In a 3- to 4-page paper:
Restate your PICO question and its significance to nursing practice.
Summarize the findings from the articles you selected for your literature review. Describe at least one nursing practice that is supported by the evidence in the articles. Justify your response with specific references to at least 2 of the articles.
Explain how the evidence-based practice that you identified contributes to better outcomes. In addition, identify potential negative outcomes that could result from failing to use the evidence-based practice.
Outline the strategy for disseminating the evidence-based practice that you identified throughout your practice setting. Explain how you would communicate the importance of the practice to your colleagues. Describe how you would move from disseminating the information to implementing the evidence-based practice within your organization. How would you address concerns and opposition to the change in practice?
This part of the Course Project will be combined with the other two components of the Course Project and turned in as your Portfolio Assignment for this course.
Note: In addition, include a 1-page summary of your project.
Attached is part 1 and 2 of the paper. You will put all the information together and make ONE SOLID, COGENT paper which will be part of your portfolio for this course.
Portfolio Assignment
Introduction
During a monthly feedback session by the research team in my facility’s Palliative and Home Health department, it was observed that chronic wounds of patients on vacuum assisted closure (VAC) generally took a shorter time to heal than those on other interventions. This drew the interest of the team, who decided to conduct an informal interview with patients who either had had wound care done, or were on wound care at home. Thirty patients were interviewed over the next five weeks, five of whom had received VAC care either immediately before (up to one month prior) or during that period.
True to the initial observation, most of those who had received VAC wound therapy reported quicker healing (less than four weeks) than their counterparts. They further expressed more satisfaction with the quality of wound care unlike those on traditional wound care. Coincidentally, of those expressing satisfaction with VAC, five of them had had diabetic related wounds. The author of this paper is a member of the team, and is interested in finding out why VAC is more efficient than the other traditional wound healing approaches in diabetic wounds.
The Significance of VAC Therapy in Home Health
Chronic wounds like decubitus ulcers, is one of the challenges faced by home based patients, especially so due to limited mobility. Vacuum assisted wound closure (VAC), a method utilizing negative pressure created by a pump (Fogg, 2009), has been gaining popularity as a remedy over the earlier methods. A research in this area will enable the nurses and other members of the team to understand the rationale behind VAC utilization based on latest evidence and reason for preference over the traditional techniques, in chronic wound care.
Possible PICO questions for study
The Preferred PICO question is: In chronic wound patients receiving home health care, how does the use of wound VAC therapy improve and decrease healing time of a wound over traditional wound care methods?
P=home- health care patients with chronic wounds. I=VAC. C= Traditional wound care. O= how healing is improved & time for healing reduced.
The dependent variables are: ‘improved wound healing’ and ‘decreased healing time.’ These are the expected outcomes- the main interest of the study.
The independent variables are: ‘VAC therapy’ and ‘traditional wound care methods.’ These will be manipulated in order to observe their effect on the subjects.
Keywords: VAC; wound healing; home based care; clinical question; negative pressure; chronic wounds; PICO; wound treatment; diabetic wounds; and pressure ulcers.
Contradictions and inconsistencies and their explanations
There is no consensus regarding the use of VAC on sacral pressure ulcers that are near the anus as well as to multiple huge ulcers that are located on lower extremities. According to the research articles used in this literature review, the following are the contraindications for using VAC in chronic wound treatment; anastomotic sites, unexplored and non-enteric fistulas, untreated osteomyelitis, exposed nerves, organs, veins, or arteries, necrotic tissues that have eschar, and malignant wounds but with palliative care exceptions that improves quality of life.
Strong evidence for changing the practice or further research to address the inquiry adequately
From the foregoing discussion, it is evident that wound V.A.C. therapy has been extremely beneficial in treating chronic wounds. In patients who are receiving health care from home, the therapy helps in reducing the time and improving healing of wounds when compared to traditional wound management approaches. The information gathered offers solid evidence regarding the continued use of VAC to treat chronic wounds.
Restatement of the PICO Question
Wound VAC therapy is more beneficial than traditional methods of wound care in regard to decreasing and improving the wound’s healing time in chronic wound patients being cared for in home settings. Therefore, there is no necessary restatement of the PICO question since research has indicated that VAC therapy has better outcomes.
Significance to Nursing Practice
Wound VAC therapy is extremely beneficial in the nursing practice since it is associated with several long- and short-term benefits. Some of the short-term benefits include better management of the wound odor and exudate, reducing pain, removing sloughy tissues, and preventing infection. The long-term goals include reducing wound exudate volume and wound area, restoring the wound site’s physical function, promoting wound closure via secondary intention healing or surgical means, and producing healthy granulation tissue.
Summary of the Findings
If there is keen subsequent open abdomen management for various conditions, there can be desirable patient outcomes (Baier et al., 2003). VAC is the preferred method of treatment for managing open abdomens and temporary abdominal closure (Philbeck et al., 1999). A combination of split thickness grafts and VAC is highly effective in treating burns especially in body areas with irregular and deep contours (Blume et al., 2008). These include hands, perineum, and axilla. VAC has proved to be exceptionally effective for treatment of donor sites particularly in areas where it is hard to use controversial techniques (Trueman et al., 2008). finally, VAC has been effective in numerous non-healing and chronic wounds such as pressure sore, leg ulcers, and amputation wounds that are below the knee (Lyder et al., 2004).
Nursing Practice- use of wound VAC therapy in treating abdominal wounds
The evidence gathered from Baier et al. (2003), Philbeck et al. (1999), Blume et al. (2008), Trueman et al. (2008), and Lyder et al. (2004) indicate that VAC therapy is extremely effective when managing open abdominal wounds.
Surgery or trauma to the abdomen usually results to wounds that may be difficult to be closed using the traditional techniques. During the therapy, a foam dressing that has a drainage tube is inserted on the wound. Consequently, the tube and a small vacuum unit that exerts suction on the wound are attached together. This helps in removing excess fluid and blood. An open abdomen VAC therapy helps in managing patients who have a laparostomy or open abdominal wound in cases where the intraperitoneal organs and the gut are exposed. Usually, these wounds result from an open wound following surgical complicated intra-abdominal problems’ treatment including severe sepsis, ruptured aortic aneurysms’ grafting, and abdominal trauma.
The 1st-line management of open abdominal wounds includes use of impermeable devices such as the Bogota bag or dressings so as to protect the organs that are exposed and reduce fluid leakage. Afterwards, the abdomen is left to heal through delayed closure using sutures, secondary intention, muscle flaps, skin grafts, mesh repair, or a combination of the outlined procedures. Several nursing considerations and wound size determine the closure technique selected.
Better Outcomes
When treating abdominal wounds, VAC therapy is associated with benefits such as increasing mitotic activity and blood flow, promoting a moist environment that is vital for wound healing, terminating interstitial pressure, faster wound healing, and removing bacteria and exudate.
Potent Negative Outcomes
Failure to use wound VAC therapy in the treatment of abdominal wounds results to prolonged periods of wound healing and the wound deteriorates further.
Disseminating the Practice
One of the most effective that can be used to disseminate the information is interactive educational meetings. Professional nurses will participate actively in problem-based learning, small-group discussions, and workshops, where they will be informed about the practice and its benefits and their feedback and opinion sought. It is anticipated that the interactive educational meetings will be particularly active and effective as far as promotion of evidence-based practice in nursing in regard to use of VAC in open abdominal wound is concerned.
Communicating the Significance to Colleagues
How an evidence based practice is communicated among nurses determines whether it is accepted or rejected. It is worth noting that interpersonal communication channels, users’ social networks influences, and communication methods influence the adoption of use of VAC in treating abdominal wounds. Opinion leaders, the mass media, consultation by experts, change champions, and education can be very effective in informing colleagues about the significance of VAC in open abdominal wound management. However, there is a need to note that although education is imperative, it is not adequate to transform a practice. Moreover, sole didactic continuing education can result to minimal outcomes.
Dissemination to Implementation
The dissemination process is aimed at ensuring that the colleagues and the entire health care institution is informed of the significance and benefits of the evidence based practice. In this regard, there will be proper education or creation of awareness so as to ensure that the colleagues are better equipped on the practice that they are about to engage in (Albert, Aranda & Baggoley, 2004). After the top management in hospital institutions embrace the practice, it will be easier for the low management levels to embrace the practice faster. Consequently, the practice will be implemented in one department and the outcomes assessed before being spread to other departments.
Addressing Opposition and Concerns
Since the results from the research indicate that VAC therapy is associated with immense outcomes, it is anticipated that similar results will be obtained. Opposition and concerns regarding the new practice will be addressed through evidence from using the practice in an institution. In addition, provision of adequate information about the practice is useful in clearing the oppositions.
Conclusion
VAC therapy enhances wound closure and, therefore, faster wound healing. This minimizes pain and discomfort, which results to a higher well-being sense. Other chronic wound treatments necessitate a minimum of two daily dressing changes, which calls for unique techniques and skills to reduce infection risks. Being a closed system, VAC requires dressing changes every forty eight hours. Minimal wound exposure leads to lower risk for infection decreasing the need for dressing changes and, thus, exposure of wound to environmental contaminants. This results to faster wound healing.
Summary of the project
The PICO question that was selected was ‘In chronic wound patients receiving home health care, how does the use of wound VAC therapy improve and decrease healing time of a wound over traditional wound care methods?’ The literature review revealed that VAC is the preferred method of treatment for managing open abdomens and temporary abdominal closure.; a combination of split thickness grafts and VAC is highly effective in treating burns especially in body areas with irregular and deep contours; VAC has proved to be exceptionally effective for treatment of donor sites particularly in areas where it is hard to use controversial techniques; and VAC has been effective in numerous non-healing and chronic wounds. The contraindications for using VAC therapy include anastomotic sites, unexplored and non-enteric fistulas, and untreated osteomyelitis.
The evidence-based practice that was selected is use of VAC in managing open abdominal wounds that result from a number of conditions. There are several positive outcomes that are associated with the practice and failing to use it results to prolonged wound healing and deterioration. Several strategies are useful in disseminating the information and communicating the significance of the practice to colleagues. Any opposition and concerns regarding the practice should be noted and addressed.
References
Albert, E., Aranda, S., & Baggoley, C. (2004). Translating evidence into practice. Med J Aust, 180(6), 43.
American Academy of Physician Assistants. 22 (8): 46, 48.
Baier, R., Gifford, D., Lyder, C., et al. (2003). Quality improvement for pressure ulcer care in the nursing home setting: the northeast pressure ulcer project. J Am Med Dir Assoc. 4:291–301.
Blume, P.A., Walters, J., Payne, W., Ayala, J., & Lantis, J. (2008). Comparison of negative pressure wound therapy using vacuum-assisted closure with advanced moist wound therapy in the treatment of diabetic foot ulcers: a multicenter randomized controlled trial. Diabetes Care 31:631–636.
Fogg, E.2009. Best treatment of non-healing and problematic wounds. Journal of the
frameworks. Evidence Based Library and Information Practice, 6(2), 75–80.
Journal on Quality and Patient Safety. 30:205–14.
Lyder, C., Grady, J., Mathur, D., et al. (2004). Preventing pressure ulcers in Connecticut hospitals using the plan-do-study-act model for quality improvement. Joint Commission
Philbeck, T. E., Whittington, K. T., Millsap, M. H., Briones, R. B., Wight, D. G., & Schroeder, W. J. (1999).The clinical and cost effectiveness of externally applied negative pressure wound therapy in the treatment of wounds in home healthcare Medicare patients. Ostomy Wound Manage, 45(11):41-50.
Trueman, T. N., Flack, L. A., Loonstra, P. D., & Hauser, W. D. (2008). The feasibility of using V.A.C. Therapy in home care patients with surgical and traumatic wounds in the Netherlands. International Wound Journal. 5(2): 225- 233