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An Innovative Approach to Wound Care Competencies in a Rural Home Health Agency

Maggie Lott, FNP, MSN, HealthCare Educators, CWON, 510 E. Princeton Ave., Fresno, CA 93704 and Donita Stewart, RN, BS, Best Care Home Health Agency, Administrator, Director of Patient Care, 770 E. Shaw Ave. Suite #112, Fresno, CA 93710.

Bckground: Rural home health nurses frequently encounter large deep wounds on the intial patient visit that have not been mentioned in the original hospital or physician referral. Because of this, our agency has adopted the protocol of packing these wounds with saline moistened gauze until the physician can be contacted and the Certified Wound and Ostomy Nurse (CWON) can evaluate the wound. Problem: The commercial skin models that are used in our annual wound competencies do not reflect the level of skill needed to correctly measure, assess and pack large deep wounds. Objectives: 1) To provide the nurses with a more life like wound model to use in the competencies; 2) To enable the supervisory staff to assess the field nurses' skills in measuring, describing and packing large wounds; 3) To create a relaxed environment that fosters learning and is not seen as punitive. Solution: The nurses all met with the CWON in a classroom and were given gloves, hand sanitizer, measuring guides and dressing supplies. They then recieved a potato that had been carved out with a melon baller to mimic the type of wounds they encounter on their rounds. They were asked to measure, assess and document all of their findings including undermining, tunneling, woundbed color and drainage then clean and pack the potato with a moist saline gauze dressing. The CWON supervised the session and used the nurses questions and techniques as educational opportunities. Outcomes: 1) More accurate and consistent wound measurements and assessments (as reflected in weekly wound sheets) and 2) improved competency in wound care.

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See more of The WOCN Society 39th Annual Conference (June 9 -- 13, 2007)