Wound Care Knowledge Research Articles

Return to Work After Burn Injury: Burn-Injured Individualsʼ Perception of Barriers and Facilitators

The aim of this study was to explore burn-injured individuals' perception of factors seen as facilitators or barriers in the process of returning to work after a severe burn injury. Semistructured interviews were prospectively conducted with 39 former burn injury patients, admitted to the Uppsala Burn Center between March 2000 and March 2007. The participants were employed or studying at the time of injury and were interviewed on average 4.6 years after the burn. The interview data were analyzed with qualitative content analysis. Factors acknowledged by the participants as facilitators and barriers to return to work (RTW) were identified and sorted into five categories: the Individual, Social Life, Health Care and Rehabilitation, the Workplace, and Social Welfare Agencies. Facilitators were perceived to a great extent as individual characteristics, such as own ability to take action, setting up goals in rehabilitation, having willpower, being persistent, and learning to live with impairments. The possibility of getting modified work tasks or a change of workplace, when having physical or psychological impairments, was also seen as facilitating factors. Some barriers experienced as delaying RTW were difficulties when ceasing pain medication, limited knowledge of wound care at primary health care facilities, lack of individualized rehabilitation plans, and lack of psychological support during rehabilitation. Former burn injury patients emphasized psychological resources and capabilities as facilitators in the RTW process. The need in rehabilitation for a coordinator and for assessment of work capacity, and not solely a focus on impairments, is discussed.

A survey of wound care knowledge in South Africa

Chronic wounds afflict millions worldwide, incurring significant health care costs and chronic suffering. Clinicians are often unsure about treatment, resulting in poor outcomes. Objective. To determine the scope of knowledge possessed by fifth-year medical students, general practitioners (GPs) and surgical registrars, concerning chronic wound management. Design. Cross-sectional study. Methods. Deans of eight South African medical schools received letters requesting information regarding time devoted to wound-care training. Knowledge-based questionnaires were distributed to final-year students at two universities, surgical registrars at four universities and GPs attending refresher courses. Results. Four medical schools replied, of whom only two offered formal teaching. 162 medical students, 45 GPs and 47 surgical registrars completed questionnaires. The overall median (25th - 75th percentiles) knowledge scores for registrars, GPs and students were 65% (55 - 70%), 55% (45 - 65%) and 45% (35 - 50%) respectively. Whereas the scores of registrars and GPs did not differ, the student scores were significantly less. Only 32% of registrars and 18% of GPs attained scores of 70% or more. 96% considered training to be inadequate. Interest in wound care was only mild to moderate, with more GPs than registrars requesting literature. Conclusions. Very little, if any, training on chronic wounds is offered in South Africa. The levels of knowledge cannot be considered adequate for successful treatment, nor for teaching to undergraduates. This preliminary study cannot reflect the attitudes and knowledge throughout the country. However, it is clear that there is a need for improved education about these conditions that have huge clinical and economic consequences.

퇴원하는 환자의 상처관리에 대한 지식과 염려에 관한 연구

본 연구는 3차병원에서 퇴원하는 환자의 상처관리에 대한 지식과 염려사항을 파악하기 위해 112명의 피부상처를 지니고 퇴원을 앞둔 112명 환자에게 구조화된 설문지로 면담을 통해 조사하였다. 상처의 유형은 외과적 절개(52.7%), 삽관상처(26.8%), 욕창(9.8%), 당뇨발과 동맥궤양(5.4%) 등이었다. 상처관리에 관한 지식은 52.0%의 정답률을 보였고, 상처관리에 대한 염려(범위1-7)는 2.79였고, 상처관리에 대한 지식과 염려는 상관관계가 유의하지 않았다. 퇴원후 상처관리에 관한 염려에 영향을 미치는 요인으로 유의한 변수는 상처관리에 대한 두려움, 상처통증, 입원기간, 및 주관적 건강인식으로 나타났다. 상처를 지니고 퇴원하는 환자들의 상처관리에 대한 지식은 부정확한 것이 많으며 다양한 염려사항들을 가지고 있으므로 퇴원계획시 이에 대한 구체적인 교육이 필요할 것이다. This study was done to examine patients' wound care knowledge and concerns prior to discharge from a tertiary hospital. The participants in this descriptive survey were 112 patients having wounds. During interview, a structured self-administered questionnaire was filled out. The participants were 71 males and 41 females. Wound types were surgical incision (52.7%), percutaneous wound (26.8%), pressure ulcer (9.8%) and diabetic foot and arterial ulcers (5.4%). Their wound care knowledge was 52.0% of correct answer and the mean of concerns (range 1-7) was 2.79. There was no significant correlation between their knowledge and concerns of wound care. The factors influence on wound care concerns were fear of wound care, wound pain, length of hospital stays, and perceived health condition. This findings showed that discharge patients with a wound had some incorrect knowledge and various concerns about wound care. They may help to direct patient teaching in discharge plan.

Outcomes of a Clinical Nurse Specialist-Initiated Wound Care Education Program

Consistent with the sphere of clinical nurse specialist (CNS) practice related to advancing nursing practice and patient outcomes, a CNS task force of 20 of the 60 CNSs in our large teaching hospital was convened to plan, implement and evaluate a comprehensive wound care education program. The purpose of the program was to ensure the 24-7 hospital-wide availability of nurses with evidenced-based wound care knowledge and skills. The facilitative environment, in which the program was developed and operates, is analyzed using the Promoting Action on Research Implementation in Health Services framework. Outcomes of the CNS task force include (1) designation of unit-based CNS as the first line resources for wound care at the unit level, (2) education of almost 10% of the 3,800 nurses at Massachusetts General Hospital as staff nurse resources, and (3) a shift in the nature of CNS wound care consultations from prescription to validation of the staff nurse-initiated wound care plan.

What is the relationship between nurses’ attitude to evidence based practice and the selection of wound care procedures?

To investigate qualified nurses' attitudes to evidence-based practice and whether this influenced their selection of wound care products. The literature shows that previous studies on attitudes to evidence-based practice tended to be part of a wider study. The general consensus was that there was a positive attitude to evidence-based practice. However, there appeared to be no published studies specifically addressing nurses' attitudes to evidence-based wound care. Survey design using a questionnaire completed by 156 qualified nurses working in three UK National Health Trusts. A statistically significant difference was seen between those nurses with a tissue viability link nurse role (p = 0.002) and those without a link nurse role; those educated to first degree (p < 0.001) and those without a first degree; and those who had received formal tissue viability training (p < 0.001) and those with informal tissue viability training. There was also a highly statistically significant relationship between the clinical grade of staff and the overall attitude to evidence-based practice (p < 0.001). Nurses who had attained a higher level academic qualification, had a tissue viability link nurse role and those who had received formal tissue viability training scored generally higher in the wound care knowledge tests and in attitude to evidence-based practice. The care received by patients in relation to wound care could be dependent upon factors that are related to the individual characteristics of the nurse providing the care and these factors, in turn, are related to education and training with respect to wound care. Better general education and better specific training in wound care could lead to better wound care.

Evidence-Based Medicine in Wound Care

The Journal of the American Medical Association (JAMA) has an ongoing series entitled “Clinician's Corner.” In the spirit of the Cochrane reviews, it covers the evidence for treatment of common clinical conditions. In December, it reviewed the treatment of pressure ulcers.1 As I read this review, I became more and more disturbed. It searched the literature to find relevant randomized controlled trials (RCTs). Out of 872 abstracts, only 103 were deemed relevant by meeting quality criteria. Only 16 out of the 103 met 4 or more of the checklist to evaluate a report of a nonpharmacologic trial (CLEAR NPT). Of the 103, 45 trials (43.7%) reported funding by for-profit manufacturers, and 29 (28.2%) did not indicate sources of funding; 83 trials (80.6%) did not provide sufficient information about the authors' potential financial conflicts of interest. Their conclusions were that there was little evidence to support the use of a particular support surface (powered vs nonpowered), a particular dressing, nutritional support, biological agents, or adjunctive therapies. A previous review in JAMA2 came to similar conclusions. We all know that pressure ulcers are common, with reported incidences as much as 38% in acute care and 23.9% in long-term care.2 The National Pressure Ulcer Advisory Panel established its staging system at the 1989 Consensus Development Conference. We have had a multidisciplinary board examination in wound care now for more than 10 years. Yet there is a paucity of quality scientific clinical research to direct the care of these morbid wounds, and the involvement of the for-profit manufacturers remains intimate. We in the practice of wound care will never achieve legitimacy in the eyes of conventional medicine, and cannot hope to establish wound care as a specialty under the National Board of Medical Examiners, until we can produce better research to validate our practice and to justify the body of wound care knowledge as truly unique and separate from other fields in medicine. I know that a “Special Report” recently published in Advances in Skin and Wound Care by two well-respected wound care practitioners argues that the standard RCT may not be practical in wound care.3 However, that runs against the tide in the rest of medicine, which is getting more and more strict in what it considers “scientific” and what can be used in “evidence-based medicine.” The Journal of Bone and Joint Surgery (the premier orthopaedic publication) published in January 2009 new rules for the publication of clinical trials.4 All trials will need to be registered in a public trials registry, clinical trials will have to follow the Consolidated Standards of Reporting Trials (CONSORT) guidelines, and primary results must be based on intention-to-treat analysis. JAMA instituted these rules in 2005. I know that pressure ulcers are heterogeneous, but so too are tibial fractures. Yet the orthopaedic community has been able to categorize these fractures and agree on standard reporting measures to allow good research to guide their practice. The wound care research community must agree on standard reporting measurements and agree on what constitutes progress in wound healing or on defined end points. Researchers must adhere to these so that trials may be combined by meta-analysis. We must work to eliminate the influence of the for-profit industry or, at the very least, have very clear disclosure requirements. Wound care practitioners must be discriminating in their use and support of various treatments, modalities, dressings, and equipment. They must demand good science before the widespread adoption of every new technique. Our journals must be appropriately peer reviewed and use the principles of good scientific literature that are widely agreed on by the rest of medicine. Only then will we achieve the legitimacy that we all desire and, even more important, only then will we assure that we are doing the best for our patients.

Wound care made incredibly visual Various Wound care made incredibly visual Lippincott Williams &amp; Wilkins 186 £22.00 9781582555546 1582555540

This is a comprehensive book with a nursing focus, which is clearly presented. It would be useful for nurses with a basic knowledge of wound care, newly qualified staff or nurses without general nurse training.

Caring for patients with difficult-to-heal ulcers

This article presents Coloplast's chronic wound care guide for community nurses, in which wound management is described in terms of assessment, treatment and reassessment. Choosing the optimal wound dressing is explained separately. Three case studies are used to demonstrate the use of the guide. Using the guide as a framework is straightforward and easily interpreted by health professionals with varying levels of wound care knowledge and experience, therefore enabling health care professionals to use evidence based practice to improve patient outcomes.

Discharge Knowledge and Concerns of Patients Going Home With a Wound

To examine patients' wound care knowledge and concerns prior to discharge from an acute care hospital. Comparative descriptive study of patients with wounds. Participants (N = 76) included 17 men and 59 women who were African American (n = 33, 43.4%) or Caucasian (n = 43, 56.6%) and ranged in age from 20 to 83 years (M = 48, SD = 13). There were 67 persons with acute wounds and 9 with chronic wounds. All were scheduled to be discharged home from a large urban acute care hospital. The questionnaire for this study included the following sections: Demographic, Admission and Discharge, Health, Wound Care, Beliefs about Wounds and their Care, Pain and Wounds, Literacy and Learning, and Discharge Concerns. Participants' greatest concerns about going home were: (1) how active to be at home, (2) wound pain, (3) looking for wound complications, and (4) watching for wound infection. Many participants did not know the dressing (38.2%) or solution to cleanse the wound (58.7%) at home. Most had taken care of a wound before (67.1%), could see (68.4%) and reach (69.7%) the wound, and had looked at it (64.5%) during the hospitalization. Patients with acute and chronic wounds did not differ significantly in their concerns about their wound or their fear of taking care of their wound. Participants generally had appropriate knowledge about wounds and hand washing, nutrition, going out of the home, and cigarette smoking. They had incorrect information about drying out wounds and leaving them open to breathe the air. The majority of patients with chronic wounds preferred getting answers to questions about their wound and its care from their physician followed by their clinic and family/friends. Patients with acute wounds overwhelmingly chose their physician as a source of information about their wound and its care, followed by calling a nurse at the hospital and using the Internet. Patients were able to verbalize their concerns about going home with a wound. Concerns about discharge may help to direct patient teaching in preparation for discharge. Teaching literature could include the most common concerns, as well as ways to avoid misinformation about wound care. Discharge teaching needs to begin early so that patients feel they have adequate time to learn and ask questions. Further research is needed about patients' wound care knowledge and discharge concerns.

A Survey of Nursesʼ Wound Care Knowledge

To provide information about nurses' knowledge and practices in the prevention and care of wounds, based on responses to a 2004 survey in Advances in Skin & Wound Care and its sister publication, Nursing2004. This continuing education activity is intended for physicians and nurses with an interest in understanding best practices for preventing and treating wounds. After reading the preceding article and taking this test, the participant should be able to: 1. Discuss the Advances in Skin & Wound Care and Nursing2004 wound care survey results. 2. Relate the survey responses to best practice standards for for preventing and treating wounds. 3. Identify implications for improvements in wound care education and practice based on survey results.

An International Partnership: Impacting Wound Care in Brazil

The purpose of this article is to review nursing literature about international partnerships, describe nursing and nursing education in Brazil, and describe an international partnership about chronic wound prevention and treatment in Brazil. Because countries often share health care concerns, nursing knowledge is greater than any one country's health care trends or clinical issues. Although the literature has numerous articles about pressure ulcers and other chronic wounds, much of this information is lacking for nurses in Brazil because it is primarily written in English. This project provided educational programs in Portuguese to nurses and nursing students in Brazil, involved them in the development of wound care protocols, allowed practice with dressings, and stimulated discussions on improvement of home care to patients and families. WOC nurses have a critical global role in sharing wound care knowledge. (J WOCN 2002;29:287-94.)

An International Partnership

The purpose of this article is to review nursing literature about international partnerships, describe nursing and nursing education in Brazil, and describe an international partnership about chronic wound prevention and treatment in Brazil. Because countries often share health care concerns, nursing knowledge is greater than any one country's health care trends or clinical issues. Although the literature has numerous articles about pressure ulcers and other chronic wounds, much of this information is lacking for nurses in Brazil because it is primarily written in English. This project provided educational programs in Portuguese to nurses and nursing students in Brazil, involved them in the development of wound care protocols, allowed practice with dressings, and stimulated discussions on improvement of home care to patients and families. WOC nurses have a critical global role in sharing wound care knowledge.

Research application: wound care in community practice.

This report describes the development of a wound management manual for district nurses. A working party of district nurses interested in wound management was established to evaluate research on wound management and its application in practice. A survey was undertaken to determine how district nurses rated their knowledge of wound care. The results showed that some nurses had a very good insight into wound management, but that a significant number felt that they needed more education on wound management in the community. A wound management manual was developed in order to meet this need. The manual puts the results of research into practice, providing a useful guide to the main principles of wound management and a basis for further research.

The Healing Hand: Man and Wound in the Ancient World

Someday, medical practice circa 1975 will astound future generations by its naiveté, irrationality, and "cures that made matters worse," and 20th century thought will seem as obscure to our descendents as the practices of physicians in ancient Mesopotamia, Egypt, and Greece now seem to us. If we are lucky, Dr Guido Majno will be reincarnated every thousand years to resurrect our dusty medical archives and clarify our medical ideas. Undoubtedly, he would display the same energy, wit, and enthusiasm evident in the present book. However, instead of tackling mummies, bones, hieroglyphics, excavations, and artwork, he would have to scrutinize miles of microfilm and millions of tons of journals, deciphering longforgotten computer codes, laboratory results, and operative procedures. With enormous curiosity and indepth knowledge of pathology, Dr Majno has analyzed the development of wound care, surgery, and anatomical knowledge between 3000 BC and AD 200. The major civilizations included in his