Outcomes of wound care nurses’ practice in patients with pressure ulcers : An integrative review

Background
Wound care nurses are recognised as a key element for improving health outcomes. However, there is still fragmented knowledge of the outcomes associated with their practice in individuals with pressure ulcers.

Aims and objectives
To identify, summarise and map all available evidence related to the outcomes of wound care nurses’ practice in individuals with pressure ulcers.

Design
Integrative literature review.

Review method
To report the review, we followed the modified version of Cooper's five-step methodology, and the PRISMA guidelines.

Methods
The search was carried out on CINAHL, PubMed, the Cochrane Library and Scopus, with a time frame ranging from each database inception to December 21, 2019. We included observational or experimental studies of adult individuals affected by (or at risk of) developing pressure ulcers who were also cared for by wound care nurses.

Results
Of the 439 peer-reviewed publications, 13 studies met the inclusion criteria. The most frequent outcomes were pressure ulcer incidence, healing rate and time taken for complete healing. Less frequent outcomes were changes in pressure ulcers’ stage, number of completely healed wounds, treatment costs and physical discomfort. No patient-reported outcomes were assessed.

Conclusion
This review indicates that clinical-related outcomes were by far the most reported. Future studies should broaden the spectrum of outcomes to include more subjective parameters (e.g. pain, quality of life, stress, etc.), in order to gain a better understanding of the global impact of wound care practice on patients with pressure ulcers.

Relevance to clinical practice
There is promising evidence of a positive impact of wound care nurses’ practice on health and economic outcomes. Nonetheless, more robust and rigorous research is needed to provide stronger evidence in the field and support investment in these practitioners.