Testing the Test: Comparing Pressure Ulcer Knowledge

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By Karen Zulkowski DNS, RN, CWS

Part 2 in a series on Pressure Ulcer Knowledge
For Part 1, Click here

I have used the Pieper Pressure Ulcer Knowledge Test for many years to examine nurse's knowledge. It actually started as a "bet" between my friend Elizabeth Ayello and me. Elizabeth thought her urban New York City nurses would have more CEU opportunity and would score better than my rural Montana nurses. So she gave the test to nurses employed in a New York hospital and I sent it to rural Montana facilities. We were both surprised when my nurses won by two points. The bad news was everyone scored at a "C" level. We found this very interesting but rather distressing.

Subsequently, we used the test at the 2005 New Jersey Hospital Association's Pressure Ulcer Collaborative. This was a two year project and I gave participants the test at each of the six meetings held within this time. We never taught to the test or would give the answers. Interestingly, nurses scored a "C" consistently the first time they took the test. It didn't matter what the nurse's educational level or number of years in nursing was. The only thing that correlated with a higher score was whether nurses had read the Agency for Healthcare Research and Quality pressure ulcer guidelines (at the time these were the most current guidelines available.) We found it took about 3-4 educational sessions for knowledge scores to improve and over the two years there was a 70% reduction in pressure ulcer incidence across the reporting organizations and a significant (p<0.05) improvement in nurses knowledge. Forty-eight of the NJHA partners had no ulcers for three months.

The Pieper Pressure Ulcer Knowledge Test was also used to test nurse's knowledge at several VA systems with similar "C" results. We then gave the test to New York City medical residents and found their knowledge was even lower than nurses (69%). Consequently, the knowledge deficit is widespread. To assess this deficit, Elizabeth and I partnered with the Hartford Geriatric Institute and looked at what wound knowledge was being taught in BSN programs across the US. We found serious deficits in nurse's education for both pressure ulcer knowledge and wound care overall. For example, only 18% of nursing students were taught how to do a monofilament test. The conclusion is that we aren't doing a good job teaching basics of wound prevention and treatment to either physicians or nurses. We need to do better.

Be sure to read next month's post where I will discuss this topic further and provide information on an opportunity for your facility to get involved in increasing the wound care knowledge base.

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.

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