Hospitalists' Needs Assessment and Perceived Barriers in Wound Care Management

Abstract

The purpose of this quality improvement (QI) project was to determine hospitalists' knowledge, practices, and perspectives related to management of pressure injuries (PIs) and neuropathic/ diabetic foot complications (having a foot ulcer or subsequent development of a foot infection because of a foot ulcer). We also sought to identify resources for and knowledge-based barriers to management of these wounds. This QI effort targeted an inter-disciplinary group of 55 hospitalists in internal medicine that consisted of 8 nurse practitioners, 10 physician assistants, and 38 physicians. The site of this initiative took place at the Johns Hopkins Bayview Medical Center, a 342 bed academic hospital located in the MidAtlantic United States (Baltimore Maryland). The first phase of our QI project comprised an on-line survey to identify hospitalists' knowledge, practices, and opinions on inpatient management of PIs and diabetic foot complications. The second phase involved semi-structured focus groups attended by hospitalists to identify resource gaps and barriers inferred by survey results. Twenty-nine of 55 (52%) hospitalists responded to the survey; 72% indicated no formal training in wound care. Over 90% had little to no confidence in management of PIs and diabetic foot complications. In a separate ranking section of the survey, respondents selected lack of knowledge/confidence 12 of 29 (41.3%) and resources 9 of 29 (31.0%) as number one barriers to wound care. Managing obese patients with was identified as a second major barrier from 10 of 29 selected options (34.5%). Eighteen of 55 (33%) hospitalists attended focus group sessions acknowledging barriers to wound care that included provider education, information technology, system factors, and interprofessional engagement. Attendees welcomed additional educational and ancillary resource support.

Overcoming patient-provider language barrier: Impact of a tailored language training on health professionals’ language proficiency

“…However, patient satisfaction is highly associated with having a language concordant provider. Furthermore, such association still remains regardless of the uency of the health care provider (20,21).…”

Factors Associated with Nurses’ Perceived Competence in Pressure Injury Care in a Tertiary Hospital in Yunnan, China

“…However, studies examining nurses' confidence in PI care similarly found that most nurses lack confidence. 27,28 Because the PI healing period takes between 9 and 21 weeks, 39 and patients stay in hospitals for an average of only 2 to 4 weeks in China, nurses do not gain self-efficacy from witnessing PIs heal. In addition, the same patient may receive PI care from many different nurses.…”

“…26 Nurses' reported self-efficacy in PI care varies, with ratings of confidence in providing PI care ranging from 12% to 90%. 27,28 Because self-efficacy is nurses' belief that the practice will produce the desired results, low self-confidence may lead them to practice less than what is recommended by the evidence-based practice guidelines. 29 It appears that many nurses provide skin care for patients with PI risk by relying primarily on their own knowledge and experience rather than regular use of assessment tools and practice guidelines.…”

“…In addition, some nurses may delegate PI care to less-qualified caregivers 26 . Nurses’ reported self-efficacy in PI care varies, with ratings of confidence in providing PI care ranging from 12% to 90% 27,28 . Because self-efficacy is nurses’ belief that the practice will produce the desired results, low self-confidence may lead them to practice less than what is recommended by the evidence-based practice guidelines 29 .…”

Trends in Nursing Research on Infections: Semantic Network Analysis and Topic Modeling

“…The highly central keywords identified in this study were as follows: ‘wound’, ‘injury’, ‘dressing’, ‘breast’, ‘temperature’, ‘drainage’, ‘diabetes’, and ‘cleaning’. These keywords suggest that overall wound management, including dressing and drainage, is an important topic in the field of infection nursing, and diabetes patients, who are at a high risk of infection and require extra caution in wound management, are major recipients of infection-related nursing care [ 23 , 24 ].…”