Listening to local voices: exploring the feasibility of a nurse-directed community-based wound care clinic

Abstract

The purpose of this feasibility study was to explore, identify and describe the factors that support the setting up of a nurse-directed, community-based wound care clinic. The study focused on developing agreed selection criteria that will enable patients to be discharged into the community. The study explored factors that supported such an initiative from the viewpoint of four clinical staff members from the Regional Centre for Reconstructive Plastic Maxillofacial and Hand Surgery, South Auckland Health. The study was motivated by my interest in taking a leading role in evidence-based wound management and models of health care delivery that incorporate innovative wound management in every day practice. Innovative wound management combined with increasing acuity of the patient, decreased length of inpatient stay, the expanding role of the registered nurse and the movement to ambulatory care generated not only a need for excellence but also an urgency in meeting these challenges. An exploratory, descriptive design was used and a purposive sample of two senior registered nurses and two medical staff participated in a one hour audiotaped, semi-structured focus group interview. The study answered the question "What are the agreed upon selection criteria for patients in hospital requiring nurse delivered wound care only, that could be discharged from hospital and cared for in the community?" The study revealed information that could provide the organisation of South Auckland Health with knowledge of factors which support the setting-up of a nurse-directed, community-based wound care clinic. The study identified three dominant themes which are: medically stable; functional status; and, specialised advanced nurse practitioners. These three themes captured the knowledge and experience of the way the study informants engaged in dialogue. Emerging from these three themes were the agreed upon selection criteria for patients in hospital requiring nurse-delivered wound care only that could be discharged and cared for in the community. These are: assessment of the patient as physically safe for discharge; functioning independently and resuming self-care and other activities of daily living; availability of transportation to and from hospital; family or caregiver support at home; and, requiring ongoing specialised plastic surgical wound management. The study demonstrated that patients in hospital exclusively to receive nurse-delivered wound care can be discharged to a community-based, wound care clinic provided that the mutually agreed upon selection criteria are met by all groups of patients. Indeed, the findings would provide support for the setting-up of such a facility that will offer integrated health care delivery with the potential for addressing the role of primary health care in the South Auckland Health area. The focus group method embraced the uniqueness of each informant's attributes by engaging colleagues in specific dialogue to generate an abundant source of information. More specifically, the focus group method obtained candid perceptions, insights and opinions from the informants in order to learn more about the question under study. It is from the informants' shared ideas of this poorly understood area of their practice that this study gained prominence as it is the first feasibility study of its type in New Zealand.