Table 4 - uploaded by Angel Romero-Collado
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Purpose: To analyze content related to chronic wounds in nursing degree programs in Spain. DesignCross-sectional descriptive study. Methods:
Course descriptions available for online access during June and July of 2012 were reviewed for the 114 centers in Spain that offer a nursing degree, according to the official Registry of Universities, Centers,...
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Citations
... Furthermore, in the European Credit Transfer and Accumulation System [ECTS], aspects focusing on impaired skin integrity are few, comprising two ECTS, corresponding to about 50 h of student work, but insufficient in the total balance of the degree [12]. It is assumed that, as a result of this training during their undergraduate degree, students should possess knowledge regarding skin integrity impairments. ...
Background: Wound healing competence is implied in the nursing profession, but there is
no standardized content regulation for wound care in university curricula. The primary objective of
this study was to identify the barriers to the acquisition of knowledge about skin integrity impairment.
Methods: A quasi-experimental pre-test and post-test study with an ad hoc questionnaire involved
304 students (control: 165; intervention: 139) from June to July 2023. A 10-h educational intervention
focused on skin integrity assessment and treatment was conducted. Results: The control group,
scoring 17 ± 0.22 out of a maximum of 61, achieved a significantly lower final test score (p < 0.001)
compared to the wound care educational intervention group, with the pre-test group scoring 30 ± 0.76
and the post-test group scoring 43 ± 0.61. The educational intervention in wound care program
improved nursing students’ knowledge of prevention, assessment/diagnosis, treatment, lower limb
wounds, and wound bed preparation by replacing the number of "Don’t know" answers in the posttest group with correct answers. Conclusions: The barriers identified to the acquisition of knowledge
about skin integrity impairment in nursing studies are the following: the transversality of teaching,
the teaching and evaluation system, and the variability in the training of professionals and teachers
in charge of their education. The educational intervention can be used to consolidate knowledge and
to enhance students’ self-confidence in caring for patients with wounds.
... However, the National Group for the Study and Advice on Pressure Ulcers and Chronic Wounds in Spain (GNEAUPP) one of the main national wound associations indicates that most Health Areas in Spain do not have a specific unit (Garcia-Fernandez et al., 2018). In other words, there is no specialised chronic wound unit within the public health system (Romero-Collado et al., 2015;Lana-Pérez et al., 2018). Currently in Spain, the care levels where patients with chronic wounds are cared for are Primary Care (PC), Hospital Care (HC) and Social and Health Care (SHC), the latter for people requiring long stays and specialised geriatric care. ...
... Although some forms of specialization have been developed in some healthcare areas, such as Advanced Practice Nursing (APN) for wounds (Welsh and Lusher, 2022), it is not enough. Wound training in Spain is mainly at postgraduate level, in contrast to the scarcity of knowledge imparted in this area during undergraduate university education (Romero-Collado et al., 2015). Only 5.45 % of undergraduate nursing degrees have an elective course on chronic wound management (Welsh, 2018;Weller et al., 2020;Kielo-Viljamaa et al., 2021). ...
Background: Chronic wounds are a challenge and a major cause of morbidity. A wound is considered chronic if healing does not occur within the expected time frame depending on the etiology and location of the wound. Objective: To assess the level of knowledge about chronic wound management of postgraduate nurses in different areas of the health system and their previous satisfaction with the training received during their undergraduate studies. Design: Cross-sectional study of a health system of 95,000 inhabitants and 557 nursing professionals working in it. Participants: Nurses working in the study health system and in areas with care for patients with chronic wounds in social, primary and hospital care. Results: Survey results described a low knowledge of chronic wound management in general. Data on knowledge according to area of work showed that nurses in primary care had the highest knowledge of wound etiology. Nurses working in health and social care were most knowledgeable in diagnostic knowledge. Hospital nurses showed the lowest knowledge overall. A relationship was observed when nurses had a master’s degree followed by an expert with better knowledge in the test. In addition, nurses reported little training in chronic wounds during their university studies (69.73 %, n =106). Conclusions: Therefore, a review of this point should be considered to improve the management of chronic wounds and their correct approach among nursing students. A review of continuing and even specialised training needs in the clinical care setting should also be considered.
... After the authors reviewed 112 teaching guides on Spanish university websites, in search of a compulsory subject addressing VLUs, different denominations have been found such as Nursing; Adult I or II, Adult Person I, Clinical I, II or III, Adult Clinical I, Advanced Clinical I, Adult Clinical I, Adult Clinical, Medical-Surgical I or II, Chronic, Advanced and Terminal Processes, Nursing Care in Health Alterations I, Adult Nursing Care, Adult Care, Adult Nursing Care, Adult Nursing Care, Nursing Care in Health Alterations I, Mechanisms and Processes of Disease I and Health Alterations I. Although no papers were found regarding content related to VLU care, Tobajas-Señor et al. (2017) and Romero-Collado et al. (2015) both published articles regarding curricula on chronic wounds (where VLU care should be included) in Spanish Nursing degrees and found that although the topic is taught in almost half of the universities, the number of hours is insufficient. For instance, Tobajas-Señor et al. (2017) found that 69.64 % of universities provide content in the second year, although it is worth less than 2 European Credits (ECTS). ...
... The results of this study match studies that also identified areas of competence in VLU management, e. g., the Wound Curriculum for Student Nurses, in line with European qualification framework level 4 (Lindahl et al., 2021). In addition to this discussion, we can take into account present curricula heterogeneity and that it is difficult to ascertain concrete content in teaching, (Romero-Collado et al., 2015;Ruiz-Rojo et al., 2022;Tobajas-Señor et al., 2017) so it is not possible to check whether all contributions from the expert panel are actually included in student nurses' training. The second consultation objective was intended to receive input on what strategies can be implemented during university education to ensure that nursing students learn how to care for people with VLU. ...
Aim:
To get consensus on the knowledge and skills that nursing students need to acquire regarding venous leg ulcer care, the strategies that can be applied during education and to design a first draft of a questionnaire to assess knowledge to be validated.
Background:
Venous leg ulcers' care is included on undergraduate nursing education programmes but without specifying the content and training implementation strategies. Different tools have been validated to assess knowledge, but have been found inadequate.
Design:
An e-Delphi study.
Methods:
The participants were Chronic Wound Care expert nurses. Two questions were constructed and agreed on by the research team to define the problem. To answer the third question, a search was conducted for publications on venous leg ulcers, to help design the questionnaire. A 2-round e-Delphi study was conducted from January to March 2022. A panel of 17 experts participated in both rounds. The data were analysed using statistical and qualitative analysis.
Results:
Content must fulfil knowledge-skill areas: epidemiology, venous pathophysiology and aetiology, classification scales, knowing how to determine a differential diagnosis, treatment, measures for prevention and care of the venous return circuit, quality-of-life scales. As implementation strategies, proposals were made in four areas: subject profile where training is to be acquired, theoretical teaching, practical teaching in the classroom and clinical practice. The average consensus of the questionnaire proposal was high (>86 %) both in relevance and clarity in both rounds. We thereby obtained a questionnaire with 72 items.
Conclusions:
Seven categories and eight subcategories were created regarding knowledge/skills that nursing students should acquire. Four categories were recognised as strategies that can be implemented during education. A high level of consensus was reached on the items in the initial versions of the questionnaire.
... Considerando al final que los centros universitarios con mejor contenido docente estaban localizados en: Granada, Jaén, Extremadura, Girona, La Rioja, Las Palmas de Gran Canaria y Murcia (Imagen 1) . Pero también debemos tener en cuenta las aportaciones pioneras de los estudios de Romero-Collado A. et al (2) , y de Tobajas-Señor EM, et al (3) . En el artículo de Romero A (2015), se trataba de analizar los contenidos relacionados con heridas crónicas según los programas de grados de 114 centros universitarios públicos de España. ...
Prevenir y/o tratar el deterioro de la integridad cutánea y tisular en pacientes afectados o en riesgo de padecerlo, suele ser una las acciones o actividades de cuidados más frecuentes del ámbito clínico sanitario y sociosanitario de las/os enfermeras/os, en su quehacer diario. Desde nuestra perspectiva enfermera, debemos prestar atención a cómo se desarrolla la formación en heridas desde la base, es decir desde el pregrado de enfermería, ya que condicionará cómo será el futuro de los profesionales en esta área de cuidados, que habilidades atesoran los recién egresados y que planificación formativa será la más adecuada adquirir u ofertar los sistemas de salud. En esta editorial se opina sobre el estado del arte en esta materia y que propuestas hay en la actualidad para evolucionar hacia un programa estandarizado de competencias en el grado de enfermería.
[NURSING DEGREE AND CORE COMPETENCIES IN CHRONIC WOUNDS]
Preventing and/or treating the deterioration of skin and tissue integrity in patients affected or at risk of suffering it, is usually one of the most frequent actions or care activities of nurses in their daily work. From our nursing perspective, we must pay attention to how wound training is developed from the base, that is, from undergraduate nursing, as it will determine how the future of professionals in this area of care will be, what skills recent graduates have and what training planning will be the most appropriate to acquire or offer health systems. This editorial gives an opinion on the state of the art in this area and what proposals there are at present to evolve towards a standardized program of competencies in the nursing degree.
... Este conocimiento se empieza a adquirir en los estudios de grado en la universidad. Así, la mayoría de centros que imparten ciencias de la salud en España, incluyen en sus contenidos la antisepsia y los antisépticos 15 . A pesar de ello, es necesario seguir formándose sobre el uso de los antimicrobianos a lo largo de la carrera profesional, para mantenerse actualizado. ...
INTRODUCCIÓN En el año 2002, el Grupo Nacional para el Estudio y Asesoramiento en Úlceras por Presión y Heridas Crónicas (GNEAUPP) elaboró la prime-ra edición sobre recomendaciones de antisépticos en heridas crónicas 1 , documento que fue elemento clave para apoyarnos en nuestra práctica asistencial diaria. Han pasado ya 20 años desde aquella edición y este ar-tículo, síntesis del documento técnico n.º VIII del GNEAUPP, pretende continuar la labor realizada por aquel entonces actualizando algunos detalles y añadiendo nuevas herramientas terapéuticas para prevenir o luchar frente a uno de los factores más importantes que impiden que ci-catrice una herida: los problemas relacionados con los microorganismos, clásicamente la infección y, ahora, también el impacto de los biofilms. En este artículo se habla sobre antimicrobianos en heridas crónicas, incluyendo a los que basan su mecanismo de acción en una acción quí-mica o bioquímica, es decir, los antisépticos, pero también se tratan algunos aspectos de los antibióticos que se continúan usando en la prác-tica clínica y, como mínimo, siguen siendo objeto de debate y contro-versia, como, por ejemplo, los antibióticos tópicos y, más actualmente, otros agentes con potenciales propiedades antibiofilm. No se incluyen otros productos con capacidad antimicrobiana en los que su mecanismo de acción sería físico o electrocéutico. Hoy en día existen diversos factores que han propiciado que existan microorganismos cada vez más resistentes a los antibióticos actuales, y el descubrimiento de nuevas generaciones de antibióticos es costoso y difí-cil, por eso a nivel mundial se realizan campañas de uso racional de los antibióticos. Uno de los problemas de esta estrategia es que, a menudo, se obvian recomendaciones sobre el uso de antisépticos, que pueden ser unos buenos aliados para evitar el uso de antibióticos en heridas o mediante su uso concomitante para luchar contra los microorganismos. Recomendaciones del uso de antimicrobianos en heridas crónicas ABSTRACT This article, based on GNEAUPP Technical Paper No. VIII, updates some concepts related to antimicrobials and adds new therapeutic tools to prevent and fight against one of the most important factors that prevent wound healing: problems related to microorganisms, classically infection and now also the impact of biofilms. The GNEAUPP's own evidence grading system is used, which classifies the strength of the recommendation as high, moderate or low. The antimicrobials analyzed in terms of their mode of action, commercial presentation, recommendations for use, contraindications and effectiveness on biofilm are: alcohol, chlorhexidine, sodium hypochlorite, octenidine, silver and iodophors. Also the effects of the so-called antibiofilm agents, although most of them have been performed in vitro. Finally, a series of recommendations are made to researchers to generate new evidence related to antimicrobials and their clinical applicability. Crónicas acreditada por el GNEAUPP. Referente de heridas del ABS Ernest Lluch de Figueres. *Autor para correspondencia. Correo electrónico: pepe.verdu@ua.es (José Verdú Soriano). Recibido el 28 de febrero de 2022; aceptado el 28 de febrero de 2022. RESUMEN En este artículo, basado en el documento técnico n.º VIII del GNEAUPP, se actualizan algunos conceptos relacionados con los antimicrobianos y se añaden nuevas herramientas terapéuticas para prevenir y luchar frente a uno de los factores más importantes que impiden que cicatrice una herida: los problemas relacionados con los microorganismos, clásicamente la infección y, ahora, también el impacto de los biofilms. Se asume el sistema propio del GNEAUPP de gradación de la evidencia, que clasifica la fuerza de la recomendación en alta, moderada o baja. Los antimicrobianos analizados mediante su modo de actuación, presentación comercial, recomendaciones de uso, contraindicaciones y efectividad sobre el biofilm son: el alcohol, la clorhexidina, el hipoclorito sódico, la octenidina, la plata y los yodóforos. También los efectos de los llamados agentes antibiofilm, aunque la mayoría se han realizado in vitro. Para finalizar, se realizan una serie de recomendaciones dirigidas a los investigadores para generar nuevas evidencias relacionadas con los antimicrobianos y su aplicabilidad clínica.
PALABRAS CLAVE: Antibacterianos, antiinfecciosos, biopelículas, infección de heridas.
... Este conocimiento se empieza a adquirir en los estudios de grado en la universidad. Así, en la mayoría de centros que lo imparten Ciencias de la Salud en España, incluyen en sus contenidos la antisepsia y los antisépticos (15). A pesar de ello, es necesario seguir formándose sobre el uso de los antimicrobianos a lo largo de la carrera profesional para mantenerse actualizado y ofrecer unos cuidados de calidad. ...
Hoy en día existen diversos factores que han propiciado que existan
microorganismos cada vez más resistentes a los antibióticos actuales, y el descubrimiento de nuevas generaciones de antibióticos es costosa y difícil, por eso a nivel mundial se realizan campañas de uso racional de los antibióticos.
Uno de los problemas de esta estrategia es que, a menudo, se obvian
recomendaciones sobre el uso de antisépticos, que pueden ser unos buenos aliados para evitar el uso de antibióticos en heridas o mediante su usoconcomitante para luchar contra los microorganismos.
A pesar de tener los antisépticos muy a mano y de uso muy extendido en nuestra práctica clínica, existe un déficit de estudios de calidad sobre su eficacia o estándares de laboratorio/resultados que permitan sacar conclusiones en igualdad de condiciones, puesto que se comparan diversos antisépticos en diferentes concentraciones y situaciones.
También existen intereses comerciales con la intención de situar unos productos por encima de otros, algunas veces sin contar con evidencia que lo sustente.
En este documento técnico se utilizan documentos de consenso y revisiones realizadas por Cochrane que, como bien sabemos, tiene unos criterios muy estrictos que la mayoría de veces muestran que no hay evidencia de peso para recomendar algunos antimicrobianos respecto a otras intervenciones. Es necesario realizar estudios robustos, que generen evidencia sobre la efectividad de su uso en la prevención y tratamiento de las infecciones.
Intentamos ofrecer una pincelada sobre las recomendaciones de uso de antibióticos y antisépticos, algunos de los cuales aún no están plenamente implantados en España, pero que las últimas guías de consenso recomiendan, y también recomendaciones que desaconsejan el uso de algunos antisépticos que sí tienen su uso muy extendido en España.
... For example, university nursing programmes in Spain include limited and insufficient hard-to-heal wound care content. 60 In this regard, Denmark and the model led by Gottrup pioneer the way. 61,62 Recent trends in Europe aimed at shifting from hospital care to home care. ...
Objective
To determine the number of specialised wound care units/clinics (SWCUs) in Spain, at present, and to describe their most important characteristics.
Method
This was an observational study with a descriptive-analytical, cross-sectional, multicentre approach, where the studied population consisted of SWCUs in Spain. A specific data-collection questionnaire was designed using a modified Delphi method, consisting of four rounds, with the collaboration of 10 wound experts. The final questionnaire included 49 items distributed across four dimensions/areas with a content validity index (CVI-Total for pertinence=0.96 and CVI-Total for relevance=0.94.
Results
A total of 42 SWCUs were included in the study. Most SWCUs were based in hospitals (n=15, 35.7%) or healthcare centres, covering a specific healthcare area (n=17, 40.5%). SWCU coordinators were primarily nurses (n=33, 78.6%). Staff members' professions in SWCUs included registered nurses (n=38 units, 92.7%), nursing assistants (n=8 units, 19.5%), podiatrists (n=8 units, 19.5%), vascular surgeons (n=7 units, 17%), osteopaths (n=2 units, 4.8%) and medical doctors from different specialties (n=3 units, 7.2%). For wound aetiology, the most prevalent wounds managed were diabetic foot ulcers (n=38 units, 90.5%), followed by venous leg ulcers (n=36 units, 85.7%) and arterial ischaemic ulcers (n=36 units, 85.7%). A statistically significant association was found between the number of staff members in a SWCU and the existence of resistance/opposition barriers when developing a SWCU (Chi-square test, p=0.049; Cramér's V=0.34; 34%), as well as between resistance/opposition barriers when developing a SWCU and a nurse as coordinator of a SWCU (MacNemar test, p=0.007, Cramér's V=0.35; 35%).
Conclusion
The typical SWCU implemented in Spain is located in a hospital or integrated in a healthcare structure that offers coverage to a whole health area and providing services for people with hard-to-heal wounds (wound management and prevention) and health professionals (advice, consultancy and training/education). Despite the growing number of SWCUs in Spain, the future of this new organisational model is uncertain, as there can be barriers to creating them and some deficiencies, such as low staff numbers, which need to be addressed.
... In fact, as many as 90% of patients with CVI receive no treatment whatsoever [10]. The literature describes several factors that might explain the low uptake of compression treatment, including a lack of awareness and skills among healthcare professionals [11,12]. ...
... However, in some countries, the disease is not detected until more advanced stages. There are gaps in healthcare professionals' knowledge of venous leg ulcer physiology and its healing process [11], partly due to a lack of training at a degree level [12]. By applying and incorporating this MDS-CVI in patients' health records, healthcare professionals will find it easier to monitor the disease course at every stage [6]. ...
The purpose of this study was to develop a minimum data set (MDS) registry for the prevention, diagnosis and treatment of chronic venous insufficiency (CVI) of the lower limbs. We designed the instrument in two phases, comprising a literature review and an e-Delphi study to validate the content. We obtained a total of 39 documents that we used to develop a registry with 125 items grouped in 7 categories, as follows: Patient examination, venous disease assessment methods, diagnostic tests to confirm the disease, ulcer assessment, treatments to manage the disease at all its stages, patient quality of life, and patient health education. The instrument content was validated by 25 experts, 88% of whom were primary healthcare and hospital nurses and 84% had more than 10 years' experience in wound care. Using a two-round Delphi approach, we reduced the number of items in the MDS-CVI to 106 items. The categories remained unchanged. We developed an MDS for CVI with seven categories to assist healthcare professionals in the prevention, early detection, and treatment history of CVI. This tool will allow the creation of a registry in the primary care setting to monitor the venous health state of the population.
... Tobajas-Señor et al. 14 y Romero-Collado et al. 15 manifiestan que los contenidos sobre heridas crónicas en los estudios de Enfermería no son suficientes. Destacan la necesidad de definir un nivel mínimo de formación para tener unas competencias adecuadas, de modo que "se reduzca la brecha teoría-práctica" 15 . ...
... Tobajas-Señor et al. 14 y Romero-Collado et al. 15 manifiestan que los contenidos sobre heridas crónicas en los estudios de Enfermería no son suficientes. Destacan la necesidad de definir un nivel mínimo de formación para tener unas competencias adecuadas, de modo que "se reduzca la brecha teoría-práctica" 15 . Parece necesario, por tanto, profundizar en el conocimiento de las ya graduadas en Enfermería sobre los aspectos principales de la práctica asistencial relacionada con las UEI. ...
RESUMEN
Objetivo: Determinar el grado de conocimiento de recomendaciones basadas en la evidencia sobre cuidados de úlceras de extremidad inferior (UEI) que tratan las enfermeras que trabajan en el Área Sanitaria de Ferrol. Analizar su relación con la formación continuada. Metodología: Estudio descriptivo, transversal y observacional mediante cuestionario diseñado ad hoc entre mayo y junio de 2015. La población de estudio la constituyeron enfermeras que trabajaban en hospital, atención primaria o centro sociosanitario que posea concierto en suministro de productos de cura en ambiente húmedo. Se obtiene autorización del CEIC de Galicia. Resultados: Participaron 205 enfermeras (66% de la población a estudio). Un 62% ha realizado algún curso de formación sobre UEI en los últimos 5 años. Todas mani estan que se debe tener en cuenta la calidad de vida de estos pacientes; un 5,9% utiliza la herramienta validada para su valoración. El 94,1% considera útil una “app” sobre UEI en algún dispositivo electrónico. Las variables con capacidad independiente para predecir el conocimiento sobre UEI son conocer las guías de práctica clínica, saber calcular el índice tobillo-brazo y los valores para detectar claudicación intermitente; esta última es la más decisiva. Conclusiones: A pesar de la formación recibida, existen áreas en las que es necesario incidir. Mejorar su capacitación es imprescindible para asegurar la calidad en la atención de las personas que las padecen. Se objetiva la necesidad sentida de los profesionales respecto a la creación de una aplicación como herramienta de ayuda en la toma de decisiones.
PALABRAS CLAVE: Conocimientos, actitudes y práctica en salud, úlcera de la pierna, enfermería, atención de enfermería, tecnología de la información, guía de práctica clínica.
... En la literatura existen varios factores que pueden explicar la baja implementación del tratamiento compresivo como un déficit de conocimientos por parte de los profesionales de la salud [14][15][16] o una baja adherencia al tratamiento por parte de los pacientes 17 . ...
