In Episode 5 of Healing By Design, hosts Jennifer Bierhup and Therese Laub are joined by wound care experts Diane Krasner, Jeanine Maguire, and Beatriz Coccaro-Word for an important conversation about skin failure, pressure injuries, and the need for greater clarity in how clinicians assess, diagnose, document, and communicate these conditions.

The discussion explores one of the most challenging questions in wound care: when is skin breakdown truly a pressure injury, and when is the skin itself beginning to fail?

Drawing from clinical experience, research, advocacy, and real patient cases, the group examines why clinicians must look beyond the wound itself and consider the whole patient. Perfusion, nutrition, mobility, chronic disease, organ failure, medications, and overall clinical decline can all change how a wound should be understood and treated.

They also discuss the difference between skin failure and unavoidable pressure injuries, the importance of accurate provider documentation, conversations with patients and families, and PAWSIC's ongoing advocacy for dedicated ICD 10 codes for skin failure.

At the center of the conversation is a shared goal: making sure the right diagnosis leads to the right care.

In this episode:

• Skin failure vs. pressure injury
• Why clinicians need to assess the whole patient
• Acute, chronic, and end stage skin failure
• Avoidable and unavoidable pressure injuries
• The role of perfusion, nutrition, organ failure, and comorbidities
• Why provider diagnosis and documentation matter
• Communicating skin failure with patients and families
• The potential impact of dedicated ICD 10 codes
• Education and implementation across the continuum of care
• PAWSIC's ongoing advocacy for recognition of skin failure

WHITE PAPER AVAILABLE SEPTEMBER 15

This episode coincides with the release of PAWSIC's new position paper on skin failure, bringing together the evidence, clinical perspective, and rationale behind the need for greater recognition and dedicated coding of skin failure.

The paper takes a deeper look at why accurate diagnosis matters, the implications across clinical, regulatory, and legal settings, and the work being done to move skin failure recognition forward.

Read the Skin Failure Position Paper beginning September 15:
https://pawsic.org/skin-failure-position-paper/read/

Healing By Design is a podcast powered by PAWSIC that explores the people, processes, and perspectives shaping better outcomes across the continuum of care.

When the Skin Begins to Fail | Diane Krasner, Jeanine Maguire & Beatriz Coccaro Word | Healing By Design EP5

In Episode 4 of Healing By Design, hosts Jennifer Bierhup and Therese Laub sit down with wound care leader Alicia Bobak to explore one of the biggest challenges facing healthcare today: the lack of standardized wound care education.

Drawing from years of experience leading wound care programs, educating clinicians, and consulting across post-acute care, Alicia shares why education cannot stop after graduation. Together, they discuss the barriers clinicians face, including limited training, time constraints, reimbursement challenges, and the overwhelming number of products and educational resources available today.

The conversation also examines the role of collaboration, accountability, and critical thinking in wound care, emphasizing that successful patient outcomes require far more than choosing the right dressing. From nursing school curriculum to bedside decision-making, this episode challenges healthcare professionals to rethink how wound care education is taught, applied, and prioritized.

Whether you're a nurse, nurse practitioner, physician, therapist, administrator, or healthcare leader, this episode offers practical insights into building stronger clinical knowledge and improving patient outcomes through lifelong learning.

In this episode:

• Why wound care education lacks standardization
• The education gap in nursing and medical training
• The importance of interdisciplinary collaboration
• Common barriers clinicians face, including time and reimbursement
• Why critical thinking matters more than dressings alone
• AI, templates, and the future of wound care education
• Building accountability through lifelong learning
• Improving patient outcomes through better education

Healing By Design is a podcast powered by PAWSIC that explores the people, processes, and perspectives shaping better outcomes across the continuum of care.

The Education Crisis in Wound Care | Alicia Bobak | Healing By Design EP4

What can healthcare providers learn when they stop talking and start listening to the patient?

In Episode 3 of Healing By Design, hosts Jennifer Bierhup and Therese Laub sit down with Joe Balusik to discuss his journey following a spinal cord injury that changed his life overnight. After decades of living with paralysis and navigating chronic wounds, Joe shares the lessons he's learned from both the patient chair and the healing journey that followed.

Joe reflects on rebuilding his life, overcoming pressure injuries, and the partnership he developed with his wound care team. Through humor, resilience, and honesty, he offers a perspective that every clinician, caregiver, and healthcare leader should hear.

Together, they explore the importance of patient engagement, communication, trust, and why successful wound healing depends on treating the whole person, not just the wound.

This conversation is a powerful reminder that the patient perspective is one of the most valuable tools in healthcare, and that healing happens best when patients and providers work as one team.

In this episode:

• Joe's spinal cord injury and life changing diagnosis
• Living with paralysis and chronic wounds
• The patient perspective on wound healing
• Building trust between patients and providers
• The role of communication and education in healing
• Resilience, humor, and maintaining hope
• Why healing is a partnership

Healing By Design is a podcast powered by PAWSIC that explores the people, processes, and perspectives shaping better outcomes across the continuum of care.

Healing is a Partnership | Joe Balusik's Story | Healing By Design EP3

What happens when the healthcare professionals who spend the most time with patients are often the last to be included in the conversation?

In this episode of Healing By Design, host Jennifer Bierhup sits down with Certified Nursing Assistant, healthcare advocate, and PAWSIC Board Member Isaac Zralii to discuss the critical role CNAs play in patient care, wound prevention, and preserving skin integrity across the continuum of care.

Drawing from more than 21 years of experience in acute care, long-term care, behavioral health, rehabilitation, and COVID relief efforts, Isaac shares a perspective that is rarely heard in healthcare leadership discussions. As the first CNA to serve on the PAWSIC Board of Directors, he brings valuable insight into the challenges, opportunities, and realities facing frontline caregivers every day.

Together, Jennifer and Isaac explore why CNAs are often overlooked in healthcare conversations, the communication barriers that exist between nursing assistants and nursing staff, and how education can empower CNAs to identify changes in patient condition before they become serious complications.

This conversation is a powerful reminder that improving patient outcomes requires listening to the people who spend the most time at the bedside. From early wound identification to preserving skin integrity and preventing avoidable complications, CNAs are often the first line of defense in protecting patient health.

In this episode:

• Isaac's journey to becoming a Certified Nursing Assistant

• Why CNAs are often overlooked in healthcare discussions

• The communication gap between nurses and nursing assistants

• The role of CNAs in wound prevention and skin integrity

• Why frontline caregivers need better wound care education

• Burnout, staffing challenges, and patient ratios

• The concept of the CNA as the "ultimate observer."

• Creating pathways for early wound identification

• Building stronger interdisciplinary care teams

• What healthcare leaders need to understand about CNAs

Interested in supporting CNA advocacy and recognition? Explore the official PAWSIC CNA Collection and help celebrate the frontline caregivers who play a vital role in patient care every day.

Shop the CNA Collection:
https://pawsic-shop.printify.me/collection/cna

Healing By Design is a podcast powered by PAWSIC that explores the people, processes, and perspectives shaping better outcomes across the continuum of care.

Why CNAs Matter in Wound Care | Isaac Zralii on Frontline Patient Care | Healing By Design EP 2

What happens when a patient spends more than three decades searching for answers?

In the premiere episode of Healing By Design, hosts Jennifer Bierhup and Therese Laub sit down with patient advocate Amy Rivera to discuss her extraordinary journey living with primary lymphedema. After 32 years of misdiagnoses, unanswered questions, and navigating a fragmented healthcare system, Amy finally received the diagnosis that changed everything.

Amy shares the realities of living with a chronic condition, the emotional toll of not being believed, and how her personal experience led her to become a nationally recognized advocate for individuals living with lymphedema and other chronic conditions.

Together, they explore the importance of patient voice, self-advocacy, care coordination, and why healthcare outcomes often depend on what happens between providers, care settings, and transitions throughout the continuum of care.

This conversation is a powerful reminder that healing is about more than treatment. It is about understanding, collaboration, and ensuring that no patient falls through the cracks.

In this episode:

• Amy's 32-year journey to diagnosis
• Living with primary lymphedema
• The impact of delayed and missed diagnoses
• Patient advocacy and empowerment
• Navigating complex healthcare systems
• The importance of care coordination and communication
• Finding purpose through lived experience

Healing By Design is a podcast powered by PAWSIC that explores the people, processes, and perspectives shaping better outcomes across the continuum of care.

32 Years Without a Diagnosis | Amy Rivera's Lymphedema Journey | Healing By Design EP 1

Post-Acute Wound & Skin Integrity Council (@max_bierhup) · Zencastr

Post-Acute Wound & Skin Integrity Council (@max_bierhup)

Healing By Design, hosted by Jennifer Bierhup and Therese Laub and powered by PAWSIC, is a podcast dedicated to elevating wound care through education, collaboration, and real conversation.

Each episode brings together clinicians, industry leaders, and patients to explore the full spectrum of chronic wound management. From evidence based strategies and interdisciplinary care models to the lived experience of navigating the healthcare system, the show examines healing from every angle.

Jennifer and Therese combine clinical insight with thoughtful dialogue, creating space for both professional expertise and patient perspective. By addressing rehospitalization risk, system gaps, access to care, and the realities faced by individuals living with chronic wounds, Healing By Design highlights what it truly takes to improve outcomes in today’s complex medical landscape.

This is where science meets humanity, and where better care begins with better understanding.

Because healing is never accidental.
It is intentional. It is collaborative. It is designed.