There are around 800 clinicians in home and community care, of which approximately 550 are RNs and LPNs across the 14 health units in Island Health. Nurses practicing in home and community care are skilled professionals with a wide knowledge base. They care for some of the most complex and diverse patients such as those living with developmental disabilities, individuals with interventional type needs, and those requiring palliative care. While these clinicians see patients in every environment with every condition possible, many may not know that skin and wound care actually takes up about 52% of the work load for nursing staff.
Having worked as a home and community care nurse for nine years, and supporting clinicians in my current role for two years, it was clear to me that the clinicians needed improved access to education and educational support for skin and wound care. After identifying this issue, I began to think of ways to solve this problem. How could we provide easily accessible education and educational support to clinicians out in the community so that they aren’t wading through pages and pages of material from different sources just to find what they are looking for?
I first gathered a small working group of subject matter experts (SME’s) to complete an analysis to answer the question: “What does the interprofessional team need to know and do to perform evidence-informed skin and wound care within the scope of practice in Home and Community Care?” This group included home care nurses, enterostomal therapists, and a leader representative, where we focused on the needs of direct care nursing staff.
The group unanimously identified that what our staff really needed was a better foundation first, where etiology specific modules could be built based on a solid foundation. In fact, we determined it was about what they needed to “know” more than what they needed to “do” in wound care. This is because there are very few absolutes in skin and wound care, and what the staff needed was the knowledge to assess thoroughly, and subsequently make the most appropriate client specific treatments. The knowledge supports the professional decisions that we make, and will allow for clinical decision making to be better supported.
Once the SMEs identified the key themes and content that home and community care clinicians needed, the next step was to establish what type of education and practice supports would make the most sense. For example what needed to be face-to-face? When could we consider e-learning? Could supports built into the daily process support practice? Once the learning plan was built with these components identified, a work plan was developed.
The big question then became, where would all of the content live? After looking at several options, a website specific to Home and Community Care Skin and Wound made the most sense. We launched the website “Skin and Wound Care for Community Services” in January of 2016, and it currently houses three pages off of the landing page:
- A product support page which contains resources for the skin and wound products on formulary. Most content on this page is external links to videos, and instructions for use from the company and Product Information Sheets from www.clwk.ca.
- A Negative Pressure Wound Therapy Learning HUB. This page is designed to provide the staff all of resources in one location to provide NPWT, and follows a liner process for obtaining information. For example all of the resources needed for “Obtaining and order for NPWT” are located beside that task, including clinical order sets. Some resources that were developed for this learning HUB include: red flags for NPWT, process documents, and a step by step guide for clients for an alternate dressing. Also included on this page are tip sheets and therapy guidelines specific to NPWT Pump that we use in out setting.
- A Q & A forum for Skin and Wound in HCC. This forum is a place that staff can pose general questions. However, currently it is used to post the answers for any commonly asked questions that come from staff or leaders. We also post any email/practice alerts on this site, and there are short PPT learning bursts posted. For example, there is a seven minute PPT with voice recording that outlines our procedures and guidelines for Wound Photography in HCC.
Three more Learning Hubs are currently being developed:
1. Foundational knowledge for Skin and Wound care
Including: factors impacting healing, the DIME principals, product categories for wound care, documentation standards, why wounds become chronic, etc.
2. Assessing the client and assessing the wound
Including: wound measurement and wound bed assessment, wound bed pain, medical and social history.
3. Care Planning, Treatment Planning and Providing Care
Including how to integrate the foundational knowledge to support the client to meet their goals, implementing and revision of treatment plans, and environmental considerations when providing care.
The work plan for these three HUBs includes 40+ e-learning modules (all to be 15 minutes long or less) and roughly 50 job aids, practice supports, and tip sheets. The intent is to provide the clinicians with shorter pieces of information that they can access as required. For example, one module will be on how medications effect healing-this will be a stand-alone component so that the learner does not need to wade through an hour of other content to review the information that they need. Having the material in “bite-size” pieces will also allow the material to be updated easier. With the increase use of mobile devices and access to technology, moving the majority of formal learning to a virtual platform allows easier access to ongoing knowledge development.
The last phase will then be to develop etiology specific “modules” that will support evidence informed practices and pathways. An example of a module that is being developed is for pressure injuries. This module will support best practice, and meet the required organizational practices for Accreditation Canada. We will be utilizing the Provincial Nursing Skin and Wound Committee decision support tools for prevention and treatment of pressure, friction and sheer, and will also access supports from the National Pressure Ulcer Advisory Panel.
Leading a project of this scale has not come without its challenges. One of the biggest challenges is the lack of recognition in the complexity of wound care, and the effects that it has on the client living with a wound. I continue to spend a lot of my time speaking with leadership, trying to gather support for this project, and to educate colleagues on why this is needed. Other barriers include the lack of funding and access to wound care clinicians to aid in the development of the resources. There’s also always something that is going on- a restructure, the development of the electronic health record, staff turnover- just a few of the competing priorities that have impacted the timeline of this project. Further, I am also concerned about the ability for the staff to truly utilize the material and e-learning due to the busyness of the work environment.
However, as professionals we are responsible for managing our own learning, and my role is to provide my colleagues with the opportunity to learn and develop. As nurses, we are all responsible for improving the way we deliver care, and when we identify issues, we must come up with solutions to fix them. While this can be challenging, from my experience, I believe we are all capable of leading and innovating.
Kerstin Lewis works as a Practice Support Nurse with Home and Community Care in Island Health. Her passion and focus is to support evidence based practice for skin and wound in the community. She is Chair of the Island Health Skin and Wound Clinical Care Collaborative and a member of the Provincial Nursing Skin and Wound Committee. As well, she is a contributing member for the Canadian Association of Wound Care. Kerstin has been a strong voice and advocate for supporting clients and staff with evidence based care, taking part in initiatives at the program level, provincial level, and on a day to day basis with helping Island Health clinicians develop their skin and wound clinical skills. She has helped to create numerous practice support tools and resources and continues to help move skin and wound practice forward in Island Health. Kerstin graduated from the University of Victoria with a BScN in 2005 and will likely turn her sights towards a Masters in Nursing. She has worked in acute care and made the move to working in Home and Community and has never looked back. She lives and works in Ladysmith, BC and enjoys a very busy life with her husband, 2 young daughters, dog, cat and whatever creature her daughters sneak home in their backpacks. Other future plans include a nice long nap and enjoying a well-deserved glass of wine with her husband.