Location
Virtual
Start Date
1-3-2024 9:25 AM
End Date
1-3-2024 9:40 AM
Keywords:
california; sjmc
Description
Background
End-of-life (EOL) wounds are identified in the literature as Kennedy Terminal Ulcers (KTU), Skin Failure (SF), Trombley-Brennan Terminal Tissue Injury (TB-TTI), and SCALE (Skin Changes at Life’s End). EOL wounds have a similar appearance to pressure injuries (PIs) with a fundamentally different etiology. The misclassification of EOL wounds as PIs results in increased Hospital Acquired Pressure Injuries (HAPI), hospital fines, and less-than-optimal EOL wound management.
Purpose
To examine the effectiveness of an educational intervention on EOL wounds in increasing nurse confidence in providing End-of-Life Care (EOLC) and differentiating PIs from EOL wounds.
Methods
This quasi-experimental study used the 28-item EOL Professional Caregiver Survey (EPCS) to measure significant differences in EOLC educational needs of nurses on a 5-point Likert scale from 0 (not at all) to 4 (very much), before and after an EOLC educational intervention on EOL wounds offered via eLearning PowerPoint video delivered through email. Two additional items measured confidence staging PIs and differentiating PIs from EOL wounds. Inclusion criteria were voluntary RNs with at least one year of experience in direct care, currently employed. Participants' demographics were collected, and relationships were examined between EPCS scores (the two additional confidence items) and participant demographics. A convenience sample of nurses was recruited from the National Association of Hispanic Nurses, nursing professors, RN to BSN and MSN students, staff nurses, and wound care nursesin the Summer of 2023. A power analysis indicated a sample of 41 was needed for adequate effect size. IRB approval was obtained.
Results
Forty-two nurses participated, and 14 specialties were represented. 81% were female, 38% were Hispanic, 2% were Black, 29% were Asian, and 33% were white. 31% were between 20-30, 27% were 31-40, 19% were 41-50, 17% were 51-60, and 7% were >60. Educational levels reported: ADN 33%, BSN 43%, MSN 19%, and Doctoral 5%. Years of experience: 55% 1-5, 21% 6-10, 9% 11-15, 0% 16-20, and 14%> 20 years. There was a significant improvement (p=<.001) in pre-intervention EPCS (M = 71.3, SD=14.9) and post-intervention (M=80, SD=146) scores. Lower scores indicated greater educational needs. Pre-intervention, most participants were unfamiliar with EOL wounds (71.4%, n=30). There was a significant increase (t =-7.32, p=<.001) in Item 29 scores: Confidence staging PIs pre-intervention (M=1.68, SD=1.22) to post (M=2.50, SD=.85). In item 30, participants pre-intervention were “not at all” confident differentiating PIs from EOL wounds (M=.85, SD= 1.35) with a significant increase (<.001) in post-intervention confidence scores (M=2.43, SD=.98). Participants with prior wound training had higher survey scores and older participants reported more confidence in staging PIs.
Conclusion
This study showed that the educational intervention on EOL wounds effectively increased nurses' confidence in providing EOLC and differentiating EOL wounds from PIs. Ensuring nurses have the confidence to identify and assess EOL wounds is essential in providing optimal care at EOL.
Implications
Educating and equipping nurses to perform EOL wound assessments may have significant outcomes related to nursing practice, patient care, and hospital expenditures.
Recommended Citation
Perez Varela, Alicia and Callis, Annette, "An Educational Intervention Differentiating Pressure Injuries from End-of-Life Wounds" (2024). Providence Nursing Research Conference 2023 – Present. 9.
https://digitalcommons.providence.org/prov_rn_conf_annual/2024/podiums/9
Specialty
Emergency Medicine
Specialty
Nursing
Specialty
Quality
Included in
Critical Care Commons, Emergency Medicine Commons, Nursing Commons, Quality Improvement Commons
An Educational Intervention Differentiating Pressure Injuries from End-of-Life Wounds
Virtual
Background
End-of-life (EOL) wounds are identified in the literature as Kennedy Terminal Ulcers (KTU), Skin Failure (SF), Trombley-Brennan Terminal Tissue Injury (TB-TTI), and SCALE (Skin Changes at Life’s End). EOL wounds have a similar appearance to pressure injuries (PIs) with a fundamentally different etiology. The misclassification of EOL wounds as PIs results in increased Hospital Acquired Pressure Injuries (HAPI), hospital fines, and less-than-optimal EOL wound management.
Purpose
To examine the effectiveness of an educational intervention on EOL wounds in increasing nurse confidence in providing End-of-Life Care (EOLC) and differentiating PIs from EOL wounds.
Methods
This quasi-experimental study used the 28-item EOL Professional Caregiver Survey (EPCS) to measure significant differences in EOLC educational needs of nurses on a 5-point Likert scale from 0 (not at all) to 4 (very much), before and after an EOLC educational intervention on EOL wounds offered via eLearning PowerPoint video delivered through email. Two additional items measured confidence staging PIs and differentiating PIs from EOL wounds. Inclusion criteria were voluntary RNs with at least one year of experience in direct care, currently employed. Participants' demographics were collected, and relationships were examined between EPCS scores (the two additional confidence items) and participant demographics. A convenience sample of nurses was recruited from the National Association of Hispanic Nurses, nursing professors, RN to BSN and MSN students, staff nurses, and wound care nursesin the Summer of 2023. A power analysis indicated a sample of 41 was needed for adequate effect size. IRB approval was obtained.
Results
Forty-two nurses participated, and 14 specialties were represented. 81% were female, 38% were Hispanic, 2% were Black, 29% were Asian, and 33% were white. 31% were between 20-30, 27% were 31-40, 19% were 41-50, 17% were 51-60, and 7% were >60. Educational levels reported: ADN 33%, BSN 43%, MSN 19%, and Doctoral 5%. Years of experience: 55% 1-5, 21% 6-10, 9% 11-15, 0% 16-20, and 14%> 20 years. There was a significant improvement (p=<.001) in pre-intervention EPCS (M = 71.3, SD=14.9) and post-intervention (M=80, SD=146) scores. Lower scores indicated greater educational needs. Pre-intervention, most participants were unfamiliar with EOL wounds (71.4%, n=30). There was a significant increase (t =-7.32, p=<.001) in Item 29 scores: Confidence staging PIs pre-intervention (M=1.68, SD=1.22) to post (M=2.50, SD=.85). In item 30, participants pre-intervention were “not at all” confident differentiating PIs from EOL wounds (M=.85, SD= 1.35) with a significant increase (<.001) in post-intervention confidence scores (M=2.43, SD=.98). Participants with prior wound training had higher survey scores and older participants reported more confidence in staging PIs.
Conclusion
This study showed that the educational intervention on EOL wounds effectively increased nurses' confidence in providing EOLC and differentiating EOL wounds from PIs. Ensuring nurses have the confidence to identify and assess EOL wounds is essential in providing optimal care at EOL.
Implications
Educating and equipping nurses to perform EOL wound assessments may have significant outcomes related to nursing practice, patient care, and hospital expenditures.
