Wound care in primary health care: District nurses' needs for co-operation and well-functioning organization

Abstract

Most patients with leg- and foot ulcers are managed within non-institutional care. The aim of this study was to investigate the district nurses' wound management, including wound appearance, assignment of responsibility, guidelines for wound treatment and co-operation with other professional groups. The study has a descriptive quantitative approach. Data was collected using a wound registration form and a questionnaire. The selection of participants was made by random sampling. District nurses (n = 26) in five health-care centers situated in central Stockholm and two of its suburbs, participated in the study. The results show that the wound appearance is dominated by traumatic wounds. Approximately 40% of the wounds were not medically diagnosed. The area of responsibility of different professional groups was not defined and guidelines for wound treatment were mostly lacking. The decision about wound management was generally made by the district nurse. Co-operation with the general practitioner was lacking and when a consultation with dermatologist was required, the routines concerning referral were undefined. Co-operation with the assistant nurses consisted of redressing the wounds in home care. Interprofessional co-operation was regarded as important for wound healing. The paper provides insights into the district nurses' wound management and co-operation in wound care.

District nurses’ experiences of caring for leg ulcers in accordance with clinical guidelines: a grounded theory study

“…The study identified challenging collaboration with GPs as an important aspect of complex treatment. Previous studies have found that barriers to following guidelines include lack of routines for cooperation between nurses and GPs (Eskilsson & Carlsson, 2010; Friman et al, 2010) and/or GPs’ lack of access to clinical guidelines and experience treating chronic leg ulcers (Cullen & Phillips, 2009; Graham, Harrison, Shafey, & Keast, 2003). DNs’ strategies for avoiding consequences of this obstacle included proactively informing GPs when it was time to take action, such as when a patient needed a referral to a dermatology clinic.…”

“…They share the responsibility for patient care with other professionals, such as GPs, registered nurses, assistant nurses and medical social workers (Lagerin et al, 2007; Strandberg, Ovhed, Borgquist, & Wilhelmsson, 2007). DNs often treat patients with leg ulcers, both at health care centres and in home care (Friman, Klang, & Ebbeskog, 2010). Since healing is often slow and recurrence rates are high, treatment requires a great deal of nursing time and a large amount of dressing materials (Öien & Forssell, 2013).…”

“…Reasons may include insufficiencies in the collaboration between DNs and GPs (Friman et al, 2010; Öien & Forssell, 2013) such as poor communication and poor coordination (Silva, Jesus, Merighi, & Oliveira, 2014); lack of support for best practice from the management of primary health care centres (Friman et al, 2010); and incomplete/inconsistent documentation (Khalil, Cullen, Chambers, Steers, & Walker, 2014). …”

Limits and possibilities experienced by nurses in the treatment of women with chronic venous ulcers

“…Studies in Sweden showed nurses' experiences in the treatment of wounds in the context of PHC and emphasize the challenges of providing care for these lesions, considering the complicating factors that overlap with this care (6)(7) .…”

Patient Satisfaction with an Interprofessional Approach to Wound Care in Qatar

“…Another study, 10 illustrated the importance of IPC in the treatment of wounds. The authors found that IPC can potentially reduce prevalence of wounds and improve wound care more efficiently.…”