

A strong skin and wound care program is not built on one set of eyes. It is built on many.

It includes the CNA who notices a change during daily care.
The nurse who assesses, reports, documents, and follows treatment orders.
The therapist who evaluates mobility, positioning, transfers, seating, strength, and function.
The dietitian who looks at nutrition, hydration, protein needs, weight changes, and healing support.
The provider or wound clinician who evaluates clinical concerns and guides treatment.
The social worker who helps communicate needs, preferences, concerns, and discharge planning.
The activities team who supports movement, engagement, and quality of life.
The family who knows what is normal for their loved one.
The resident who can say, “Something feels different.”

When these roles work together, skin care becomes more than a task. It becomes a system of awareness.

The CNA: closest to daily skin changes

CNAs are often the first to notice subtle changes because they provide the most hands-on care. They may see the skin during bathing, dressing, toileting, turning, transferring, changing linens, applying socks, assisting with briefs, or helping a resident get ready for the day.

Families and residents should understand that CNAs are essential observers. A CNA may be the first person to notice:

• Redness

• Bruising

• Skin tears

• Moisture irritation

• Complaints of pain

• Changes in tolerance

• Poor positioning

• A missing cushion

• A heel resting on the bed

• A resident refusing to turn or move

The CNA does not have to know the type of skin problem. The CNA’s role is to notice and report.

The nurse: assessment, communication, and follow-through

The nurse plays a central role in skin and wound care because nursing connects observation to clinical action. When a skin concern is reported, the nurse assesses the area, documents findings, communicates changes, follows treatment orders, monitors for infection or decline, notifies the provider when needed, and helps ensure the care plan reflects the resident’s needs. Families may think wound care is only about the dressing. But nursing involvement is much broader than that.

Nurses monitor the full picture:

• What does the skin look like?

• Is the area improving or worsening?

• Is there drainage, odor, pain, warmth, or swelling?

• Is the treatment being tolerated?

• Is the resident refusing care?

• Does the provider need to be notified?

• Does the care plan need to change?

• Does the family need an update?

• What referrals are needed?

The nurse helps turn skin awareness into coordinated action.

Therapy: movement, positioning, function, and prevention

Therapy is often underrecognized in skin and wound care awareness, but therapists are a vital part of prevention and healing. Physical therapy, occupational therapy, and speech therapy may each contribute in different ways depending on the resident’s needs.

Therapy may help identify:

• Transfer challenges

• Bed mobility limitations

• Wheelchair positioning concerns

• Seating tolerance issues

• Pressure risks during sitting or lying

• Need for cushions, surfaces, or positioning strategies

• Contracture risk

• Decline in strength, balance, or endurance

• Swallowing or nutrition-related concerns that may affect healing

• Functional changes that increase skin risk

• Wound healing modalities / techniques for pain management, healing, and wound bed management.

A resident who cannot reposition independently is at higher risk.
A resident who slides down in a wheelchair may experience friction and shear.
A resident who sits too long without pressure relief may develop skin concerns.
A resident with poor footwear or transfer technique may be more likely to experience injury.

Therapy helps connect skin care to mobility, function, safety, and independence. Physical and Occupational Therapists can also be wound specialists and skilled in advanced wound healing techniques and should be an active part of the complete plan of care when available.

The dietitian: healing needs fuel

Skin cannot heal well without support from the inside. The dietitian helps evaluate nutrition and hydration factors that may affect skin integrity and wound healing. Families often understand that food matters, but they may not realize how closely nutrition connects to skin.

The dietitian may look at:

• Weight loss

• Appetite changes

• Protein intake

• Hydration

• Supplements

• Meal preferences

• Swallowing concerns

• Lab trends when available

• Overall risk for poor healing

A wound is not just treated from the outside. Healing also depends on what the body has available to repair tissue. That makes nutrition a key part of interdisciplinary skin care. Dieticians need assistance of Speech Therapists, Occupational Therapists, CNAs and nurses to ensure the nutritional plan is safe and effective and able to be carried out.

The provider and wound clinician: medical guidance and treatment direction

Providers, wound physicians, nurse practitioners, physician assistants, and wound specialists help guide the clinical plan. They may evaluate the wound, review contributing conditions, order treatments, recommend diagnostics, assess infection concerns, review medications, and adjust the plan when healing is delayed. These practitioners and specialists do not replace front-line clinicians nor do they replace front-line clinician documentation, observation and daily care.

Families and residents should understand that wound care decisions are not random. Treatment should be based on the type of wound, wound characteristics, resident condition, goals of care, risk factors, and response to current interventions.

When a wound is not improving, the team may need to ask:

• Is there pressure?

• Is there poor circulation?

• Is there infection?

• Is nutrition affecting healing?

• Is moisture contributing?

• Is the resident able to reposition?

• Is pain limiting care?

• Is the treatment appropriate?

• Are there other medical issues slowing healing?

This is why wound care must be interdisciplinary. A wound rarely has only one cause.

Families: the voice of history, preference, and normal

Families bring something essential to the team: personal knowledge. They know what their loved one’s skin usually looks like. They know routines, habits, preferences, fears, pain behaviors, and past health history. They may notice when their loved one is quieter, more restless, eating less, moving less, or acting differently.

Families should know they are allowed to ask questions such as:

• “Has this area been reported to the nurse?”

• “Can we look at his heels?”

• “Is there a repositioning plan?”

• “Is therapy involved for seating or transfers?”

• “Has nutrition been reviewed?”

• “Is this wound improving?”

• “What can I watch for when I visit?”

• “Who should I tell if I notice a change?”

Families do not replace the care team. They strengthen the care team.

Residents: the most important voice in the room

Residents should be encouraged to speak up about their own skin. A resident may feel pain, pressure, burning, itching, or discomfort before anyone else sees a visible change. Their voice is critical.

Residents should be reminded that it is okay to say:

• “My heel hurts.”

• “This chair feels uncomfortable.”

• “My brief feels wet.”

• “This dressing is bothering me.”

• “My skin is itching.”

• “I feel pressure here.”

• “I do not want to sit this long.”

• “Something feels different.”

Self-advocacy is not complaining. It is communication. A successful skin and wound care program protects the resident’s voice, choices, dignity, and participation.

What families and residents should expect from a strong skin and wound care awareness program

A successful program should feel coordinated, not confusing. Families and residents should expect a team approach that includes:

• Regular skin observation

• Timely reporting of changes

• Clear communication between departments

• Nursing assessment and follow-through

• CNA involvement and reporting

• Therapy input when mobility, seating, positioning, or function are concerns

• Nutrition review when healing risk is present

• Provider involvement when clinical guidance is needed

• Care plan updates when needs change

• Family education and communication

• Resident-centered goals and preferences

• Advanced care planning and transparent, compassionate clinical education

The goal is not just to treat wounds. The goal is to prevent avoidable decline, support healing, protect comfort, and preserve dignity.

Why role clarity matters

When people do not understand their role, important details can be missed.

A CNA may think, “It is just a little redness.”
A family member may think, “I do not want to bother anyone.”
A resident may think, “This pain is probably normal.”
A therapist may not know the skin concern has changed.
A nurse may not hear about a new complaint right away.
A provider may not know the full story behind the wound.

Role clarity helps prevent gaps. Everyone does not need to do the same thing. But everyone needs to understand what part they play. That is the heart of interdisciplinary skin and wound care awareness.

The simple message

Skin and wound care works best when everyone knows their role.

The CNA notices and is the “preventer”.
The nurse assesses and follows through as the “predictor”.
Therapy supports movement, positioning, and function as the “promoter”.
Nutrition supports healing from the inside.
Providers guide the clinical plan.
Families share history and advocate.
Residents speak up about what they feel.

Together, the team creates awareness, supports prevention and protects dignity. This is how simple skin awareness becomes a successful skin and wound care program.

Through my SUCCESS Model of Skin and Wound Care — Securing Unmatched Clinical Competence in an Evolving Skin System — we are reminded that strong programs are not built on one person alone.

They are built on competence.
They are built on confidence.
They are built on continuous quality awareness.
They are built on people who understand their role and value the role of others.

This June, as we recognize skin and wound awareness, let’s make the message simple:

Skin care is everyone’s job.
Wound prevention is everyone’s responsibility.
Healing requires everyone’s awareness.
And residents and families deserve to understand and collaborate with the team standing beside them.

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