Chronic wounds at home: what the nurse does, week by week
Written by Julie Martin, State-registered nurse · · 3 min read
Reviewed on · Reviewed by Rabah Slimani
A wound that has not healed after six weeks becomes a chronic wound. Here is what home care actually involves: assessment, protocol, monitoring, warning signs and the exact role of everyone involved.
Key points
- A wound is called chronic beyond six weeks without healing: follow-up then becomes methodical and dated.
- The dressing is not the care: the care is assessing the wound, offloading pressure and treating the cause.
- A dated photograph, with the patient's consent, is the only reliable way to evidence progress to the prescriber.
- Deterioration is judged on three objective signs — odour, exudate, surrounding skin — not on today's impression.
What makes a wound chronic rather than ordinary
An acute wound follows a timetable: it closes. A chronic wound stalls, because a cause keeps acting: sustained pressure, poor circulation, unbalanced diabetes, undernutrition.
Treating the wound without treating the cause is emptying a bath without closing the tap. That is why the first visit is never only a dressing: it looks at the bed, the chair, the shoes, the meals and the current medicines.
This initial assessment is what makes everything after it credible: without a documented starting point, no progress can be demonstrated.
The cycle of a monitored dressing at home
What we repeat at every visit — the organisation of care, not the choice of protocol, which belongs to the prescriber.
Observation
State of the wound and its edges, pain reported, comparison with the previous visit.
Preparation
Hand hygiene, clean field, equipment laid out in order of use.
Redressing
The dressing is renewed according to the prescription in force that day.
Recording
What was done and observed is written, dated and signed at the home.
Reporting
Any change from the previous visit goes to the doctor without waiting for the next one.
The next visit starts again at observation, with the previous note at hand.
The course of care, week by week
The real rhythm of a course of care, barring complications. Exact frequencies are set by the prescription and adapted to the wound, never the other way round.
| Period | What the nurse does | What is decided |
|---|---|---|
| Week 1 | Full assessment: size, depth, edges, exudate, pain, likely cause. Dated photograph if agreed. | Choice of dressing protocol and visit frequency. |
| Weeks 2 to 4 | Dressing changes per protocol, weekly measurement, pressure offloading, pain and nutrition monitoring. | Keep or adjust the dressing; alert the doctor if progress stalls. |
| Week 6 | Measured review: has the surface reduced? Photographic comparison. | Continue, change dressing class, or request specialist advice. |
| Beyond | Visits gradually spaced out, patient and family education, relapse prevention. | Discharge from protocol once healing is achieved and the cause controlled. |
What is checked at every visit
Five observations take two minutes and catch almost every early complication.
- The wound bed: granulating, sloughy, necrotic
- Exudate: amount, colour, odour — a new smell is reported the same day
- Surrounding skin: spreading redness, heat, swelling, maceration
- Pain: its intensity, but above all any change in its nature
- General condition: fever, unusual fatigue, loss of appetite
What patients and relatives can do
Three simple actions matter more than any technical dressing.
Remove the pressure
Change position every two to three hours when the wound is a pressure ulcer, and report any mattress or cushion that seems inadequate.
Feed the healing
A wound consumes protein. Insufficient intake slows closure, however good the local care.
Protect the dressing without opening it
The dressing stays in place until the planned visit. If it lifts or leaks, call us — do not redo it yourself.
When we call the doctor, and when you should call us
We contact the prescriber as soon as any of these appear: spreading redness, a distinct smell, fever, sharply increased pain, or a wound enlarging despite a followed protocol.
On your side, call without waiting for the next visit if the dressing is torn off, if the wound bleeds, or if the person becomes confused or feverish.
A wound that changes smell or colour within 24 hours does not wait for the next appointment: call the practice.
Supplies, waste and traceability
Dressings are prescribed and dispensed by the pharmacy: we pass on the exact list to avoid mid-week shortages, which force improvised protocols.
Sharps and soiled waste go into an approved container, collected through the DASTRI channel via the pharmacy. Nothing goes in the household bin.
Every visit is recorded: date, appearance, product used, decision. That record — not memory — lets a locum or a doctor pick up the case with nothing lost.
What helps between two dressings
The dressing is our job. What happens between visits belongs to daily life, and weighs just as much on healing.
- Do not wet the dressing: adapted showering, protection agreed with us.
- Do not remove or re-stick a lifted dressing: tell us instead.
- Change position regularly when the wound sits on a pressure point.
- Keep food intake sufficient: healing consumes protein.
- Report any new smell, any discharge coming through the dressing.
- Keep supplies dry and flat, in their original packaging.
Why the protocol does not change every week
A chronic wound changes slowly. Switching product at every shade of appearance makes evaluation impossible: nobody could tell what worked.
So we keep a stable protocol, agreed with the prescriber, and we document it — measurement, appearance, photograph where permitted. A change is decided on a dated trend, not an impression.
That discipline has a useful side effect: the day a specialist opinion is needed, the file tells a readable story rather than a series of attempts.
When to call
Fever, redness spreading around the wound, clearly increasing pain, a new smell, heavy discharge, bleeding that does not stop, a dressing torn off: call the same day.
A wound that changes fast must be seen fast: the one case where we do not wait for the scheduled visit.
What we measure, and why
At fixed intervals we record the wound's dimensions, the appearance of edges and bed, the amount of exudate, the pain reported and the condition of the surrounding skin. Always the same items, always in the same order.
A single measurement says nothing; a dated series says everything. It is what allows the prescriber to continue, change protocol or request a specialist opinion — on facts, not on an impression of better or worse.
Frequently asked questions on this page
How long before a wound is considered chronic?
Can I redo the dressing myself between visits?
Are wound photographs compulsory?
Who pays for the dressings used at home?
Can you shower with a dressing?
How long does chronic wound care last?
Can a relative change the dressing between visits?
Why does healing sometimes stall for weeks?
Do you photograph the wound?
Terms explained
- Pressure sore
- Damage to skin and tissue caused by prolonged pressure on a support area (sacrum, heels, hips), common with immobility.
- Prescription
- A doctor's written order stating the procedure, frequency and duration. Without it, nursing care cannot be delivered or reimbursed, apart from procedures allowed in direct access.
- Care protocol
- A written, dated description of how a specific patient's care must be delivered: products, supplies, frequency, alert criteria.
- Handover notes
- The written record of a visit: what was done, what was observed, what must be watched. The shared memory of the care episode.
- Sharps waste (DASRI)
- Infectious healthcare waste — needles, syringes, lancets — collected in an approved yellow container, never in household waste.
- Long-term condition (ALD)
- A chronic condition recognised by French health insurance, granting 100 % cover for care related to that condition.
Official sources
What we write is based on public references you can check for yourself.
This page is informational and replaces neither a medical consultation nor a prescription.