Chronic wound care delivery in wound clinics, community nursing and residential aged care settings: A qualitative analysis using Levine's Conservation Model.
advanced nursing practice
ambulatory care facilities
community health nursing
foot ulcer
leg ulcer
nursing homes
qualitative research
venous ulcer
wound clinic
wound healing
Journal
Journal of clinical nursing
ISSN: 1365-2702
Titre abrégé: J Clin Nurs
Pays: England
ID NLM: 9207302
Informations de publication
Date de publication:
May 2021
May 2021
Historique:
revised:
21
11
2020
received:
06
08
2020
accepted:
13
12
2020
pubmed:
29
1
2021
medline:
29
7
2021
entrez:
28
1
2021
Statut:
ppublish
Résumé
To explore patient experience of chronic wound care across diverse models of outpatient wound care delivery. Chronic wounds represent a significant personal, family and healthcare system burden. Evidence suggests specialist wound clinics are more effective and less expensive, however, most outpatient wound care is delivered by general community nurses. There is little understanding of how patients experience diverse models of wound care delivery and the subsequent impact on their capacity to adapt to imbalances in their internal/external environment. Descriptive, qualitative study. Eighteen patients with chronic wounds from three wound services were engaged in semi-structured interviews. Initial inductive analysis was refined deductively using Levine's Conservation Model. Chronic wounds lead to imbalances and subsequent adaptions in energy conservation and personal, social and structural integrity. Nursing process and wound care system responses suggest specialist wound clinics provide access to the right person and care at the right time, with less care variation. The community nursing model is most effective with a small team of nurses and a documented care plan, with specialist wound nurse oversight. Residential aged care facilities emerged as important sites for wound care delivery revealing higher variance in care and less specialist wound oversight. The application of Levine's conservation model provides a theoretical understanding and important insights into the patient experience of nurse and system elements across diverse models of wound care delivery. Specialist oversight by expert wound nurses with the capacity for medical specialist referral is the cornerstone of good wound care. A frequently reviewed wound care plan and skill development for nurses in primary, aged care and community settings are vital. Shared care between specialist and primary care should include evidence-based pain assessment, clear referral pathways, collaborative relationships, telehealth capacity, patient-held wound plans and upskilling of frontline clinicians.
Sections du résumé
AIMS AND OBJECTIVES
OBJECTIVE
To explore patient experience of chronic wound care across diverse models of outpatient wound care delivery.
BACKGROUND
BACKGROUND
Chronic wounds represent a significant personal, family and healthcare system burden. Evidence suggests specialist wound clinics are more effective and less expensive, however, most outpatient wound care is delivered by general community nurses. There is little understanding of how patients experience diverse models of wound care delivery and the subsequent impact on their capacity to adapt to imbalances in their internal/external environment.
DESIGN
METHODS
Descriptive, qualitative study.
METHODS
METHODS
Eighteen patients with chronic wounds from three wound services were engaged in semi-structured interviews. Initial inductive analysis was refined deductively using Levine's Conservation Model.
RESULTS
RESULTS
Chronic wounds lead to imbalances and subsequent adaptions in energy conservation and personal, social and structural integrity. Nursing process and wound care system responses suggest specialist wound clinics provide access to the right person and care at the right time, with less care variation. The community nursing model is most effective with a small team of nurses and a documented care plan, with specialist wound nurse oversight. Residential aged care facilities emerged as important sites for wound care delivery revealing higher variance in care and less specialist wound oversight.
CONCLUSIONS
CONCLUSIONS
The application of Levine's conservation model provides a theoretical understanding and important insights into the patient experience of nurse and system elements across diverse models of wound care delivery. Specialist oversight by expert wound nurses with the capacity for medical specialist referral is the cornerstone of good wound care. A frequently reviewed wound care plan and skill development for nurses in primary, aged care and community settings are vital.
RELEVANCE TO CLINICAL PRACTICE
CONCLUSIONS
Shared care between specialist and primary care should include evidence-based pain assessment, clear referral pathways, collaborative relationships, telehealth capacity, patient-held wound plans and upskilling of frontline clinicians.
Types de publication
Journal Article
Langues
eng
Pagination
1295-1311Informations de copyright
© 2021 John Wiley & Sons Ltd.
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