Wound Care Experts Research Articles

Enterostomal Therapy Nursing in the Canadian Home Care Sector

Approximately one-third of all home care patients have wound care needs. Home care patients tend to be older and have multiple chronic diseases rendering them at risk for developing wounds and impairing their ability to heal wounds. Enterostomal therapy (ET) nurses have expertise in wound, ostomy, and continence care, and were recently recognized by the Canadian Nurses Association as a specialty practice. We completed a systematic review in order to identify and synthesize evidence about the value of ET nurses in the Canadian home care sector, focusing on wound care. A literature search was conducted, using 9 computerized library databases. Eight articles were identified for review; each was analyzed using qualitative content analysis. Two themes emerged from our analysis: (1) assessing the outcomes of ET nurse involvement in client care and (2) methods for using ET nurses' expertise. Within these themes, the benefits of ET nurses working in home care were identified: (1) a decreased number of visits, (2) reduced wound-healing times, (3) successful healing, (4) reduced cost of wound care, (5) greater support for nurses and families, (6) fewer emergency department visits, (7) fewer hospital readmissions, (8) increased interest in education in wound care among other nurses, and (9) standardized protocols for wound care. Although only 8 studies were located for this review, their findings provide evidence that ET nurses' contributions to wound care are not only positive but also necessary in the home care sector.

The EWMA Patient Outcome Group

Across Europe, clinical experts in wound care and industry representatives have joined forces to propose recommendations for clinical data collection on chronic wound management. Here, the chair of the group, Finn Gottrup, outlines its main objectives.

Professional Practice-Clinical Practice Outcomes; Standards of Care; Clinical Pathways

The purpose of this project was to create a simple, point- of-care, picture tool, dubbed SLICK (standard language and image comparison kard), to aid nurses in basic pressure ulcer assessment. Using the National Pressure Ulcer Advisory Panel (NPUAP) staging definitions, Phase I involved establishing the inclusion criteria and identifying images. Regional wound care experts provided thousands of images from which to select. Using a quota sampling design to include both Caucasian and African American skin tones, the researchers unanimously selected ten images representing each of the five NPUAP stages (Stage I, Stage II, Stage III, Stage IV, and Unstageable/ Nonobservable) and five images illustrating three wound beds descriptions (fully granulating, early/partial granulating, and not healing) (n = 130). In Phase II a panel of three nurses, certified wound care specialists or nurses with five or more years of clinical wound experience, were given the inclusion criteria and images. The nurses were ask to identify and classify the images by stage or wound bed category for each skin tone, then rank the images (1 = best to 5 = worst). For each skin tone, interrater reliability scores were used to determine the top five images for the five stages and the top two images depicting the wound bed. (n = 62) In Phase III, five different wound care experts (including both physicians and nurses) repeated the process outlined in Phase II. Again, using interrater reliability scores the top two rated images depicting the stages and the top-rated image depicting the wound beds were determined (n = 26). The final SLICK tool provides two images in each skin tone (Caucasian and African American) for each stage with several simple, text descriptors to aid in the assessment. The wound bed component includes three images (fully granulating, early/partial granulating, and not healing) for each skin tone with simple, text descriptors to aid in the assessment.

Introduction

Introduction

Bringing together expertise in wound care: The European Wound Management Association (EWMA)

Bringing together expertise in wound care: The European Wound Management Association (EWMA)

Impact of tele‐advice on community nurses’ knowledge of venous leg ulcer care

This paper reports a study assessing the impact of the provision of expert tele-advice to community nurses in enhancing their knowledge of leg ulcer care. Community nurses have traditionally been responsible for the care of patients with leg ulcers. However, access to expert medical and nursing advice has been restricted to the local hospital environment. The introduction of e-health and telemedicine have created opportunities to provide online and immediate access to wound care expertise from centres of excellence to primary health care staff in managing patients' wounds in their own home. A stratified randomized controlled trial was used to examine community nurses' knowledge before and after the provision of expert tele-advice. A knowledge measurement tool comprised of 40 multiple-choice questions was adopted, with correct responses identified by a panel of wound care experts. The questions covered the three themes of dressings, management and physiology, with different levels of difficulty categorized as easy, medium or difficult. The tool was administered before and after the intervention (12 weeks) to both the experimental and control groups. Statistically significant improvements were observed only for the experimental group in the areas of dressings and management, as well as in the medium level questions. No statistically significant improvement was seen for the easy questions, as there was little room for improvement because of preintervention high scores. For the difficult questions, it was thought that more time would be needed for a more positive outcome. The results suggest that tele-advice can be of great benefit to community nurses in enhancing their knowledge in the practice of leg ulcer care. This will have significant implications for more efficient use of human resources and cost effectiveness in wound care.

Wound Teleconsultation in Patients with Chronic Leg Ulcers

Background: The treatment of chronic leg ulcers requires frequent assessments of local wound status and adjustment of therapy. The availability of reasonably priced photographic equipment and quick electronic transfer of high-quality digital images should make it possible that the assessment of wound status can be made by remote experts. Objective: This study examines the feasibility of using teledermatology for wound assessment and therapeutic suggestions for patients with chronic leg ulcers. Methods: One hundred ten chronic leg ulcers of different origins were examined in face-to-face consultations. The examining doctor assessed the wound, made therapeutic recommendations and took 1–4 photographs of the wound using a digital camera. The digital images and relevant clinical information were then transmitted via a web application to an expert in wound care, who provided an independent teledermatological assessment of wound status and therapeutic recommendations. Results: In our study, a high accordance between direct consultations and electronic consultations was found in the assessment of chronic leg ulcers, especially for important features like slough (concordance: 84.6%), necrosis (concordance: 98.2%) and granulation tissue formation (concordance: 76.4%). Furthermore, the teledermatologist generally felt confident in recommending further treatment strategies and in planning further wound assessments via the internet. Conclusions: Our results suggest that teledermatology offers great potential for the future in chronic wound care. By reducing the need to travel long distances to the hospital or to consult a physician with expertise in wound care, wound teleconsultation might lower health care costs and improve the quality of life for patients with chronic wounds, while still maintaining a high quality of wound care.

Validity and reliability: basic research concepts.

Purpose: Valid and reliable heuristic devices facilitating optimal wound care are lacking. The objectives of this study were to establish content validation data for a set of wound care algorithms, to identify their associated strengths and weaknesses, and to gain insight into the wound care decision-making process. Methods: Forty-four registered nurse wound care experts were surveyed and interviewed at national and regional educational meetings. Using a cross-sectional study design and an 83-item, 4-point Likert-type scale, this purposive sample was asked to quantify the degree of validity of the algorithms' decisions and components. Participants' comments were tape-recorded, transcribed, and themes were derived. Results: On a scale of 1 to 4, the mean score of the entire instrument was 3.47 (SD ± 0.87), the instrument's Content Validity Index was 0.86, and the individual Content Validity Index of 34 of 44 participants was > 0.8. Item scores were lower for those related to packing deep wounds (P < .001). No other significant differences were observed. Qualitative data analysis revealed themes of difficulty associated with wound assessment and care issues, that is, the absence of valid and reliable definitions. Conclusion: The wound care algorithms studied proved valid. However, the lack of valid and reliable wound assessment and care definitions hinders optimal use of these instruments. Further research documenting their clinical use is warranted. Research-based practice recommendations should direct the development of future valid and reliable algorithms designed to help nurses provide optimal wound care. (J WOCN 1999;26:238-49)

Using wound care algorithms: A content validation study

Purpose: Valid and reliable heuristic devices facilitating optimal wound care are lacking. The objectives of this study were to establish content validation data for a set of wound care algorithms, to identify their associated strengths and weaknesses, and to gain insight into the wound care decision-making process. Methods: Forty-four registered nurse wound care experts were surveyed and interviewed at national and regional educational meetings. Using a cross-sectional study design and an 83-item, 4-point Likert-type scale, this purposive sample was asked to quantify the degree of validity of the algorithms' decisions and components. Participants' comments were tape-recorded, transcribed, and themes were derived. Results: On a scale of 1 to 4, the mean score of the entire instrument was 3.47 (SD ± 0.87), the instrument's Content Validity Index was 0.86, and the individual Content Validity Index of 34 of 44 participants was > 0.8. Item scores were lower for those related to packing deep wounds ( P < .001). No other significant differences were observed. Qualitative data analysis revealed themes of difficulty associated with wound assessment and care issues, that is, the absence of valid and reliable definitions. Conclusion: The wound care algorithms studied proved valid. However, the lack of valid and reliable wound assessment and care definitions hinders optimal use of these instruments. Further research documenting their clinical use is warranted. Research-based practice recommendations should direct the development of future valid and reliable algorithms designed to help nurses provide optimal wound care.

Bioregulators of Reproduction

<h3>Introduction</h3> Most patient-reported outcome measures (PROM) for chronic wounds are specific to a single wound type (eg, pressure ulcer) or part of the body. A barrier to outcome assessment in wound care and research is the lack of a rigorously designed PROM that can be used across wound types and locations. This mixed method study describes the protocol for an international collaboration to develop and validate a new PROM called the WOUND-Q for adults with chronic wounds. <h3>Methods and analysis</h3> In phase I, the qualitative approach of interpretive description is used to elicit concepts important to people with wounds regarding outcome. Participants from Canada, Denmark, the Netherlands, and the USA are aged 18 years and older and have a wound that has lasted 3 months or longer. Interviews are digitally recorded, transcribed and coded. A conceptual framework and preliminary item pool are developed from the qualitative dataset. Draft scales are formed to cover important themes in the conceptual framework. These scales are refined using feedback from people with chronic wounds and wound care experts. After refinement, the scales are translated into Danish and Dutch, following rigorous methods, to prepare for an international field-test study. In phase II, data are collected in Canada, Denmark, the Netherlands, and the USA. An international sample of people with a large variety of chronic wounds complete the WOUND-Q. Rasch Measurement Theory analysis is used to identify the best subset of items to retain for each scale and to examine reliability and validity. <h3>Ethics and dissemination</h3> This study is coordinated at Brigham and Women’s Hospital (Boston, USA). Ethics board approval was received at each participating site for both study phases. Findings will be published in peer-reviewed journals and presented at national and international conferences and meetings.