Study reveals gaps in wound care knowledge

The Wound Management Innovation Cooperative Research Centre aims to improve wound healing through the adoption of best practice. Research shows there is room for improvement, writes project manager Karen Innes-Walker.
[caption id="attachment_4880" align="alignright" width="200"] Wound care nurse Michelle Gibb from Queensland’s University of Technology’s wound clinic bandaging a patient with a leg ulcer.[/caption]
The Wound Management Innovation Cooperative Research Centre (WMICRC) is a leading organisation for integrated and collaborative research into innovative wound management tools, systems and technologies. Funding is provided by the Australian Government and the 21 WMICRC Participants for a three-year education and training project which commenced in early 2012. The aim of the first stage of the project was to determine the wound management education and training needs of health consumers and the relevant health workforce and to identify and map the available education and training activities and resources.
The project’s goal is to improve wound healing through the adoption of best practice facilitated by high quality and accessible education and training. An important aim of the project is to develop a plan, including a framework, to guide effective delivery of wound healing education and training across Australia. The first stage of this was to engage health professionals and consumers, and to conduct a stocktake of wound healing education material.
The relevant occupational groups in the health workforce include nurses, medical practitioners and relevant allied health professionals. Other groups such as personal care workers, and assistants in nursing were also involved.
The full range of care settings is included in the project scope - the acute, community and other primary care settings (residential aged care and general practice), all geographical locations, and all wound types, with greater emphasis being placed on chronic wounds.
The project is working closely with other related WMICRC funded projects, other projects funded by external bodies and the Australian Wound Management Association (AWMA), the not-for-profit peak body for clinicians working in this field.
The purpose of the needs analysis component was to determine the priorities for future wound management education and training planning for both the clinical workforce and health consumers. Online surveys, with an option for hard-copy completion, were developed for the general health workforce and advanced practitioners and leaders (experts). One-on-one interviews were used to gather information from health consumers and/or their carers.
“Nurses and GPs working in the primary healthcare setting, particularly in regional and remote locations, had the highest needs for wound management education and training.”
The purpose of the stocktake was to identify and map the current wound management education and training activities and resources, targeting the wound workforce and health consumers, both nationally and internationally.
Overall, the response levels were very pleasing, with more than 500 respondents from across Australia to the general workforce survey, and more than 60 experts participating. Health consumers proved to be the most difficult group to access, however 23 individual interviews were undertaken and some very important information gained. The stocktake survey attracted over 30 respondents.
General workforce respondents
More than 90 per cent of the general workforce respondents indicated that they currently provide wound care as a part of their clinical practice, with skin tears being the most commonly managed wound. Most of the other listed wound types were reported to be managed regularly by over 40 per cent of respondents.
Overall the wound type they reported being the least confident in managing was mixed venous/arterial leg ulcers, followed by arterial leg ulcers. When looked at by care setting there is some variability among wound types that respondents were less confident managing. However, mixed venous/arterial wounds were consistently rated as “somewhat or not confident” across most care settings.
The standout topics of need were using diagnostic investigations and wound products, pharmaceuticals and devices.
Expert respondents
The experts were asked for their views on the priorities regarding the wound management education and training needs of the entire health workforce, as well as their own needs. Most respondents were female Registered Nurses or Nurse Practitioners with extensive wound management experience. Over half possessed relevant post graduate qualifications. They indicated that nurses and GPs working in the primary healthcare setting, particularly in regional and remote locations, had the highest needs for wound management education and training.
The basics of wound management were rated the area of greatest education and training need, followed by assessment, diagnosis and prevention. They indicated that ‘mixed wounds’ was the type of wound most needing to be included in education and training for the general wound workforce, followed by venous leg ulcers, pressure injuries and diabetic foot ulcers.
They were fairly satisfied with their own opportunities to receive education and training, but did specify a need for more education and training around the topics of diagnostic investigation and interpretation, advanced assessment and diagnosis and diagnostic techniques.
Consumer respondents
Health consumers were asked about their wound history and the educational information they received, as well their views on the educational needs of themselves and those involved in their wound management.
A total of 23 health consumer interviews were undertaken, with a near balance of men and women. Most were aged sixty years and older, with the majority living in Queensland and smaller numbers from Victoria and NSW. Fifty per cent of the health consumers had a venous leg ulcer, with arterial leg ulcers, mixed venous/arterial ulcers, surgical wounds and pressure injuries also represented. Interestingly most participants were unsure of their wound type.
In most cases their current wounds were either nearly healed or in the process of healing, with the patient or their family reportedly not playing a role in managing the wound/s. Most supported the role of research and education and training in improving wound management and some talked about (mostly previous) experiences where they believed their wound management had been sub-optimal. Many felt their current wound management provider had more knowledge and skill than others previously involved. Many consumers reported not receiving any form of education relating to their wound. Some of those currently attending a wound clinic said they had received a brochure from the clinic but nothing from previous wound management providers.
The question relating to the main areas of need for education materials for themselves was met with varying responses - from unsure to quite specific requests. Several mentioned the need for more information on dressings, different treatment options and healing timeframes.
In terms of the education needs of wound management providers, many respondents found it difficult to be specific, although several indicated there was a gap in the knowledge and skills of many healthcare providers. For example, “At other places, my management has been “trial and error” whereas at the clinic (i.e. current specialist wound clinic) “I feel there has been a plan”. In this case, the respondent wondered if he had come to the wound clinic earlier he may not have had his other leg amputated.
More than half those interviewed did not use a computer or, not surprisingly, the internet. Most preferred hard copy brochures or handwritten information as primary sources of education.
“[While] fifty per cent of the health consumers had a venous leg ulcer, with arterial leg ulcers, mixed venous/arterial ulcers, surgical wounds and pressure injuries also represented… most participants were unsure of their wound type.”
Project development
The first phase of the education and training project has been successful in gaining information on the wound management education and training needs of the workforce. The data, whilst skewed towards the nursing workforce, provides an insight into the significant need for more education and training in this area.
Although the sample size of health consumers or carers was less than anticipated, or perhaps ideal, valuable information about the educational needs and preferences was gained. The project has also been able to establish some priorities in terms of occupational groups, settings of care, stage of practice, wound types and educational topics.
The stocktake component of the project identified a range of learning activities. It is recognised that this is only a sub-set of what is actually available but it provides a basis for the planned online directory, which will be dynamic and hopefully enlarged and improved over time.
The next stage of the project will require a strategic planning approach to addressing identified education and training priority areas and gaps. This will involve focussing on groups such as pre-entry and early career professionals, health consumers and the primary healthcare workforce.
Further relationship building with key stakeholders, such as Medicare Locals, will be undertaken in order to increase access by the primary healthcare workforce to wound management education and training activities.
The development of an online directory of wound education activities as well as a range of point of care resources, such as online and application based resources is planned.
Further development and refinement of the Wound Education Framework will be undertaken. This framework will articulate the knowledge and skills of both patients and the wound workforce using a patient centred pathway approach.
In addition, research is being undertaken with GP Practice Nurses investigating factors affecting the transfer of wound management learning. This will provide valuable information to guide future learning methods and aims to enhance wound management practice in this setting.
Karen Innes-Walker joined the WMICRC team in February 2012 as Project Manager for the Education Project within Program Three, Clinical Applications.
Karen has a clinical and learning and development/clinical education background. Karen’s tertiary qualifications include a BSc (UQ), Grad Dip Nutr and Diet (QIT), MHSc (QUT) and Grad Dip Ed (QUT). She worked in clinical dietitian/nutritionist roles for eighteen years, including thirteen years at the Mater Hospitals, seven of these as Director of Nutrition and Dietetics. In 2002 Karen moved into learning and development management roles and then into clinical education and training as Assistant Director of the allied health unit, ClinEdQ within Queensland Health.