Nurse-delivered patient education on postoperative wound care: a prospective study.

OBJECTIVE: It is estimated that one in four postoperative wound complications occur within 14 days of hospital discharge. Some estimate that up to 50% of readmissions are preventable with effective postoperative education and closer follow-up. Providing patients with information enables them to detect when medical intervention may be required. The aim of this study was to describe the content of postoperative wound care education given to patients, and to identify demographic and clinical factors that predict receipt of surgical wound care education across two tertiary hospitals in Queensland, Australia. METHOD: A prospective correlational design using structured observations, field notes and an electronic chart audit was used. A consecutive sample of surgical patients and a convenience sample of nurses were observed during episodes of postoperative wound care. Field notes were documented to gain a nuanced understanding of the wound care education delivered by nurses. Descriptive statistics were used to describe the samples. A multivariate logistic regression model was developed to describe associations between seven predictors: sex; age; case complexity; type of wound; dietetic consult; the number of postoperative days; and receipt of postoperative wound care education. RESULTS: In total, 154 nurses delivering surgical wound care and 257 patients receiving wound care were observed. Across the combined number of patients across the two hospitals, 71/257 (27.6%) wound care episodes included postoperative wound education. The content of the wound care education mainly focused on keeping the wound dressing dry and intact, while the secondary focus was on showing patients how to remove and replace the dressing. In this study, three of the seven predictors were significant: sex (ß=-0.776, p=0.013); hospital site (ß=-0.702, p=0.025); and number of postoperative days (ß=-0.043, p=0.039). Of these, sex was the strongest, with females twice as likely to receive some form of wound care education during the postoperative period. These predictors explained 7.6-10.3% of variance in the postoperative wound care education patients received. CONCLUSION: Further research to develop strategies designed to improve the consistency and comprehensiveness of the postoperative wound care education delivered to patients is needed.

Surgical wound care preferences and priorities from the perspectives of patients: a qualitative analysis.

OBJECTIVE: To explore patients' priorities and preferences for optimal care of their acute or hard-to-heal surgical wound(s). METHOD: This qualitative study involved semi-structured individual interviews with patients receiving wound care in Queensland, Australia. Convenience and snowball sampling were used to recruit patients from inpatient and outpatient settings between November 2019 and January 2020. Interviews were audio recorded, transcribed verbatim and analysed using thematic analysis. Emergent themes were discussed by all investigators to ensure consensus. RESULTS: A total of eight patients were interviewed, five of whom were male (average median age: 70.5 years; interquartile range (IQR): 45-80 years). Four interrelated themes emerged from the data that describe the patients' surgical wound journey: experiencing psychological and psychosocial challenges; taking back control by actively engaging in care; seeking out essential clinician attributes; and collaborating with clinicians to enable an individualised approach to their wound care. CONCLUSION: Findings from this study indicate that patients want to actively collaborate with clinicians who have caring qualities, professional skills and knowledge, and be involved in decision-making to ensure care meets their individual needs.

Wound care practices across two acute care settings: A comparative study.

AIMS AND OBJECTIVES: Describe and compare current surgical wound care practices across two hospitals in two health services districts, Australia. BACKGROUND: Surgical site infections (SSI) are a complication of surgery and occur in up to 9.5% of surgical procedures, yet they are preventable. Despite the existence of clinical guidelines for SSI prevention, there remains high variation in wound care practice. DESIGN: Prospective comparative design using structured observations and chart audit. METHODS: A specifically developed audit tool was used to collect data on observed wound care practices, documentation of wound assessment and practice, and patients' clinical characteristics from patients' electronic medical records. Structured observations of a consecutive sample of surgical patients receiving wound care with a convenience sample of nurses were undertaken. The manuscript adheres to the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) Statement. RESULTS: In total, 154 nurses undertaking acute wound care and 257 surgical patients who received wound care were observed. Across hospitals, hand hygiene adherence after dressing change was lowest (Hospital A: 8/113, 7%; Hospital B: 16/144, 11%; χ2 : 8.93, p = .347). Most wound dressing practices were similar across sites, except hand hygiene prior to dressing change (Hospital A: 107/113, 95%; Hospital B: 131/144, 91%; (χ2 : 7.736, p = .021) and use of clean gloves using nontouch technique (Hospital A: 88/113, 78%; Hospital B: 90/144, 63%; χ2 : 8.313, p = .016). The most commonly documented wound characteristic was wound type (Hospital A: 43/113, 38%; Hospital B: 70/144, 49%). What nurses documented differed significantly across sites (p < .05). CONCLUSIONS: Clinical variations in wound care practice are likely influenced by clinical context. RELEVANCE TO CLINICAL PRACTICE: Using an evidence-based approach to surgical wound management will help reduce patients' risk of wound-related complications.

The needs of families of trauma intensive care patients: A mixed methods study.

OBJECTIVE: To identify the needs of families of trauma patients in the Intensive Care Unit and to assess nurses' perceptions of those needs. METHODOLOGY: A sequential mixed-methods study was utilised combining survey data and semi-structured interviews. SETTING: A tertiary Intensive Care Unit in Australia. OUTCOME MEASURES: The Critical Care Family Needs Inventory assessed the needs of families of general and trauma patients. Nurses were also surveyed for their perspectives on the needs of trauma patients' families. Interviews with families were analysed using an inductive thematic analysis technique. RESULTS/FINDINGS: 214 surveys were completed (50 family members of trauma patients; 53 family members of general patients; 111 nurses). No statistically significant sub-scale differences in survey responses between the family groups were found. However, differences on four of the five survey sub-scales (p ≤ .001) were identified between families of trauma patients and nurses. Three themes emerged identifying unique needs of families of trauma patients from the interviews and included: Personal Distress and Adjustment,Guidance, and Care. CONCLUSION: This mixed methods study identified that families of trauma patients have different needs to families of general patients and the nurses rated the needs of the families of trauma patients as less important than the families rated their own needs. Through a collaborative partnership with these families, nurses can assist and better meet their needs. The provision of individualised patient/family-centred care is likely to have a positive influence.