The coronavirus disease 2019 (COVID-19) pandemic has forced health care professionals to take a closer look at the most effective and appropriate measures for pressure injury prevention. In 17% of all COVID-19 cases pneumonia secondary to acute respiratory distress syndrome is the most common...
By Karen Zulkowski DNS, RN, CWS
How many of you know how knowledgeable you are about wounds? Keeping up with the latest articles and treatments is difficult. This is especially true for a staff nurse that only encounters patient wounds occasionally. Larger facilities and home health agencies have wound nurses, but smaller facilities do not. Pressure ulcer knowledge has been examined for Registered Nurses across the United States using the Pieper Pressure Ulcer Knowledge Test. When urban versus rural nurses' knowledge was examined between rural Montana nurses and urban New York City nurses all scored at a "C" level. Similar testing at a Florida VA found nurses score 77% and only improved to 81% after education programs. Registered nurses that participated in the New Jersey Hospital Association pressure ulcer collaborative scored slightly higher on the Pressure Ulcer Knowledge test at 83%. However, percent correct is still a "B-" average. Certified wound care nurses scored at 93%.
Physicians were also given the Pieper Pressure Ulcer Knowledge Test base well as a wound photograph test. Physicians' mean knowledge scores were 69% on the knowledge test which were well below average scores of nurses' 76% on the same test. Physicians had greatest difficulty identifying suspected deep tissue injury and unstageable ulcers.
Because nurses have scored so poorly on the test, baccalaureate nursing program content was examined by the Hartford Geriatric Institute. Multiple deficiencies in wound content were identified including types of dressings, peripheral vascular testing and documentation. It is important to understand that neither physicians nor nurses are receiving adequate wound content in their programs. Consequently, it is difficult for the average practitioner to identify and assess wounds accurately and then plan current evidence-based treatment. Online programs or starting a wound team at each facility will help. All units need a "champion" to be the go-to person that helps improve care planning.
A toolkit is available from the Agency for Healthcare Research and Quality which is designed to help you and your facility assess your process for screening pressure ulcer risk. While this is focused on acute care the tools and information can be applied to any setting.
About The Author
Karen Zulkowski DNS, RN, CWS is an Associate Professor with Montana State University-Bozeman, teaches an online wound course for Excelsior College, and is a consultant for Mountain Pacific Quality Improvement Organization. She has served as a Research Consultant with Billings Clinic Center on Aging, and was the Associate Director for Yale University’s Program for the Advancement of Chronic Wound Care.
The views and opinions expressed in this blog are solely those of the author, and do not represent the views of WoundSource, Kestrel Health Information, Inc., its affiliates, or subsidiary companies.