Validating Wound Care Algorithms for Use by Registered Nurses

Research shows that providing quality wound care affects outcomes and costs.  Heuristic devices, such as clinical guidelines and algorithms to facilitate this process, are widely available.  Unfortunately, most have not been validated for content or clinical usage by wound experts or non-expert health professionals for whom they were designed.  While validity of one set of wound care algorithms has been established by expert wound clinicians and excellent preliminary clinical usage outcomes reported, ^1,2 their validity to expedite the clinical decision-making process when used by non-expert registered nurses (RNs) has not been established.  The purpose of this study was to validate usage of these wound care algorithms with non-expert RNs using a cross sectional, mixed methods quantitative survey design.           

Two hundred-and-four (204) RNs associated with an urban university participated. Following a brief introduction, participants were asked to rate 11 components pervading the algorithms, apply them to a variety of acute and chronic wounds (N=15), and comment on the research process and algorithm structure and processes. The majority of the participants (n=180) were women, practicing in acute care settings (n=146).  Participant average age was 34.8 years (S.D. 11.95).  The Content Validity Index (CVI) of all 11 components was strong (CVI ≥ 0.96).  Percent correct analysis demonstrated that 71-98% of nurses selected the correct (primary) or appropriate but not entirely correct (secondary) algorithm and correct dressing selection occurred for 75-91% of the 15 wounds.  Correct algorithm and dressing selection percents were lower for wounds with necrotic tissue.  Intra-rater reliability (two sets of wounds) was modest but unexpectedly higher for necrotic wounds.  Participant wound assessment insecurity was a common qualitative theme. 

Results support that these algorithms have face and content validity, facilitate the provision of optimal care with diverse wound types (construct validity), and confirm that wound education improvements for RNs are critically needed.