Wound care evidence, knowledge and education amongst nurses: a semi-systematic literature review

Patient Participation in Acute Surgical Wound Care: A Descriptive Qualitative Study

AIM

To explore patients' experiences of participation in surgical wound care and provide an in-depth understanding of their experiences with post-operative wound care during and post-hospitalisation.

DESIGN

A descriptive qualitative study.

METHODS

Adult participants who had undergone surgery within 30 days were purposively selected from two surgical wards at Gold Coast University Hospital. Seventeen semi-structured phone interviews were conducted using a specifically developed and piloted interview guide. Textual data were analysed using inductive content analysis.

RESULTS

Three main categories were identified. The first category, 'I didn't expect how distressing post-operative wound care would be; it's tougher than I thought,' highlights the significant and unexpected physical and emotional challenges participants faced, which initially hindered their engagement. The second category highlights the impact of healthcare professional interactions on patient participation, 'I want to be involved, but conflicting advice and dismissive behaviour discourage me.' The third category, 'With my family's help, wound care got easier as I tried, learned, and recovered,' illustrates how family support facilitated participants' independence and engagement over time.

CONCLUSIONS

The spectrum of patient participation in surgical wound care is dynamic and impacted by environmental, physical and psychological factors. This research deepens understanding of patient participation by highlighting the importance of family support and a temporal perspective in patients' wound care journeys.

IMPACT

Findings showed participants were unprepared for surgical wound care, greatly influenced by healthcare provider communication and family support, and evolved in participation as time passed and their wounds healed. Additionally, participants valued intent just as significantly as their behaviours and regarded even minor involvement as totally participative. These insights can inform strategies to improve patient participation in surgical settings.

REPORTING METHOD

SRQR (Standards for Reporting Qualitative Research).

PATIENT AND PUBLIC CONTRIBUTION

No patient was involved in this study.

Healing beyond the surface: Empathy's role in chronic wound care a qualitative study

AIM

This study aimed to investigate health professionals' perceptions of the impact of empathy on healing outcomes, patient satisfaction and delivery of wound care.

MATERIALS AND METHODS

A descriptive qualitative approach was used, employing semi-structured face-to-face interviews with 10 healthcare professionals specializing in wound care in Australia. Participants were purposively sampled, and interviews lasted between 22 and 47 min. Data collection concluded upon achieving saturation. Interviews were transcribed verbatim using CORV, a secured transcription tool, and analyzed using Braun and Clarke's six-phase thematic framework. Rigor was ensured by employing COREQ guidelines, triangulating data analysis, and including direct quotes for confirmability.

RESULTS

Three key themes emerged: (1) Empathy as a Foundation for Trust, Engagement, and Collaboration where participants emphasized that empathy promotes trust, improves patient adherence, and aligns treatment goals. (2) The Dual Role of Empathy in Addressing Emotional and Physical Barriers to Healing where empathetic care alleviated psychological distress, built resilience, and improved adherence to care regimens. (3) Barriers and Facilitators to Empathy in Wound Care where time constraints, emotional fatigue, and cultural differences were identified as barriers, while mentorship, training, and supportive environments facilitated empathetic care.

CONCLUSION

Health professionals considered empathy to be a critical factor in enhancing patient satisfaction and supporting healing outcomes in wound care. By providing trust, addressing emotional barriers, and aligning care with patient needs, empathy plays a meaningful role in the care process. Additionally, addressing systemic barriers and thoughtfully integrating empathy training into clinical practice can contribute to improved outcomes in chronic wound management.

Nurses' and Nursing students' perceptions of their knowledge and satisfaction in managing wound infections: A cross-sectional study

OBJECTIVE

To analyze the perception and satisfaction of nurses and nursing students regarding their knowledge of the clinical management of infected wounds in Spain.

METHODS

A cross-sectional descriptive study was conducted using an ad hoc questionnaire with 18 questions on knowledge of infected wounds, divided into three sections, and was distributed electronically to nurses and nursing students over a two-month period. The questionnaire was piloted with a group of nurses and students, and data were collected anonymously and voluntarily.

RESULTS

A total of 520 completed questionnaires were collected, including 158 from professionals and 362 from students. Professionals demonstrated a significantly higher average knowledge score than students (4.7 ± 0.13 vs 3.8 ± 0.09; p < 0.001). Students performed worse in questions related to biofilm and assessment of subtle and manifest signs of infection in wounds. Specifically, only 45% of students correctly identified the role of bacterial biofilm in wound infections. Significant differences were observed in various items (p < 0.05) favoring non-clinical professionals over clinical professionals, particularly regarding biofilm and the use of topical antiseptics. Overall, professionals expressed significant satisfaction with their knowledge compared to students (p < 0.05).

CONCLUSION

Nursing professionals, especially those with teaching, research, and/or managerial roles, demonstrate a greater perception of knowledge in specific areas. However, both professionals and students exhibit gaps in perceived knowledge regarding the management of wound infections, highlighting the importance of continuous education and the review of teaching strategies to address these deficiencies. Implementing a specific mandatory subject is suggested to ensure the quality of nursing education in this area from undergraduate level.

Wound Care Education in Undergraduate and Graduate Nursing Settings

Chronic wounds are a significant global health issue, yet they are not adequately addressed in nursing education. This lack of focus results in nursing students graduating with insufficient knowledge in chronic wound care, leading to inadequate clinical practice. Consequently, nurses often struggle to manage wounds effectively, which negatively impacts patient care quality. To address this, it is crucial to enhance the nursing curriculum by incorporating more comprehensive content on chronic wound management. This will help ensure that nurses are better equipped with the necessary clinical competencies, ultimately improving patient outcomes.

Knowledge in the Area of Prevention and Treatment of Pressure Injuries Among Nurses: Report from the Study

Introduction: Pressure injuries represent a significant issue in nursing care, with prevalence rates ranging from 5 to 27% among hospitalized patients and 3-32% in long-term care settings. Nurses' knowledge of pressure injury prevention and treatment plays a crucial role in reducing their incidence. Objective: The aim of this study was to assess nurses' knowledge of pressure injury prevention and treatment, taking into account their professional and postgraduate education, self-directed learning activities, and interest in wound care. Materials and Methods: This study included 500 nurses working in hospital wards and primary healthcare settings who participated in specialized nursing training programs. The Pieper-Zulkowski Pressure Ulcer Knowledge Test (PZ-PUKT), in its 2021 version and adapted into Polish was used to assess the nurses' knowledge. The main study was conducted over five months, from March to July 2024. Results: This study revealed that nurses' knowledge of pressure injury prevention and treatment was above average, with a mean score of 49.6 ± 5.2. Conclusions: The level of knowledge among the nurses assessed using the Polish version of the PZ-PUKT was above average. The PZ-PUKT test can be a useful tool for evaluating pressure injury knowledge among both nursing students and employed nurses and may serve as a means for identifying knowledge gaps in pressure injury prevention and treatment.

The Wound Care Pathway: a Danish effect study

AIMS

To investigate how the implementation and training in the WCP affects the behaviour of generalist nurses, focusing on four specific endpoints: motivation, confidence, critical thinking and knowledge.

METHODS

A total of 89 generalist nurses received 6 hours of training in the WCP, over a period of 10-16 weeks. The participants filled a questionnaire before and after the training. Data were collected between January 2023 and January 2024.

FINDINGS

There was a significant improvement in the participants' wound care knowledge, motivation and self-efficacy. The participants' confidence in their wound care skills also increased after the training. A notable improvement was seen in nurses' critical thinking when treating wounds and delivering wound care.

CONCLUSIONS

The WCP guide supports healthcare professionals in their day-to-day work and strengthens their critical thinking and knowledge of wound care management.

An inter-assessor reliability study on the categorization and staging of pressure injuries

BACKGROUND

The first step in effective management of pressure injuries (PIs) is to assess, categorize and stage correctly.

PURPOSE

This study aims to examine the agreement regarding the classification and staging of PIs among nurse academicians working on chronic wounds and with different stage of expertise.

METHODS

Three nurse academicians were assigned as assessors according to Benner's stages of clinical competence (Competent, Proficient, and Expert). The assessors independently evaluated PIs photographs (n = 694). The assessors then met for the wounds where there was disagreement, and a Consensus agreement was reached. Kappa Statistics analysed the agreement between two assessors; Fleiss Kappa Statistics analysed the agreement between Competent, Proficient, Expert, and Consensus.

RESULTS

Statistically, almost perfect agreement was obtained between Competent, Proficient, Expert, and Consensus assessments, respectively (Ƙ = 0.871; p < 0.001, Ƙ = 0.842; p < 0.001, Ƙ = 0.937; p < 0.001). The highest agreement between the assessors were Unstageable PIs, Deep Tissue PIs, and Stage 3 PIs respectively. The most common disagreements were between Deep Tissue PIs and Stage 1 PIs, and between Deep Tissue PIs and Stage 2 PIs.

CONCLUSION

In the study, it was found that the categorization, and staging of PIs had varying degrees of reliability among the assesors, although at a statistically acceptable level.

In-Person and Video-Based Education: Do They Affect Pressure Injury Knowledge in Nursing?

OBJECTIVE

To determine how training on the nursing care of pressure injuries (PIs) affects knowledge levels and satisfaction.

METHODS

This study was semiexperimental, conducted in the form of a pretest and posttest in one group of 105 nurses working in a training and research hospital. The training took place in person and via video. All nurses included in the study group first received in-person training in 15-person groups followed by weekly video training for 4 consecutive weeks. Before training, investigators assessed the nurses' PI knowledge using the Nurses' Knowledge Level Assessment for PI Care (NKLAPIC; pretest). After the in-person module (posttest 1) and video-based module (posttest 2), investigators provided the NKLAPIC again. The independent-sample test, one-way analysis of variance, repeated-test-measures analysis of variance, Bonferroni test, and pairwise comparisons were used in data analysis.

RESULTS

Mean NKLAPIC scores were 47.71 ± 13.5 (out of 100 points) at pretraining, 68.5 ± 12.32 after the in-person training, and peaked at 72.38 ± 4.74 after video-based training (P < .001). Video-based training appeared to lead to a larger increase in knowledge levels than in-person training alone (P < .001). Further, although the average satisfaction score given to the in-person training was 3.97 ± 0.93, the same score for the online training was 4.12 ± 0.95 (P > .05).

CONCLUSIONS

Outcomes suggest that in-person training and video-based training regarding PI care improve the knowledge levels of nurses.

Standardized Wound Care: Patchwork Practices?

Standardized care is crucial in health care for ensuring consistent, safe, high-quality, efficient, and evidence-based practices. Care pathways that standardize procedures promote adherence to best practices, reduce variability in treatment, and encourage collaboration among health care teams. This approach ultimately improves patient outcomes, enhances safety, and boosts the overall effectiveness of health care services. However, despite these benefits being widespread across most of the U.S. health care system, wound care stands out as an area where standards can vary significantly. The inconsistency in wound care standards in the United States can be traced to several factors. These include limited structured clinical wound care education, the discretion of health care providers in different business environments, differences in wound care settings, varying access to advanced treatments and technology, patient demographics and socioeconomic status, as well as differences in state laws and regional or institutional practices. Addressing these disparities requires a comprehensive approach that considers the complex interplay of the abovementioned factors. Active measures are needed to improve access, equity, and the quality of wound care services for all patients, regardless of where they live, their socioeconomic status, their health care coverage, or the business interests of providers and their institutions as well as of vendors marketing wound care products inconsistent with evidence-based practice. By understanding and actively addressing these factors, we can work toward achieving more standardized, evidence-based, and patient-centered practices in wound care across the nation.

Co-creation and evaluation of an algorithm for the development of a mobile application for wound care among new graduate nurses: A mixed methods study

Chronic wounds are a growing concern due to aging populations, sedentary lifestyles and increasing rates of obesity and chronic diseases. The impact of such wounds is felt worldwide, posing a considerable clinical, environmental and socioeconomic challenge and impacting the quality of life. The increasing complexity of care requires a holistic approach, along with extensive knowledge and skills. The challenge experienced by health-care professionals is particularly significant for newly graduate nurses, who face a gap between theory and practice. Digital tools, such as mobile applications, can support wound care by facilitating more precise assessments, early treatment, complication prevention and better outcomes. They also aid in clinical decision-making and improve healthcare delivery in remote areas. Several mobile applications have emerged to enhance wound care. However, there are no applications dedicated to newly graduate nurses. The aim of this study was to co-create and evaluate an algorithm for the development of a wound care mobile application supporting clinical decisions for new graduate nurses. The development of this mobile application is envisioned to improve knowledge application and facilitate evidence-based practice. This study is part of a multiphase project that adopted a pragmatic epistemological approach, using the 'Knowledge-to-Action' conceptual model and Duchscher's Stages of Transition Theory. Following a scoping review, an expert consensus, and stakeholder meetings, this study was pursued through a sequential exploratory mixed methods design carried out in two phases. In the initial phase, 21 participants engaged in semi-structured focus groups to explore their needs regarding clinical decision support in wound care, explore their perceptions of the future mobile application's content and identify and categorize essential components. Through descriptive analysis, five overarching themes emerged, serving as guiding principles for conceptual data model development and refinement. These findings confirmed the significance of integrating a comprehensive glossary complemented by photos, ensuring compatibility between the mobile application and existing documentation systems, and providing quick access to information to avoid burdening work routines. Subsequently, the algorithm was created from the qualitative data collected. The second phase involved presenting an online SurveyMonkey® questionnaire to 34 participants who were not part of the initial phase to quantitatively measure the usability of this algorithm among future users. This phase revealed very positive feedback regarding the usability [score of 6.33 (±0.19) on a scale of 1-7], which reinforces its quality. The technology maturation process can now continue with the development of a prototype and subsequent validation in a laboratory setting.

Harnessing Cannabis sativa Oil for Enhanced Skin Wound Healing: The Role of Reactive Oxygen Species Regulation

Cannabis sativa emerges as a noteworthy candidate for its medicinal potential, particularly in wound healing. This review article explores the efficacy of cannabis oil in reducing reactive oxygen species (ROS) during the healing of acute and chronic wounds, comparing it to the standard treatments. ROS, produced from various internal and external sources, play a crucial role in wound development by causing cell and tissue damage. Understanding the role of ROS on skin wounds is essential, as they act both as signaling molecules and contributors to oxidative damage. Cannabis oil, recognized for its antioxidant properties, may help mitigate oxidative damage by scavenging ROS and upregulating antioxidative mechanisms, potentially enhancing wound healing. This review emphasizes ongoing research and the future potential of cannabis oil in dermatological treatments, highlighted through clinical studies and patent updates. Despite its promising benefits, optimizing cannabis oil formulations for therapeutic applications remains a challenge, underscoring the need for further research to realize its medicinal capabilities in wounds.

An expanded focus in advanced wound care for geriatric emergency management nursing: a case study analysis

Geriatric emergency management (GEM) nursing has emerged as a critical response to the increasing number of emergency department (ED) visits by older people, particularly in North America and specifically in Canada. This demographic often presents with complex medical conditions and atypical disease manifestations. The GEM programme, implemented in Ontario, Canada, aims to provide targeted assessment and establish community connections for frail older individuals, helping prevent their decline and loss of independence. There is a significant demand for specialised wound care services in EDs and frontline ED staff have a limited capacity to provide these. Advanced wound management was integrated into the GEM nursing scope of practice in an initiative. Patients who received wound care from GEM nurses and clinical nurse specialists had positive outcomes; those treated by GEM nurses had shorter wait times. Although the wound care role requires additional training and adds to the GEM nurse workload, the advantages appear substantial. Merging geriatric-focused care with specialist wound management may significantly benefit the care and satisfaction of older people attending the ED, as well as improve patient flow in the ED. This initiative requires further consideration by healthcare leaders and policymakers.

A survey of UK nurses about their care of people with malignant fungating wounds

PURPOSE

To gain an understanding of the nursing professionals who treat people with malignant fungating wounds (MFW) in the UK and their current practices, including perceived barriers and facilitators to providing MFW care.

METHOD

An online anonymous questionnaire was created with questions about the role of nursing professionals who reported caring for patients with MFW, the number of people with MFW they regularly cared for, treatment aims, treatments used, and challenges faced. These questions were developed with professional input and piloted. Using a convenience sampling method, we collected responses from UK nurses by distributing the questionnaire via social media and through relevant professional organisations. The questionnaire was constructed in QualtricsXM software and analysed using SPSS.

RESULT

We received 154 questionnaire responses, with three-quarters from tissue viability nurses and the rest from community and other specialist nurses. The most important treatment aim reported was pain management, followed by odour management. Almost all respondents used antimicrobial and standard dressings for these patients, with a range of products reported. Poor access to MFW care training and lack of local and national guidelines were reported as barriers to providing care for people with MFW. Availability of dressings, access to training, and good communication processes were reported as facilitators.

CONCLUSION

This is the first study to explore MFW wound care practices in the UK. A range of nurses are involved in care delivery with variations in the treatments used. Lack of access to MFW care training, resources, and standardised guidelines may impede care delivery.

Identifying Barriers to the Acquisition of Knowledge about Skin Integrity Impairment in Nursing Students: An Educational Intervention

BACKGROUND

Wound healing competence is implied in the nursing profession, but there is no standardized content regulation for wound care in university curricula. The primary objective of this study was to identify the barriers to the acquisition of knowledge about skin integrity impairment.

METHODS

A quasi-experimental pre-test and post-test study with an ad hoc questionnaire involved 304 students (control: 165; intervention: 139) from June to July 2023. A 10-h educational intervention focused on skin integrity assessment and treatment was conducted.

RESULTS

The control group, scoring 17 ± 0.22 out of a maximum of 61, achieved a significantly lower final test score (p < 0.001) compared to the wound care educational intervention group, with the pre-test group scoring 30 ± 0.76 and the post-test group scoring 43 ± 0.61. The educational intervention in wound care program improved nursing students' knowledge of prevention, assessment/diagnosis, treatment, lower limb wounds, and wound bed preparation by replacing the number of "Don't know" answers in the post-test group with correct answers.

CONCLUSIONS

The barriers identified to the acquisition of knowledge about skin integrity impairment in nursing studies are the following: the transversality of teaching, the teaching and evaluation system, and the variability in the training of professionals and teachers in charge of their education. The educational intervention can be used to consolidate knowledge and to enhance students' self-confidence in caring for patients with wounds.

Improving wound infection management: education and evaluation of an infection management pathway

OBJECTIVE

To assess the clinical impact and acceptance of an infection management (IM) pathway, designed to improve the consistency of care of wound infection when introduced, and supported by an educational programme.

METHOD

An education and evaluation programme (T3 programme) was-conducted in Portugal, Spain and Italy. This consisted of a two-hour educational, virtual seminar, followed by a four-week evaluation of an IM pathway during which survey data were collected on the impact of this pathway on clinician-selected patients. Finally, all participants reconvened for a virtual meeting during which the combined results were disseminated. The pathway provided guidance to clinicians regarding the targeted use of antimicrobial wound dressings according to the presence and absence of signs and symptoms of wound infection.

RESULTS

Responses relating to 259 patients treated according to the IM pathway, 139 (53.7%) of whom had received previous antimicrobial treatment, were captured. Signs and symptoms of infection resolved within four weeks of treatment in >90% of patients. All 25 patients who had received prior antimicrobial treatment for ≥3 months experienced a resolution in the signs and symptoms of infection within four weeks. The majority of participating clinicians agreed that the IM pathway improved decision-making (94.9%) and confidence (97.3%), and helped to determine the correct antimicrobial treatment (91.4%) in the context of wound infection.

CONCLUSION

The T3 programme was an efficient way to deliver a structured educational programme. The use of the IM pathway resulted in >90% of patients achieving resolution of their signs and symptoms of wound infection.

Acute care nurses' experience in providing evidence-based care for patients with laparotomy wounds: A scoping review

To systematically search and synthesise available literature on barriers and enablers to evidence-based care for patients with laparotomy wounds reported by acute care nurses. Specifically, we focused on wound assessment, infection control techniques, wound products used, escalation of care, dressing application, documentation and holistic care. The Preferred Reporting Items for Systematic review and Meta-Analyses extension for Scoping Reviews Checklist and explanation documents directed the review. The methodology framework created by Arksey and O'Malley, updated by Levac et al., and the Joanna Briggs Institute were utilised to assist the scoping review process. Data synthesis was guided by the Theoretical Domains Framework. Six qualitative and mixed methods studies were selected for the review. Most reported barriers and enablers were mapped to knowledge, skills, beliefs about consequences, environmental context and resources and beliefs about capability domains. The main barriers were limited access to and utilisation of wound assessment tools and clinical practice guidelines for wound management and suboptimal time management skills. Inconsistent management of laparotomy wounds was related to ward culture and nurses' lack of knowledge and skills in surgical wound assessment and aseptic technique during wound encounters. The reported enablers were knowledge of multi-factorial risk factors for surgical wound recovery, valuing education and reflective practice and believing that protocols should be utilised alongside comprehensive wound assessments. Holistic wound care included patient education on the role of mobilisation and nutrition in wound healing. Acute care nurses do not routinely incorporate comprehensive, evidence-based care recommendations for laparotomy wound management. Further research on evidence-based care behaviours in managing laparotomy wounds is required. The results indicate a need for standardising the practice of laparotomy wound management while acknowledging the current challenges faced in the ward environment.

The Effect of Virtual Reality Application on Pain During Wound Care Dressing Change: A Systematic Review and Meta-analysis of Randomized Controlled Trials

OBJECTIVE

To evaluate the effect of virtual reality application on pain during a wound care dressing change.

DESIGN

Systematic review and meta-analysis DATA SOURCES: PubMed, Cochrane Central Register of Controlled Trials, Web of Science, CINAHL (EBSCOhost), and YÖKTEZ REVIEW/ANALYSIS METHODS: The last screening of all databases was performed on 20.07.2022. Parallel-group RCTs suitable for the research subject were included in the study. The "Cochrane risk-of-bias tool" was used to measure the risk of bias. A heterogeneity test was done with the I2 value and the p value for the Q statistics. Five methods were employed to assess publication bias. Sensitivity analysis was performed for studies with a high risk of bias.

RESULTS

As a result of the screening, 13 RCTs involving 882 wound care patients were included in the study. It was determined that the virtual reality application reduced pain moderately during a wound care dressing change (SMD= -0.60; 95% CI= -0.73 and -0.46; p < .001). The fixed effect model was used because the value of heterogeneity (I2 = 0%, p = 0.796) was low in the analysis. No significant results were obtained in the moderator analysis.

CONCLUSION

It was found that the virtual reality application moderately reduced pain during a wound dressing change and was a reliable application. However, it was suggested that the virtual reality application alone was insufficient to reduce pain during wound care and should be applied together with analgesic or anesthetic drugs included in the standard wound care procedure.

Artificial Intelligence in Wound Care Education: Protocol for a Scoping Review

As healthcare continues evolving in the age of digital technology, the integration of artificial intelligence has emerged as a powerful force, particularly in wound care. The education of healthcare professionals in wound care is crucial for ensuring they acquire the necessary knowledge and skills, optimizing patient outcomes. This paper outlines the protocol for a scoping review with the goal of mapping and analyzing the current scientific evidence regarding the potential impact of artificial intelligence in wound care education. The current protocol follows the JBI methodological framework. The search was conducted in December 2023 in the following databases: CINAHL Complete (via EBSCOhost), MEDLINE (via PubMed), Cochrane Library, Academic Search Complete, Scientific Electronic Library Online (Scielo), Scopus, and Web of Science. Electronics searches were conducted in the Scientific Open Access Scientific Repositories of Portugal (RCAAP) and ProQuest Dissertations and Theses, OpenAIRE, and Open Dissertations databases to access gray literature. Additionally, searches were performed on Google Scholar and specific journals such as the International Wound Journal, Skin Research and Technology, Journal of Wound Care, and Wound Repair and Regeneration. The initial database searches retrieved a total of 11,323 studies. After removing duplicates, a total of 6450 studies were submitted for screening. Currently, 15 studies are included in this review, and data charting and analysis are underway. The findings of this scoping review will likely provide insights into the application of artificial intelligence in wound care education.

Emerging horizons and prospects of polysaccharide-constructed gels in the realm of wound healing

Polysaccharides, with the abundant availability, biodegradability, and inherent safety, offer a vast array of promising applications. Leveraging the remarkable attributes of polysaccharides, biomimetic and multifunctional hydrogels have emerged as a compelling avenue for efficacious wound dressing. The gels emulate the innate extracellular biomatrix as well as foster cellular proliferation. The distinctive structural compositions and profusion of functional groups within polysaccharides confer excellent physical/chemical traits as well as distinct restorative involvements. Gels crafted from polysaccharide matrixes serve as a robust defense against bacterial threats, effectively shielding wounds from harm. This comprehensive review delves into wound physiology, accentuating the significance of numerous polysaccharide-based gels in the wound healing context. The discourse encompasses an exploration of polysaccharide hydrogels tailored for diverse wound types, along with an examination of various therapeutic agents encapsulated within hydrogels to facilitate wound repair, incorporating recent patent developments. Within the scope of this manuscript, the perspective of these captivating gels for promoting optimal healing of wounds is vividly depicted. Nevertheless, the pursuit of knowledge remains ongoing, as further research is warranted to bioengineer progressive polysaccharide gels imbued with adaptable features. Such endeavors hold the promise of unlocking substantial potential within the realm of wound healing, propelling us toward multifaceted and sophisticated solutions.

Assessment of nurses' level of knowledge of the management of chronic wounds

BACKGROUND

Chronic wounds are a challenge and a major cause of morbidity. A wound is considered chronic if healing does not occur within the expected time frame depending on the etiology and location of the wound.

OBJECTIVE

To assess the level of knowledge about chronic wound management of postgraduate nurses in different areas of the health system and their previous satisfaction with the training received during their undergraduate studies.

DESIGN

Cross-sectional study of a health system of 95,000 inhabitants and 557 nursing professionals working in it.

PARTICIPANTS

Nurses working in the study health system and in areas with care for patients with chronic wounds in social, primary and hospital care.

RESULTS

Survey results described a low knowledge of chronic wound management in general. Data on knowledge according to area of work showed that nurses in primary care had the highest knowledge of wound etiology. Nurses working in health and social care were most knowledgeable in diagnostic knowledge. Hospital nurses showed the lowest knowledge overall. A relationship was observed when nurses had a master's degree followed by an expert with better knowledge in the test. In addition, nurses reported little training in chronic wounds during their university studies (69.73 %, n = 106).

CONCLUSIONS

Therefore, a review of this point should be considered to improve the management of chronic wounds and their correct approach among nursing students. A review of continuing and even specialised training needs in the clinical care setting should also be considered.

What influences the inclusion of skin tone diversity when teaching skin assessment? Findings from a survey

BACKGROUND

Understanding the variances in visual skin changes across all skin tones is important in clinical care. However, the experiences of those teaching skin assessment to pre- and post-registrant nurses are unknown.

AIMS

To determine the barriers and facilitators experienced in teaching skin assessment across a range of skin tones to pre- and post-registrant nurses.

METHODS

A cross-sectional, mixed-methods online survey was undertaken throughout February and March 2023 based on the Theoretical Domains Framework of behaviour change.

FINDINGS

In this self-selecting sample, most participants were aware of why it was important to include all skin tones when teaching skin assessment and were professionally motivated to include this in their practice. However, resources and support are needed to overcome an unconscious bias in teaching skin tone diversity, resulting in a lack of availability of good quality photographs and educator confidence in their own skills. Educators not considering skin tone when selecting patient cases and relying on people with dark skin tones to highlight where practice is not inclusive may also lead to insufficient exposure for students.

CONCLUSION

There is some awareness of the importance of including diverse skin tones in teaching, but further education and resources are needed.

The Crucial Role of Nurses in the Comprehensive Management of Postoperative Enteroatmospheric Fistula: A Narrative Review

Postoperative enteroatmospheric fistula (EAF) presents a complex challenge in surgical care, with multifactorial causes and significant implications for patient outcomes and quality of life. This narrative review explores the essential role of nurses in the comprehensive management of EAF, encompassing preoperative, intraoperative, and postoperative care. It emphasizes the importance of wound care management, nutritional support, psychosocial assistance, patient education, collaboration, continuous professional development, and research engagement in optimizing patient outcomes. By addressing these facets, healthcare providers can enhance their understanding and management of EAF, ultimately improving patient care in this intricate surgical complication.

Integrating factors associated with complex wound healing into a mobile application: Findings from a cohort study

Complex, chronic or hard-to-heal wounds are a prevalent health problem worldwide, with significant physical, psychological and social consequences. This study aims to identify factors associated with the healing process of these wounds and develop a mobile application for wound care that incorporates these factors. A prospective multicentre cohort study was conducted in nine health units in Portugal, involving data collection through a mobile application by nurses from April to October 2022. The study followed 46 patients with 57 wounds for up to 5 weeks, conducting six evaluations. Healing time was the main outcome measure, analysed using the Mann-Whitney test and three Cox regression models to calculate risk ratios. The study sample comprised various wound types, with pressure ulcers being the most common (61.4%), followed by venous leg ulcers (17.5%) and diabetic foot ulcers (8.8%). Factors that were found to impair the wound healing process included chronic kidney disease (U = 13.50; p = 0.046), obesity (U = 18.0; p = 0.021), non-adherence to treatment (U = 1.0; p = 0.029) and interference of the wound with daily routines (U = 11.0; p = 0.028). Risk factors for delayed healing over time were identified as bone involvement (RR 3.91; p < 0.001), presence of odour (RR 3.36; p = 0.007), presence of neuropathy (RR 2.49; p = 0.002), use of anti-inflammatory drugs (RR 2.45; p = 0.011), stalled wound (RR 2.26; p = 0.022), greater width (RR 2.03; p = 0.002), greater depth (RR 1.72; p = 0.036) and a high score on the healing scale (RR 1.21; p = 0.001). Integrating the identified risk factors for delayed healing into the assessment of patients and incorporating them into a mobile application can enhance decision-making in wound care.

People's Knowledge and Attitudes About Factors That Can Impact Wound Healing in the Eastern Province, Saudi Arabia

Background Wounds, ranging from acute to chronic, demand timely intervention to prevent complications. Infections can impede healing, leading to sepsis. Chronic wounds impact society, causing limitations in mobility and social exclusion. Early identification of infections is crucial for effective treatment, reducing unnecessary antibiotic use, and improving patient outcomes. Methodology This cross-sectional study was conducted from June to October 2023 in Saudi Arabia using a self-administered online questionnaire to assess wound healing knowledge and attitudes. Convenient random sampling via social media was employed to collect data. Data analysis was performed using SPSS version 23 (IBM Corp., Armonk, NY, USA). Results Our study predominantly featured female (67.1%), Saudi (94.8%), aged 18-25 years (42.0%), and married (51.1%) participants. Chronic illnesses were prevalent in 24.2%, with heart disease (5.7%) and hypertension (4.5%) being notable. Burn injuries (27.4%) and upper extremity wounds (40.9%) were common, prompting immediate medical care (54.1%). Internet sources (22.6%) and relatives/friends (18.4%) were key for wound care information. Participants displayed solid awareness of wound-related factors, with notable misconceptions regarding Zamzam water (44.4%) and coffee beans (39.3%). Participants prioritized stopping bleeding (41.1%) and using wound patches (42.1%) for home injuries. Age group, education, marital status, and occupation impacted knowledge about wound healing. Conclusions Our study highlights key demographics, prevalent chronic illnesses, common wound types, and crucial sources of wound care information. Participants' awareness, coupled with notable misconceptions, emphasizes the importance of tailored education. Factors such as age, education, marital status, and occupation impact knowledge about wound healing.

A cross-sectional evaluation of the current state of wound healing education in the United Kingdom's undergraduate medical curriculum

Between 2013 and 2018, there has been a 71% increase in the number of patients who have required wound care in the NHS and such large numbers has placed a significant burden on healthcare systems. However, there is currently no evidence as to whether medical students are equipped with the necessary skills to deal with an increasing number of wound care related issues that patients present with. A total of 323 medical students across 18 UK medical schools completed an anonymous questionnaire evaluating the wound education received at their medical school, encompassing the volume, content, format and efficacy of teaching. 68.4% (221/323) of respondents had received some form of wound education during their undergraduate studies. On average students received 2.25 h of structured, preclinical teaching and only 1 h of clinical based teaching in total. All students that received wound education reported undertaking teaching on the physiology of, and factors affecting wound healing, with only 32.2% (n = 104) of students receiving clinically based wound education There was very weak correlation and no significant association in student's ability to assess wounds (R2  = 0.190, p = 0.013), manage wounds (R2  = 0.060, p = 0.37), and prescribe wound care products (R2  = 0.093, p = 0.18) with their stage of training. Students strongly agreed that wound education is an important part of the undergraduate curriculum and post graduate practice, and do not feel their learning needs have been met. This is the first study to assess the provision of wound education in the United Kingdom, demonstrating a clear deficit in the provision of wound education compared to expectation of junior doctors. Wound education is largely overlooked in the medical curriculum, lacks a clinical focus and does not prepare junior doctors with the necessary clinical abilities to deal with wound related pathology. Expert opinion to direct changes to future curriculum and further evaluation of teaching methodology is required to address this deficit and ensure students have the necessary clinical skills to excel as newly graduated doctors.

Integrated protocol for the prevention and treatment of skin ulcers in patients with end-stage renal disease

Chronic Kidney Disease (CKD) is an escalating global health concern, affecting more than 10 % of the general population worldwide, amounting to over 800 million individuals. One of its major complications for patients is the high prevalence of skin ulcers . This study aims to develop a protocol for ulcer management within the context of a hospital-based dialysis center. The success of this strategy is deeply rooted in the collaboration of a multidisciplinary team, continually enriched by specialist training. The clinical nurse specialist (CNS) in wound care plays a pivotal role in this approach. By employing a systematic methodology, the protocol is tailored to emphasize holistic care for patients diagnosed with end-stage renal disease undergoing hemodialysis. It accentuates the significance of proactive prevention, in-depth patient education, and the immediate identification of early wound signs. The research underscores the necessity to further weave in specialized training for ulcer care, ensuring each hospital visit is maximized for efficiency and effectiveness. Central to this protocol is the understanding that CKD is a growing concern, that the optimal management of ulcers relies heavily on multidisciplinary collaboration, and that an emphasis on prevention, patient education, and timely wound recognition is crucial to enhance patient care and experience.

Acts of negotiation: toward a grounded theory of nursing practice in chronic wound care in Austria

BACKGROUND

Demographic change and the rise of diabetes mellitus are leading to a projected increase in the prevalence of chronic wounds. People suffering from chronic wounds experience significant losses in their health-related quality of life. Health systems struggle to meet the needs of these persons, even in high-income countries. This paper explores wound nurses' perspectives on their professional practice in Austria. They play a key role as they do much of the treatment work, contribute to advancing the field, and enable interprofessional coordination. Their perspectives enable insights into how a health system provides care for elderly and chronically ill people.

METHODS

We used the Constructivist Grounded Theory framework to analyse transcripts of 14 semi-structured qualitative interviews with nurses who work in different treatment settings.

RESULTS

We identified three themes. Firstly, the interviewees characterise working with patients as a balancing act between offering enough support to build a trustful relationship while protecting themselves against the overwhelming situation of caring for a chronically ill person. Secondly, the interviewees compensate for nonexistent care pathways by building informal networks with doctors, which requires delicate relationship work. Thirdly, the study participants must prove their competence in every new professional encounter. Their need for professional autonomy clashes with the traditional doctor-nurse hierarchy. Based on these insights, we propose a grounded theory that conceives of nursing practice in terms of 'acts of negotiations'.

CONCLUSION

Our results demonstrate that wound nurses in Austria operate in an institutional environment whose outdated imagination of the nursing role is at odds with the care demands that arise from a growing number of elderly and chronically ill people. We detailed the 'acts of negotiation' nurses deploy to compensate for this situation. We identify areas for policy intervention to strengthen the autonomy of wound nurses, including access to statutory health insurance billing.

Evaluation of earthquake-related wounds; example of a university

BACKGROUND

It is a holistic assessment of the forms of the first few piles of wound care. The right approach in this process directly affects the healing stages and treatment rates of the wound.

OBJECTIVE

To examine earthquake injuries retrospectively and to contribute to the literature.

METHODS

The data of patients who were treated in a university hospital between February 10 and February 21 after the earthquake were evaluated retrospectively using the wound evaluation formula.

RESULTS

A total of 116 patients' wounds were evaluated. The mean age of the participants was 31 ± 19.5 (min = 1, max = 72), the mean wound follow-up day was 6.5 ± 3 (min = 1, max = 15), and the most common type of injury was crushing (45.7%).), the injury site was found to be the lower extremity region (73,3) the most. There were signs of infection in the wound area in 62.9% of the patients. The most signs of pocketing, exudate, and infection in the wound were found in amputation (p < 0.05). The wound type with the highest moisture content of the wound and healthy skin around the wound was found to be fasciotomy (p < 0.05). The highest mean percentage of black necrosis was found in crushing (p < 0.05).

CONCLUSION

The study gives us information about the type and location of the injury and the condition of the wound bed. Earthquakes are among the disasters that cause the most loss of life and injury in developing countries such as our country. This study is one of the rare studies evaluating the wound and its features in the literature of our country, and more studies are needed in this area.

Online (versus face-to-face) augmented reality experience on nursing students' leg ulcer competency: Two quasi-experimental studies

AIM

The aim of this study was two-fold. Firstly, to describe the influence of an augmented reality (AR)-based online educational experience on the academic performance and learning determinants of nursing students related to the study of leg ulcer care. We also set out to compare these online results with those obtained in the same experience developed a year before but in a face-to-face design.

BACKGROUND

Undergraduate education in nursing aims to train students towards an acceptable level of competence for professional practice. Sometimes, some essential clinical areas of knowledge are particularly challenging for both students and nurse educators. One of these is the care of chronic wounds, particularly in leg ulcers where nurses play a key role. Currently face-to-face teaching methods are evolving to more active contexts and alternative means such as online learning and AR are becoming widely used, garnering encouraging results.

DESIGN

A quasi-experimental design was used. Two experiments were carried out to meet the aims of the study, the first one was a pre-test post-test design in one group and the second one a post-test two experimental groups design.

METHODS

Participants were undergraduate nursing students from the School of Nursing of the University of Santiago de Compostela (Spain). The two experimental groups received the same training but in different environments: online during 2019/2020 (n = 111) and onsite during 2018/2019 (n = 72). The instruments selected were a knowledge and skills test and two validated questionnaires.

RESULTS

Regarding academic performance, the study demonstrated significant differences towards learning after the AR-based online experience (Z = -9.074; p ≤ 0.001). The participants also showed good results in relation to the learning determinants studied. Compared with students receiving AR-based face-to-face teaching, the students with the online learning approach scored better in the dimensions Autonomous Learning (U=3104.5; p = 0.020) and 3D Comprehension (U=3167.0; p = 0.035). However, the participants in the onsite experience scored higher in the Attention dimension (U=3163.0; p = 0.035).

CONCLUSIONS

AR positively influences academic performance and diverse educational variables when this experience is carried out online. Since both the online and face-to-face experience show statistically significant benefits in different dimensions of the learning determinants, the need to improve the AR learning experience through blended-learning environments should be promoted.

Wound Care Nursing Education in the Acute Care Setting

OBJECTIVE

To assess the feasibility of a survey study exploring how nurses in acute care prefer to be educated, particularly regarding wound management in the acute care setting.

METHODS

This pilot study utilized a cross-sectional survey design that included both open-ended and close-ended questions. Participants (N = 47) completed the Index of Learning Styles Questionnaire and provided information regarding their educational preferences related to wound management through use of an online survey.

RESULTS

Participants described the importance of varying educational techniques by topic, ensuring an appropriate time of day for education, and preferring smaller educational sessions over time. Most participants preferred one-on-one bedside education, and the most commonly reported learning styles were active, sensing, visual, and a balanced approach to sequential and global learning. There were few correlations between learning styles and choice of education method, only one of which was expected.

CONCLUSIONS

It would be beneficial to conduct this study on a larger scale to confirm results, improve understanding of the correlations, and determine further potential correlations between study variables.

Getting wound care right: evaluation of a week of intensive teaching on wound care for undergraduate nursing students

INTRODUCTION

Tissue viability skills are essential for nurses, but education on this in undergraduate programmes can be inadequate. After approval of the Future Nurse curriculum in 2019, a small team of staff at the University of Salford developed a Getting Wound Care Right week to improve students' knowledge and clinical skills.

METHODS

To evaluate the week, the 250 students who had participated in all activities were invited 6 months after the week to contribute a 250-word reflection for a case series. The aim of this was to understand the impact of the week on participants' knowledge, skills and confidence in caring for patients with wounds and whether it had sparked interest in further learning.

RESULTS

Four students contributed reflections, which were overwhelmingly positive. They described the knowledge attained, which included that on anatomy and physiology of the skin and wound healing, evidence-based assessment, treatment and management of wounds, and the impact of wounds on patients' quality of life. Skills gained included those in categorisation of wounds, wound assessment and pressure redistribution when seated. Responses on the impact on clinical practice focused on the importance of multidisciplinary working within wound care, seating provision for pressure ulcer prevention and management, and dressing selection. Negative comments related to students realising that clinical practice could be improved rather than indications that the format is ineffective or inappropriate. Limitations of the evaluation included the small number of participants and a lack of responses from every field of practice.

CONCLUSIONS

The Getting Wound Care Right week format is a viable approach to meeting Future Nurse curriculum requirements. The approach could be enhanced by a greater emphasis on the relevance of wound care teaching to children and young people's nursing students. The week improved students' clinical confidence on placements when caring for patients with wounds. Further robust evaluation of the module is needed to confirm the findings of this initial evaluation.

ABCDEFGHI Systematic Approach to wound assessment and management

ABSTRACT

The ABCDEFGHI approach introduces a systematic approach to wound care. It instructs the clinician to Ask pertinent questions, including those that may identify local and systemic Barriers to wound healing. After obtaining a thorough history, the clinician may proceed to Clean the wound and Do a physical examination, specifically looking for Exposed structures and Factors that will complicate the healing process. Good Healing strategies involving various dressings can then be implemented to promote healing. If necessary, a referral can be made to Involve specialists using various referral pathways. Information used to synthesize this approach was obtained through a review of national and international guidelines and Google Scholar, MEDLINE, and PubMed databases. The ABCDEFGHI approach to wound assessment and management is a simple and easy-to-follow guide that can be easily implemented into practice, thereby improving clinician confidence and competence in wound care.

Nurses' wound care competency in a sample of hospitals in Northern Vietnam

BACKGROUND

This study aimed to investigate the current situation regarding wound care by nurses in eight hospitals in the north of Vietnam, in order to plan the training for nurses to enable them to achieve the National Basic Competency Standards for Nurses.

METHODS

A cross-sectional descriptive prospective study was conducted from June 2020 to October 2020, with nurses in eight hospitals in four provinces of Northern Vietnam - Hanoi, Quang Ninh, Thai Nguyen and Bac Ninh. Data were collected based on a checklist of direct observation of nurses who provide wound care. The two main indicators were the knowledge score and the practical capacity/competence of the nurses in wound care.

RESULTS

A total of 518 nurses participated in the study, the mean age was 32.25±7.31; with 438 (84.6%) being female. Clinical experience of less than 10 years was reported by 63.6%; college education level (diploma) was reported by 58.1%, university level by 28.2%; and post-university level by 4%. The highest mean scores for knowledge were found in the categories of health education for patients, followed by care of clean wounds, communication skills and team work, management and professional development and pressure ulcer wound care. Under the practice domain the highest mean scores were ability to plan wound care, followed by self-evaluation, identification of wound types and implementation of wound care plans.

CONCLUSIONS AND RECOMMENDATIONS

The results showed that when judged against the competency standards, nurses' level of wound care competency needs to be improved. Also that there is a distinct theory-practice gap, which must be addressed. It is recommended that hospitals should conduct training for all nurses using the basic competency standards for Vietnamese nurses to improve the quality of care.

Self-supporting wound care mobile applications for nurses: A scoping review protocol

AIM

Mobile health (mHealth) is playing an increasingly important role in the computerization of wound care on an international scale with an aim to improve care. The aim of this scoping review protocol is to present a transparent process for how we plan to search and review the existing evidence related to self-supporting mobile wound care applications used by nurses.

MATERIALS AND METHODS

The scoping review will follow the Joanna Briggs Institute (JBI) methodology. An exploratory search was performed using MEDLINE (Ovid), Embase, CINAHL (Ebsco), to identify concepts, keywords, MeSH terms, and headings to identify study types looking for mobile applications in wound care. The findings of this search will determine the final search strategy. Data sources will include MEDLINE, Embase, CINAHL, Web of Science, LiSSa, Cochrane Wounds (Cochrane Library) and Erudit. The titles and abstracts of the identified articles will be screened independently by two authors for relevance. Full texts will also be screened by two independent reviewers and data extraction will be performed in accordance with a pre-designed extraction form. All types of studies and literature linked to self-supporting mobile wound care application used by nurses will be included (quantitative, qualitative, mixed methods and grey literature).

CONCLUSION

The results of the scoping review will give an overview of the existing self-supporting mobile applications in wound care used by nurses. These will also help to identify the existing applications, and describe knowledge in nursing about their utilisation, development, and evaluation, as well as synthesize the available literature on their impacts.

The use of occlusive dressings: influence on excisional wound healing in animal model

PURPOSE

To analyze the influence of occlusive dressing on the healing of excisional skin wounds in mice.

METHODS

Pre-clinical, comparative, and translational study. Mice were divided into three experimental groups: wounds occluded with hydrocolloid (HD) dressings, transparent polyurethane film (TF) dressings, and without occlusion (WO), monitored at three, six and 14 days, with eight animals each. Closure rate, infiltration of neutrophils and macrophages, measurement of tumor necrosis factor-α (TNF-α) and vascular endothelial growth factor (VEGF) and, histologically, angiogenesis were evaluated.

RESULTS

Wound closure was accelerated in the occlusive groups. There was a decrease in TNF-α levels in the HD group when compared to the WO and TF groups. Neutrophils accumulation decreased in the HD group. Increased dosages of macrophages were evidenced in the HD group, compared to the WO and TF groups. Levels of VEGF were increased in the TF and HD groups.

CONCLUSIONS

It is suggested that the occlusion of wounds modulates the inflammatory response.

Management of acute surgical wounds in Saudi Arabia: nursing staff knowledge and practice

OBJECTIVE

Nursing staff play a crucial role in postoperative wound care and management; it is therefore imperative that their knowledge is kept up to date to avoid complications. The overarching objective of this study was to assess the knowledge and practice of nursing staff regarding various aspects of the management of acute surgical wounds.

METHOD

We conducted a cross-sectional study to assess nurses' clinical knowledge and practices in the management of acute wounds in four large hospitals in Saudi Arabia. The eligible participants included nurses who were working in the medical or surgical departments and those who were employed by the Ministry of Health. We administered a study questionnaire and conducted descriptive analysis to report frequencies and proportions of knowledge and practice aspects.

RESULTS

A total of 360 nurses responded to the survey, giving a response rate of 70%. A total of 221 nurses completed all survey questions. Of the participants, 56.56% were ≥30 years old, 95.48% were female, and 50.02% had >6 years' working experience. With regards to nurses' knowledge: 71.9% of the participants had updated their knowledge about wound care in the past two years; 54.3% perceived their knowledge of the availability of wound products as good; 74.66% correctly reported the classic signs of inflammation; 66.97% correctly identified general signs of wound infection; 84.62% of the sample considered surgical site infection as one complication of surgical wound infection. Only 61.09% of the nurses reported following wound care guidelines, 48.42% considered wound appearance as a highly important factor that influences nurses' choice of surgical dressing products, and 41.63% considered hospital policies and practices as important in making evidence-based decisions in wound management.

CONCLUSION

This study found that nurses' knowledge about the management of wounds was generally good; however, there were gaps in the practical component which need to be filled to avoid wound complications.

The initiation of oxidative stress and therapeutic strategies in wound healing

When the production of reactive oxygen species (ROS) is overloaded surpassing the capacity of the reductive rheostat, mammalian cells undergo a series of oxidative damage termed oxidative stress (OS). This phenomenon is ubiquitously detected in many human pathological conditions. Wound healing program implicates continuous neovascularization, cell proliferation, and wound remodeling. Increasing evidence indicates that reactive oxygen species (ROS) have profound impacts on the wound healing process through regulating a series of the physiological and pathological program including inflammatory response, cell proliferation, angiogenesis, granulation as well as extracellular matrix formation. In most pathological wound healing processes, excessive ROS exerts a negative role on the wound healing process. Interestingly, the moderate increase of ROS levels is beneficial in killing bacteria at the wound site, which creates a sterile niche for revascularization. In this review, we discussed the physiological rhythms of wound healing and the role of ROS in this progress, aim to explore the potential manipulation of OS as a promising therapeutic avenue.

Socioecological model-based design and implementation principles of lower limb preservation programs as partners for limb-loss rehabilitation programs- A mini-review

People with lower limb loss, especially of dysvascular etiology, are at substantial risk for both ipsilateral and contralateral reamputation. Additionally, while not as well documented for reamputation, there is recognition that amputation incidence is influenced by not only sociodemographic factors such as sex, race, socioeconomic status, but also by system factors such as service access. A systems strategy to address this disparity within the field of limb-loss rehabilitation is for Limb-loss Rehabilitation Programs (LRP) to partner with medical specialists, mental health professionals, and Limb Preservation Programs (LPP) to provide comprehensive limb care. While LPPs exist around the nation, design principles for such programs and their partnership role with LRPs are not well established. Using a socioecological model to incorporate hierarchical stakeholder perspectives inherent in the multidisciplinary field of limb care, this review synthesizes the latest evidence to focus on LPP design and implementation principles that can help policymakers, healthcare organizations and limb-loss rehabilitation and limb-preservation professionals to develop, implement, and sustain robust LPP programs in partnership with LRPs.

Effectiveness of an E-Book App on the Knowledge, Attitudes and Confidence of Nurses to Prevent and Care for Pressure Injury

AIMS

This study evaluates the effectiveness of an interactive E-book app training program in improving nurses' knowledge, attitudes, and confidence to prevent and care for pressure injury.

DESIGN

Randomized experimental study.

METHODS

Participants were recruited from a teaching hospital in Taiwan. The study was carried out between 20 March 2014 to 1 April 2016. In total, 164 participants were randomly assigned to a pressure injury E-book app training program (n = 86) or a conventional education program (n = 78) with a one-month follow-up. Outcome variables were levels of pressure injury knowledge, attitudes, and confidence of pressure injury care.

RESULTS

Participants answered 51.96% of the pressure injury knowledge questions correctly before the intervention and 75.5% after the intervention. The pressure injury attitude score was slightly positive, with moderate confidence in pressure injury care. The knowledge, attitudes, and confidence of pressure injury care of the two groups in the pretest and posttest groups increased significantly. Analysis of covariance indicated that nurses in the pressure injury E-book app group had significantly greater improvement in knowledge, attitudes, and pressure injury care confidence as compared with the control group.

CONCLUSION

The pressure injury E-book app interactive training program was effective in improving nurses' knowledge and attitudes toward pressure injury care and in enhancing their confidence in pressure injury care; therefore, this program has potential for nurses' in-service education in both Taiwan and worldwide.

IMPACT

E-book apps allow individuals to control the time and place of learning. Direct observation of procedural skills can provide feedback to trainees on techniques to ensure learning effectiveness and pressure injury care quality.

Wound Care Self-Efficacy Assessment of Italian Registered Nurses and Wound Care Education in Italian Nursing Education System: A Cross-Sectional Study

Wounds are a major public health challenge for nurses, and poor wound care has important implications for patients and health care systems. The aim of this study is to assess the Italian registered nurses’ (RNs) perception in the area of wound care, regarding their knowledge, tasks of care delivery, wound management, values, and attitudes, exploring also the previous specific education received during nursing education. An observational online web-based survey was used to assess learning goals and content for wound care education in undergraduate nursing education and the skills and level of self-efficacy in this area during clinical practice. The data were collected between April and May 2022. A total of 210 RNs were interviewed and divided into five national geographic areas. Northwestern RNs showed a better education about the wound care area during university courses: the rate of RNs that did not receive any training in the wound care area was lower than in other Italian geographical areas. Southern RNs presented a better knowledge about factors that expose the wound to becoming chronic, wound drains care, and the ability to assess diabetic foot. This study showed that, in Italy, education in wound care among nursing students is relatively poor, and many skills are achieved during an RN’s career in an empirical way.

Primary Care Wound Clinics: A Qualitative Descriptive Study of Patient Experiences in Community Pharmacies

The expansion of primary care wound services serves to alleviate secondary and tertiary care utilization. However, patient satisfaction is required to ensure service uptake. In recent years, various community pharmacies in Australia have begun to offer dedicated wound clinics; however, evaluations of patient experiences have yet to be conducted. Thus, the present study seeks to explore: (1) the experiences and satisfaction of patients who have received wound care consultations for their acute wounds in a community pharmacy setting; and (2) how current pharmacy-based wound services can be improved. Semi-structured individual interviews were conducted with patients across five pharmacy-based wound care clinics in Western Australia. Interviews were audio-recorded, transcribed verbatim, and imported into QSR NVivo 12 Plus. Interview transcripts were coded and thematically analyzed using the framework method. Twelve interviews were required to reach data saturation. Five key themes emerged: the accessibility of wound services, the comprehensiveness of wound care services, confidence in wound care consultants, the awareness and promotion of wound services, and the expansion of wound care services. Overall, participants were satisfied with the accessibility and comprehensiveness of pharmacy-based wound service delivery, trusted the health care providers, and wanted the service to be expanded. The reported patient satisfaction, confidence in the health care provider, and desire to expand the service suggests there is potential for the service to grow in Australia. Due to the growing costs of wound care globally, there is scope to further evaluate and expand wound care services in the primary care setting on an international level.

ABCDEFGHI Systematic Approach to Wound Assessment and Management

GENERAL PURPOSE

The purpose of this continuing education article is to introduce the ABCDEFGHI approach to wound assessment and management.

TARGET AUDIENCE

This continuing education activity is intended for physicians, physician assistants, nurse practitioners, and nurses with an interest in skin and wound care.

LEARNING OBJECTIVES/OUTCOMES

After participating in this educational activity, the participant will:1. Distinguish barriers to wound healing.2. Summarize best practices for wound treatment strategies.3. Explain the usefulness of complete blood count results during a wound investigation.4. Identify a major factor to consider when deciding on a referral for wound management.

The state of wound assessment tools in Singapore: an evaluation study

OBJECTIVE

Variations in wound assessment and documentation remain an issue for clinicians despite efforts to standardise practices using national guidelines such as the Wound Care Assessment Minimum Data Set (WCA-MDS). As little is known about the quality of the wound assessment tools (WATs) used in Singapore, this study aimed to determine whether the existing WATs used meet the WCA-MDS criteria and clinicians' needs.

METHOD

The study adopted an action evaluation methodology to evaluate seven well-established WATs, such as the Applied Wound Management (AWM) and National Wound Assessment Form (NWAF), and eight locally-designed WATs against the 34-item WCA-MDS criteria. Two clinicians reviewed the WATs using a self-developed audit form between June and July 2020.

RESULTS

The results show that only five WATs met at least 50% of the 34 criteria indicators, with the MEASURE assessment framework achieving the most at 68%, followed by TIME-CDST at 65%, Hospital C WAT at 56%, NWAF at 53%, and AWM form at 50%. The five most common criteria indicators included wound type/classification, date and time of wound, wound size, wound bed tissue type, and exudate information. Most criteria indicators under the 'patient information' and 'specialist's referral' subdomains were omitted, reflecting the lack of focus on these areas in the local WATs.

CONCLUSION

Despite advances in WAT development in the literature, the current state of wound assessment and documentation across healthcare institutions remains inconsistent. There is a need to focus on clinician training and establishing a nationally-validated WAT in Singapore.

ABCD before E-verything else-Intensive care nurses' knowledge and experience of pressure injury and moisture-associated skin damage

Patients in intensive care units are at high risk of developing pressure injuries and moisture-associated skin damages. Prevention and care rely much on intensive care nurses' competency and attitudes. This study explored intensive care nurses' experience, knowledge and bedside practice in prevention and care of pressure injuries and moisture-associated skin damages with a descriptive qualitative design. Six focus groups (n = 25) were carried out in three University hospitals, two in Norway and one inIceland. Interviews were guided by a questioning route, recorded and transcribed verbatim before an inductive content analysis. Three interconnected main categories related to nurses' experience, knowledge and bedside care were identified: (a) nursing; (b) context; and (c) patients. Intensive care nurses recognise patients' risk of developing pressure injuries, as well as their continuous need of personal hygiene because of leakage of body fluids. Nurses were therefore attentive to skin inspection and preventive care but felt insecure and in need of expert help in pressure injury wound care. It varied whether nurses had access to suitable beds and mattresses and experts in wound care. ABCD had to be before E-verything else, but the skin had higher priority in long-stay compared with short-stay patients.

Learning goals and content for wound care education in Finnish nursing education - A Delphi study

BACKGROUND

Caring for patients with wounds requires diverse competences from nursing professionals. However, wound care education in undergraduate nursing education is often fragmented and lacks consistent learning goals and content.

OBJECTIVES

To create learning goals and content for wound care education in Bachelor's level nursing education in Finland and to assess the consensus relating to these learning goals and content among wound care experts.

DESIGN

A consensus-building approach using the Delphi technique.

SETTINGS

A Delphi panel of wound care experts built on an online platform.

PARTICIPANTS

The participants of the Delphi panel were registered nurses, authorised wound care nurses, nurse educators and physicians.

METHODS

Learning goals and content for wound care education which had been formulated on the basis of previous focus-group interviews were presented to the Delphi panel. The data were collected in 2021 with two online Delphi rounds: 51 panellists participated in the first round and 36 in the second round. The data were analysed using statistical and qualitative analysis.

RESULTS

Learning goals and content were divided into four competence areas: 1) Anatomy and physiology, 2) Care of chronic and acute wounds, 3) Wound management and care of a patient with a wound, 4) Values and attitudes. These competence areas comprised 26 learning goals and 29 pieces of content. The consensus between the panellists was high, at >90% in all competence areas.

CONCLUSIONS

The basis of registered nurses' wound care competence is built during their undergraduate nursing studies. The results of this study can be used to standardise wound care education by implementing consistent learning goals and content in Bachelor's level nursing education.

Using Case-Based Reasoning in a Learning System: A Prototype of a Pedagogical Nurse Tool for Evidence-Based Diabetic Foot Ulcer Care

BACKGROUND

Currently, evidence-based learning systems to increase knowledge and evidence level of wound care are unavailable to wound care nurses in Denmark, which means that they need to learn about diabetic foot ulcers from experience and peer-to-peer training, or by asking experienced colleagues. Interactive evidence-based learning systems built on case-based reasoning (CBR) have the potential to increase wound care nurses' diabetic foot ulcer knowledge and evidence levels.

METHOD

A prototype of a CBR-interactive, evidence-based algorithm-operated learning system calculates a dissimilarity score (DS) that gives a quantitative measure of similarity between a new case and cases stored in a case base in relation to six variables: necrosis, wound size, granulation, fibrin, dry skin, and age. Based on the DS, cases are selected by matching the six variables with the best predictive power and by weighing the impact of each variable according to its contribution to the prediction. The cases are ranked, and the six cases with the lowest DS are visualized in the system.

RESULTS

Conventional education, that is, evidence-based learning material such as books and lectures, may be less motivating and pedagogical than peer-to-peer training, which is, however, often less evidence-based. The CBR interactive learning systems presented in this study may bridge the two approaches. Showing wound care nurses how individual variables affect outcomes may help them achieve greater insights into pathophysiological processes.

CONCLUSION

A prototype of a CBR-interactive, evidence-based learning system that is centered on diabetic foot ulcers and related treatments bridges the gap between traditional evidence-based learning and more motivating and interactive learning approaches.