Introduction
The given paper is devoted to the investigation of treatment methods for venous leg ulcers (VLUs) focusing on foam dressings. The major advantage of this type of advanced dressing is that it is highly absorbent and, therefore, may reduce the risk for maceration of peri-ulcer skin and does not require a secondary dressing. However, the data on the effects of foam dressings remains underrepresented. Thus, one of the goals of the given project is to collect the relevant information that could be used in the EBP.
Change Model Overview
The ACE Star Model consists of five major steps: discovery research, evidence summary, translation to guidelines, practice integration, outcome evaluation. The model represents a learning cycle. It supports the systematic integration of evidence into practice and data synthesis. Thus, the model facilitates the process of knowledge development and behavioral change. For this reason, nurses and other health practitioners should use it in the EBP.
Define the Scope of the EBP
VLU is a common chronic condition affecting nearly 2.5 million individuals annually, characterized by an extended healing trajectory and a high risk of recurrence. According to the statistics, only 58 percent of patients heal, and 4 percent undergo amputation (Carter, Waycaster, Schaum, & Gilligan, 2014). Thus, the condition poses great clinical and economic challenges and requires an effective approach to its treatment.
Nowadays, practitioners may choose various methods for the healing of VLUs. Foam dressing is one of them, but it is not utilized so often compared to other products (Omeara & James, 2013). Currently, there is not enough evidence on the efficacy of foam dressings in the treatment of the condition. Thus, the EBP research in this area is of great importance as it may contribute to the expansion of the existing knowledge base.
Stakeholders
The leader of the project will be selected from the nursing team. He/she will be responsible for the arrangement and supervision of the EBP process. Other involved parties are the Director of the Nursing Department, a nurse epidemiologist, and a charge nurse.
Determine Responsibility of Team Members
Stakeholders are selected from different organizational levels and professional backgrounds because, in this way, it will be easier to integrate changes throughout the hospital. The Director will participate as a co-leader and will provide managerial support. The nurse epidemiologist will be responsible for monitoring and evaluation of the results. The charge nurse will co-manage and ensure the program follow-up.
Evidence
The evidence for the given project was collected using the PubMed, EBSCO, and NCBI databases. The qualitative and quantitative studies were located. The selected papers provide high-quality, recent evidence. Thus, a high level of reliability of findings may be considered the major strength of this research.
Summarize the Evidence
The results of the systematic literature review conducted by Valle et al. (2014) indicate that there is insufficient evidence on the effects of foam dressings, and it prevents researchers from making a solid conclusion about their efficacy. The meta-analysis by Omeara and James (2013) does not reveal any significant difference in the healing properties of foam dressing comparing to knitted viscose dressing, and other types of dressings. Moreover, the efficacy of the remedy largely depends on the characteristics of a patient population and the product itself.
As such, foam dressing is a form of advanced dressings. They are highly absorptive and provide thermal insulation (Sood, Granick, & Tomaselli, 2014). Due to their properties, foam dressings may be used for the treatment of a great variety of wounds, including diabetic ulcers, and can be left in place for up to seven days. Additionally, Sood et al. (2014) state that “if changed daily, they can also be used on infected wounds” (p. 516).
The findings of a comparative study by Fogh et al. (2012) reveal that foam dressings ensure efficient moist wound healing, while ibuprofen added dressings are especially effective in reducing wound pain throughout the wearing time (within first seven days) “while maintaining a beneficial safety profile” (p. 819). Therefore, medicated foam dressing is recommended for patients with exuding, painful venous ulcers. The properties of foam dressing allow avoiding secondary dressing, yet the major disadvantage of this method is that it cannot be used for dry wounds and requires frequent change (Dhivya, Padma, & Santhini, 2015).
Develop Recommendations for Change Based on Evidence
Based on the findings, it can be recommended to select the dressing type based on wound factors. Medicated foam dressing may be suggested for patients who need pain relief because the beneficial effects of such dressings may help to reduce the gastroenterological risks due to medicine intake (Fogh et al., 2012). Non-medicated foam dressings can be recommended for the treatment of moist wounds not associated with significant pain.
To obtain sufficient evidence, a comparative study of different products (e.g., hydrocolloids vs. foam dressings) using randomly selected samples should be conducted.
Translation
Action Plan
Process, Outcomes Evaluation, and Reporting
During the EBP realization, the information about cost-efficiency, time of healing, and the overall patient outcomes should be collected. The evaluation will be carried out based on the objective patient data and nurses’ self-reports regarding the compliance with the specifically designed care protocols. The information will be collected on a daily basis and, by the end of week 11, evaluated by the nurse epidemiologist and the project leader. A comprehensive report on the project outcomes will be submitted to the hospital management and discussed at the collective meeting of the involved stakeholders.
Identify Next Steps
The implementation of the evidence on a larger scale will be facilitated when sufficient evidence is collected. The EBP can be enforced through policies that would abide by all practitioners to comply with patient care protocols and guidelines for the identification of wound healing factors. The obtained evidence will be applicable to all hospital units because the random sampling is associated with a high level of generalization.
Disseminate Findings
Within the hospital, the findings may be communicated through the local information system, e.g., via corporate e-mails, or through meeting minutes format. Externally, the data may be communicated through the publication in a professional or academic journal.
Conclusion
VLU is characterized by high morbidity rates and is associated with significant economic burden. It is thus detrimental to both individual and public well-being. Despite the severity of the problem, the evidence on the types of dressings used for the treatment of VLU remains underrepresented in the contemporary literature. Still, some researchers suggest using foam dressings as a potentially effective remedy. Based on this, the given EBP project focuses on the implementation on foam dressings and, at the same time, aims to collect sufficient evidence on their effects in comparison to other types of dressings.
The ACE Star Model supports the purposes of the given project. Through reiteration of the learning cycle embedded in it, the involved practitioners will become able to collect preliminary and primary data, synthesize it, and then achieve conscious and directional growth in the area of interest. In this way, the selected EBP model facilitates the development of the favorable professional culture within the setting.
References
Carter, M., Waycaster, C., Schaum, K.., & Gilligan, A. M. (2014). Cost-Effectiveness of three adjunct cellular/Tissue-Derived products used in the management of chronic venous leg ulcers. Value in Health, 17(8), 801-813. doi:10.1016/j.jval.2014.08.001
Dhivya, S., Padma, V. V., & Santhini, E. (2015). Wound dressings – A review. BioMedicine, 5(4). doi:10.7603/s40681-015-0022-9
Fogh, K., Andersen, M. B., Bischoff-Mikkelsen, M., Bause, R., Zutt, M., Schilling, S., &… Jørgensen, B. (2012). Clinically relevant pain relief with an ibuprofen-releasing foam dressing: Results from a randomized, controlled, double-blind clinical trial in exuding, painful venous leg ulcers. Wound Repair & Regeneration, 20(6), 815-821. doi:10.1111/j.1524-475X.2012.00844.x
Omeara, S., & James, M. M. (2013). Foam dressings for venous leg ulcers. Cochrane Database of Systematic Reviews,2013(5), 1-114. doi:10.1002/14651858.cd009907.pub2
Sood, A., Granick, M. S., & Tomaselli, N. L. (2014). Wound Dressings and Comparative Effectiveness Data. Advances in Wound Care, 3(8), 511-529. doi:10.1089/wound.2012.0401
Valle, M. F., Maruthur, N. M., Wilson, L. M., Malas, M., Qazi, U., Haberl, E., &… Lazarus, G. (2014). Comparative effectiveness of advanced wound dressings for patients with chronic venous leg ulcers: A systematic review. Wound Repair & Regeneration, 22(2), 193-204. doi:10.1111/wrr.12151