The use of this evidence-based best practice framework will allow for consistency across all health care institutions involved in the provision of an adaptation and assessment programme to nurses … The results provide a measure of how well the selected wound assessment tools meet the criteria of the optimal wound assessment tool. to a Stage 3 or 4 Pressure Injury. Table 1 presents the inclusion/exclusion criteria and Table 2 summarises the WATs that were included in the action evaluation. • fourteen wound assessment tools were evaluated using an audit tool comprising a set of criteria for an optimal wound assessment tool. Increased focus on wound management in nurse education might improve nurses' theoretical understanding of wound healing, but according to Benner's theory of novice and expert 20, knowledge takes time to develop. Delays in wound healing require more nursing time and additional resources. This can be used to help nurses decide which WATs to use in practice: WATs which score higher on the audit are proposed to better meet the needs of nurses in wound assessment. Pressure ulcer care alone is estimated to cost around £1.2 billion a year 12, while surgical site infections are estimated to cost between £814 and £6626 per patient 13. Ashton and Price 16 found that nurses lack knowledge of wound management and feel unprepared to carry out wound care, particularly when newly qualified. to a Stage 2 Pressure Injury; a Full Thickness wound is . Jump to search results. She suggests that a standardised WAT could improve care 46. In order to conduct the evaluation, a literature review was undertaken to identify the criteria of an optimal wound assessment tool which would meet nurses' needs. We would argue that these criteria are equally important as the basic criteria which are more commonly included in WATs. Computer-Assisted Wound Assessment and Care Education Program in Registered Nurses. A complex evaluation was not considered appropriate for this study because the aim was simply to determine whether nurses' needs for wound assessment, as indicated in the current literature, are being met by selected WATs. Management of wounds in the community: five principles. The extent to which each of the criteria was met by the WATs ranged from 86% for ‘tissue type’ to 7% for ‘guiding practice’: the latter was met by only two WATs, namely the NWAF which was ranked second and the East Kent Hospitals Wound Assessment Chart which was ranked seventh. Health professionals' perspectives on delivering patient-focused wound management: a qualitative study. The age of the patient 2. Impaired blood supply 5. Initially, we did not differentiate between WATs used for specific purposes/clinical conditions, but some were subsequently excluded on the basis of specialised wound types according to the exclusion criteria in Table 1. These were: ‘wound healing’; ‘nurses needs for wound assessment’; ‘nurses use of WATs’; ‘nurse education and wound assessment’; ‘wound healing and exudate’; ‘wound healing and tissue type’; ‘wound assessment and dressings’; ‘wound management’. The two wound assessment tools were •Applied Wound Management (AWM) Gray et … This is closely followed by the National Wound Assessment Form (NWAF). It is likely that your workplace will utilize a single tool. Figure 1 shows how well the sample WATs (ranked from left to right) met the criteria for the optimal WAT as a whole. Neither is it known which WATs nurses are actually using in practice as there has been no research into this 3. This may be the first study to critically compare and evaluate a selected number of readily available WATS and to determine whether they meet the needs of nurses. Criteria are ranked according to what percentage of WATs met each criterion. These costs are likely to rise as the number of older people in the population continues to increase. Not all products referred to may be approved for use or available in all markets. We employed an action evaluation methodology. In most cases the criteria were scored as either met or unmet. A wound assessment app that scans wounds and shares images with tissue viability nurses and district nurses for further assessment is among a range of technology receiving funding in Wales. (iii) how can I achieve this objective without damaging healthy tissue? It has been argued that nurses, particularly inexperienced nurses, would benefit from a WAT which is capable of supporting them in carrying out wound assessment and that AWM is one such adjunct to decision making 51. Toronto, ON: Registered Nurses… Although both WATs scored well, the implementation of the NWAF would be more straightforward than the AWM. is not important in wound assessment, but that the point of recording this is to give nurses information about the wound which they can use to plan care. However, a WAT can never be a substitute for clinical knowledge and expertise 51. The study provides a mechanism for the appraisal of wound assessment tools using a set of optimal criteria which could aid practitioners in their search for the best wound assessment tool. The number of indicators rather than parent criteria is used, because individual WATs may meet some indicators of a particular criterion but not others. A second search was carried out to find published and unpublished WATs. The results identify which WATs performed well and which performed poorly. Learn about our remote access options, Faculty of Medicine and Health Sciences, School of Nursing, Midwifery and Physiotherapy, Queen's Medical Centre, University of Nottingham, Nottingham, UK, School of Nursing, Midwifery and Physiotherapy, E‐mail: sheila.greatrex‐white@nottingham.ac.uk, Haematology and Oncology Day Treatment Unit, Churchill Hospital, Headington, Oxford, UK. Timmins concludes that a structured WAT can help improve nurses' practice, but that this requires adequate educational support. The criteria for the optimal WAT were selected on the basis that they were included in the literature as being of equal importance in wound assessment, but they can be divided into two groups: basic criteria and advanced criteria. This evaluation provides an important step in identifying and meeting nurses' needs in wound assessment, but more work is required. Team Leader: Clinical Nurse Consultants Area/Dept: Stomal Therapy (CHW) and Surgical and Wound Care (SCH) Date of Publishing: 6 June 2014 3:23 PM Date of Printing: Page 1 of 17 K:\CHW P&P\ePolicy\May 14\Wound Assessment Mgt.docx This Guideline may be varied, withdrawn or replaced at any time. The methodology employed was evaluation research. Although this will inevitably involve financial investment, it is worth bearing in mind that the expenditure on dressings fell from £44,580 over the four months before the trial, to £35,816 during the four months of the trial. Several freely available wound assessment tools were selected based on predetermined inclusion and exclusion criteria and an audit tool was developed to evaluate the selected tools based on how well they met the criteria of the optimal wound assessment tool. ADIE - Nursing Interventions of Diabetic Foot Ulcer: An Integrative Review of the Literature. The SIMPLY SWIFT BLOG: Wound Assessment Tools 101 paper provides an overview of several tools, describing their purpose, validity, reliability, responsiveness and utility in the real-world … Action evaluation 29 is a simple and quick form of evaluation which is carried out for one user group (nurses in this instance), using their value criteria (WAT criteria developed from nursing literature), to enable them to make informed decisions (which WAT should be used). In order to develop standardised treatment pathways for wound management, research is needed to identify what is currently happening in practice, which WATs are being used and how well they are meeting nurses' needs. The NWAF is a standalone tool which is intuitive to use without any additional training. A search of electronic databases was carried out (EMBASE 1980–present and MEDLINE 1996–present) using the search terms ‘wound’ and ‘assessment’. However, learning wound care ‘on the job’ is only likely to perpetuate practice based on ritual and personal preference. Use the link below to share a full-text version of this article with your friends and colleagues. It was found that before training only 20% of the nurses selected the correct dressings whereas after Timmins' intervention, this rose to 73%. Potential Properties of Lactobacillus plantarum F-10 as a Bio-control Strategy for Wound Infections. To identify from existing literature what nurses require from a WAT. The full text of this article hosted at iucr.org is unavailable due to technical difficulties. There are several possible reasons why nurses may find wound assessment and wound care difficult. In addition to published WATs, this search also identified WATs used by UK NHS Trusts which were publically available on the Internet. Additionally, there are many patients requiring wound care in the community setting. Number of times cited according to CrossRef: Surgical wound assessment in Vietnam: a think-aloud technique and interview analysis. While much research is being carried out into developing sophisticated dressings, designed to interact with the wound bed and accelerate wound healing 54, these expensive dressings will be wasted if they are used incorrectly as a result of poor wound assessment and management. It is important to point out that a number of titles were unavailable thus limiting the number of tools included. The Peristomal Skin Assessment Guide for Clinicians is a mobile tool that provides basic guidance to clinicians on identifying and treating peristomal skin complications, including instructions for patient care and conditions that warrant referral to a WOC/NSWOC (Nurse Specialized in … Potential Properties of Lactobacillus plantarum F-10 as a Bio-control Strategy for Wound Infections. As a search revealed no suitable audit tool in existence, it was necessary to develop a new instrument. To achieve this, the following aim and objectives were established. The number of indicators rather than parent criteria is used, because individual WATs may meet some indicators of a particular criterion but not others. The reference lists from the literature were also scrutinised for references to additional WATs. An individual WAT may meet one, two or all of these indicators. The Bates-Jensen Wound Assessment Tool (BWAT) is used to assess wound healing in clinical practice. These may include: 1. Management tool and the National Wound Assessment Form) met the most criteria of the optimal tool and were therefore considered to best meet nurses needs in wound assessment 1/06/2015 Blenheim May 2015 4 . The purpose of this study was to evaluate BWAT use among nursing home residents with pressure injury. The WATs to be evaluated were selected from tools readily available for nurses to use in their practice. Figure 1 shows how well the sample WATs (ranked from left to right) met the criteria for the optimal WAT as a whole. Percentage of criteria indicators met/not met/unclear. This particularly applies to chronic wounds in which the normal healing trajectory is not followed 15. However, the criteria of monitoring healing and guiding practice were met in less than 20% of the WATs. This is closely followed by the National Wound Assessment Form (NWAF). It may be that these criteria have not previously been identified as important in wound assessment. If you do not receive an email within 10 minutes, your email address may not be registered, 22-24. Applied Wound Management seeks to improve wound care by facilitating a systematic approach to the complex issue of wound assessment and management 4. The aim of a general health assessment is to identify and eliminate any underlying causes or contributing factors which may impact the healing process. It is the advanced criteria that add value to the wound assessment process by making it more useful and meaningful. It ‘seeks to address practical problems and make judgements of merit or worth so as to provide recommendations and outcomes that may inform future activities’ 28. 8 Wound assessment itself therefore is not the goal; rather it is the means to the end 21, which is to achieve optimal wound management. Size 20 = wound is closed (skin intact) or nearly closed (<0.3cm) 1 = 0.5 – 22.0 cm 2 = 2.0 - 10.0 cm2 Haram et al. No tool was identified which fulfilled all the criteria, but two (the Applied Wound Management tool and the National Wound Assessment Form) met the most criteria of the optimal tool and were therefore considered to best meet nurses' needs in wound assessment. The challenging nature of wound healing has led to calls for practitioners worldwide to adopt a holistic and systematic approach to wound care 1-3. Effect of Photobiomodulation on Repairing Pressure Ulcers in Adult and Elderly Patients: A Systematic Review. According to Leaper 19, no systematic reviews have been carried out in the area of wound assessment and this has led to a reliance on expert opinion for guidance. It seeks to incorporate the principles of debridement, wound bioburden control, and exudate management 47 and attempts to create the right conditions in a wound to allow healing to take place 48. Although both WATs scored well, the implementation of the NWAF would be more straightforward than the AWM. Guideline - Key objectives of wound assessment 8 Factors that could delay wound healing 8 . Poor ischemic wound knowledge is another crucial area for the analysis. The NWAF was devised through discussion of previous WATs by a panel of experts and whilst the experts involved are likely to have possessed a wealth of experience in relation to wound assessment, no empirical work was carried out to support the contents of the tool. There were only a few instances in which it was unclear whether the criteria indicators were present or not. the Registered Nurses’ Association of Ontario. Fletcher recognised that there is inconsistency in wound assessment practice and that documentation of care is often poor. The results could be used to assist nurses when selecting a WAT for use in their area of practice. In order to conduct the evaluation, a literature review was undertaken to identify the criteria of an optimal wound assessment tool which would meet nurses' needs. Specific assessment of the wound 11 . In order to maximise wound healing, nurses need to be able not just to record certain parameters in their wound assessment, but also to know what to do next. The extent to which each of the criteria was met by the WATs ranged from 86% for ‘tissue type’ to 7% for ‘guiding practice’: the latter was met by only two WATs, namely the NWAF which was ranked second and the East Kent Hospitals Wound Assessment Chart which was ranked seventh. Wound Assessment Tools. A skilled nurse who can accurately assess a wound, plays a vital role in determining the appropriate management of a wound to promote healing and avoid secondary complications. The advanced criteria comprise the more subjective components of a WAT and are often more difficult to assess in an audit. Enter your email address below and we will send you your username, If the address matches an existing account you will receive an email with instructions to retrieve your username. This raises the issue of whether education on AWM should occur as part of preregistration training or as the continual professional development of qualified staff. The ‘Best practice statement’ 9 states that ‘wound management in the United Kingdom and Ireland is generally not organised or delivered in a uniform fashion against measureable standards of care and with clear referral pathways’. Current economic pressures within the NHS, including the need to make £20 billion in efficiency savings by 2015 14, means that treatments must be cost effective. Evidence‐based practice requires that nursing practice is informed by up‐to‐date research 18, 19. First, ‘at what stage is this wound?’ Second, ‘what do I want this wound to do next?’ Third, ‘how can I achieve this objective without damaging healthy tissue?’ Hence, it is important for nurses to be able to accurately establish the current condition of the wound, evaluate whether it is improving or deteriorating, and decide upon the most suitable treatment. Legal implications of pressure injuries: experience of a tissue viability nurse expert. The audit results show that the Applied Wound Management (AWM) Tool meets the most criteria of the optimal WAT. It does not give any information on how well individual criteria were met. Evaluation of the assessment and documentation of chronic wounds in residential social care in the Czech Republic, Generic tools and tools for common wounds (including leg ulcers, pressure ulcers, general surgical wounds, traumatic wounds), Tools for specialised wounds (e.g. It has also revealed that more research is needed to establish what is currently happening in practice, and what nurses believe their needs to be. Many nurses lack knowledge of wound management and wound assessment, and it has been suggested that a WAT could provide support for nurses in this area. Probing community nurses' professional basis: a situational case study in diabetic foot ulcer treatment. The audit tool required specific evidence from the WAT to determine whether the optimal criteria were met. For example, 79% of the WATs was found to meet the criteria indicators for wound details, while the remaining 21% did not. Neither do we know what nurses feel as their needs in carrying out wound assessment. This is not to say that recording wound size, exudate, tissue type etc. We have shown that there are WATs in existence which meet many of the needs of nurses in carrying out wound assessment and that no tool has been identified which meets all the requirements of nurses. A literature search revealed that the majority of publications concerning wound care comprise discussion or opinion papers rather than empirical papers. Risk, Prevention and Management of Complications After Vaginal and Caesarean Section Birth. The Nurses for Nurses Network has created a nine-module Wound Management Program, called the Fabulous World of Wounds that provides the Nurse with the skill and knowledge to assess, plan, and manage wounds in the clinical setting, to achieve the best possible outcome for the client. Bates-Jensen, B., & McNees, P. (1995). Presence of disease and/or use of medication 3. These criteria were subdivided into a total of 35 relevant ‘indicators’. similar . They represent the more apparent, objective aspects of wound assessment, for example, wound details, patient details, measurement, tissue type, exudate, surrounding skin, pain and infection. To achieve this, the following aim and objectives were established. Although this may initially appear relatively straightforward, in practice this is often not the case and there is recognition that in order to achieve optimal wound care, nurses require more support 9. This action evaluation supports the use of either the NWAF or AWM as a tool to facilitate wound assessment. Findings and reliability estimates from the BWAT related to pressure injury characteristics (stage … The purpose of this study was to ascertain whether selected WATs meet the needs of nurses in carrying out wound assessment and whether current tools are fit for that purpose. Studies have found that postregistration training for nurses does improve wound care practice 53. 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