Digital Repository Masters Projects Spring 2023 Nurse-Led Wound Care Patient Education Lashele Rothlisberger Weber State University Follow this and additional works at: https://dc.weber.edu/collection/ATDSON Rothlisberger, L. 2023. Nurse-led wound care patient education. Weber State University Masters Projects. https://dc.weber.edu/collection/ATDSON This Project is brought to you for free and open access by the Weber State University Archives Digital Repository. For more information, please contact scua@weber.edu. WSU REPOSITORY MSN/DNP NRSG 6802 Final MSN Scholarly Project Paper Nurse-Led Wound Care Patient Education Project Title by Lashele Rothlisberger Student’s Name A project submitted in partial fulfillment of the requirements for the degree of MASTERS OF NURSING Annie Taylor Dee School of Nursing Dumke College of Health Professions WEBER STATE UNIVERSITY Ogden, UT April 2, 2023 Date Lashele Rothlisberger, BSN, RN, MSN student April 2, 2023 Student Name, Credentials Date (electronic signature) Tressa Quayle, PhD, RN 4/21/23 MSN Project Faculty Date (electronic signature) 05/25/2023 Melissa NeVille Norton (electronic signature) DNP, APRN, CPNP-PC, CNE Graduate Programs Director Note: The program director must submit this form and paper. Date 1 Nurse-Led Wound Care Patient Education Lashele Rothlisberger, BSN, RN, MSN Student Weber State University Annie Taylor Dee School of Nursing 2 Abstract Wound care is complex and requires special training for Registered Nurses (RNs) to perform correctly. A vascular clinic in northern Utah recently hired Registered Nurses (RNs) as part of their staff to provide wound care to patients as of 2022. However, due to the shortage of Registered Nurses (RNs) at the vascular clinic, there has not been training or guidance for newly hired nurses in the vascular clinic. This MSN project aims to develop a nurse-led discharge wound checklist to prepare the Registered Nurses (RNs) in the vascular clinic to become specially trained to provide wound care. In addition, this project aims to enable Registered Nurses (RNs) to create an environment to provide a safe space for patients to learn about their wounds and how to care for them. The literature demonstrates that wound care provided by specially trained nurses positively affects patient outcomes. These positive outcomes are achieved by consulting with a wound care expert to develop a checklist and training the nurses in the vascular clinic to become confident in wound care. Continuing research on evidence-based practice, planning meetings to evaluate nursing wound care, and reviewing surveys on improvement suggestions will assist the evolution of this project. Implementing and evaluating this project allows for continuous improvement from the Registered Nurses (RNs) and the vascular clinic to improve patient care and satisfaction. Keywords: Wound care, evidence-based practice, wounds, patient education, patient care, nurse-led, vascular, checklist 3 Nurse-Led Wound Care Patient Education Nursing is a complex profession with many topics to learn. Due to the wide range of issues, specific nursing concepts are reviewed more briefly during a nurse's education than others. For example, the cardiac system is reviewed more in-depth and for a more extended time compared to wound care. However, wounds can be complex and require extensive education. Due to the complexity, caring for wounds requires physicians, nurse practitioners, physician assistants, or nurses with additional wound care knowledge to train staff and new hires within the vascular clinic. There are concerns about the limited education and training Licensed Practical Nurses (LPNs) and Registered Nurses (RNs) receive regarding how patient wound care is given and explained (Welsh, 2018). This MSN project aims to create a wound care teaching checklist for nurses hired into a vascular clinic. Nurses will be instructed on the checklist's use, benefits, and steps. Nurses will use the checklist as a roadmap to ensure all follow the required steps while providing patient education. Creating a teaching checklist will allow nurses to increase patient involvement during discharge wound teaching (Mattessich, 2020). Statement of Problem The literature on wound care management commonly notes one of three limitations: lack of health management, wound care expertise, and limited patient and nurse education (Dhar et al., 2020; Franco-Buenaventura & Garcia-Perdomo, 2021; Kapp & Santamaria, 2021). Life factors, including health history, habits, and lack of health management, can lead to vascular insufficiency that affects wound healing differently for individuals. In addition, many individuals may be experiencing chronic wounds, which reduces the quality of life and increases patient burden (Dhar et al., 2020). Allowing the opportunity for nurses to provide thorough health and 4 wound care, teaching can enhance the patient's quality of life. Including this education on the checklist regarding patients' self-managing their health is effective for chronic conditions (Kapp & Santamaria, 2021). With different phases of wound healing, a nurse with extensive knowledge and training is vital to provide nurse-led patient discharge teaching. There is a need for nurse-led patient discharge teaching within the vascular clinic due to the insufficient staff available to provide this service. The delivery of wound care is crucial to the wound's healing progress and the patient's health management. For example, a conventional dressing may require more changes than a wound vacuum to help with wound healing (FrancoBuenaventura & Garcia-Perdomo, 2021). Understanding the debridement process, cleaning, applying antibiotics, and using correct dressing wraps can make all the difference in wound healing. Training nurses in wound care is the first step in providing patients with quality care and effective wound management teaching. Patient education, provided by nurses, allows patients to participate in their health care (Lasa-Blandon et al., 2019). Educational aids such as a teaching checklist will help nurses provide the most beneficial patient-centered education during discharge teaching from the vascular clinic (Mattessich, 2020). Therefore, this MSN project aims to create a wound care teaching checklist for nurses hired into a vascular clinic to follow during patient education. The teaching checklist will include the proper wound cleaning steps, when to debride the wound, suitable wound bandages to apply, and the care needs at home, with anticipation to improve patient healing time, infection rates, and the return rate to the vascular clinic. Ways Project Contributes to Intended Recipients The MSN project will benefit nurses, physicians, patients, and family members. When nurse-led patient teaching is available in the clinical setting, it can help patients understand 5 wound management to promote wound healing (Dhar et al., 2020). A nurse providing discharge teaching within the vascular clinic will also benefit the physicians and providers. The physicians and providers will have more time to see other patients while the nurse is providing discharge wound care for patients. In contrast, educating patients while using the wound care checklist allows nurses to avoid missing a crucial step during instruction and assess the patient's level of understanding (Gao et al., 2018). In addition, a checklist handout regarding wound care for patients to take home and refer to when needed can assist and provide a more lasting experience of the nurse-led teaching received in the clinic (Dhar et al., 2020). Furthermore, allowing nurses to provide wound care education that includes a patient discharge teaching checklist can increase the nurse's knowledge and confidence (Surme et al., 2022). Rational for Importance of Project This MSN project will contribute to decreasing the wound care education gaps within the vascular clinic. For example, the vascular clinic recently added a registered nurse. The absence of a nurse before this hire led to a limited amount of time for providers to provide patient education, leading to misinterpreted discharge teaching content by the patient. Developing and creating a checklist for the nurse to follow during patient wound care education will ensure the nurse is better prepared. The checklist is a valuable tool to provide the correct information in a structured approach for teaching assistants to improve their understanding of health management, how it may affect wound healing rates, and what may be missing within the instruction at the vascular clinic (Kapp & Santamaria, 2021; Mattessich, 2020). Developing an education checklist will allow patients to increase their understanding of personal care and assist staff in providing the required information. 6 Due to the variety of factors that contribute to wounds, proper training is critical. More importantly, the management of wounds is complex; providers involved in patient care and treatment should have appropriate knowledge and skills (Haalboom et al., 2019; Welsh, 2018). Learning from physicians, nurse practitioners, and physician's assistants in the vascular field will help provide information to create a teaching program and checklist to assist in training a nurse wound content expert. In addition, providing the information learned from physicians, nurse practitioners, and physician's assistants in a written report on a checklist serves as a map to follow when educating patients. These resources and tools will benefit nurses within the vascular clinic to provide thorough, quality patient education. Literature Review and Framework The literature searched for evidence in nurse-led discharge teaching while providing proper patient wound care. However, the delivery of adequate education regarding wound care is specialized, with these nurses needing further education, knowledge, direction, and skill. In addition, when new nurses are hired, they lack the specific guidelines and guidance for their new role. The outline of the ACE Star Model of Knowledge Transformation allows guidance to assist in developing the literature into action. By incorporating a wound content expert and nurse-led discharge teaching, this MSN project proposes to create a teaching checklist to bridge this gap of missing information using the following framework and evidence-based change model. Framework The ACE Star Model of Knowledge Transformation can assist individuals with the volume of research and integrating knowledge into best practices individually and organizationally (Dang et al., 2015; Indra, 2018). Specifically, this model focuses on how knowledge is the solution to moving research into practice (Leinenbach, 2019). Five points 7 define this model's different knowledge forms, including discovering new knowledge, evidence summary, translation of evidence, practice integration, and process or outcome evaluation (Indra, 2018; Leinenbach, 2019; Onuchukwu-Azuonye, 2021). The ACE Star Model of Knowledge Transformation framework applies to this evidencebased practice (EBP) MSN project to assist in creating a checklist for nurse-led discharge wound teaching. Using the five points of this model to help guide this project, starting with discovering new knowledge. Researching information regarding teaching checklists and taking the time to learn the full extent of wound care from experts at the vascular clinic can help find new knowledge. With this further knowledge, information can be formulated to create different tools, such as other wound care teaching checklists or wound care supply packets, to assist in translating the evidence to integrate into a checklist. Furthermore, continually evaluating and assessing the new education program from a professional and patient viewpoint can assist in creating valuable discharge teaching instructions. Strengths and Limitations The ACE Star Model of Knowledge Transformation model is simplistic and easy to understand, which is a strength (Bottos, 2019). The model is directed explicitly toward healthcare and is easily understood by nurses (Indra, 2018). The similarity of the nursing process of assessment, diagnosis, outcomes/planning, implementation, and evaluation makes it easier for nurses to understand and interpret this model. In addition, the model's simplicity will assist in providing guidelines to follow while finding evidence and creating the checklist for this MSN project. The ACE Star Model of Knowledge Transformation is limiting because not all evidence translates into implementation or practice (Bottos, 2019). For example, nurses may need time to 8 research and find evidence to implement promptly, which can be a limitation of this model. Also, in the translation section, clinician and patient expertise can be hard to achieve depending on patient involvement and the availability of clinicians. Despite these limitations, the ACE Star Model of Knowledge Transformation will benefit this MSN project because of the guidelines for finding evidence and creating content. Analysis of Literature There is considerable variability in wound care practice, reflecting ineffective care and uncertainty about what constitutes appropriate care (Gillespie et al., 2020). The literature was analyzed to examine evidence regarding education for nurses to provide discharge wound care teaching. The current process within the vascular clinic includes the nurse practitioner (NP) or physician assistant (PA) assessing the wound, and then the wound is treated and wrapped by the NP, PA, or Registered Nurse. There has yet to be a wound care class or specific directions to prepare new nurses in providing discharge wound care education. In addition, promoting teaching aids to assist nurses in providing appropriate care is crucial to quality patient care. This literature reviews multiple articles focusing on three themes: nurse-led patient teaching programs, wound care experts, and wound care delivery checklists. Search Strategies A literature search was conducted to identify current evidence using Google Scholar, Weber State University's Stewart Library's OneSearch and Advanced Search (which span multiple databases), and Medline to direct initial exploration. Only articles from 2018 through 2022 were included in this literature review to keep the information current. The search included keywords such as wound healing, nurse education, discharge teaching, vascular insufficiency, wounds, wound care, nurses, training, checklist, pamphlet, and education. In addition, various 9 Boolean combinations were created with the keywords mentioned above to create a broad search. This search provided three themes to guide a wound care teaching program, a wound care expert, and a wound care delivery checklist to assist in the MSN project. Nurse-Led Patient Teaching Programs Nurses delivering education that is easy to understand and follow during discharge and teaching proper wound care can help patients not become overwhelmed with the information presented. Redmond et al. (2018) reported that reusable learning objects (RLOs) increased nurse competency in assisting patient discharge teaching. Incorporating RLOs enhances patients learning by gaining practice. Using different inanimate objects, such as mannequin limbs, allows nurses, patients, and family members to learn and practice the correct wrapping of various wounds. In addition, physically practicing extra care and wrapping methods allows individuals doing the wound care wrapping to become more comfortable with the task at hand and eliminate knowledge deficits (Neilsen & Coleman, 2022). These opportunities can benefit the participants and patients within wound care education. Nurses play a significant role in implementing preventative measures, so nurse-led teaching is crucial to continuity and success in a patient's healthcare. Furthermore, a systematic quantitative literature review by Dhar et al. (2020) found that patients understood more about ulcers and the care required from nurse-led teaching programs. The ultimate test is the ability to digest information on proper wound care in such a way that allows patients to understand how to care for their wounds. Improving the nurse's knowledge and training to become wound care experts will improve patients' quality of care. Wound Care Expert 10 Due to the vast topics in healthcare, nurses may require more opportunities to train or practice wound care. Education is vital to improving the knowledge and skills of nurses in all aspects of nursing processes. Therefore, it is essential to ensure that the right person, such as a vascular surgeon or wound care clinic staff, gets involved with wound care at the right time (Monaro et al., 2021). Incorporating their expert knowledge can provide the proper guidelines for the wound care checklist that nurses will follow during their discharge teaching instructions. Management of wounds is complex; providers engaged in patient care and treatment should have appropriate knowledge and skills (Lopez-Franco et al., 2020; Neilsen & Coleman, 2022; Welsh, 2018). Furthermore, health management and wound care delivery affect proper and continued healing outcomes while requiring diverse professional competencies (Kapp & Santamaria, 2021; Kielo-Viljamaa et al., 2022). Therefore, wound care management should involve a multifaceted approach (Falcone et al., 2021; Ohnstedt et al., 2019). In addition, patients who manage their health can benefit from proper wound healing (Gillespie et al., 2020). As a result, a wound care expert is crucial in developing a checklist for nurse-led discharge teaching for wound care delivery, increasing patients' positive outcomes and health management. Including a wound care expert in creating a checklist will ensure that care is appropriately taught and given to patients. Wound Care Delivery Checklist Incorporating a wound care delivery checklist is beneficial to provide a patient-centered approach, allowing the nurse to be cognizant of their patient's needs and concerns (Green et al., 2018; Gao et al., 2018). In addition, this checklist will help limit omissions in proper wound care education during discharge. A nurse may accidentally exclude crucial information regarding wound care in the discharge conversation. For example, at the vascular clinic, nurses may only 11 perform dressing changes occasionally due to the infrequency of patient wounds or rotating assignments. To incorporate standardized treatment among nurses within the vascular clinic, following a teaching checklist ensures that treatment is standardized. A checklist during wound care delivery allows patients to be involved and discuss concerns with nurses (Green et al., 2018). Teaching the nurse to follow the checklist during the wound care discharge can provide the time required for patients to receive quality care (Legallois et al., 2019). In addition, the checklist can provide the communication and teaching requirements for patients and nurses to participate actively in wound care education (Mattessich, 2020). Finally, the checklist allows for success among the vascular clinic staff and patients by providing the time and focus required to prevent harm. Summary of Literature Review Findings and Application to the Project A detailed review of current literature on wound care nurse-led teaching revealed that educating and training nurses contributes positively to the patient's experience with discharge teaching, increases preventative measures, and allows opportunities for education and practice. The literature also suggests that including a content expert is a realistic solution to educate nurses to learn and create the correct content needed within the clinics that provide wound care. Increasing the use of reusable learning objects and including a wound care checklist wil l assist nurses in providing the proper care and including the patients in their healthcare. This information has helped substantiate this project's potential to improve nurse-led patient wound care by providing adequate training and education. This project will use the data from the literature to create an evidence-based checklist for nurse-led discharge teaching that nurses can refer to during wound care to ensure quality patient care. Project Methodology 12 Change begins with an idea that leads to action and, when followed through, produces results. The vascular clinic recently hired a registered nurse, and one task assigned is wound care and patient education. This project benefits nurses within or hired to the vascular unit and the patients receiving wound care at the vascular clinic. Creating a nurse-led discharge teaching checklist with a wound care expert and then implementing and evaluating the benefits and consequences of this checklist. This section includes an overview of the deliverables for this project, the interdisciplinary team involved, and the timeline for implementation. Description and Development of Project Deliverables Four deliverables were created to aid this project's planning, production, implementation, and evaluation. These include a content expert interview questionnaire, a wound care checklist, a PowerPoint for teaching, and a follow-up survey. A wound questionnaire, wound care checklist, PowerPoint, and follow-up survey are described in detail. Wound Content Questionnaire The process for this project begins by scheduling a meeting with a content expert specialized in wound care. Then, developing questions for the content expert that wound care patients have asked in previous appointments that nurses couldn't address due to their level of knowledge. In addition, questions asked by wound care nurses will be addressed during the development meetings to ensure strategies and materials are produced correctly (Kapp & Santamaria, 2021) (see Appendix A). Finally, reporting to the wound content expert is crucial to ensure that nurses can be given the correct information and provide the best patient care. Wound Care Checklist Information obtained from the content expert's meetings will be the foundation for creating a wound care checklist for nurses to follow during patient interaction with wound care 13 education. Appendix B demonstrates an example of what the wound care checklist may include and will be updated throughout the project. When a patient arrives at the vascular clinic for a wound care visit, the nurse will review the patient's health history and obtain a wound care checklist to help provide step-by-step directions for the nurse to complete the tasks for wound care. One of the goals of the wound care checklist is to help the team to compare the improvement or the worsening of the patient's wound. During the evaluation process of the wound, the nurses will consider the different risk factors for each patient when reviewing their charts. Nurse-Led Discharge Teaching Checklist PowerPoint A PowerPoint presentation was created to train wound care nurses for discharge teaching, using a checklist as a guide (see Appendix C). This presentation will prepare nurses to use the wound care checklist to teach patients and family members about their wound care. In addition, this presentation will help remind Registered Nurses (RNs) to evaluate whether the patient's understanding of the information taught is perceived correctly. Observing the patients and ensuring they feel comfortable discussing questions during the education will determine whether they understand the information. Patient Wound Care Checklist Follow-up Survey After implementing a checklist with patients, a Registered Nurse (RN) will conduct an inperson survey during their wound care visits (see Appendix D). The survey will allow patients to share what went well during their appointment and what they had difficulty understanding. After their wound care visit, a follow-up phone call will be made to determine the effectiveness of the wound care received in the clinic. Patients may have more questions after leaving their wound care appointment that can be addressed during the follow-up phone call. A follow-up phone call 14 allows the patient to ask further questions and enables the nurse to follow up with how the patient is doing regarding the wrapping of the wound, pain level, and concerns the patient may have. Plan and Implementation Process This MSN project will be implemented with the vascular clinic's physicians, advanced practitioners, and Registered Nurses. Developing this project begins with the support of physicians, providers, and nurses to ensure the incorporation of this checklist into patients' care. Meeting with a wound content expert helps develop the wound care checklist and the steps needed to provide proper wound care to patients by Registered Nurses (RNs). Incorporating the wound care checklist with the vascular team RNs provides a step-by-step guide for the nurses to follow and review during the wound care visit. Next, a coordination meeting is set up with providers in the vascular clinic to start the checklist process with the providers in the vascular clinic. The meeting will occur at the clinic vascular team break room. This meeting will help show the physicians, providers, and nurses the need for this checklist and gain support to incorporate this change to improve patient wound care in the clinic. The presentation and explanation of the project will be at this meeting. After implementing the checklist with the vascular team, it will be incorporated into standard nursing care for all patients receiving wound care at the vascular clinic. For example, when patients come into the clinic for wound care treatments, they are checked in with the medical assistant and taken to a treatment room. Then the nurse is informed of the patient 's arrival and removes the last wound bandage. Once the provider has evaluated the wound, the nurse is informed to provide care and wrap the wound. As the nurse goes in to provide wound 15 care and treatment, the checklist will provide a map of the direction of steps to follow in the correct order. Incorporating this checklist with patients can be used for nurse-led wound care discharge teaching, and then the patients will be included to provide feedback with the list. This feedback will be obtained and assessed by the nurse supervisor at the vascular clinic. As the patients offer feedback, the information gathered by the nurse supervisor will be taken back to the initial team of wound content experts, physicians, advanced practice providers, and the nurses included in the teaching to evaluate and address what issues the checklist may have. Interdisciplinary Teamwork The healthcare professionals contributing to the project include individuals who can collaborate relationships among the vascular team of physicians, advanced practice providers, and nurses. Having team members collaborate on the same project allows for the success of implementing a nurse-led wound care teaching checklist, which can improve patient outcomes. Furthermore, including interdisciplinary healthcare professionals will help establish a system that will benefit staff working more as a team. By implementing a unified wound care teaching checklist, patient care can thrive in a positive direction. Working with a group provides multiple people to provide the best outcome for patients by increasing their chances of success. Using a unified checklist gives each professional the road map of how to lead wound care discharge teaching, allowing patients to ask questions and learn the proper way of wound care to set them up for success. Physician: Two vascular physicians can provide insight into outcomes they want to see in their patient's care. Physicians can also guide specific wound care items for each patient. The physicians must approve the plan before implementation into patient care can occur. 16 Advanced Practice Providers (APPs): Three APPs, including physician assistants and nurse practitioners, will assess the patient's wound before delegating the wound care task to the Registered Nurses (RNs). They have been the healthcare professionals providing wound care before hiring a nurse; they also know different techniques that would benefit wound care for patients. Registered Nurses (RN): Nurses will be responsible for delivering educational materials and using the checklist to observe nonverbal behaviors to understand how the checklist is used and internalized by the patients. Ensure to ask questions and provide patient feedback when this discharge teaching checklist is used and evaluated by nurses and patients. The Registered Nurse's (RNs) job is to bring feedback to the nursing supervisor and wound content expert to determine what changes would assist in helping patients comprehend the wound care received while at the clinic. Medical Assistants (MA): Medical assistants are the first person the patients see when they arrive at the vascular clinic. The medical assistant checks the patient in by reviewing medications, vital signs, and concerns or questions the patient may have had since their previous visit. Then the medical assistant reviews the information with the providers and informs the nurse of the patient's arrival for the nurse to begin the wound care visit by removing the old dressing if one is in place. Timeline This project discusses many aspects required to implement a change within the vascular clinic. The detailed timeline helps organize this project's implementation (see Appendix E). The goal is to have a nurse-led wound care teaching checklist used by a year's mark. Discussing this project with the wound content expert and interdisciplinary team- the team is small; therefore, a 17 two-hour meeting should be adequate for each meeting. The discussion of the checklist may require multiple sessions over two months. After gathering data from individuals and teams, the checklist will be created over a month. By creating this checklist, the nurse will reconvene a meeting with the team to discuss and review the checklist, making changes if required. Again, incorporating this action can be evaluated and reviewed over a month. The goal is to have a standardized nurse-led discharge teaching wound checklist ready to use with wound care patients by the six-month mark. The providers use this tool for the first two months to evaluate the nurses to ensure the information is correct. Then the nurses will question patients to learn what is beneficial and what may have been confusing to understand the gaps within the checklist. This step is crucial to the evaluation process. After surveying patients, the responses will be returned to the interdisciplinary team and wound content expert, discussing how to change those topics over the next month. By the year mark, there will be an improved wound care checklist for each patient with wounds in the vascular clinic. Plan for Evaluation of Project The evaluation process is crucial to the success of patient care within the vascular clinic. The nurse conducting the follow-up appointments and survey will use a rating of 1-4 for each question. One is challenging for the patient to understand; four, the patient quickly understood the wound care provided. The patient will decide on a number to assign for each task or topic discussed during the wound care visit, and if it were successful, the rating would determine if they understood it well or if it was difficult to comprehend. The nurse supervisor will gather the survey results, sort answers to each question, and determine the different responses. Evaluating the different ratings from the patient's perspective regarding the wound care tasks/topics and then 18 discussing with the wound content expert, physicians, and advanced practice providers to determine what changes need to occur for the tasks and issues that received a challenging score. The nurses will also answer a question about the nonverbal observations they witnessed or encountered during the visit. Ethical Considerations Participants for this project will be treated equally by nurses using the same checklist and ensuring the care they receive is proper from the wound care expert. For example, if a patient has a history of smoking cigarettes daily, their wound care will not be diminished due to the risk factor of smoking. They will receive the same respect as other patients because the wound care checklist will be a universal teaching aid for nurses. Participant privacy is another ethical consideration. Informing the patient of the checklist implemented and their decision on whether to participate in developing the new checklist. The information shared from the patient surveys will be anonymous to ensure privacy by not including names or patient identifiers. Nurses will not discriminate due to race, gender, ethnicity, age, religious affiliation, or lifestyle. Nurses must be honest in their observations of the patients on the survey. This checklist is a tool to ensure every patient will receive equal quality care when at the vascular clinic. Discussion There are different levels and layers to wound care; in nursing school, one is taught the basics and may be unable to perform wound care often. Therefore, incorporating this project can enhance the profession of Registered Nurses (RNs) knowledge to provide the proper technique and care for patients' wounds. In addition, encouraging nurses to do research and training skills to learn various aspects of wound care can enhance the nursing profession. This section will 19 discuss the project's dissemination and the strengths and limitations within this project that will continue to be monitored and evaluated. Evidence-based Solutions for Dissemination Significant project findings will be shared by presenting a poster, giving a presentation, and publishing an article. The sign will provide a nurse-led wound care checklist's main points, objectives, and benefits to the patient's care. The poster will be presented to peers and the Weber State University (WSU) graduate faculty. The poster will then be presented to colleagues within the vascular clinic and other clinics throughout the corporation facility. In addition, presenting a poster allows a condensed version of the wound care checklist, helping others understand the information. A podium presentation will be delivered to outside clinics that refer patients to the vascular clinic—offering the opportunity for other providers to see and understand the care provided within the vascular clinic when the patients come for wound care treatment. In addition, sharing a podium presentation can help build trust between other physicians and the vascular clinic providing specialized wound care treatment. Building trust encourages physicians to refer patients to the vascular clinic to evaluate, diagnose, and treat the patient's wounds. To create a publication of this MSN project in the Journal of Wound Management and Research and the Intermountain Health organization. Organizing this publication in the journal allows it to reach as many individuals as possible. In addition, this publication can assist other healthcare professionals with wound care information, the benefit of a wound care checklist, and how it could benefit their patients and staff. With these significant findings from this project, the quality of time spent treating patients' wounds can increase the patient's quality of life. Significance to Advance Nursing Practice 20 This project can benefit the nursing profession by providing a reliable clinic where patients can be treated for their wound care because nurses can use evidence-based practice in the patient's care. Also, treating patients' wounds allows nurses to practice their wound care skills, sharing with students who may follow clinical rotations, and will help the nursing profession. Outpatient wound clinics positively affect patients by encouraging continued attendance and compliance (Monaro et al., 2021). Wound care is complex and can affect the quality of life that patients experience. Creating the wound care checklist with a wound content expert lets others know the proper technique and steps in treating wounds such as venous stasi s ulcers, arterial ulcers, and diabetic wounds. In addition, creating a checklist with step-by-step wound care provides control and consistency in a specialty clinic (Gonzalez et al., 2019; Monaro et al., 2021). Implications Strengths of this project include generalizability, cost-effectiveness, and continual evaluation. Generalizability consists of the nursing staff at the vascular clinic providing a continuity of care for wound care patients. Providing continuity of care and minimizing extra tools or supplies that are not needed is cost-effective. In addition, continually evaluating the wound care checklist and the receptiveness of patients ensures that items on the list are constantly reviewed and changed if required. Limitations of this project include participation in the follow-up survey, time constraints, and nurses becoming casual in care. The follow-up survey may be a limitation because patients may have difficulty filling out a paper survey, do not care to fill it out or forget to deliver it back to the clinic. A follow-up phone call may be more beneficial but could also be a limitation because of the patient not answering or wanting to answer the questions. Clinic visits are 20 to 21 30-minute appointments; this does not provide much time if the provider runs behind or the patient has complex wounds and requires more extensive treatment, which is why the time constraint could be a limitation of this project. Finally, as a nurse providing wound care multiple times a day with many patients, the nurse may eventually feel that they know the checklist and can provide the care without reviewing the checklist; this can subsequently cause the nurse to miss items on the list. Eliminating obstacles can be achieved by continuing education for vascular clinic staff and the constant evaluation of nurse performance which is a part of their quarterly review. In addition, when a patient comes into the vascular clinic for a wound care visit, the nurse will communicate the tasks or events that will take place and explain the purpose of the survey to help the patients know of its importance to help with clinic and staff improvement. Communication for the survey and the wound care appointment helps patients feel included in their care. Recommendations Improvements for the project include staying current on evidence-based practice by research and attending wound care conferences. The discovery of new technology or techniques to enhance wound treatment and healing processes that could change a patient's life. In addition, planning quarterly or biannual meetings with the wound content expert to ensure the tasks are appropriate. Finally, continually evaluate the survey, its success, and defaults, as well as the best way to deliver and obtain patient feedback. Conclusion In conclusion, wound care requires extensive knowledge due to its complexity. Achieving this project through a wound care expert and vascular providers allows Registered 22 Nurses (RNs) to become specially trained for wound care management in the vascular clinic. Developing a wound content expert questionnaire, wound care checklist, nurse training PowerPoint, and patient survey assists in the progress of this project. A current review of the literature supports training nurses to become specialists in the wound care management of patients, as it provides patients with positive experiences, increases preventative measures, and supports the professional role of RNs to provide education and practice. 23 References Bottos, M. (2019). Meditation as an intervention to help college students cope with stress. Valparaiso University. https://scholar.valpo.edu/cgi/viewcontent.cgi?article=1123&context=ebpr Dang, D., Melnyk, B. M., Fineout-Overholt, E., Ciliska, D., DiCenso, A., Cullen, L., Stevens, K. R. (2015). Models to guide implementation and sustainability of evidence-based practice. In B. M. Melnyk & E. Fineout-Overholt (Eds.), Evidence-based practice in nursing and healthcare: A guide to best practice. Philadelphia, PA: LWW. Dhar, A., Needham, J., Gibb, M., & Coyne, E. (2020). The outcomes and experience of people receiving community-based nurse-led wound care: A systematic review. Journal of Clinical Nursing, 29(15-16), 2820-283. https://doi.org/10.1111/jocn.15278 Falcone, M., De Angelis, B., Pea, F., Scalise, A., Stefani, S., Tasinato, R., Zanetti, O., & Paola, L. D. (2021). Challenges in the management of chronic wound infections. Journal of Global Antimicrobial Resistance, 26, 140-147. https://doi.org/10.1016/j.jgar.2021.05.010 Franco-Buenaventura, D. & Garcia-Perdomo, H. A. (2020). Vacuum-assisted closure device in the post-operative wound care for Fournier's gangrene: A systematic review. International Urology and Nephrology, 53, 641-653. https://doi.org/10.1007/s11255-02002705-6 Gao, M., Martin, P., Motal, J., Gingras, L., Chai, C., Maikoff, M. E., Sarkisian, A. M., Rosenthal, N., & Eiss, B. (2018). A multidisciplinary discharge timeout checklist improves patient education and captures discharge process errors. Quality Management in Health Care, 27(2). https://doi.org/10.1097/qmh.0000000000000168 24 Gillespie, B. M., Walker, R. M., McInnes, E., Moore, Z., Eskes, A. M., O'Connor, T., Harbeck, E., White, C., Scott, I. A., Vermeulen, H., & Chaboyer, W. (2020). Preoperative and post-operative recommendations to surgical wound care interventions: A systematic meta-review of Cochrane reviews. International Journal of Nursing Studies, 102. https://doi.org/10.1016/j.ijnurstu.2019.103486 Gonzalez, A., Delgado, V., & Buscemi, C. P. (2019). Wound closure rates: A comparison between advanced practice registered nurse and primary care physician treatment . The Journal for Nurse Practitioners, 15(9). https://doi.org/10.1016/j.nurpra.2019.04.015 Green, J., Corcoran, P., Green, L., Read, S. (2018). A new quality of life wound checklist: The patient voice in wound care. Wounds UK, 14(4). https://www.woundsuk.com/journals/issue/548/article-details/new-quality-life-wound-checklist-patient-voicewound-care Haalboom, M., Blokhuis-Arkes, M. H. E., Beuk, R. J., Meerwaldt, R., Knot, R., Schijffelen, M. J., Bowler, P. B., Burnet, M., Sigl, E., & van der Palen, J. A. M. (2019). Culture results from wound biopsy versus wound swab: Does it matter for the assessment of wound infection? Clinical Microbiology and Infection, 25(5). https://doi.org/10.1016/j.cmi.2018.08.012 Indra, V. (2018). A review on models of evidence-based practice. Asian J. Nursing Education and Research 8(4). https://doi.org/10.5958/2349-2996.2018.00115.5 Kapp, S. & Santamaria, N. (2021). The "self-treatment of wounds for venous leg ulcers checklist" (STOW-V checklist V1.0): Part 1 – Development, pilot, and refinement of the checklist. International Wound Journal, 19(3). https://doi.org/10.1111/iwj.13666 25 Kielo-Viljamaa, E., Viljamaa, J., Suhonen, R., Salminen, L., & Stolt, M. (2022). Learning goals and content for wound care education in Finnish nursing education – A Delphi study. Nurse Education Today, 110. https://doi.org/10.1016/j.nedt.2022.105278 Lasa-Blandon, M., Stasi, K., Hehir, A., & Fischer-Cartlidge, E. (2019). Patient education issues and strategies associated with immunotherapy. Seminars in Oncology Nursing, 35(5). https://doi.org/10.1016/j.soncn.2019.08.012 Legallois, D., Chaufourier, L., Blanchart, K., Parienti, J. J., Belin, A., Milliez, P., & Sabatier, R. (2019). Improving quality of care in patients with decompensated acute heart failure using a discharge checklist. Archives of Cardiovascular Diseases, 112(8-9), 494-501. https://doi.org/10.1016/j.acvd.2019.05.003 Leinenbach, A. (2019). Implementation of an educational workshop on the use of evidencebased lifestyle management programs to prevent diabetes. University of Louisville's Institutional Repository. https://ir.library.louisville.edu/cgi/viewcontent.cgi?article=1018&context=dnp Lopez-Franco, M. D., Parra-Anguita, L., Comino-Sanz, I. M., & Pancorbo-Hidalog, P. L. (2020). Development and validation of the pressure injury prevention barriers questionnaire in hospital nurses in Spain. BMJ Open, 10(12). https://doi.org/10.1136/bmjopen-2020041376 Mattessich, N. T. (2020). Goals-to-discharge patient checklist. National Library of Medicine, 24(3). https://doi.org/10.1188/20.cjon.316-319 Monaro, S., Pinkova, J., Ko, N., Stromsmoe, N., & Gullick, J. (2021). Chronic wound care delivery in wound clinics, community nursing, and residential aged care settings: A 26 qualitative analysis using Levine's Conservation Model. Journal of Clinical Nursing, 30(9-10). https://doi.org/10.1111/jocn.15674 Neilsen, G. & Coleman, K. (2022). Healing wound management. Clinics in Integrated Care, 11. https://doi.org/10.1016/j.intcar.2022.100096 Ohnstedt, E., Tomenius, H. L., Vagesjo, E., & Phillipson, M. (2019). The discovery and development of topical medicines for wound healing. Expert Opinion on Drug Discovery, 14(5), 485-497. https://doi.org/10.1080/17460441.2019.1588879 Onuchukwu-Azuonye, C. O. (2021). Thiazides as a monotherapy/combination therapy in the management of essential hypertension. University of Texas El Paso. https://scholarworks.utep.edu/cgi/viewcontent.cgi?article=1001&context=cohort_9 Redmond, C., Davies, C., Cornally, D., Adam, E., Daly, O., Fegan, M., & O'Toole, M. (2018). Using reusable learning objects (RLOs) in wound care education: Undergraduate student nurses evaluate their learning gain. Nurse Education Today, pp. 60, 3–10. https://doi.org/10.1016/j.nedt.2017.09.014 Surme, Y. Kacmaz, H. Y., & Ceyhan, O. (2022). Knowledge and practices of the intern nursing students on wound care. International Journal of Caring Sciences, 15(1), 609. http://www.internationaljournalofcaringsciences.org/docs/62.pp_609_616-surme.pdf Welsh, L. (2018). Wound care evidence, knowledge, and education amongst nurses: A semisystematic literature review. International Wound Journal, 15(1), 53–61. https://doi.org/10.1111/iwj.12822 27 Appendix A Questions to Include for the Wound Content Expert 1. After the wound is unwrapped, what is the first step to care for each wound care patient? (washing with betadine scrub, removing dead skin, etc.) 2. What is the best way to clean a wound in the clinic setting? How would one stop the bleeding from the wound in the clinic setting? 3. Which ointment is a universal wound care ointment? 4. How does one protect the wound? (example: xeroform, soft cast padding, kerlex, etc.) 5. How often should each dressing be changed? 6. What symptoms should patients observe for a while at home? 7. How do venous stasis wounds differ from arterial ulcers regarding wound care? 8. At any time, do we provide numbing medications/assistance? 9. What items of wound care are required to be done by the APPs in the clinic? 28 Appendix B Wound Care Discharge Checklist Procedure Checklist 1. Review the patient's wound history and last wound care appointment 2. Gather supplies (absorbent pad, saline, gauze, ABD pad, xeroform, measuring instruments, cotton cast, Coban, ace bandage, etc.) 3. Wash hands 4. Position patient appropriately 5. Ask assessment questions to see how the patient is doing since the last wound care visit and how care at home has been 6. Apply gloves (googles and mask if needed) 7. Verify patient allergies 8. Place an absorbent pad under the patient's wound area 9. Remove old dressing. Use saline if the dressing sticks to the wound bed 10. Wash hands 11. Apply new gloves 12. Wash the wound with Hibiclens scrub 13. Measure wound 14. Apply mupirocin (or antibiotic) ointment to the tissue if ordered by the provider 15. Pack wound gently with moist gauze if needed 16. If the wound does not need to be packed, place xeroform over the wound tissue. Making sure that there are no wrinkles 17. Apply gauze, ABD pad, or cotton cast around the wound area 18. Wrap the area in a Coban or an ACE bandage. This will help with swelling. 19. Label dressing with initials, date, time 20. Ask if the patient has any concerns or questions 21. Help the patient in a comfortable position Comments 29 22. Discard dirty supplies/gloves 23. Perform hand hygiene 24. Schedule patient for follow-up wound care appointment if needed 25. If the patient requires supplies at home, gather and provide supplies if needed 30 Appendix C Nurse-Led Discharge Teaching Checklist PowerPoint 31 32 33 34 35 Appendix D Patient Wound Care Checklist Follow-up Survey 1. On a scale of 1-10, 1 being the worst and 10 being the best, how would you rate your care at the vascular clinic? Not great 1 2 Best care 3 4 5 6 7 8 9 10 2. Were you satisfied with the medical care providers you encountered? Yes No 3. Was the staff able to answer all of your questions? Yes No 4. Do you have further health concerns you would like to share? 5. On a scale of 1-10, 1 being the worst and 10 being the best, how comfortable were you with the wound care you received? Not great 1 2 Best 3 4 5 6 7 8 9 10 6. On a scale of 1-10, how would you rate the easiness of scheduling a follow-up appointment? Not easy 1 2 Easy 3 4 5 6 7 8 9 10 7. Did you feel there was information missing from the care you received? Yes No 36 8. Was it easy to follow the directions that the medical personnel shared? 9. What should we incorporate or work on when providing wound care? 10. Do you have any further questions or concerns you would like to address? 37 Appendix E Timeline First two months Wound content expert meeting Interdisciplinary team meeting Six months Third month Create a nurse-led wound care discharge teaching checklist Eighth month Patients who require wound care to implement the checklist with Review survery responses with multidisciplinary team Survey patients and review issues Make changes to checklist. Fourth month Having meeting with wound content expert and interdisciplinary team members to reviews and edit the checklist One year Implement the checklist with all wound care patients