Pressure ulcers are prevalent among patients with mobility issues in long-term care settings. Understanding the risk factors can help nurses respond to complications and prevent the development of these wounds. Improving patient outcomes and reducing hospitalization costs can result from adopting best practices in this area. Therefore, prevention and treatment components of training are essential because they help decrease the impact of ulcers and related complications on patients.
Background
In their article, Chen et al. (2015) address the problem of wound management difficulties due to a lack of standardized evidence-based guidelines, poor care coordination, and the absence of a dedicated specialist unit. The significance of the article to nursing relates to improved healing outcomes (less pain) when a three-step treatment approach is adopted in chronic wound care. An efficient referral system would enhance diagnosis, communication, and coordination among multidisciplinary teams. The purpose of the study was to establish a protocol for efficient wound management and referral that would ensure optimal outcomes for patients and caregivers. Its main objective entailed developing a conceptual framework for a wound care pathway in a rural facility. The approach includes three components of the care continuum: patient entry, wound re-evaluation, and patient care plan. The research questions are not provided.
Choi et al. (2016) examine the problem of unverified responsiveness of the Pressure Ulcer Scale for Healing (PUSH) tool in severe and chronic wounds. The ability of the method to identify small but clinically significant changes is unknown, which can impact the outcomes of care interventions. The article established the internal and external responsiveness of this tool; hence, in nursing practice, it can be used for measurement of wound types, healing progress, and outcomes of accurate interventions. The study’s purpose was to investigate the usefulness of the PUSH method in evaluating the healing of severe and chronic wounds. The specific objective was to assess the responsiveness (both external and internal) of this tool in detecting small improvements resulting from nursing interventions. Research question is not provided in this article.
Article Support of Nursing Practice
Both articles answer the PICOT question addressed through this project. Chen et al. (2015) demonstrate that onsite screening and debriding of different wound types followed by re-evaluation, and individualized care plans (multidisciplinary follow-up) accelerates healing and improvement. The consultation team referred to in the PICOT has a specific capacity to manage pressure ulcers more efficiently in patients admitted at the nursing home than when protocol care is used. On the other hand, Choi et al. (2016) show that the PUSH tool can aid nurses track wound healing and responsiveness to interventions. This finding indicates that the consultation team at the nursing home can use PUSH in routine assessments to monitor the healing progress of pressure ulcers. The tool will form the basis for continuing with an intervention or replacing it with another.
Method of Study
Chen et al. (2015) implemented a three-step wound management pathway in a Taiwanese facility with high rural referrals. This prospective cohort study used a convenient sample of 1,103 patients presenting with diverse wound types, for example, pressure ulcers. After a staff-led assessment, referral, and debridement of the patient, the wound was re-evaluated, and a comprehensive individualized wound care plan developed. The institutional review board of the facility approved the study.
On their part, Choi et al. (2016) used a prospective, longitudinal observational design to study the responsiveness of the PUSH method in evaluating wound healing. Thirty-three subjects with acute wounds were recruited from 27 clinics in Hong Kong and received primary care. Nurses recorded the patients’ baseline and at-discharge PUSH scores and compared them to clinically determined wound status. The data were used to evaluate the responsiveness of the PUSH tool. Approvals were sought and approved for the study protocol from six institutional review boards before starting the research.
Both studies used a prospective cohort study design, which allowed multiple outcomes to be measured. However, Chen et al. (2015), the multidisciplinary team implemented different integrated interventions, including education, community-level prevention, appropriate clinical protocols by doctors, and follow-up. In contrast, Choi et al. (2016) measured the PUSH scores after nurse-led wound care treatment at a primary facility. Sample size differences can also be seen in the studies (1,103 vs. 33 subjects). Additionally, Chen et al. (2015) implemented the wound management protocol in a tertiary facility while Choi et al. (2016) conducted their study in primary care settings.
The research method adopted in each study has some benefits and limitations. The large sample size used by Chen et al. (2015) and the 4-year data collection period enhanced the external validity of their results. Thus, the benefit of this method is that the findings can be generalized to diverse tertiary wound care settings. However, post-discharge data on complications and re-ulcerations were not measured; hence, a limitation was caused. On the other hand, a benefit of Choi et al.’s (2016) study is that the sample subjects used the patients presented at primary care facilities in terms of age, gender, and wound type. However, the study’s findings may not be generalized to tertiary wound care environments that involve specialized care.
Results of the Study
Chen et al. (2015) reported a significant wound healing in 62% of the subjects with 13% of them having no progress. A further 25% of the participants were lost to follow-up. The most healed wound type was diabetic foot ulcers while pressure ulcers were least responsive to integrated care. Based on these results, the authors found that the 3-step wound management pathway was associated with “efficient onsite screening, timely debridement, and multidisciplinary team care” (Chen et al., 2015, p. 6). Another finding was that the framework improved the quality of wound care through effective follow-up and patient education. The results of Choi et al.’s (2016) study indicated that the PUSH scores were significantly higher at discharge compared to the baseline, validating the internal and external responsiveness of the tool (P<0.001). Therefore, the main finding was that the PUSH method could monitor diverse wound pathologies of different severities, for example, as skin cuts and burns.
The implications of Chen et al.’s (2015) findings for nursing practice are that scheduling appointments outside waitlists ensures timely and quality wound care. Additionally, in-person assessment and debridement of the wound by the healthcare practitioners coupled with follow-up and education ensure holistic treatment that improves patient outcomes. Choi et al.’s (2016) findings have two practice implications. First, nurses inexperienced in wound assessment can use the PUSH method can be used to evaluate different wounds accurately. Further, PUSH scores can be utilized to assess the efficacy of nursing interventions.
Outcomes Comparison
It is anticipated that wound care consultation will reduce the risk of pressure ulcers (PU) after three months. The post-intervention outcomes will include a lower incidence of PU wounds in immobile or at-risk patients due to better skincare, nurse training, appropriate nutritional support, and effective prophylactic dressing (Byrne et al., 2016; Feng et al., 2016). The consultation team will collaborate to reduce the risk of pressure injury (Ousey et al., 2016). Accordingly, the outcomes of one of the chosen articles support the use of integrated, multidisciplinary teams in holistic care that includes follow-up, education, and prevention of wounds (Chen et al., 2015). Nurses not familiar with wound assessment can use the PUSH tool to so accurately (Choi et al., 2016). Thus, consistent with the anticipated outcomes, the method can prevent acute and chronic wounds.
References
Byrne, J., Nichols, P., Sroczynski, M., Stelmaski, L., Stetzer, M., Line, C., & Carlin, K. (2016). Prophylactic sacral dressing for pressure ulcer prevention in high-risk patients. American Journal of Critical Care, 25(3), 228-234.
Chen, Y. T., Chang, C. C., Shen, J. H., Lin, W. N., & Chen, M. Y. (2015). Demonstrating a conceptual framework to provide efficient wound management service for a wound care center in a tertiary hospital. Medicine, 94(44), 1-7.
Choi, E. P., Chin, W. Y., Wan, E. Y., & Lam, C. L. (2016). Evaluation of the internal and external responsiveness of the Pressure Ulcer Scale for Healing (PUSH) tool for assessing acute and chronic wounds. Journal of Advanced Nursing, 72(5), 1134-1143.
Feng, H., Li, G., Xu, C., & Ju, C. (2016). Educational campaign to increase knowledge of pressure ulcers. British Journal of Nursing, 25(12), 30-35.
Ousey, K., Kaye, V., McCormick, K., & Stephenson, J. (2016). Investigating staff knowledge of safeguarding and pressure ulcers in care homes. Journal of Wound Care, 25(1), 5-11. Web.