Guest Editorial: Enhanced Resources Help Answer the Question, Why Wound Care?

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Barbara Pieper, PhD, RN, CWOCN, ACNS-BC, FAAN

All of us have decisive (aka, “Ah ha!”) moments that lead to choosing a career focus. One of my “moments” was my realization of how little I knew about new wound care dressings and specialty products coming on the market. What are these products? How are these products used? What is the evidence to support their use? Another “moment” occurred when persons who injected drugs came to me for care and I found literature about their wounds was in short supply. I realized I did not know the science that was evolving in wound care well enough to teach the next generation of nurses or provide the highest level of patient care in my joint university-clinical practice. I sought wound care education and certification to better prepare myself for my growing wound care patient load, and I have remained ever-vigilant regarding research and information to improve my instruction and patient care. 

If asked whether wound care is an area of clinical and research specialization in nursing, I will respond with a resounding Yes! According to statistics from the National Alliance of Wound Care1 and the American Board of Wound Management,2 approximately 16 500 United States health care professionals have obtained some type of wound care certification; ~5000 are certified wound ostomy continence nurses. Are those numbers sufficient to meet the exponentially increasing demand for professional wound care providers? Can we (and more critically, our patients) wait for nurses to have years of experience before entering the wound care specialty? 

The answer to both questions is No. With the aging baby boomer generation, the number of older adults is increasing. Wounds disproportionately affect older adults who are already burdened with multiple morbidities and negatively affect quality of life, comfort, socioeconomic living status, and the economics of health care, to name a few issues. According to Singer et al,3 more than 6.5 million US patients are estimated to have chronic wounds. Lower extremity ulcers have a 1% to 2% prevalence among adults, and even with the best care only 25% to 50% of leg ulcers and 30% of foot ulcers are healed after 6 months of treatment. Additional wound care issues affect children, persons receiving palliative and/or end-of-life care, and those with an acute wound; on a larger scale, societal issues such as the opioid epidemic can affect wound care and further stress the management of chronic pain.4 We cannot sit back and wait for a more opportune moment — it is urgent that we expeditiously encourage students, nurses, and nurse faculty to embrace wound care as a specialty, increase their knowledge, and actively work to enhance wound care for all. 

In 2015, HMP examined the need for wound care nurses and developed the program Why Wound Care? The mission of the program is to inform nursing students, recent graduates, and nursing faculty about rewarding careers in wound care; its vision is to increase the number of nurses who choose a career in wound care in order to enhance safe, effective care for people with or at risk for wounds. Research about nursing education identified numerous gaps. For example, Pieper et al5 found only 26.4% of patients assigned for care to students in a fundamentals of nursing course had a wound; the most common wounds were surgical incisions and Stage 2 pressure ulcers/injuries, and gauze was the most common dressing used. When Pieper et al6 analyzed nursing care plans written by beginning students for patients with a wound, impaired skin integrity was the third most common nursing diagnosis preceded by impaired physical mobility or activity intolerance or impaired comfort. None of the care plans included a detailed description of the wound and once again, the most common dressing in the care plan was gauze. Ayello et al7 found only 30% nurses interviewed about wounds believed they received sufficient education about chronic wounds in their basic nursing education program. Ribu et al8 reported home care nurses and nursing students performed poorly in clinical assessment of the wound, use of wound care protocols, pain management, and documentation. 

To address these and other research/knowledge gaps, the Why Wound Care? program offers evidence-based educational resources about wounds and their care. Its design overcomes accessibility and learning barriers to content, with instructional modules and information readily available online. The 9-member Why Wound Care? Board of nurse leaders developed both basic and advanced educational modules about wounds and wound care, including sections regarding wound care education, certification, and careers. Nurses now also have access to the entire 2018 Chronic Wound Care: The Essentials e-book.9 In addition, the program continues to offer scholarships to students to attend the Symposium on Advanced Wound Care (SAWC). Students attending SAWC are paired with nurse mentors so they will feel comfortable attending sessions and asking questions. For some students, the SAWC is their first professional meeting. Importantly, Why Wound Care? resources are free, which is critical for students and graduates who have student loans and other financial commitments. 

The Why Wound Care? Board is proud of the excitement, enthusiasm, and professional growth this program has engendered — all reasons why the number of participants continues to increase. The success of Why Wound Care? for nurses has led to the development of a similar program for medical students. We congratulate the Why Wound Care? program as it continues to provide resources, underscore the need for continuing education and nurse-driven research, and positively impact a major health care problem … not to mention to potentially inspire seasoned/novice wound care professionals with their own “Ah ha!” moments. n

References

1. National Alliance of Wound Care and Ostomy. Comparison of Wound Certificate Programs. Available at: www.nawccb.org/library/images/New%20images%20no%20people/Certification%2. Accessed January 30, 2016.

2. American Board of Wound Management. Certification Statistics. Available at: www.abwmcertified.org/about-us/certification-statistics/. Accessed January 25, 2016.

 3. Singer AJ, Tassiopoulos A, Kirsner RS. Evaluation and management of lower-extremity ulcers. N Engl J Med. 2017;377(16):1559–1567.

4. Kroenke K, Cheville A. Management of chronic pain in the aftermath of the opioid backlash. JAMA. 2017;317(23):2365–2366.

5. Pieper B, Keves-Foster MK, Ashare J, Zugcic M, Albdour M, Alhasanat D.  A cross-sectional, descriptive, quality improvement project to assess undergraduate nursing students’ clinical exposure to patients with wounds in an introductory nursing course. Ostomy Wound Manage. 2016;62(4):20–29.

6. Pieper B, Monahan J, Keves-Foster MK, Farner J, Alhasanat D, Albdour M. A quality improvement project: what first-year nursing students include in their nursing care plans for patients with acute or chronic wounds. Ostomy Wound Manage. 2017;63(10):42–47.

7. Ayello EA, Baranoski S, Salati DS. A survey of nurses’ wound care knowledge. Adv Skin Wound Care. 2005;18(5 Pt 1):268–275.

8. Ribu E, Haram R, Rustøen T. Observations of nurses’ treatment of leg and foot ulcers in community health care. J Wound Ostomy Continence Nurs. 2003;30(6):342–350.

9. Krasner L, van Rijswijk L, eds. Chronic Wound Care: The Essentials e-Book. Malvern, PA: HMP; 2018. Downloadable at: www.WhyWoundCare.com

 

Dr. Pieper is a Professor/Nurse Practitioner, College of Nursing, Wayne State University, Detroit, MI. She can be reached at: bapieper@comcast.net