Beginning Nursing Students' Care Plans for Patients with Acute or Chronic Wounds

Barbara Pieper, PhD, RN, ACNS-BC, CWOCN, FAAN, Janean Monahan, PhD, RN, Mary Kathryn Keves-Foster, MSN, RN, Julia Farner, DNPc, BSN, RN, HHP, Dalia Alhasanat, BSN, RN and Maha Albdour, RN, APHN-BC, College of Nursing, Wayne State University, Detroit, MI
Purpose: Nursing care plans provide direction for the nursing team to individualize care and help patients meet their health goals. The purpose of this project was to examine what beginning nursing students included in a care plan assignment when a patient had an acute or chronic wound.

Methodology: This quality improvement project was conducted by a faculty team using a cross-sectional, descriptive design. Data were collected from students’ nursing care plans and analyzed in terms of wound assessment, nursing diagnoses, and interventions. Students recorded their assessment data using Gordon’s Functional Patterns and identified the patients’ priority nursing diagnoses using the North American Nursing Diagnosis Association (NANDA) terminology.

Statistics: Data were analyzed with descriptive statistics.

Results: For the 80 care plans collected, 38 (47.5%) were about a patient who had a wound. Patients included 23 (60.5%) men; 28 (73.68%) were African-American. They had a mean age of 60.11 years (SD=14.17 years).Twenty-five patients (65.8%) had surgical incisions; 4 (10.5%) had pressure ulcers/injuries; 7 (18.4%) were other wounds (i.e., stab, laceration, burn etc.). None of the students’ assessments provided a detailed wound description. The most common wound descriptions were location (n=19) and drainage (n=15). For eight patients (21.1%), students stated the wound was covered by a dressing, usually gauze (n=3). Thirty nursing diagnoses were listed; the most common were impaired physical mobility or activity intolerance (n=17), impaired comfort (n=14), impaired skin integrity (n=13), imbalanced nutrition (n=7), and risk for infection (n=6). Students sometimes mentioned the wound (n=20) in their nursing impressions, usually the need to teach about the wound.

Conclusions: Nursing students had beginning skills in assessment and writing nursing care plans for patients with an acute or chronic wound. Wound descriptions lacked depth of discernment. WOC nurses may help students understand wounds and their care by offering varied educational programs.