Educating Staff: Implementing Change Guidelines

Description of the Change Model Used

  • Ace Star change model for knowledge development
  • Behavioral changes can be facilitated with it
  • Ensures integration of evidence into practice
  • Maintained in five steps as a learning cycle
  • Research, evidence, guidelines, practice, and result evaluation

Ace Star’s change model allows implementing new treatment approaches with no serious difficulties. Thus, it does not matter that the treatment of venous leg ulcers with foam dressings is underrepresented. This model can be used to collect relevant information to prove its effectiveness.

PICO Question

  • Population: patients with exuding, painful venous ulcers
  • Intervention: the usage of foam dressings
  • Comparison: knitted viscose dressings
  • Outcome: reduce the risk for maceration of peri-ulcer skin
  • In addition, no secondary dressing is needed

Foam dressings have absorbent and thermal characteristics. They benefit patients with venous leg ulcers and prevent maceration of peri-ulcer skin. Comparing the effects of knitted viscose dressings, outcomes can be observed.

Scope of the Problem

  • Venous leg ulcers are rather common
  • Nearly 2.5 million are affected every year
  • Less than 60% of them heal
  • Almost 5% undergo amputation
  • Clinical and economic challenges of treatment (Carter, Waycaster, Schaum, & Gilligan, 2014).

Millions of people experience venous leg ulcers annually. It prevents people from maintaining normal lives. Even the smallest wound can end in amputation because it would not heal.

Involved Team/Stakeholders

  • The nursing team will implement interventions
  • Initially selected leader of the project
  • The Director of Nursing Department
  • A nurse epidemiologist is needed
  • A charge nurse should be identified

Intervention implementation involves various parties. Each stakeholder has a particular role. They differ in responsibility greatly.

Evidence to Support a Need for Change

  • Poor evidence regarding foam dressings usage (Valle et al., 2014)
  • Foam dressings are rather absorptive
  • Ensure proper thermal isolation (Sood, Granick, & Tomaselli, 2014)
  • Effective for moist wound healing (Fogh et al., 2012)
  • Not for dry wounds; need frequent change

The lack of evidence prevents professionals from using foam dressings. However, they are believed to be effective. Even though they have drawbacks, they are advantageous for venous leg ulcer treatment.

Action Plan

  • Data collection and synthesis; environmental evaluation
  • Development of appropriate recommendations
  • Allocation of roles and training
  • Implementation and supervision
  • Continuous monitoring of the process
  • Evaluation of outcomes and spread of findings

Interventions should be maintained according to particular guidelines. They should begin with the information provided by other people but end with personal results. Monitoring is always required in case of errors.

Recommendations

  • Foam dressing for pain relief
  • Reduce gastroenterological risks
  • Treatment of moist wounds
  • The medicated and non-dedicated dressing can be used
  • Further comparison

Foam dressing can be used for treatment. Both its kinds are recommended. Further research can reveal if a better option exists.

Timeline for the Plan

  • Week 1: data collection and evaluation
  • Week 2: development of recommendations
  • Week 3: roles and training
  • Weeks 4-11: implementation and supervision
  • Week 11: evaluation of outcomes; findings

Timeline is critical for any plan because it determines how to implement it. Implementation is rather difficult and time-consuming. However, monitoring should be maintained all the time.

The Nurses Role and Responsibility in the Pilot Program

  • The Director in the role of co-leader
  • He will provide managerial support
  • The nurse epidemiologist monitors the program
  • This professional also evaluates results
  • The charge nurse assists and ensures follow-up

Nurses have different roles and responsibilities depending on their professional background. Their organizational levels also matter. Only when considering them, tasks can be appropriately allocated and decently fulfilled.

Procedure

  • Consider cost-efficiency, time of healing, and outcomes
  • Collect information on the daily basis
  • Define special protocols to gather data
  • Patient information and nurses’ self-reports are required
  • Report on outcomes should be provided

The whole procedure of project implementation is rather time-consuming and complex. It consists of several steps that are focused on data collection and evaluation. Much attention should be paid to results, as they are vital for research and the possibility to use its findings in practice.

Next Steps

  • Enforcement of change through policies
  • Development of guidelines for healthcare professionals
  • The research focused on wound healing factors
  • Implementation of initiative on all hospital units
  • Further generalization of findings

Sufficient evidence that supports this intervention is likely to be gathered. Thus, patients should benefit from them. Foam dressing can be used in all hospital units.

Spread of Findings

  • Findings can be disseminated via e-mails
  • Shared during meetings
  • Discussed at conferences
  • Printed in scholarly journals
  • Shared orally among professionals

Dissemination of findings is important for stakeholders. It ensures that research is useful for practice. Patients can benefit from findings in this way.

Forms that Will Be Used

  • Specifically designed forms will be needed
  • They are to serve as guidelines
  • They streamline data gathering
  • Objective patient data should follow them
  • Nurses’ self-reports should have the same format

Specific forms are needed if large amounts of data are to be gathered. They make it easier to perceive and analyze data due to their similarity. Forms are to be distributed among the sample.

Resources Available to the Staff

  • Relevant data can be from online databases
  • Approach the PubMed, EBSCO, and NCBI sites
  • Professionals can share information
  • The dressing should be bought from authoritative suppliers
  • Assistance can be provided by other professionals

The staff can look for information in different places. It can be obtained on the Internet, from a library, or other people. Anyway, it must be authoritative, accurate, and current.

Summary

  • Venous ulcers affect individual and public well-being
  • Morbidity rates increase because of them
  • Some professionals suggest using foam dressing
  • Additional research is needed to gain evidence
  • The ACE star model is appropriate for it

Venous leg ulcers have adverse effects on people’s health. They may be treated with a foam dressing. Research should be conducted to provide a rationale for this claim.

References

Carter, M., Waycaster, C., Schaum, K., & Gilligan, A. M. (2014). Cost-effectiveness of three adjunct cellular: Tissue-derived products used in the management of chronic venous leg ulcers. Value in Health, 17(8), 801-813.

Fogh, K., Andersen, M. B., Bischoff-Mikkelsen, M., Bause, R., Zutt, M., Schilling, S., &… Jørgensen, B. (2012). Clinically relevant pain relief with an ibuprofen-releasing foam dressing: Results from a randomized, controlled, double-blind clinical trial in exuding, painful venous leg ulcers. Wound Repair & Regeneration, 20(6), 815-821.

Sood, A., Granick, M. S., & Tomaselli, N. L. (2014). Wound dressings and comparative effectiveness data. Advances in Wound Care, 3(8), 511-529.

Valle, M. F., Maruthur, N. M., Wilson, L. M., Malas, M., Qazi, U., Haberl, E., &… Lazarus, G. (2014). Comparative effectiveness of advanced wound dressings for patients with chronic venous leg ulcers: A systematic review. Wound Repair & Regeneration, 22(2), 193-204.

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