There is not a great deal of research about nursing education with regard to nursing care plans for patients with wounds or the use of the nursing diagnosis impaired skin integrity. When impaired skin integrity is mentioned, it is often 1 of several variables of a nursing care plan project. For example, in their intervention study in Sweden, Falk and Bjorvell8 included impaired/risk skin integrity and risk for pressure injury. The study was not about wounds per se, but whether the use of the North American Nursing Diagnosis Association (NANDA) classification9 affected nursing students’ choice of nursing interventions. Thirty-three (33) nursing students assigned to an orthopedic unit participated; the intervention group (n = 19) had access to the NANDA classification textbook and attended a presentation on the subject while the comparison group (n = 14) did not. Nursing diagnoses/interventions about skin — namely, impaired/risk skin integrity and risk for pressure injury — were listed for 22 of 97 interventions (22.7%) in the intervention group and for 33 of 121 interventions (27.2%) in the comparison group. Both groups were similar in the frequencies of nursing diagnoses and interventions. The authors concluded nursing students were able to analyze patient data and formulate nursing care plans.
In a descriptive study, Can and Erol7 assessed the self-perceived levels of nursing students (N = 55) regarding their sufficiency at preparing patient care plans and determined the effects of nursing care plans on students’ occupational development. Self-perceived sufficiency was described as the student’s self-rating of ability to perform patient assessment, identify nursing diagnoses, and prepare nursing care plans. The study took place during oncology training in Turkey. Students completed a demographic form and a 40-question, self-perceived sufficiency form about all aspects of nursing care plans; 67.3% of students said they were capable of determining nursing diagnosis criteria for the skin and 63.6% were comfortable determining nursing diagnosis regarding direction of patient assessment when skin was a factor. The correlations between the patient’s assessment for skin and components of nursing care plans were significant for the aim, nursing interventions, evaluation, and nursing record (r = .33 to .50). Among the participating students, 60% reported that preparing and implementing nursing care plans had positive effects on their occupational development. They encouraged educators to think about the best curricular timing for teaching nursing care plans. Nursing care plan knowledge needs to be reviewed and used in a practical way to enhance occupational development.
Turk et al10 performed a descriptive study to determine nursing diagnoses that freshman nursing students used in their first clinical practice course in Turkey. Data were collected from 208 care plans developed by 61 nursing students. They used domains of Taxonomy II North American Nursing Diagnosis Association – International9 (NANDA-I). The study found students identified 31 different diagnoses in 9 domains of NANDA-I. The most common domains were safety/protection, activity/rest, comfort, elimination and exchange, and nutrition. The most-used nursing diagnoses were risk of infection, acute pain, constipation, disturbed sleep pattern, anxiety, activity intolerance, impaired physical mobility, and risk of trauma. Risk for impaired skin integrity (2.7%) and impaired skin integrity (1.4%) were infrequently listed. The study authors concluded beginning students had insufficient knowledge about diseases and thus were not able to make holistic assessments of their patients. The students’ nursing diagnoses also were affected by their beginning assessment and novice critical thinking skills.
In a descriptive study in Turkey to determine use of and opinions regarding nursing diagnoses, Yönt et al11 used a vignette developed by faculty to reflect content taught to 32 first-year students in the first semester. Students identified 15 out of the 18 predetermined nursing diagnoses for the vignette. The most frequently identified diagnoses were disturbed sleep pattern, nutritional imbalance, constipation, chronic pain, and anxiety. Impaired skin integrity was identified by 16 students (50%). A description of the vignette was not presented for comparison/accuracy; without this information, it was difficult to determine whether the nursing diagnosis about impaired skin integrity was critical to the patient’s plan of care. The authors concluded students were knowledgeable regarding commonly used nursing diagnoses even though they had limited clinical experience and recommended use of case study vignettes in nursing education.
Karadaq et al12 compared the effects of using case studies and simulated patients in teaching 70 second-year nursing students in Turkey to plan their nursing care; these instructional approaches were believed to help students develop their critical thinking and problem-solving skills and transfer theory into practice. The case used in the study described a patient with spinal cord trauma. The students were placed into 2 equal groups using either the case study or simulation teaching method. Impaired skin integrity was one of the most commonly identified nursing diagnoses, and the majority of nursing diagnoses involved physiological versus psychosocial problems. The students in the simulation group identified more nursing diagnoses and interventions than those in the case study group (33 versus 20). The 2 methods did not differ significantly on contributing to planning care or interventions. Students’ perceptions were that the simulated patient experience contributed significantly more to learning than the case study.
To summarize, a limited amount of research has addressed students’ development of nursing care plans for patients who have wounds. However, patients with acute or chronic wounds are present in all health care settings and students need to plan care for them. Studies reported inconsistent findings regarding beginning students’ ability to perform holistic assessments and identify nursing diagnoses. For example, students were reported to be comfortable assessing the skin7,12 but a nursing diagnosis about impaired skin integrity was infrequently included in their plans of care.8,10 Because they had only beginning assessment and critical thinking skills, students experienced stress when learning care planning and may need the content repeated in subsequent nursing courses.7 Simulated patient experiences were effective in teaching care planning.12
Nursing education continues to evolve in terms of teaching strategies such as classroom hours, exposure to patients with varied health care needs, and use of case studies and simulations. Strengthening components of the nursing curriculum in terms of the nursing process may help nursing students increase their confidence and ability to work with patients with wounds.
This quality improvement project was conducted to inform teaching about nursing care planning for patients with wounds and to reinforce with students the importance of wound assessment by examining what first-year nursing students in a Bachelor of Science in Nursing program included in a nursing care plan assignment when caring for an assigned patient with a wound in an acute care setting.