There is a growing need for the education of healthcare workers, for them to efficiently cover and treat wounds and prevent contamination. Thus, there should be an evidenced approach in evaluating differences in the approach of treatment that medical practitioners use in various spheres. For this, it is important to examine some evidences on the different treatment of wounds that are being used nowadays in healthcare. This is crucial for medical practitioner training, while providing opportunity for developing proficiencies with regards to proper wound care, which may avert undesired patient outcomes in hospitals.
Evidence Review
Based on the article of Aalaa et al. (2012), nurses have critical role in wound infection prevention and care through multidisciplinary team approach that are said to be effective, as it reduces amputation rates and prevent complications, as well as save costs. Nurses have the ability to combine science and art in the provision of healthcare services, such as wound treatment, to patients. More so, they center on patient education and consulting, which is very important nowadays, especially in the diabetes ward. They have a major role in the education of patients for the prevention of foot ulcers and lower limb amputation, through interventions that would make sure patients are familiar with the basics of foot care. Aalaa et al. (2012) stated that there are so many things that nurses can do to patients. As they implied,
Nurses can teach patients how to perform physical examination and take care of their feet on a daily basis [they] can encourage patients to carry out a series of simple rules in order to help prevent foot ulcers or recurrence, such as checking the shoes before wearing, keeping feet clean and continuing care of the skin and nails. Training about choosing the right shoes is essential as well. (Aalaa et al., 2012, p.3)
This evidence appears to be significant in this study, as it shows relevant practices that nurses can do in education interventions of nurses to the patients. This educational programs usually facilitate active participation of patients and their families, to make sure they are effective.
In addition to nurses, the physical therapists also hold a unique role in wound care, especially since many of them treat their patients at home, especially the acute, chronic wounds. With the shortage of nurses taking place in the United States, physical therapists play an integral part in wound care through the use of their skills, which help ease the burden of the nurse shortage. Thus, in addition to educating the patients and their families, there should likewise be education intervention programs for the carers and physical therapists. This includes “free online tutorials, e-learning systems, and in-services provided by a wound care specialist or wound supply representative” (Abeln & Pitassi, 2012, p.164). For this to take place, there should be teamwork and effective communication between the healthcare practitioners, to prevent conflicts and battles over the turf. As Abeln & Pitassi (2012) stated,
The team must continuously work together through frequent communication and develop respect for the role that each individual plays on the team. Educate the staff as to what unique advantages each discipline brings to the care of the patient with a wound. (Abeln & Pitassi, 2012, pp.164-165)
This evidence appears to be moderately significant, as this insists the need for collaboration and care coordination among health practitioners, such as the physical therapists. In the continuous provision of education to health practitioners, the basics of team collaboration and care coordination have always been vital, and they should be self-sufficient when learning.
In an article by Van Acker & Kuriata (2014), they mentioned the use of video education in providing effective wound care instruction and education to pre- or post-Mohs micrographic surgery. In implementing Mohs surgery in the field of dermatology, there are usually some complications that take place within the skin, and proper wound education always plays a vital role. Thus, in the previous studies, they used high-definition video modules to deliver wound care instruction, as well as informed consent, to patients who undergo the Mohs surgery. They also used digital media for instructional delivery, which also provide and maintain patient satisfaction among dermatological surgeons. This evidence is very important, as it is crucial in preventing skin cancer through proper wound care management, by delivering appropriate patient education and instruction to prevent infection. It would be a wise decision to implement this practice therefore, for better clinical practice.
Meanwhile, another advanced method in the management of wound care, is the use of telemedicine, as Rolf Jelnes (2014) proposed. Clinicians in Denmark used telemedicine in 2005 as communications tool for the organization of new wound treatment (Jelnes, 2014, p.48). The following is a clear description of this communications system:
The system should facilitate communication among a tissue viability nurse in one municipality, another tissue viability nurse working in an outpatient clinic at a hospital situated 80 km away, and a medical doctor with interest in wound care working in a different hospital another 40 km away. (Jelnes, 2014, p.48)
This tool allowed them to work in close contact, which allowed knowledge sharing and efficient information among caregivers, nurses, and medical doctors. This evidence however, only goes for team collaboration and efficiency of knowledge and information—not for the provision and management of education among healthcare practitioners. Telemedicine can be useful in team collaboration and efficient communication, although it may be utilized in education purpose through the sharing of knowledge and information between members.
In the study done by Dobke, Bhavsar, & Herrera (2011) on the use of telemedicine in wound care management, it turns out that telemedicine was effective—not in education—but in deciding a course of action during a state of uncertainty. It will therefore, reduce the level of uncertainty when it comes to directing the patient to conservative treatment, as well as influence the perception of patient and their families through shared decision making. It is likewise effective in the care and treatment of difficult wounds, while it strengthens the relationship between the patient and the caretakers. For this, there is also some benefit in education, in terms of using telemedicine in the caring and treatment of chronic wounds, to prevent decisional conflict and provide consultation and communication to the members. This evidence can therefore be efficient, and it can change the practice of educating healthcare practitioners concerning the delivery and management of wound care.
In the article that Alan Sherman (2010) wrote on the continuing medical education methodology, he insisted that the field of professional medical continuing education has been changing rapidly over the days, with the traditional format taking place in classrooms. It was insisted therefore, that the use of online continuing medical education (CME) Web sites are to be used instead. This would combine on-demand didactic presentations that, at the same time, would enhance the ability in discussing the education content, which allows them to apply what they learn in real-life clinical situation. What is important would be to make sure that what they teach is being filtered down to the actual practice level. In the real-world context, the clinicians experience adult learning all throughout their careers, and continuous education is vital to improve the way they care for their patients and treat their wounds. This can be done through live lectures, print publications, and online lectures, as well as the help of peers within the healthcare environment for better clinical problem solving and treatment. This evidence therefore, appears to be very efficient and useful in improving the practice and management of wound care through continuous education of healthcare practitioners.
Meanwhile, Dea Kent (2010) mentioned the effects of the Just-In-Time Educational Intervention that are being placed on wound dressing packages, which help caregivers in improving wound-healing outcomes. If the instructions are being followed and the dressings selected and applied appropriately, and if adequate education is being ensured, then the wound would heal faster and more effectively. Still, wound care and management requires multiple decisions, such as selecting appropriate dressings for faster healing of wound. By this, it would be efficient to apply the Just-In-Time education intervention, in which education is set in a time-sensitive manner, with the provision of appropriate tools. It enhances the skill in being more self-directed, while making them more confident with dressing application, although they may be unfamiliar with the wound dressing. This evidence is therefore very efficient, as it proves that the said educational intervention enhances the application technique, with more confidence in applying an unfamiliar dressing. It may be used in creating a new practice or policy for better wound care treatment.
Last but not the least is the article of David Berry (2012), in which he stated that in wound cleaning, closing and dressing, there is always the learning and development of the skill, which can be based on either the suture model or the wound care model. According to Berry (2012, p.142), utilizing the suture model always has its advantages, including the low cost and the ease of acquiring the concepts. Still, they were able to teach the skill by pairing the students together, which goes for peer learning and having corrective feedback. As said,
[G]iven the length of the limb I can typically get two groups of two students working at a time on the model from different directions [which] helps to eliminate the lag time between student participation. (Berry, 2012, p.142)
In addition to this is the strategy of using check sheets of critical skill steps, wherein the use of images can be very helpful in the acquisition of skills and concepts. They can also integrate the skill into different scenarios, for students to demonstrate skills in decision making, as well as the use of integration. This evidence therefore presents an actual manner of educating students in healthcare, which may be useful in improving the practice of wound cleaning, closing and dressing. In this judgment of the quality of evidences, clinical expertise of the writer was found to be valuable in deciding which of these were useful and significant.
References:
Aalaa, M., Malazy, O.T,, Sanjari, M., Peimani, M., & Mohajeri-Tehrani, M.R. (2012). Nurses’ role in diabetic foot prevention and care; a review. Journal of Diabetes & Metabolic Disorders, 11(24), 1-6.
Abeln, M., & Pitassi, A. (2012). The role of the physical therapist in wound care. Home Healthcare Nurse, 30(3), 161-169.
Berry, D. (2012). Teaching wound care management: a model for the budget conscious educator. Athletic Training Education Journal, 7(3), 140-145.
Dobke, M.K., Bhavsar, D., & Herrera, F. (2011). Do telemedicine wound care specialist consults meet the needs of the referring physician? A survey of primary care providers. International Journal of Telemedicine and Applications, Article ID 321376, 1-6. doi: 10.1155/2011/321376
Jelnes, R. (2014). Reflections on the use of telemedicine in wound care. European Wound Management Association, 14(2), 48-51.
Kent, D.J. (2010). Effects of a Just-in-Time educational intervention placed on wound dressing packages. Journal of Wound, Ostomy and Continence Nurses, 37(1), 1-6.
Sherman, A. (2010). Continuing medical education methodology: Current trends and applications in wound care. Journal of Diabetes Science and Technology, 4(4), 853-856.
Van Acker, M.M., & Kuriata, M.A. (2014). Video education provides effective wound care instruction pre- or post-Mohs micrographic surgery. Journal of Clinical and Aesthetic Dermatology, 7(4), 43-47.
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