The sussman wound healing tool

A good WAT should make this information easily available to nurses encountering a wound for the first time. By facilitating continuity of care, the WAT will help nurses provide optimum wound management at all times.

Ease of use —In order for a WAT to be useful, it must be user friendly and quick and easy to use A balance needs to be struck between including all the necessary information and producing a tool which is too detailed and which deters nurses from using it.

Setting of goals for healing and planning care —Wound assessment is the first step in identifying appropriate treatment objectives in wound management The next step is to use the information gathered during wound assessment to set these objectives and start planning for how to achieve them.

Monitoring of the healing process —The aim of treating most wounds is to heal the wound For wounds which are not progressing, the nurse needs to identify possible barriers to healing and how these may be overcome Guiding practice —Many nurses, particularly inexperienced nurses, struggle when it comes to wound assessment.

WATs have the potential to guide nurses both through their assessment, and also in their decision making and care planning which follows assessment. The pathway leads the clinician from assessment and diagnosis, to setting objectives and provision of care.

A clinical pathway for wound care is also advocated by Barr and Cuzzell In light of evidence suggesting nurses do not currently receive the necessary level of support in providing wound care, it is suggested that a WAT could have the potential to lead nurses through this pathway.

The WATs to be evaluated were selected from tools readily available for nurses to use in their practice. A second search was carried out to find published and unpublished WATs. Initially titles were scanned to determine relevance. If titles were relevant, the abstracts were read and if the article still seemed relevant the whole article was obtained.

It is important to point out that a number of titles were unavailable thus limiting the number of tools included. An Internet search www. The reference lists from the literature were also scrutinised for references to additional WATs. The final number of included WATs was In order to assess the quality of the selected WATs, an audit tool was needed.

As a search revealed no suitable audit tool in existence, it was necessary to develop a new instrument. This tool was developed to assess the quality of the WATs based on the 14 previously determined criteria for the optimal WAT. The audit tool required specific evidence from the WAT to determine whether the optimal criteria were met.

The number of indicators rather than parent criteria is used, because individual WATs may meet some indicators of a particular criterion but not others. An individual WAT may meet one, two or all of these indicators. The Sessing scale meets the least criteria of the optimal WAT. It does not give any information on how well individual criteria were met. In most cases the criteria were scored as either met or unmet. There were only a few instances in which it was unclear whether the criteria indicators were present or not.

Criteria are ranked according to what percentage of WATs met each criterion. The results of the action evaluation provide a measure of how well the included WATs performed against criteria of the optimal WAT.

The results identify which WATs performed well and which performed poorly. This can be used to help nurses decide which WATs to use in practice: WATs which score higher on the audit are proposed to better meet the needs of nurses in wound assessment. On the basis of this evaluation, it can be recommended that either of these WATs be introduced into practice, if not already in use.

In addition to identifying which WATs perform well, the process reveals which WATs performed poorly against the evaluation criteria. As far as we know, this is the first study to compare WATs in this way. No other studies identified in the literature review have compared a range of WATs for their suitability in helping nurses deliver high standards of wound assessment. Some studies have assessed the reliability of particular tools 26 , 44 , 45 , but it is important to distinguish between a tool being reliable and it being useful or fit for purpose.

This may be the first study to critically compare and evaluate a selected number of readily available WATS and to determine whether they meet the needs of nurses. The results could be used to assist nurses when selecting a WAT for use in their area of practice.

Importantly, if nurses are using a WAT that has not been included in this study, the audit tool described could be used to evaluate it for its suitability in their area of practice. Further analysis of the individual WATs was carried out to determine how each WAT performed against each of the criteria and this information is available on request from the authors.

While the higher ranking WATs met more criteria indicators overall, some of these were deficient in certain areas by comparison with WATs that were generally ranked lower. These examples show that overall rank does not necessarily predict performance against a particular criterion.

This raises the question of whether overall performance is the most important consideration, and whether there are some criteria which are more important than others.

The criteria for the optimal WAT were selected on the basis that they were included in the literature as being of equal importance in wound assessment, but they can be divided into two groups: basic criteria and advanced criteria. Basic criteria are the more obvious components of a WAT: easy to record and easy to assess in an audit.

They represent the more apparent, objective aspects of wound assessment, for example, wound details, patient details, measurement, tissue type, exudate, surrounding skin, pain and infection. The advanced criteria comprise the more subjective components of a WAT and are often more difficult to assess in an audit.

The reason for this is uncertain. It may be that these criteria have not previously been identified as important in wound assessment. We would argue that these criteria are equally important as the basic criteria which are more commonly included in WATs.

It is the advanced criteria that add value to the wound assessment process by making it more useful and meaningful. Apart from the WATs included in this study there appear to be many more in existence, a number of which are local unpublished tools used in individual areas of practice.

This evaluation provides an important step in identifying and meeting nurses' needs in wound assessment, but more work is required. Nurses have been left to care for patients with wounds without national guidelines and consequently it is not known what the standard of wound assessment is. Neither do we know what nurses feel as their needs in carrying out wound assessment. In this evaluation nurses' needs were identified from the literature review.

However, there has not been a study which specifically asks nurses what they require in a WAT, how useful they find current WATs, and where they see scope for improvement. Neither is it known which WATs nurses are actually using in practice as there has been no research into this 3. In order to develop standardised treatment pathways for wound management, research is needed to identify what is currently happening in practice, which WATs are being used and how well they are meeting nurses' needs.

Despite the existence of dedicated wound journals, we currently do not possess basic information on what nurses require from WATs. The lack of research to evaluate WATs in relation to nurses' needs means that there is little previous work with which to compare this study. Fletcher recognised that there is inconsistency in wound assessment practice and that documentation of care is often poor. She suggests that a standardised WAT could improve care Fletcher examined existing WATs in order to determine which factors to include in the development of a new WAT that could improve practice, culminating in the production of the NWAF which was ranked second in our evaluation.

However, despite creating a high scoring tool, the methodology of Fletcher's paper could be criticised in several areas. The NWAF was devised through discussion of previous WATs by a panel of experts and whilst the experts involved are likely to have possessed a wealth of experience in relation to wound assessment, no empirical work was carried out to support the contents of the tool.

In this action evaluation, the AWM scored highest out of all the WATs and is therefore recommended for use in clinical practice. The finding that the AWM WAT meets nurses needs, as they are currently understood to be, provides support for this work. The Applied Wound Management framework was developed as part of the theory of wound bed preparation WBP in the management of chronic wounds healing by secondary intention.

It seeks to incorporate the principles of debridement, wound bioburden control, and exudate management 47 and attempts to create the right conditions in a wound to allow healing to take place Applied Wound Management seeks to improve wound care by facilitating a systematic approach to the complex issue of wound assessment and management 4. It enables the implementation of evidence based practice via the practical application of theory to everyday practice The AWM scored well across the majority of the criteria of the optimal WAT, but was not considered to meet the criteria indicators for guiding practice since it did not include any prompts of treatment objectives or links to sources of guidance for dressing selection.

However, the WAT is just one of several AWM clinical tools: in addition there is a pocket guide, a wall chart, and a computer database The wall chart suggests treatment objectives and treatment options for wounds at each stage of healing.

If the wall chart is used in conjunction with the WAT, the ability of AWM to meet nurses' needs in wound assessment is further strengthened. It has been argued that nurses, particularly inexperienced nurses, would benefit from a WAT which is capable of supporting them in carrying out wound assessment and that AWM is one such adjunct to decision making This is supported by Padmore, whose report found that AWM was easy to use for inexperienced staff and acted as an aide memoir for experienced nurses Many nurses lack knowledge of wound management and wound assessment, and it has been suggested that a WAT could provide support for nurses in this area.

The NWAF is a standalone tool which is intuitive to use without any additional training. The AWM however, is part of a wider framework. Padmore found the theory behind AWM simple to teach to students at various levels However, time must be invested in teaching students to ensure they are using AWM to full effect.

This raises the issue of whether education on AWM should occur as part of preregistration training or as the continual professional development of qualified staff. Studies have found that postregistration training for nurses does improve wound care practice This methodologically sound study shows not only that nurses' baseline wound management is often poor, but that it can be significantly improved with appropriate intervention.

Timmins concludes that a structured WAT can help improve nurses' practice, but that this requires adequate educational support. We have shown that there are WATs in existence which meet many of the needs of nurses in carrying out wound assessment and that no tool has been identified which meets all the requirements of nurses.

Those needs which remain unfulfilled are possibly some of the most important, in particular the need to be able to monitor healing and to guide nurses towards best practice. In order to maximise wound healing, nurses need to be able not just to record certain parameters in their wound assessment, but also to know what to do next.

This is not to say that recording wound size, exudate, tissue type etc. This brings us back to the three questions that follow wound assessment: i at what stage is this wound? While much research is being carried out into developing sophisticated dressings, designed to interact with the wound bed and accelerate wound healing 54 , these expensive dressings will be wasted if they are used incorrectly as a result of poor wound assessment and management.

It has also revealed that more research is needed to establish what is currently happening in practice, and what nurses believe their needs to be.

We have suggested that a good WAT can help guide nurses towards best practice in wound management. However, a WAT can never be a substitute for clinical knowledge and expertise It can provide a framework to structure assessment and an adjunct to decision making, but in order to provide the best quality wound care possible, nurses require educational support and clear guidelines for practice.

National Center for Biotechnology Information , U. Journal List Int Wound J v. Int Wound J. Published online May Author information Article notes Copyright and License information Disclaimer. Corresponding author. International Wound Journal published by Medicalhelplines. This article has been cited by other articles in PMC. Abstract The purpose of this study was to ascertain how well different wound assessment tools meet the needs of nurses in carrying out general wound assessment and whether current tools are fit for purpose.

Keywords: Evaluation research, Nursing practice, Wound assessment tool, Wound management. Introduction The challenging nature of wound healing has led to calls for practitioners worldwide to adopt a holistic and systematic approach to wound care 1 , 2 , 3. Purpose and study design The purpose of this study was to ascertain whether selected WATs meet the needs of nurses in carrying out wound assessment and whether current tools are fit for that purpose.

Methodology and methods We employed an action evaluation methodology. Aim The aim was to ascertain whether selected readily available WATs currently in existence meet the needs of nurses in carrying out general wound assessment, and whether current tools are fit for purpose. Objectives To identify from existing literature what nurses require from a WAT. To establish criteria for an optimal WAT. To ascertain to what extent currently available tools fulfil these criteria. To determine which readily available tool is best fit for purpose.

Based on the above, the question asked was: Do selected WATs meet the needs of nurses in carrying out best practice wound assessment? Criteria selection for the optimal WAT The criteria against which the WATs were evaluated were developed from the international literature on wound assessment. Criteria for inclusion in the optimal WAT were identified as follows: Details and characteristics of the wound —In order to achieve holistic wound management, it is important for nurses to have access to basic background information on the wound, including details of site, duration, and if known aetiology WAT selection The WATs to be evaluated were selected from tools readily available for nurses to use in their practice.

Search strategy The search terms used were Wound assessment tool. Testes de confiabilidade e validade devem ser considerados em estudos futuros. Caring for patients with chronic wounds has been a major challenge in nursing clinical practice; resulting in high rates of morbidity and a significant impairment of quality of life.

Monitoring pressure ulcer healing in persons with disabilities. Rehabil Nurs. These injuries affect a large portion of the world's population, generating high costs for public health in many countries. Human skin wounds: a major and snowballing threat to public health and the economy. Wound Repar Regen. Wound assessment is one of the basic stages for care planning in all healthcare levels: ambulatory, home or hospital.

International guidelines for wound treatment recommend a minimum of weekly evaluation, using a standardized instrument that enables monitoring of the healing process.

However, there is not yet consensus on the best way to evaluate the wound and its healing process. Tools to measure wound healing. Texto Contexto Enferm. Rev Latino-Am Enfermagem. Assessment of wound healing: validity, reliability and sensitivity of available instruments. Wound Practic Res. Pressure ulcer scale for healing: derivation and validation of the PUSH tool.

Adv Wound Care. Wound healing scale, version 1. Utility of the Sussman Wound Healing Tool in predicting wound healing outcomes in physical therapy. Bates-Jensen Wound Assessment Tool: pictorial guide validation project. J Wound Ostomy Continence Nurs. These instruments are validated, reliable, aid clinical practice, and can be used as decision tools by nurses for patient care.

Among the available instruments, the Pressure Sore Status Tool PSST , developed in , using the Delphi technique; aims to monitor the healing process of pressure ulcers.

The current version of the BWAT contains 13 items assessing size, depth, edges, undermining, type and amount of necrotic tissue, type and amount of exudate, peripheral tissue edema and induration, skin color surrounding wound, granulation tissue, and epithelialization.

The measuring scale is a five point Likert types, where 1 indicates the best condition of the wound and 5, the worst condition. The total score is obtained as the sum of all the items, and can range from 13 to 65 points, with higher scores indicating the worst wound conditions. Items such as size, depth, edges and detachment should be scored as zero when the lesions are healed. The instrument contains two additional items - location and shape - which are not part of the total score.

This guide enables professionals to use the same criteria during the evaluation process, as it defines each characteristic to be observed. Considering the recommendations from the main international consensus that guide the assessment of wound conditions through a reliable method, and the difficulty of nurses in clinical practice to assess and monitor the healing process of chronic wounds, this study aims to translate and adapt the Bates-Jensen Wound Assessment Tool instrument for the Brazilian culture, and to assess its feasibility.

This was a methodological study, characterized by translation and adaptation of the BWAT to Brazilian culture, conducted after authorization from Bates-Jensen, the author of the original instrument.

The instrument and the completion guide were submitted for translation and a cultural adaptation procedure, in accordance with international recommendations, 11 11 Beaton D, Bombardier C, Guillemin F, Ferraz MB. Pan American Health Organization. The purpose of these steps was to ensure the quality of the adapted instrument and its equivalence with the original instrument. Two independent translators, a nurse and a language teacher, fluent in English and having Portuguese as their first language, performed the first BWAT translation; only the language teacher was informed of the study objectives.

PUSH is most effective when used for a heterogenous mixture of wounds to track bioburden as well as healing rate. The SWHT was developed as a diagnostic tool to monitor and track the effectiveness of physical therapy techniques. SWHT is a qualitative instrument composed of 10 wound attributes combined with nine descriptive attributes of size, extent of tissue damage plus location, and acute wound healing phase.

Table 1. Comparison of Wound Healing Tools reproduced from Sussman 1. Interested in learning more about wound care and certification?

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Laurie Swezey, founder and president of WoundEducators. Where can I get samples of products to use for measuring. I would like to have fir nurses at a nail and foot care class. This site uses Akismet to reduce spam. Learn how your comment data is processed. Wound Care. A collaborative practice manual for health professionals. Bates-Jensen wound assessment tool: pictorial guide validation project.

J Wound Ostomy Continence Nurs. Ostomy Wound Manage. Comments Where can I get samples of products to use for measuring.