Nursing education and wound care. Undergraduate nursing education includes a broad array of theoretical and clinical topics. Faculty must make tough curricular decisions as to what is taught and what is left out.7 Nursing students generally obtain theoretical and clinical content about wounds in the classroom and through varied clinical placements. The clinical setting is the least controlled of the learning environments because of the patients’ changing health status.7 Thus, nursing students may see wound management performed by other practitioners, may not see it at all, or sometimes be allowed to perform wound care.7 The limited research regarding undergraduate nursing education in terms of wounds and their care is summarized to follow.
Huff8 conducted a quantitative, quasi-experimental nonrandomized study of undergraduate nursing students’ knowledge of wound care. She compared 65 undergraduate nursing students in their second year of a baccalaureate nursing program (intervention group) with 55 first-year nursing students in a 2-year community college program (control group). All students received basic instruction on wound care and read a chapter about wound care in their textbook. Huff used a 10-item questionnaire to measure wound care knowledge before and after an intervention. The intervention was a 2-hour lecture and clinical laboratory experience delivered by a wound care specialist. The students who received the intervention had significantly higher test scores compared to the control group; the knowledge persisted for 2 months. Huff concluded a modest increase in curricular time may help fill a void in wound care education.
Romero-Collado et al9 examined course content regarding chronic wounds in 114 centers in Spain that offered a nursing degree; 95 programs posted their course content online and were the basis for the analysis. No center offered a course dedicated to chronic wounds or presented content about wound pain and its management. The concept/content of pressure ulcer prevention was lacking in 60 of the centers; 36 centers did not mention pressure ulcer treatment. Twenty-one (21) centers included content on wound dressing selection. Only 4 courses in 4 centers presented content about care of the diabetic foot; in contrast, venous and arterial disorders of the lower extremities were presented in 55 centers. Only 1 course presented wound bed assessment. The study authors concluded course content related to chronic wounds was deficient and nursing degree programs need to guarantee the acquisition of minimum basic skills in the prevention and treatment of chronic wounds and thus reduce theory-practice gaps.
Ousey et al10 examined final year nursing students’ (N = 217) formal teaching about skin integrity during their clinical placement at 2 educational institutions in England. Students were invited to complete a questionnaire. A majority of all respondents (67.9%) reported receiving <10 hours of formal teaching on skin integrity across their 3-year nursing education at the university. Most (70.3%) participants stated the teaching had developed their knowledge and skills to maintain skin integrity for all patients. Formal teaching also occurred during clinical experiences. The authors concluded it was essential for mentors and clinical staff to understand the importance of actively contributing to nursing students’ learning about skin integrity.
Ribu et al11 explored home care nurses’ (n = 31) and nursing students’ (n = 30) knowledge of the treatment of patients with leg and foot ulcers in the community in Norway. The authors used a structured observation form. They did not compare nurses with nursing students or separate the care by the nurse’s educational level. They reported some patients (16/32) lacked an ulcer diagnosis; most (79.9%) of the patients had other chronic diseases. The authors observed 35 wound care treatments on 32 patients. The most common ulcers were venous (7), diabetes-related foot/leg ulcers (5), and mixed cause ulcers (4). Nurses performed poorly in several aspects of wound care: lack of clinical assessment of the wound, poor use of wound care protocols, lack of hand washing, poor pain management, and poor documentation. The authors concluded nurses in the community needed more education about wound care and more time to provide wound treatments and documentation.
Day et al12 presented a 2-hour session about basic wound management to mental health nursing students (N = 20) in England. Wound types included trauma, leg ulcers, pressure ulcers, burns, and melanoma. Students raised questions about dressing selection, application of dressings, and documentation. Mental health nursing students acknowledged a deficit in skill acquisition, especially wound care, within the practice setting related to a lack of physical resources, support, mentor time, and knowledge. The authors concluded mental health nursing students need to be exposed to clinical skill teaching preregistration; one of the key areas was wounds.
Ayello et al13 conducted a survey of nurses’ wound care knowledge through a questionnaire placed in 2 journals; 692 nurses from 48 states, 5 Canadian provinces, and 7 other countries returned the survey. Of the 23 survey questions and statements regarding wound care knowledge and practice, 1 question was about chronic wound education in basic nursing education programs. Only 30% of respondents believed they received sufficient education about chronic wounds in their basic nursing education program. Younger, less experienced nurses compared to older, more experienced nurses felt better about their level of wound care education. The authors concluded the difference between less and more experienced nurses may reflect improved education about wound care, forgetting what they learned, or not knowing what they do not know until they have some experience. Only 20% of nurses who work with the most vulnerable populations (ie, home care, long-term care/subacute care, and the like) believed they had received sufficient wound care education. When nurses were asked how comfortable they were about making recommendations to practitioners on appropriate wound dressings, the most common response was sometimes (41%).
Medical education and wound care. Collaboration among health care providers is a means to improve patient outcomes. Nurses work collaboratively with other clinicians in determining interventions for wound care; thus, they need to be cognizant of what other practitioners offer in terms of knowledge and skill. The lack of education in medical schools about wounds and their care has been identified. Patel and Granick4 examined the time devoted to physiology of tissue injury, physiology of wound healing, and clinical wound healing at 50 medical schools in the US. Data were obtained from the American Association of Medical Colleges database. The mean hours of education in physiology of tissue injury were 0.05 in year 1, 0.2 in year 2, and none in years 3 and 4. The mean hours of education about physiology of wound healing were 2.1 in year 1, 1.9 in year 2, and <1 hour in years 3 and 4. The clinical education about wound management was highest at 2.1 hours in year 2 compared to 0.4 hours in years 1 and 4. Total hours of wound education across the 3 topics (physiology of tissue injury, physiology of wound healing, and clinical wound healing) for 4 years were 9.2. The study authors concluded there was a lack of direct education about wound topics in American medical schools.4
Fourie5 examined themes about wound management and treatment that medical professionals (N = 30) considered during their studies. The author interviewed 9 medical practitioners and had 21 others complete a questionnaire. During their training, 88% stated they received none to minimal formal wound management education. For specific wounds, 77% of participants were uncertain about what the best wound care treatment would be. Five themes were identified as challenges in wound management within their practice/setting: lack of resources (23%), uncertainty of what products to use and when (44%), patient factors of sepsis and complications (13%), poor continuity of nursing care and failure to follow instructions (15%), and lack of team work (5%). Most participants (75%) stated no formal policy was available on wound management best practice in their practice or institution. Most (97%) medical practitioners said wound care education was very important and more training should be provided about it.5
Summary. Theoretical knowledge about wounds and their care and clinical experience with patients with wounds are important components in undergraduate nursing education. Studies about wound care in nursing education are scant. Two (2) studies from the US8,13 and 4 from Europe9-12 examined wound care education in nursing, and 2 studies looked at wound care education in medicine.4,5 All studies identified deficiencies in wound care education. In the US, the number of individuals with wounds is increasing with the aging population and the number of persons with chronic health conditions.
The literature lacks information about the exposure and experiences of students in an introductory baccalaureate nursing course to patients who have wounds. The current study authors had the following questions: 1) What types of patients with wounds are assigned to beginning students? 2) What wound care procedures and dressings are ordered for patients with wounds? 3) What experiences do students have providing wound care?