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MAGGOT THERAPY- the words caught my attention as I scanned the kardex on the surgical unit, looking for clinical assignments for junior nursing students. It was always a challenge to connect the right student with the right patient. I selected Amy because she would have the critical thinking skills plus the genuine compassion needed to meet the complex needs of Flora, an eighty-five-year-old lady with bilateral gangrene of the lower extremities, secondary to diabetes mellitus.

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Flora's many health problems would have challenged even the most experienced nurse, let alone a student. Flora also had congestive heart failure, pneumonia, impaired hearing, confusion and a history of cerebrovascular accident. She was on strict contact isolation due to methicillin resistant staph aureus (MRSA). I copied the article on maggot therapy from the kardex and realized that I, like my student, had some clinical preparation to do for the next day.


Maggot therapy has been around since the Civil War, but its use has diminished with the dawn of the antibiotic age. However, with the growing problem of antibiotic resistant organisms, health care is taking a new look at an old remedy. The purpose of the maggot therapy for Flora was to debride the stasis ulcers on both lower extremities so that a partial amputation could be done. By controlling the degree of infection preoperatively, Flora's chances for postoperative healing would increase.


The sterile maggots supplied by the hospital pharmacy were placed under a secure hydrogel dressing by Flora's physician. Lucilia sericata is the species of fly usually used in larval therapy to debride a wound. The larvae are produced commercially under sterile conditions to ingest the wound bacteria and exert a broad-spectrum antibacterial action. The larvae are useful against MRSA. These larvae devour the dead tissue from the wound and digest it by a variety of enzymes the larvae produced.1


Amy came to clinical well prepared but with some obvious apprehension. As she shared her plan of care for Flora in pre-conference, her peers encouraged her as she started this unique experience. Amy donned a gown, gloves and mask before entering Flora's room to do her initial nursing assessment. The usual morning care followed: breakfast, medication administration, bathing and tedious dressing changes. As I worked side-by-side with Amy, I observed with pride the care routine she implemented. Flora had many individual needs, and I watched Amy address each of them.


Flora was hearing impaired, but Amy leaned close to Flora and spoke clearly in her ear. Flora chewed her food slowly, but Amy deliberately helped Flora take each bite of her breakfast, a process that took over thirty minutes. Flora was afraid and in pain, so Amy used caring touch, holding Flora's hand, combing her hair and massaging her skin. Flora said she couldn't remember when her family last visited, so Amy read her greeting cards to her and listened as Flora reminisced about family. Flora was socially isolated, so Amy opened the curtains to let Flora feel the warmth of the sun and see the activities outside her window.


Flora was confused, secondary to sleep deprivation. Amy outlined a plan of care in the kardex to establish a bedtime routine for Flora-dimming the bright lights at night, turning off the TV and creating an environment conducive to sleep.


Flora refused to take her medications. I watched Amy painstakingly help Flora with each pill, even calling the pharmacy to get liquid meds where possible. By the end of the fortyminute "med routine," Flora had taken all of them willingly.


Flora dreaded the painful dressing changes to her lower extremities. Amy carefully explained each step in the process and used strategies to minimize Flora's pain. When a wandering maggot escaped from under the edge of the dressing, Amy unobtrusively and without comment removed it.


Amy seemed weary when she came out of the room after morning care, sweat matting the hair around her face as she sat down for the first time in two hours. She was catching up on her charting as I left to check on my other students.


When I returned later to see how Amy was doing, she was gone. Surely she wasn't back in the isolation room!! I opened the door a crack to see Amy sitting by Flora's bed, holding her hand.


What would make Amy go back into that hot isolation room, donning gown, gloves and mask, enduring the claustrophobic odor of wounds, when she certainly had already given this patient more than was expected of her? When asked this question later, Amy replied, "I saw Jesus going back into that isolation room to bring comfort to a lonely woman, but I knew Flora would not be able to see him, so I went instead."


Epilogue: This experience occurred in 2002 with a junior nursing student, Amy Morris, at Indiana Wesleyan University. Amy was presented with a Servant Leadership Award for her demonstration of servant leadership. The spirit she showed with Flora was, in part, the basis for her selection to receive the award.


1 Steven Thomas, Mary Jones, Simon Shutler and S. Jones, (n.d.), "Maggots in Wound Debridement-An Introduction," retrieved March 10, 2002 from [Context Link]