Wound healing is a fundamental aspect of patient care, particularly in nursing practice (Ghaly et al, 2021). This complex process comprises several stages – haemostasis, inflammation, proliferation, and remodelling – each dependent on specific nutrients to facilitate tissue repair and regeneration (Carr, 2022). This article explores the role of nutrition in wound healing, focusing on key nutrients, their physiological functions, and practical strategies for incorporating nutritional care into nursing practice. It also highlights that supplementation may not always provide additional benefits unless addressing specific deficiencies.
Although the importance of nutrition in wound healing is widely recognised, and there is strong evidence in the context of pressure injuries (Daher et al, 2022; Manley and Mitchell, 2022; Munoz and Posthauer, 2022; Langer et al, 2024), evidence outside this context remains limited.
The physiology of wound healing
Wound healing progresses through four overlapping stages: haemostasis, inflammation, proliferation, and remodelling (Yang et al, 2021). Appropriate nutrition is vital during each of these stages to sustain cellular activity, promote tissue formation, and enhance immune function. Although the importance of nutrients in wound healing is well-established, their precise effects on different wound types are not yet fully understood.
Haemostasis, the first stage, involves blood clotting to prevent excessive bleeding (LaPelusa, 2023). This phase relies on sufficient levels of vitamin K and calcium. The inflammatory phase recruits immune cells to combat infection, with adequate protein intake and omega-3 fatty acids playing critical roles in modulating inflammation. During the proliferation phase, protein – particularly sources of amino acids such as arginine and glutamine – is vital for collagen synthesis (Peate and Evans, 2020). However, some studies suggest that arginine supplementation alone may not provide consistent benefits in wound healing (Schneider and Yahia, 2019). In addition, vitamin C and zinc act as crucial co-factors in collagen production. The remodelling phase involves the maturation and strengthening of new tissue, with collagen continuing to be a central component (Peate and Evans, 2020). Micronutrients such as copper and manganese facilitate collagen cross-linking, which enhances tissue integrity and resilience (Penny et al, 2022).
Key nutrients in wound healing
Protein
Protein is essential for collagen synthesis, immune function, and cell proliferation (Peate and Evans, 2020). Patients with wounds often require increased protein intake. However, although protein deficiency impairs healing, supplementation in the absence of deficiency may not guarantee additional benefits for all patients (Alam et al, 2021). High-quality protein sources include lean meats, dairy products, and legumes (Soh et al, 2024).
In addition to overall protein intake, specific amino acids such as leucine and glutamine play critical roles in wound healing. Leucine is involved in the mTOR pathway, which regulates protein synthesis and muscle recovery, making it especially important for patients at risk of muscle wasting (Xu et al, 2023). Glutamine supports immune cell function and has been associated with shorter hospital stays when supplemented in critically ill patients (Arribas-López et al, 2021).
Vitamins
Vitamins are vital for wound healing due to their diverse physiological roles (Ghaly et al, 2021). Vitamin A promotes epithelialisation and enhances immune function, with sources including liver, fish, and carrots (Peate and Evans, 2020). Vitamin C, found in foods including citrus fruits and bell peppers, is crucial for collagen synthesis (Bechara et al, 2022), while vitamin E acts as an antioxidant. Vitamin K supports clotting and is essential during the haemostasis phase (Popa et al, 2021).
Recent studies have highlighted the importance of vitamin D in wound healing, particularly for patients with orthopaedic conditions and chronic wounds (Maier et al, 2021). Vitamin D deficiency has been linked to delayed healing times and an increased risk of infection due to its regulatory effects on the immune system and calcium metabolism, particularly in patients with diabetes (De Martinis et al, 2021; Wimalawansa, 2023). Supplementation is recommended for those with low vitamin D levels (Grada and Phillips, 2022), although further research is needed to establish optimal dosage and duration for wound management.
Minerals
Minerals such as zinc, iron, and copper are crucial for wound healing (Nosewicz et al, 2022). Zinc supports immune function and collagen formation, while iron is necessary for oxygen transport. Copper facilitates collagen cross-linking, which enhances tissue integrity.
Selenium, an antioxidant trace mineral, has been shown to reduce oxidative stress and improve immune responses in wound healing (Vaghari-Tabari et al, 2021) Selenium deficiency is associated with impaired wound recovery, and supplementation in deficient patients can inhibit bacterial growth and improve outcomes.
Omega-3 fatty acids
Omega-3 fatty acids exhibit anti-inflammatory properties, which can help reduce excessive inflammatory responses during the wound healing process (Kavyani et al, 2022). Dietary sources of omega-3 include oily fish and flaxseeds.
Practical strategies for nurses
Nutritional assessment
Nurses play a crucial role in evaluating the nutritional status of patients, often employing validated tools to guide their assessments. The Malnutrition Universal Screening Tool (MUST), developed by BAPEN, is widely used to identify malnutrition risk and establish appropriate interventions (Malnutrition Advisory Group, 2003; Serón-Arbeloa et al, 2022). When time constraints exist, alternative tools such as the Short Nutritional Assessment Questionnaire (SNAQ) can be used for a quicker assessment of nutritional risk. These tools provide an effective means for nurses to prioritise care and support optimal wound healing outcomes. However, SNAQ is often considered more generic and less specific compared with other nutritional screening methods (Karahan Yilaz and Eskici, 2023).
Advanced tools, such as bioelectrical impedance analysis (BIA), are increasingly used in clinical settings to offer rapid and reliable measurements of body composition. BIA provides insights into fat mass, muscle mass, and hydration status, making it particularly valuable for patients at risk of malnutrition or sarcopenia. These insights enable nurses to develop more tailored nutritional interventions (Son et al, 2025).
Psychological factors and nutritional adherence in wound healing
Psychological health is a critical but often overlooked factor influencing nutritional adherence and wound healing outcomes. Stress, anxiety, and depression can significantly impair a patient's ability to maintain proper nutritional intake, which may delay the wound healing process. Research shows that elevated stress levels increase cortisol production, which can suppress the immune system, reduce the body's ability to fight infections, and slow tissue repair (Cheng et al, 2021).
Patients with chronic wounds often experience reduced appetite and gastrointestinal issues related to stress, further hindering their ability to consume essential nutrients (Grada and Phillips, 2022; Penny et al, 2022). Addressing these psychological factors is essential for ensuring effective nutritional interventions. Mental health support, such as counselling or mindfulness-based stress reduction techniques, can improve a patient's adherence to nutritional recommendations and enhance overall wound healing outcomes.
Nurses can collaborate with psychologists and other health professionals to provide holistic care that addresses both the physical and mental health of the patient. By incorporating mental health strategies into the care plan, nurses can help optimise both nutritional intake and wound healing processes.
The role of hydration in wound healing
Hydration is a critical yet often underestimated factor in wound healing. Proper hydration supports skin elasticity, enhances blood circulation, and ensures the efficient transport of nutrients to the wound site (Peate and Evans, 2020). Dehydration can impair tissue perfusion, delay collagen synthesis, and weaken immune responses, all of which are essential for effective wound healing (Yang et al, 2021). This is particularly important for older adults, who are at higher risk of dehydration due to a diminished thirst response and potential comorbidities.
Nurses play a vital role in assessing hydration status by identifying signs of dehydration, such as dry skin, reduced urine output, and confusion. They should encourage patients to maintain adequate fluid intake and consider intravenous hydration in severe cases (Peate and Wild, 2017). Adequate hydration is crucial for overall health and directly supports wound healing by promoting adequate blood flow, oxygenation, and nutrient delivery to the wound site. In patients with complex wounds or burns, dehydration can exacerbate tissue damage, impair immune responses, and delay the healing process due to reduced cellular activity and moisture at the wound bed (Abazari et al, 2022). Therefore, maintaining optimal hydration is essential to support recovery in these vulnerable patients.
Implementing nutritional interventions
Nutritional interventions should be personalised, considering the patient's specific needs and circumstances. Recommendations should focus on nutrient-dense foods and, where appropriate, supplementation. In time-constrained clinical settings, nurses can utilise mobile apps and validated protocols to perform quick yet effective assessments. Oral nutritional supplements containing key nutrients like protein and arginine may also be beneficial, although their efficacy may be limited in the absence of nutrient deficiencies (Daher et al, 2022).
Patient and caregiver education
Educating patients and caregivers about the role of nutrition in wound healing is essential. Nurses should use evidence-based, up-to-date resources and guidelines and seek support from a dietitian when available. Educational tools, such as tailored meal plans, can further enhance adherence by aligning with individual preferences and lifestyles. By empowering patients and caregivers with practical knowledge, nurses can improve nutritional intake and optimise wound healing outcomes.
Conclusion
Nutrition plays a critical role in wound healing, influencing both the speed and quality of recovery. Although the evidence is strong for pressure injuries, research gaps remain for other wound types, such as venous leg ulcers. The role of specific nutrients, including arginine, remains inconclusive when used in isolation, highlighting the need for further investigation. In addition, the safety and efficacy of nutritional supplements must be carefully considered, as excessive use or low-quality products can pose risks.
Nurses are pivotal in assessing, implementing, and monitoring nutritional interventions. Through personalised care, education, and collaboration with dietitians, nurses can optimise patient outcomes. A holistic approach that integrates nutritional strategies not only enhances wound recovery but also supports patients' overall health. Further research is essential to expand evidence-based practices and improve care across diverse wound types.