Implementing Wound Care Guidelines: Observations and Recommendations from the Bedside
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Abstract:The successful implementation of wound care guidelines requires an appreciation for the frustrations experienced by nurses trying to incorporate these tools into clinical practice. These frustrations or barriers to best wound care practice implementation are examined from the perspective of: 1) the practice environment, which must be understood; 2) the potential adopters, predominantly nurses seeking the best fit between evidence and their clinical practice setting; and 3) the evidence-based innovation created to change wound care practice at the point of care. Barriers identified include lack of available resources, time constraints, prescriptive guidelines that incorrectly assume details of the practice environment, and wound care product confusion. Recommendations to facilitate implementation from the bedside are discussed and include expanding guidelines to incorporate detailed educational content and dissemination strategies that serve to increase relevancy to everyday practice. Additional suggestions include decreasing wound care product confusion by developing standardized, function-based product nomenclature and improving the quality of wound care research to increase nurses’ confidence in the evidence and resultant recommendations. Resources currently used to develop guidelines also should be utilized to create accompanying educational material to support the transfer and uptake of knowledge.
Key Words: wound care, guidelines, implementation, barriers, nursing
Ms. Lloyd-Vossen is a member of the faculty, Nursing Education Program of Saskatchewan. Please address correspondence to: Jan Lloyd-Vossen, NEPS SIAST Kelsey Campus, PO Box 1130, Saskatoon, Saskatchewan S7K 3R5 Canada; email: firstname.lastname@example.org.
Tracey is a 30-year-old registered nurse who graduated from a baccalaureate program 5 years ago. She recently accepted the only clinical nurse educator position in her 100-bed hospital. Tracey’s manager asked her to create an effective in-service to remedy “all the confusion the nurses have about those new dressings.” Tracey investigated the value-added educational programs offered by the wound care manufacturers. The facilities in the region recently standardized the wound care product formulary, awarding products to six manufacturers, each with independent programs and company-specific product information. Tracey contacted the regional wound care specialist, who suggested that rather than focusing only on dressing selection, a comprehensive education program consistent with the province’s skin and wound care guidelines should be planned. After studying the regional guidelines, Tracey attempted to assemble a multidisciplinary team to organize and facilitate guideline implementation. Unfortunately, although most clinicians thought wound care standardization was a good idea, only two people attended the initial meetings. After several unsuccessful attempts to elicit support from the stakeholder and countless attempts to “chunk down” the guidelines to a series of short educational events, Tracey put the wound care product in-service on hold.
To the expert wound care provider, it may seem implausible that something as simple as creating a product in-service can become difficult. How hard can it be to plan and implement wound care educational sessions when nurses have access to a wealth of wound care resources, including specialist journals and textbooks, conferences and educational courses, numerous websites, clinical guidelines, care maps, implementation checklists, wound care specialists, and associations dedicated to the advancement of wound care?
Research-based practice is a hallmark of professional nursing. Although this example is specific to wound care, it typifies the frustration experienced by nurses trying to incorporate practice guidelines into clinical practice.
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