Temple University School of Podiatric Medicine Journal Review Club

Editor's note: This post is part of the Temple University School of Podiatric Medicine (TUSPM) journal review club blog series. In each blog post, a TUSPM student will review a journal article relevant to wound management and related topics and provide their evaluation of the clinical research therein.

Article Title: Graduating Student Nurses' and Student Podiatrists' Wound Care Competence: A Cross-Sectional Study

Authors: Kielo E, Salminen L, Suhonen R, Puukka P, Stolt M

Journal: J Wound Care. 2019;28(3):136-145

Reviewed by: Stephanie Golding, class of 2020, Temple University School of Podiatric Medicine

Introduction

The current study defines wound care as the prevention of wound complications and the promotion of wound healing. Nurses and podiatrists both commonly see patients in need of wound care, depending on their clinical setting. Although nurses may see a large variety of wounds, podiatrists mainly treat chronic wounds, such as vascular, neuropathic, and pressure ulcers. It is important that both nurses and podiatrists have competence and skills in the wound care field to improve quality of care for patients and decrease costs. There is limited research on the competence of student nurses and student podiatrists in terms of their wound care knowledge, despite their important roles in prevention of wounds and wound management.

Previous studies have shown that, although student nurses and student podiatrists acknowledge the importance of wound care competence, the students do not feel prepared for pressure ulcer care. Studies have shown that students have increased their wound care competence with extracurricular activities, such as wound care lectures and reading and e-learning interventions. The current study aimed to explore graduating student nurses' and student podiatrists' theoretical wound care competence as well as their own perceptions of their competence and opinions on their wound care education.

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Methods

The study included student nurses and student podiatrists in their final semester of study at Finnish universities of applied sciences. The total number of participants was 213, with 194 (91%) student nurses and 19 (9%) student podiatrists. The mean age of participants was 27 years, and 86% were women; 34% of participants had a prior health care profession. Data were collected using a wound care competence questionnaire developed specifically for this study with questions pertaining to demographic information, perceptions of wound care education and attitudes toward wound care, a wound care knowledge test, and a self-evaluation of their own wound care competence.

Eight of the 25 questions in the wound care knowledge section of the questionnaire were adapted from the Assessment and Documentation of Various Wounds questionnaire. The knowledge test's content validity index (CVI) was computed, with scores of 0.88 for clarity, 0.97 for relevance, and 0.96 for importance, with an overall average CVI of 0.94.

Results

For the knowledge test portion of the questionnaire, the average percentage of correct answers was 48%. The student nurses had 46% of the answers correct, and the student podiatrists had 60% of the answers correct, on average. The student podiatrists' knowledge was statistically significantly higher than the student nurses'. Student nurses had the most knowledge in regard to pressure ulcer risk factors, debridement, pain management, silver dressings, and surgical wounds.

They had the least knowledge about pressure ulcer risk management, wound infection, foot ulcers, healing process, and burn injuries. For podiatry students, their highest knowledge was in the topics of maceration, silver dressings, debridement, high-exudate wounds, venous leg ulcers, arterial ulcers, and wound size measurements. Student podiatrists were least knowledgeable regarding the wound healing process, wound proliferation, pain management, wound infection, hydrophobic dressings, and wound healing. Overall, the students had a positive attitude toward wound care, with 78% indicating interest in the field and 99% indicating that nurses and podiatrists should be competent in wound care. Most podiatry students reported that they received little or very little theoretical and practical wound care education.

A total of 42% reported that they had poor knowledge of wound care products, and 7% stated they were not familiar with wound products at all. A total of 48% of student nurses reported their surgical wound care competence as being quite good, whereas 19% rated it as quite poor. It was reported that students learn more through practical training than at school, with both student nurses and podiatrists wishing they had received more wound care education in both settings. It was found that students who received more practical training in wound care had more correct answers on the knowledge test.

Discussion

The current study shows that student nurses' and student podiatrists' theoretical wound care competence is deficient, as shown through a knowledge test and students' own rating of their skills in the field. This study sheds light on the need for better wound care education, including practical training. The amount of practical training was found to be varied and generally limited, but it was shown that more practical training led to significantly better knowledge outcomes. Interprofessional training with both student nurses and student podiatrists could also be helpful because an interprofessional approach to wound care may increase quality of care. The study also showed a positive attitude toward wound care by both groups of students.

The authors related that this occurred in spite of the students' limited knowledge because students recognize the importance of the wound care field. The increased knowledge of student podiatrists as compared with student nurses is explained by the podiatry curriculum, and the study recommends an increase in foot care education in the nursing curriculum to improve this. There were many limitations of the current study in its design, sampling, instrumentation, and data collection. Because the wound care competence questionnaire was specifically designed for this study, the validity and reliability of the instrument are unknown. There were also many more student nurses than podiatrists participating in the study. Additionally, this study was conducted solely in Finland, so it does not accurately reflect the wound care education of student nurses and student podiatrists worldwide.

About the Author

Stephanie Golding is a third-year podiatric medical student at Temple University School of Podiatric Medicine (TUSPM) in Philadelphia. She graduated from the University of Maryland in College Park in 2016 with a Bachelor of Science in Physiology and Neurobiology. In the fall of 2016, Stephanie matriculated at TUSPM with a merit scholarship. She is the Director of Project Management for FootAid, a new non-profit organization, and recently traveled to Port-au-Prince, Haiti for a podiatry and wound care medical mission trip. Dr. James McGuire is the director of the Leonard S. Abrams Center for Advanced Wound Healing and an associate professor of the Department of Podiatric Medicine and Orthopedics at the Temple University School of Podiatric Medicine in Philadelphia.