Wound management provided by advanced practice nurses: a scoping review

Abstract

Objective: The objective of the review was to map the similarities and differences in the wound care practices of nurse practitioners, clinical nurse specialists, and advanced practice registered nurses, globally. Introduction: Advanced practice nurses have graduate education and advanced scope of practice. Adding advanced wound care training to their skillset provides an opportunity for advanced practice nurses to provide wound care. Inclusion criteria: This review considered for inclusion advanced practice nurses globally who are registered nurses with graduate-level education and advanced training (certification/education) in wound care in any setting. Methods: The review was conducted using JBI methodology for scoping reviews. The databases searched included MEDLINE, CINAHL, ProQuest Nursing and Allied Health, Cochrane Database of Systematic Reviews, Cochrane Central Register of Controlled Trials, Scopus, and ProQuest Dissertations and Theses. To reflect changes in the advanced practice nursing scope of practice, searches were limited to articles published from 2011. Articles in languages other than English were translated. Two reviewers independently reviewed titles and abstracts; relevant sources were retrieved in full and reviewed. An additional independent reviewer resolved any disagreements. Data were extracted using a data extraction tool. Extracted data included similarities and differences in wound care practice (type of wound, practice setting, treatments). Results: There were 2504 abstracts screened, and 158 were screened at full text. Seven articles were included in this review: 3 sources from the United States, 2 from Australia, and 1 each from Canada and The Netherlands. All 7 sources focused on nurse practitioners; wound care education varied from certification in wound ostomy to a master’s education in wounds. The practice setting varied; there were 2 primary care clinics; 2 community clinics; 1 wound care center; a suburban hospital, and a study that included tertiary, community, and residential care. Treatments varied, but sources specific to pressure injuries discussed assessments, cleansing, dressings, topical products, and offloading surfaces/equipment, and 1 examined the impact of hiring nurse practitioners as wound care consultants. Sources that discussed treatments for various wounds described comprehensive assessments, diagnostic investigations, referrals, wound management, and medications prescribed. Outcomes included improved healing, decreased incidence, increased patient satisfaction, access to care, and reduced referrals for additional care. Conclusions: This review outlined the characteristics of advanced practice nurses and their practice settings, types of wounds, and treatments provided. The findings demonstrated positive results with advanced practice nurses providing wound care. Many articles regarding advanced practice nurses with advanced wound care expertise lack the description of the graduate-level education and/or the specifics regarding wound care certification. This prevents comparison of advanced practice nurses with each other and other providers on the impact that advanced practice nurses have on the health care system in relation to wound care, including cost, access to services, and patient satisfaction.