Problems identified in gaining non‐expert consensus for a hypothetical Wound Assessment Form

Abstract

A post-hoc analysis was carried out of a session on a wound management diploma level module that was intended to promote understanding of the complexity of wound assessment. Postregistration student nurses (n = 16) from both hospital and community settings participated in brainstorming of categories (i.e. verbatim expression) they thought should be included in a hypothetical Wound Assessment Form (WAF). Ranking of suggested categories indicated in terms of 'votes' that the most important was 'date', and the least was 'factors affecting healing'. Some categories were rejected (e.g. exudate). Category definitions and rationale were checked after 3 weeks, and compared with those of lecturers in adult nursing (n = 16) to test whether similar themes emerged amongst other non-experts. Postregistration nurses and lecturers gave similar definitions and rationale for categories. A limitation of the study was that it was opportunistic and methodology for researching consensus issues had not been investigated. Views represent nurses in a wide spread of disciplines and have to date only been compared with expert consensus derived from published literature. Themes to emerge were: the importance of WAFs to record-keeping, different understanding of terminology and the monitoring of progress and use of intuition. It was concluded that the purpose of WAFs needs clarification and research should investigate how change in wounds could take account of differences of personal perception. A new method of charting progress or deterioration is being developed.

Establishing nurses’ preferences in wound assessment: a concept evaluation

“…This investigation is part of a plan to test the extent to which personal assessor preferences might have an impact on wound assessment. It has confirmed the findings of a previous study (Maylor 2003) which indicated that where consensus does not exist on the meaning of an assessment criterion (e.g. size of wound), respondents would use additional words to justify their own description.…”

“…This would form the basis of an item pool for future work in the development of a new method of wound assessment incorporating mapping wound progress (or otherwise) over time. On the basis of a previous study which showed that nurses use the same descriptive terms in different ways (Maylor 2003), it was judged important to attempt to find a consensus on words that all could agree were indicators of healing, stasis and deterioration. This second study is part of a sequence not only aimed to identify words that could be applied to specific wound types, but also to inform a new method of assessment to reduce the effect of assessor personality and information processing preferences.…”

“…An update of a literature review of August 2002 (Maylor 2003) was done in August 2004 to check whether there had been any new developments in the methodology of wound assessment, and specifically whether characteristics of the wound assessors had been described. Databases included: CINAHL, journals@ovid, EMBASE, PubMed and MEDLINE.…”

Wound assessment tools and nurses' needs: an evaluation study

“…Documents such as, ‘ Record keeping—guidance for nurses and midwives ’ outline the expectation that nursing records should be clear, accurate and factual and should include details of assessments and reviews, so that information can be effectively communicated to colleagues. In an increasingly litigious society, nursing records are the first source of evidence investigated if a complaint is made and are considered legal documents. Communication and continuity of care —A WAT should enable the nurse to establish how well the wound has progressed since it was last assessed, or whether in fact the wound has become static or deteriorated as this information will inform treatment decisions . A good WAT should make this information easily available to nurses encountering a wound for the first time.…”

“…In an increasingly litigious society, nursing records are the first source of evidence investigated if a complaint is made (3) and are considered legal documents. Communication and continuity of care -A WAT should enable the nurse to establish how well the wound has progressed since it was last assessed, or whether in fact the wound has become static or deteriorated as this information will inform treatment decisions (41). A good WAT should make this information easily available to nurses encountering a wound for the first time.…”