Computer-Assisted Wound Assessment and Care Education Program in Registered Nurses: Use of an Interactive Online Program by 418 Registered Nurses.

PURPOSE: The purpose of this descriptive study was to evaluate use of a previously validated, online, interactive wound assessment and wound care clinical pathway in a group of RNs. Specific aims were to (a) evaluate the proportions of correct, partially correct, and incorrect algorithmic decisions and dressing selections, (b) compare response rates between nurses who are and who are not wound care certified, and (c) evaluate its ease of use, educational value, and applicability in clinical practice. DESIGN: Descriptive study. SUBJECTS AND SETTING: Participants were recruited using convenience and snowball sampling methods. Four hundred eighteen nurses completed all 15 assessments; nearly half held a bachelors' degree in nursing (189, 45%), more than two-thirds worked in an inpatient acute care settings (277, 68%), and 293 (70%) were not certified in wound care. METHODS: After providing written informed consent and completing the participant demographics form, participants assessed 15 photographs of wounds with accompanying moisture descriptions and completed an algorithm and dressing selection for each. All responses were anonymously collected by the program. Existing, retrospective, program data were also downloaded and data from nurses who completed all assessments were extracted and analyzed. Descriptive statistics were used to analyze all variables. Selection outcomes and survey responses between nurses who were and who were not wound care certified were compared using a 2-sample Student t test assuming unequal variances. Individual responses for the first 6 wounds were compared to the last 6 wounds using a paired t test. RESULTS: The mean (M) proportions of fully or partially correct (operationally defined as safe but not fully correct) algorithm and dressing choice were 81% (SE: 0.88, 95% confidence level: 1.73) and 78.1% (SE: 0.70, 95% confidence level: 1.39), respectively. Wound care-certified nurses had higher mean algorithm scores than those who were not certified (M: 89.2%, SE: 1.27 vs M: 77.8%, SE: 1.10, P < .001). Most incorrect/partially correct choices were attributable to incorrect necrotic tissue assessment (n = 845, 58%). The difference between fully correct first 6 and last 6 algorithm choices was statistically significant (M: 310, SE: 0.02 vs M: 337, SE: 9.32, P = .04). On a Likert scale of 1 (not at all) to 5 (very), average scores for ease of program and algorithm use, educational value, and usefulness for clinicians ranged from M: 4.14, SE: 0.08 to M: 4.22, SE: 0.08. CONCLUSIONS: Results suggest that the algorithm is valid and has potential educational value. Initial evaluation also suggests that program refinements are needed. Evaluation of participant responses indicated potential problems with the definitions used for necrotic tissue or assessment knowledge deficits. Results also substantiate the importance of instructional design and testing online education programs. More research is needed to uncover potential gaps in nurses' wound care knowledge that may hamper evidence-based practices adoption and the need to develop effective, evidence-based education-delivery techniques.

Calling All Nursing Students: How Much Wound Care is in Your Future?

This month, more than 2,000 student nurses and nursing faculty will attend the National Student Nurses Association Annual Convention in Orlando, FL. Thinking about this event presents the perfect time for student nurses, faculty, clinical instructors, and preceptors--anyone involved in wound prevention and care practice or education--to look ahead and ponder the future of nursing in general and wound care nursing in particular.

Pressure ulcer prevention algorithm content validation: a mixed-methods, quantitative study.

Translating pressure ulcer prevention (PUP) evidence-based recommendations into practice remains challenging for a variety of reasons, including the perceived quality, validity, and usability of the research or the guideline itself. Following the development and face validation testing of an evidence-based PUP algorithm, additional stakeholder input and testing were needed. Using convenience sampling methods, wound care experts attending a national wound care conference and a regional wound ostomy continence nursing (WOCN) conference and/or graduates of a WOCN program were invited to participate in an Internal Review Board-approved, mixed-methods quantitative survey with qualitative components to examine algorithm content validity. After participants provided written informed consent, demographic variables were collected and participants were asked to comment on and rate the relevance and appropriateness of each of the 26 algorithm decision points/steps using standard content validation study procedures. All responses were anonymous. Descriptive summary statistics, mean relevance/appropriateness scores, and the content validity index (CVI) were calculated. Qualitative comments were transcribed and thematically analyzed. Of the 553 wound care experts invited, 79 (average age 52.9 years, SD 10.1; range 23-73) consented to participate and completed the study (a response rate of 14%). Most (67, 85%) were female, registered (49, 62%) or advanced practice (12, 15%) nurses, and had > 10 years of health care experience (88, 92%). Other health disciplines included medical doctors, physical therapists, nurse practitioners, and certified nurse specialists. Almost all had received formal wound care education (75, 95%). On a Likert-type scale of 1 (not relevant/appropriate) to 4 (very relevant and appropriate), the average score for the entire algorithm/all decision points (N = 1,912) was 3.72 with an overall CVI of 0.94 (out of 1). The only decision point/step recommendation with a CVI of ≤ 0.70 was the recommendation to provide medical-grade sheepskin for patients at high risk for friction/shear. Many positive and substantive suggestions for minor modifications including color, flow, and algorithm orientation were received. The high overall and individual item rating scores and CVI further support the validity and appropriateness of the PUP algorithm with the addition of the minor modifications. The generic recommendations facilitate individualization, and future research should focus on construct validation testing.

The Association for the Advancement of Wound Care (AAWC) venous and pressure ulcer guidelines.

Guidelines based on best available evidence to support pressure ulcer (PU) or venous ulcer (VU) management decisions can improve outcomes. Historically, such guidelines were consensus-based and differed in content and development methods used. Since 2002, the Association for the Advancement of Wound Care (AAWC) Guideline Task Force has used a systematic approach for developing "guidelines of guidelines" that unify and blend recommendations from relevant published guidelines while meeting Institute of Medicine and Agency for Healthcare Research and Quality standards. In addition to establishing the literature-based strength of each recommendation, guideline clinical relevance is examined using standard content validation procedures. All final recommendations included are clinically relevant and/or supported by the highest level of available evidence, cited with every recommendation. In addition, guideline implementation resources are provided. The most recent AAWC VU and PU guidelines and ongoing efforts for improving their clinical relevance are presented. The guideline development process must be transparent and guidelines must be updated regularly to maintain their relevance. In addition, end-user results and research studies to examine their construct and predictive validity are needed.

Creating a pressure ulcer prevention algorithm: systematic review and face validation.

Pressure ulcer (PU) prevention is a care imperative supported by substantive evidence, but translating that knowledge into clinical decision-making at the point of care remains challenging. The purpose of this study was to create a succinct, evidence-based algorithm for inclusion in an existing industry-sponsored, evidence-based wound care program that will: 1) help clinicians assess and document overall patient PU risk; 2) help clinicians assess and address modifiable PU risk factors; and 3) guide clinicians toward an evidence-based protocol of care for patients with impaired skin integrity. First, using a systematic literature review and the Strength of Recommendation Taxonomy (SORT), a one-page algorithm containing 26 distinct decision points/steps was developed with study quality ratings for all publications identified. Second, based on the quality-of-evidence ratings, the strength of each recommendation was obtained for each decision point/ step. Lastly, face validation and subsequent instrument revision based on analytic input occurred. Twelve (12) wound care experts were asked to review each decision step and rate its appropriateness/relevance on a 4-point Likert scale, where 1 = not relevant/appropriate and 4 = very relevant and appropriate. Average scores and a content validity index (CVI) were calculated for the algorithm and each individual component. Two components, the use of high-quality foam and medical grade sheepskin for at-risk patients, had sufficient evidence to receive an A strength of recommendation. However, the latter had a very low CVI (0.18). One other step, frequency of assessment for current or recent history of limited mobility (B strength of recommendation), had a low CVI (0.7). The overall literature-based level of evidence was good, but overall evidence gaps remain. The overall mean score was 3.6 (SD 0.8) with a CVI of 0.89 (out of 1). Both scores indicate strong face validity. This is the first PU prevention algorithm based on systematic literature review and face validation. Future content and construct validation is needed to refine the algorithm.