Introduction: The current method of skin inspection utilizes the components of; color, temperature, texture, moisture, and integrity to provide subjective data. There is a gap in the nursing skin assessment for providing objective and quantifiable data which is important in patient care. Physiological data in the form of temperature change allows for documentation of successful treatment outcomes or alerts for additional intervention. Signs and symptoms including pain/erythema often lead to a delayed approach. This multifaceted approach includes increased patient stress, unnecessary diagnostic testing, and higher costs. Nursing advocacy has been limited to conversations with patients/caregivers, provider-based testing, and subjective patient presentation.
Methods: Long Wave Infrared Thermography, (LWIT) provides temperature differentials of intact skin and/or open wounds. Temperature can indicate increased or decreased physiological activity which can provide signs and symptoms of potential inflammatory or ischemic processes in the form of objective and quantifiable measurements. Placing LWIT at the bedside is a nurse-driven assessment adjunct that provides quantifiable data which expands the current nurse advocacy role by adding thermographic findings to help guide further diagnostic tests/interventions.
Results: Advocating for further interventions with all case study patients was successful in using LWIT as an assessment adjunct leading to additional diagnostic testing and intervention, changing their plan of care. One patient was placed on antibiotics s/p a left breast mastectomy showing visual signs and symptoms of infection which was quantified thermographically. Another patient progressed to further diagnostic testing based on decreased metabolic activity on the lower extremity quantified by LWIT. The final patient who presented with right knee pain and discomfort also progressed to further diagnostic testing based on decreased metabolic activity quantified with LWIT.
Discussion: LWIT is a valuable bedside assessment tool that is quick, non-invasive, and non-radiating. Nurses may utilize this objective and quantifiable data when advocating for further patient diagnostic tests and interventions, coining the term, "Thermal Advocacy".
Trademarked Items:
References: [1] Langemo D, Spahn JG. A multimodality imaging and software system for combining an anatomical and physiological assessment of skin and underlying tissue conditions. Adv Skin Wound Care 2016;29:155-163. [2]. Chanmugam, A., Langemo, D., Thomason, K., Haan, J., Altenburger, E. A., Tippett, A., Henderson, L., & Zortman, T. A. (2017). Relative Temperature Maximum in Wound Infection and Inflammation as Compared with a Control Subject Using Long-Wave Infrared Thermography. Advances in Skin & Wound Care, 30(9), 406–414.
.png)
