Date of Award

January 2019

Document Type

Thesis

Degree Name

Doctor of Nursing Practice (DNP)

Department

Yale University School of Nursing

First Advisor

Elizabeth Ercolano

Abstract

Purpose: The purpose of this QI project was to use the best available evidence and expert opinion to develop and implement a simple inpatient nursing care guideline for minor skin lesions.

Participants and Setting: This wound care guideline was developed for nurses working on inpatient adult acute care units. The setting was a large community hospital in southwest Minnesota.

Approach: The guideline was validated for its clarity and appropriateness by external and internal expert wound care nurses. It was implemented through in-person unit rounding on the nursing units, distribution of badge cards with the guideline, and a required online education module about the guideline. Surveys and audits were conducted to measure changes in knowledge and skin care pre- and post-guideline implementation.

Outcomes: Wound documentation audits assessing whether patients had an appropriate treatment improved from 45% (104 out of 231) to 80% (209 out of 260). Nurses’ self-rating of their knowledge about which dressings and topical treatment to use improved from 18% (16 out of 89) agreement to 57% (55 out of 96). Nurses’ self-rating of their knowledge about when to change dressings and reapply topical treatments improved from 27% (24 out of 89) agreement to 65% (62 out of 96).

Implications for Practice: Although there is evidence for a variety of dressings or products to treat wounds, this QI project demonstrated increased compliance with providing appropriate care when just a few treatment options were recommended to nursing staff through a structured guideline. This guideline continues to be used at the project site and is now being implemented at affiliate hospitals.

Comments

This thesis is restricted to Yale network users only. It will be made publicly available on 10/19/2022

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