Electronic Thesis and Dissertation Repository

Thesis Format

Integrated Article

Degree

Doctor of Philosophy

Program

Health and Rehabilitation Sciences

Supervisor

Houghton Pamela E

2nd Supervisor

Campbell K

Co-Supervisor

Abstract

Nurse Practitioners (NP) diagnose and treat wounds and wound-related conditions based on their advanced scope of practice. An NP with graduate-level wound care education (NP(W)) gains additional knowledge and clinical experience to provide comprehensive wound care.

This research aimed to explore community patients’ access to wound care in Southwestern Ontario (Canada). A quality improvement project was initiated utilizing stakeholder feedback to develop and implement a 12-week pilot NP(W)-Led community-based wound care service; the NP(W) wound care practices, clinical outcomes, and adverse events were described. One hundred twelve participants attended the service over 117 visits. The NP(W) services included prescribing and administering medications, providing treatments, ordering laboratory and diagnostic tests, sending referrals, and consultations.

Patient experience was captured via a mail-in survey of the Generic Short Patient Experiences Questionnaire. There were 49 completed questionnaires from the NP NP(W)-Led service. Respondents reported confidence in the NP(W) skills and satisfaction with the overall care.

Chart audits were conducted on 2066 charts to examine emergency department (ED) utilization before, during, and post-implementation of the NP(W)-Led wound care service. The most common reason for going to the ED was at the ED providers’ request, followed by being sent by a community nurse. There was a statistical difference between the total visits and visits for wound care at two points. Results from this small pilot study suggested a high-level patient satisfaction and noted decreased ED visits during the time the clinic was open.

Keywords: Nurse practitioner, NP, wounds, wound care, community, emergency department, patient experience, quality improvement project

Summary for Lay Audience

Nurse Practitioners (NP) have an advanced scope of practice that allows them to determine a diagnosis, provide treatments, order medications, and order laboratory and diagnostic tests. NPs also work with other health care providers and refer patients to specialists. This advanced scope of practice enables NP to diagnose and treat wounds and wound-related conditions and coordinate care in the community. An NP with advanced graduate-level wound care education (NP(W)) has additional knowledge and clinical experience, enabling them to provide comprehensive care.

This doctoral research aimed to explore community patients’ access to wound care in an urban centre in Southwestern Ontario (Canada). A quality improvement project was initiated to develop and implement an NP(W)-Led community-based wound care service. Feedback from stakeholders provided information to assist with the development and implementation of a wound care service.

The NP(W)-Led service ran as a 12-week pilot; NP(W) wound care practices, clinical outcomes, and adverse events were described. One hundred twelve participants attended the service over 117 visits. The NP(W) services included prescribing and administering medications, providing treatments, ordering laboratory and diagnostic tests, sending referrals, and consultations. One patient was sent to the emergency department (ED) with a resistant wound infection, and another to receive medication.

Patient experience was captured via a mail-in survey of the Generic Short Patient Experiences Questionnaire. There were 49 completed questionnaires from the NP(W)-Led wound care service. Respondents reported confidence in the NP(W) skills and satisfaction with the overall care. Participants also indicated a short wait to receive care. Experience score was higher in females than males.

Chart audits were conducted on 2066 charts to examine ED use before, during, and post-implementation of the NP(W)-Led wound care service. Fifty-four percent (n=1124) of the total visits were wound-related. The most common reason for going to the ED was at the ED providers’ request, followed by being sent by a community nurse. This study provides information to aid with future NP(W) role development.

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