Improving Patient Outcomes through Coaching in Evidence-Based Wound Management
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Please cite this article in press as: Innes-Walker, K., et al. Improving patient outcomes by coaching primary health gen-
eral practitioners and practice nurses in evidence based wound management at on-site wound clinics. Collegian (2018),
https://doi.org/10.1016/j.colegn.2018.03.004
ARTICLE IN PRESSG Model
COLEGN-518; No. of Pages 7
Collegian xxx (2018) xxx–xxx
Contents lists available at ScienceDirect
Collegian
j o u r n a l h o m e p a g e : w w w . e l s e v i e r . c o m / l o c a t e / c o l l
Improving patient outcomes by coaching primary health general
practitioners and practice nurses in evidence based wound
management at on-site wound clinics
K. Innes-Walker a,b , C.N. Parker a,b,∗, K.J. Finlayson a,b , M. Brooks c , L. Young d , N. Morley e ,
D. Maresco-Pennisi f , H.E. Edwards a,b
a Wound Management Innovation Cooperative Research Centre, Oxley House, 25 Donkin St West End, QLD, Australia
b Faculty of Health, Institute of Health & Biomedical Innovation, Queensland University of Technology, 60 Musk Ave. Kelvin Grove, QLD 4059, Australia
c World of Wounds, Latrobe University, Bundoora, Victoria 3086, Australia
d Wound Management Nurse Practitioner, Tasmanian Health Service, Southern Region, Hobart, Tasmania, Australia
e Vascular Nurse Practitioner, Queensland Health, Brisbane South, QLD, Australia
f University Queensland Centre for Clinical Research, Faculty of Medicine, Royal Brisbane and Women’s Hospital, Brisbane, QLD, Australia
a r t i c l e i n f o
Article history:
Received 19 May 2017
Received in revised form 7 March 2018
Accepted 18 March 2018
Available online xxx
Keywords:
Wound management
Primary health care
Wound clinic
Model of care
General practice
a b s t r a c t
Background: Wound management is frequently performed in the community and forms a large part
of daily activities of General Practice health professionals. However, previous research has acknowl-
edged a need for further education and training on evidence based wound management for these health
professionals.
Aim: The aim of this project was to develop and trial a Cooperative Wound Clinic model of care in Gen-
eral Practices, using a nurse led, interdisciplinary, holistic approach; including training and coaching to
increase the wound management expertise and capacity of health professionals working in the primary
healthcare environment.
Methods: A longitudinal, pre-post design was used. Four Cooperative Wound Clinic pilot sites and nine
wound clinics were established in General Practices across three Australian states with the intervention
of the study being the model of care and incorporating a local wound expert employed to provide the
training and coaching. Pre and post survey data were collected on wound management practices, health
professional confidence in evidence based wound management, patient health, wellbeing and healing
outcomes. Longitudinal patient data were collected for 24 weeks.
Findings: Results included an increase in the confidence of health professionals to manage wounds. Util-
isation of a repetitive coaching model over a six month period empowered the decision making process
and assessment knowledge for a variety of wound types. A positive impact on patient outcomes for a
variety of wound types was also observed.
Conclusion: The potential for expanding this model will bring many benefits including: empowerment of
nurses’ confidence in managing wounds, promoting the role of nurse led clinics; improved wound related
capability and confidence of health professionals; improved wound management, patient knowledge and
better patient satisfaction and outcomes.
© 2018 Australian College of Nursing Ltd. Published by Elsevier Ltd.
Problem
Primary Health is a high priority area requiring more education
and training particularly around evidence based wound manage-
ment practice.
∗ Corresponding author at: Queensland University of Technology, Victoria Park
Rd. Kelvin Grove, QLD 4059, Australia.
E-mail address: christina.parker@qut.edu.au (C.N. Parker).
What is already known
Wound management occurs primarily in the community with
wounds being a common admission diagnosis to community
nursing services and general practice where patients are seen
for frequent on-going visits. There are many barriers to nurses
updating their evidence based wound management knowledge
and significant social and economic benefits would be gained if
resources and strategies were directed to facilitating implementa-
https://doi.org/10.1016/j.colegn.2018.03.004
1322-7696/© 2018 Australian College of Nursing Ltd. Published by Elsevier Ltd.
eral practitioners and practice nurses in evidence based wound management at on-site wound clinics. Collegian (2018),
https://doi.org/10.1016/j.colegn.2018.03.004
ARTICLE IN PRESSG Model
COLEGN-518; No. of Pages 7
Collegian xxx (2018) xxx–xxx
Contents lists available at ScienceDirect
Collegian
j o u r n a l h o m e p a g e : w w w . e l s e v i e r . c o m / l o c a t e / c o l l
Improving patient outcomes by coaching primary health general
practitioners and practice nurses in evidence based wound
management at on-site wound clinics
K. Innes-Walker a,b , C.N. Parker a,b,∗, K.J. Finlayson a,b , M. Brooks c , L. Young d , N. Morley e ,
D. Maresco-Pennisi f , H.E. Edwards a,b
a Wound Management Innovation Cooperative Research Centre, Oxley House, 25 Donkin St West End, QLD, Australia
b Faculty of Health, Institute of Health & Biomedical Innovation, Queensland University of Technology, 60 Musk Ave. Kelvin Grove, QLD 4059, Australia
c World of Wounds, Latrobe University, Bundoora, Victoria 3086, Australia
d Wound Management Nurse Practitioner, Tasmanian Health Service, Southern Region, Hobart, Tasmania, Australia
e Vascular Nurse Practitioner, Queensland Health, Brisbane South, QLD, Australia
f University Queensland Centre for Clinical Research, Faculty of Medicine, Royal Brisbane and Women’s Hospital, Brisbane, QLD, Australia
a r t i c l e i n f o
Article history:
Received 19 May 2017
Received in revised form 7 March 2018
Accepted 18 March 2018
Available online xxx
Keywords:
Wound management
Primary health care
Wound clinic
Model of care
General practice
a b s t r a c t
Background: Wound management is frequently performed in the community and forms a large part
of daily activities of General Practice health professionals. However, previous research has acknowl-
edged a need for further education and training on evidence based wound management for these health
professionals.
Aim: The aim of this project was to develop and trial a Cooperative Wound Clinic model of care in Gen-
eral Practices, using a nurse led, interdisciplinary, holistic approach; including training and coaching to
increase the wound management expertise and capacity of health professionals working in the primary
healthcare environment.
Methods: A longitudinal, pre-post design was used. Four Cooperative Wound Clinic pilot sites and nine
wound clinics were established in General Practices across three Australian states with the intervention
of the study being the model of care and incorporating a local wound expert employed to provide the
training and coaching. Pre and post survey data were collected on wound management practices, health
professional confidence in evidence based wound management, patient health, wellbeing and healing
outcomes. Longitudinal patient data were collected for 24 weeks.
Findings: Results included an increase in the confidence of health professionals to manage wounds. Util-
isation of a repetitive coaching model over a six month period empowered the decision making process
and assessment knowledge for a variety of wound types. A positive impact on patient outcomes for a
variety of wound types was also observed.
Conclusion: The potential for expanding this model will bring many benefits including: empowerment of
nurses’ confidence in managing wounds, promoting the role of nurse led clinics; improved wound related
capability and confidence of health professionals; improved wound management, patient knowledge and
better patient satisfaction and outcomes.
© 2018 Australian College of Nursing Ltd. Published by Elsevier Ltd.
Problem
Primary Health is a high priority area requiring more education
and training particularly around evidence based wound manage-
ment practice.
∗ Corresponding author at: Queensland University of Technology, Victoria Park
Rd. Kelvin Grove, QLD 4059, Australia.
E-mail address: christina.parker@qut.edu.au (C.N. Parker).
What is already known
Wound management occurs primarily in the community with
wounds being a common admission diagnosis to community
nursing services and general practice where patients are seen
for frequent on-going visits. There are many barriers to nurses
updating their evidence based wound management knowledge
and significant social and economic benefits would be gained if
resources and strategies were directed to facilitating implementa-
https://doi.org/10.1016/j.colegn.2018.03.004
1322-7696/© 2018 Australian College of Nursing Ltd. Published by Elsevier Ltd.
Please cite this article in press as: Innes-Walker, K., et al. Improving patient outcomes by coaching primary health gen-
eral practitioners and practice nurses in evidence based wound management at on-site wound clinics. Collegian (2018),
https://doi.org/10.1016/j.colegn.2018.03.004
ARTICLE IN PRESSG Model
COLEGN-518; No. of Pages 7
2 K. Innes-Walker et al. / Collegian xxx (2018) xxx–xxx
tion of strategies to increase evidence based practices in wound
management in these health areas.
What this paper adds
The establishment of Cooperative Wound Clinics improved
patient outcomes by enhancing the capabilities of health profes-
sionals in primary health care settings to implement evidence
based wound management.
1. Introduction
The majority of wounds progress smoothly through the stages
of healing, however, some wounds will remain unhealed for
long periods of time. Wounds can occur as a disruption of skin
integrity, as part of a disease process, or from intentional or acci-
dental indications (Young & McNaught, 2011). Having a wound
can be debilitating and patients often suffer multiple symptoms
and effects, including pain, reduced mobility, lower limb oedema,
venous eczema, wound exudate, decreased quality of life and
depression (Jones, Barr, Robinson, & Carlisle, 2006; Parker, 2012).
The effects of chronic leg ulcers involves 1–3% of the population
(Briggs & Closs, 2003; Margolis, Bilker, Santanna, & Baumgarten,
2002) with many remaining unhealed for years or even decades.
Caring for acute and chronic wounds is a multi-billion dollar bur-
den on Australia’s health system with reported costs in excess of
A$3 billion (The Australian Wound Management Association Inc &
The New Zealand Wound Care Society Inc, 2011).
Wound management occurs primarily in the community with
wounds being a common reason for admission to community nurs-
ing services (RDNS, 2008) and/or General Practice (GP), where
patients are seen for frequent, on-going visits. One study investi-
gating adults with leg ulcers who were visiting GPs for care of their
ulcers, found that 82% attended 1–2 times/week for a median of 21
weeks (Edwards et al., 2014). The ageing of the Australian popula-
tion, the increasing incidence of chronic illnesses and recognised
inequities in access to health care have prompted governments to
look for new ways to fund care that has more of a focus on pre-
vention and ongoing disease management (Jolly, 2007). This has
resulted in current health care policy that aims to transfer health
services from the hospital sector to primary care where possible.
With the number of nurses in GPs rapidly increasing from 7728 in
2007 to 10,683 in 2012 (Australian Medicare Local Alliance, 2012),
nurses are well placed to play a lead role in redesigning care to meet
these challenges.
Wound management is a large and important part of the daily
activities for most primary health care nurses (Australian Medicare
Local Alliance, 2012). The treatment of people with wounds is an
important issue for nearly every GP in Australia (Britt et al., 2012).
In 2011–12, a considerable proportion (33%) of Medicare claims
were for wound management item numbers (Britt et al., 2012).
Dressings accounted for 20% of all procedures performed by prac-
tice nurses and three of the five most common procedures in GPs
involved wound management (Britt et al., 2012). An education and
training needs analysis performed by the Wound Management
Innovation Cooperative Research Centre indicated that primary
health care was a high priority area requiring more education and
training around evidence based best wound management practice
(Innes-Walker & Edwards, 2013). There are many well documented
barriers to nurses updating their evidence based wound manage-
ment knowledge (Coyer, Edwards, & Finlayson, 2005), however, it
has been indicated that significant social and economic benefits
would be gained if resources and strategies were directed to facil-
itating implementation of these strategies in GP (Edwards et al.,
2013; Graves, Finlayson, Gibb, O’Reilly, & Edwards, 2014).
This project implemented a Cooperative Wound Clinic (CWC)
model of care which was underpinned by the principles of the “Leg
Club®
” model of care, developed in the United Kingdom (Lindsay,
2004), and utilising a coaching model of education. The “Leg Club®
”
model provides wound management for patients with an emphasis
on social interaction, education, participation and peer support for
patients (Lindsay, 2004). A randomised controlled trial in Australia
that compared this model of care to in-home wound care reported
significant improved outcomes in patient quality of life, morale,
self-esteem, healing, pain and functional ability of the patient
(Edwards, Courtney, Finlayson, Shuter, & Lindsay, 2009). It was pro-
posed that a service delivery model based on the Leg Club®
model
undertaken in a primary health care environment would also offer
improved outcomes for patients and the health care system.
The CWC model of care also utilised coaching strategies
designed to provide holistic, evidence based care and dedicated
wound management clinic time to patients through the utilisa-
tion of a coaching model of education with a wound care expert.
A coaching role in the delivery of education and clinical skills has
been used effectively and has been noted to encourage communi-
cation, leadership and adaptability (Johnson, Hamilton, Delaney,
& Pennington, 2011), while utilising skills in facilitation, prac-
tice development principles, adult learning strategies to support
a person centred approach to care (Faithfull-Byrne et al., 2016).
The successful utilisation of a coaching model has also been
shown to increase documented assessments and knowledge in
chronic conditions (Johnston et al., 2007) and health organisa-
tions (Faithfull-Byrne et al., 2016). The role of a practice nurse
in today’s medical environment often occurs in rapidly changing
circumstances and contemporary demands for workplace learning
have been supported by coaching roles in teaching (Faithfull-Byrne
et al., 2016). One-on-one or small group coaching allows for health
professionals to be able to coach other staff through the wound
assessment and management process, allowing for questions to be
asked and critical decision making to be discussed throughout the
process. This included staff development training, work integrated
learning and the development of organised referral pathways for
multidisciplinary care as appropriate.
Specifically, the expert attended the clinic and simultaneously
led education to the health professionals and care to patients to
facilitate the transfer of learning into practice. The wound expert
used a patient centred approach incorporating holistic assessment
and the development of plans with the health professional and
patients and families while also encouraging the socialisation of
patients and/or families and carers with other patients and/or fam-
ilies and carers in the wound clinic environment as per the Leg
Club®
model of care.
2. Aim
The aim of this project was to evaluate outcomes following the
implementation of the CWC model on:
• Health professionals’ knowledge and patients’ satisfaction about
evidence based practice in wound management;
• Feasibility and sustainability within the primary care setting; and
• Patient outcomes (healing and quality of life).
3. Methods
3.1. Design
A longitudinal, pre-post design was used where survey data
from health professionals and patients were collected prior
to implementation of the intervention and 24 weeks post-
eral practitioners and practice nurses in evidence based wound management at on-site wound clinics. Collegian (2018),
https://doi.org/10.1016/j.colegn.2018.03.004
ARTICLE IN PRESSG Model
COLEGN-518; No. of Pages 7
2 K. Innes-Walker et al. / Collegian xxx (2018) xxx–xxx
tion of strategies to increase evidence based practices in wound
management in these health areas.
What this paper adds
The establishment of Cooperative Wound Clinics improved
patient outcomes by enhancing the capabilities of health profes-
sionals in primary health care settings to implement evidence
based wound management.
1. Introduction
The majority of wounds progress smoothly through the stages
of healing, however, some wounds will remain unhealed for
long periods of time. Wounds can occur as a disruption of skin
integrity, as part of a disease process, or from intentional or acci-
dental indications (Young & McNaught, 2011). Having a wound
can be debilitating and patients often suffer multiple symptoms
and effects, including pain, reduced mobility, lower limb oedema,
venous eczema, wound exudate, decreased quality of life and
depression (Jones, Barr, Robinson, & Carlisle, 2006; Parker, 2012).
The effects of chronic leg ulcers involves 1–3% of the population
(Briggs & Closs, 2003; Margolis, Bilker, Santanna, & Baumgarten,
2002) with many remaining unhealed for years or even decades.
Caring for acute and chronic wounds is a multi-billion dollar bur-
den on Australia’s health system with reported costs in excess of
A$3 billion (The Australian Wound Management Association Inc &
The New Zealand Wound Care Society Inc, 2011).
Wound management occurs primarily in the community with
wounds being a common reason for admission to community nurs-
ing services (RDNS, 2008) and/or General Practice (GP), where
patients are seen for frequent, on-going visits. One study investi-
gating adults with leg ulcers who were visiting GPs for care of their
ulcers, found that 82% attended 1–2 times/week for a median of 21
weeks (Edwards et al., 2014). The ageing of the Australian popula-
tion, the increasing incidence of chronic illnesses and recognised
inequities in access to health care have prompted governments to
look for new ways to fund care that has more of a focus on pre-
vention and ongoing disease management (Jolly, 2007). This has
resulted in current health care policy that aims to transfer health
services from the hospital sector to primary care where possible.
With the number of nurses in GPs rapidly increasing from 7728 in
2007 to 10,683 in 2012 (Australian Medicare Local Alliance, 2012),
nurses are well placed to play a lead role in redesigning care to meet
these challenges.
Wound management is a large and important part of the daily
activities for most primary health care nurses (Australian Medicare
Local Alliance, 2012). The treatment of people with wounds is an
important issue for nearly every GP in Australia (Britt et al., 2012).
In 2011–12, a considerable proportion (33%) of Medicare claims
were for wound management item numbers (Britt et al., 2012).
Dressings accounted for 20% of all procedures performed by prac-
tice nurses and three of the five most common procedures in GPs
involved wound management (Britt et al., 2012). An education and
training needs analysis performed by the Wound Management
Innovation Cooperative Research Centre indicated that primary
health care was a high priority area requiring more education and
training around evidence based best wound management practice
(Innes-Walker & Edwards, 2013). There are many well documented
barriers to nurses updating their evidence based wound manage-
ment knowledge (Coyer, Edwards, & Finlayson, 2005), however, it
has been indicated that significant social and economic benefits
would be gained if resources and strategies were directed to facil-
itating implementation of these strategies in GP (Edwards et al.,
2013; Graves, Finlayson, Gibb, O’Reilly, & Edwards, 2014).
This project implemented a Cooperative Wound Clinic (CWC)
model of care which was underpinned by the principles of the “Leg
Club®
” model of care, developed in the United Kingdom (Lindsay,
2004), and utilising a coaching model of education. The “Leg Club®
”
model provides wound management for patients with an emphasis
on social interaction, education, participation and peer support for
patients (Lindsay, 2004). A randomised controlled trial in Australia
that compared this model of care to in-home wound care reported
significant improved outcomes in patient quality of life, morale,
self-esteem, healing, pain and functional ability of the patient
(Edwards, Courtney, Finlayson, Shuter, & Lindsay, 2009). It was pro-
posed that a service delivery model based on the Leg Club®
model
undertaken in a primary health care environment would also offer
improved outcomes for patients and the health care system.
The CWC model of care also utilised coaching strategies
designed to provide holistic, evidence based care and dedicated
wound management clinic time to patients through the utilisa-
tion of a coaching model of education with a wound care expert.
A coaching role in the delivery of education and clinical skills has
been used effectively and has been noted to encourage communi-
cation, leadership and adaptability (Johnson, Hamilton, Delaney,
& Pennington, 2011), while utilising skills in facilitation, prac-
tice development principles, adult learning strategies to support
a person centred approach to care (Faithfull-Byrne et al., 2016).
The successful utilisation of a coaching model has also been
shown to increase documented assessments and knowledge in
chronic conditions (Johnston et al., 2007) and health organisa-
tions (Faithfull-Byrne et al., 2016). The role of a practice nurse
in today’s medical environment often occurs in rapidly changing
circumstances and contemporary demands for workplace learning
have been supported by coaching roles in teaching (Faithfull-Byrne
et al., 2016). One-on-one or small group coaching allows for health
professionals to be able to coach other staff through the wound
assessment and management process, allowing for questions to be
asked and critical decision making to be discussed throughout the
process. This included staff development training, work integrated
learning and the development of organised referral pathways for
multidisciplinary care as appropriate.
Specifically, the expert attended the clinic and simultaneously
led education to the health professionals and care to patients to
facilitate the transfer of learning into practice. The wound expert
used a patient centred approach incorporating holistic assessment
and the development of plans with the health professional and
patients and families while also encouraging the socialisation of
patients and/or families and carers with other patients and/or fam-
ilies and carers in the wound clinic environment as per the Leg
Club®
model of care.
2. Aim
The aim of this project was to evaluate outcomes following the
implementation of the CWC model on:
• Health professionals’ knowledge and patients’ satisfaction about
evidence based practice in wound management;
• Feasibility and sustainability within the primary care setting; and
• Patient outcomes (healing and quality of life).
3. Methods
3.1. Design
A longitudinal, pre-post design was used where survey data
from health professionals and patients were collected prior
to implementation of the intervention and 24 weeks post-
Please cite this article in press as: Innes-Walker, K., et al. Improving patient outcomes by coaching primary health gen-
eral practitioners and practice nurses in evidence based wound management at on-site wound clinics. Collegian (2018),
https://doi.org/10.1016/j.colegn.2018.03.004
ARTICLE IN PRESSG Model
COLEGN-518; No. of Pages 7
K. Innes-Walker et al. / Collegian xxx (2018) xxx–xxx 3
implementation of the intervention. The outcome measures
included health professionals’ knowledge, confidence and prac-
tices re evidence based wound management, and patient outcome
measures of wound healing and prevention measures and satis-
faction with care. The health professional survey collected data on
demographics, education, clinical practice details, confidence lev-
els and barriers and limitations in assessment, management and
prevention of wounds. Patient data collected when attending the
wound clinic at the first visit with a wound or for prevention strate-
gies included demographic, medical history, wound characteristics,
wound management and prevention strategies; and then further
data (wound characteristics) were collected from patients attend-
ing the clinic at least every two weeks or until healing for open
wounds.
3.2. Procedure
Nine nurse-led CWCs were established in a variety of GP
practices which were located across three Australian states
(Queensland, Victoria and Tasmania). A local wound expert in each
state was employed to assist health professionals to consult with
patients and to provide training and coaching at each of these sites.
The role of the expert trainer was to provide evidence-based wound
management training and coaching for general health profession-
als as well as playing an active clinical role in the clinic for the time
that they were there. The expert trainer was in most cases a Nurse
Practitioner in wound management.
The expert trainer as part of the intervention in this study was
involved in the initial training of health professionals within each
of the clinics and then attended the clinic once/fortnight to coach
and mentor staff in clinical practice. The initial training in the prac-
tice included a workshop that covered the implementation of the
model of care, wound aetiologies, wound assessment, management
and prevention principles and evidence based practice including
the need for good documentation. The need for a multidisciplinary
approach to wound care was enforced and a referral pathway was
provided to health professionals in chart form that included details
of specialist clinics and health professionals within the area that
could offer specialist wound care advice. This workshop utilised
PowerPoint presentations that also included case studies and real
life scenarios. To assist with staff education, a wound education
and training material package named the CWC Resource Kit was
developed as part of the project and was made available to health
professionals and patients. The training content was also specifi-
cally directed towards GP with the necessary incorporation of the
relevant MBS item numbers that may be relevant to wound care
practice.
This was followed up by the wound expert attending wound
care appointments once/fortnight where the wound expert worked
with the health professional staff to treat the patients using a coach-
ing model of teaching. The wound expert would work with the
health professionals to complete an assessment of a patient with a
wound followed by the planning and implementation of evidence
based care for that patient. The health professionals were encour-
aged over time to complete all skills themselves with the ability to
ask questions and discuss options with the wound expert. Sociali-
sation of patients and carers was encouraged by scheduling at least
two visits at the same time and in the same room. Referral path-
ways were developed in consultation with GP health professionals
and utilised for referral on to specialists as appropriate.
Follow up attendance at clinical appointments by the wound
expert, in conjunction with the health professional staff, ensured
repetitive coaching in a nurturing, safe non-judgemental learn-
ing environment while incorporating the patient and family/carer
within the plan of care.
3.3. Sample
As places were limited, General Practices were invited to sub-
mit expressions of interest and were recruited if they fitted the
following inclusion criteria:
– Clinic was large enough to accommodate two or more wound
patients simultaneously
– Clinic had an interest in wound management and support from
GPs and practice managers.
– Clinic was willing to collect patient clinical and satisfaction data
and health professional surveys
Patients were recruited if they fitted the inclusion criteria:
– Patients with an open wound of any type or who visited the clinic
specifically for prevention of a wound
3.4. Data collection and measures
3.4.1. Health professionals
Data were collected from March 2013 to June 2015 to gather
information before implementation of the CWC model and after
implementation of the CWC model. The health professional survey
was developed to obtain data including demographic information
(i.e. age and gender) and qualifications (i.e. what is the highest level
of school you have completed or the highest qualification you have
received) and current wound practices (i.e. what percentage of your
work time is currently taken up with providing clinical care or pre-
ventative management to patients at risk of developing wounds or
with current wounds). The survey also asked questions in relation
to evidence based practice based on the validated Self-Efficacy in
Evidence Based Practice scale (Chang & Crowe, 2011) and included
items on attitudes (i.e. please indicate your level of agreement or
disagreement with the following statement: An interprofessional
collaborative approach to wound management results in better
patient outcomes), confidence levels in assessment, management
and prevention of wounds as well as transfer of learning and evi-
dence based wound management guidelines (i.e., please rate your
confidence level to undertake the following: Finding evidence on
wound management and clinical practice) and barriers to education
and training.
3.4.2. Patients
Data were collected from March 2013 to June 2015 and con-
tained baseline and follow up data for up to 24 weeks obtained from
medical records, clinical assessment and surveys. This informa-
tion included demographic (age, gender, medical characteristics),
health (medical history, medications, nutrition), clinical charac-
teristics of any wounds (aetiology, area, tissue type, progress in
healing), management and socioeconomic information. The Pres-
sure Ulcer Scale for Healing (PUSH) tool (National Pressure Ulcer
Advisory Panel, 2013) was used to document ulcer severity in all
wounds as this scale has demonstrated reliability and found to be
responsive in different types of leg ulcers and diabetic ulcers (Hon
et al., 2010; Ratliff & Rodeheaver, 2005; Santos, Sellmer, & Massulo,
2007). The PUSH tool takes into account the area, the amount of
exudate and wound bed tissue type/surface appearance as deter-
mined by the clinician. The PUSH scale was scored from 0 to 17 with
an increasing score indicating deterioration of a wound (National
Pressure Ulcer Advisory Panel, 2013). Self-reported survey data
were collected on health-related quality of life (SF-12 v2) (Ware
et al., 1996) and the Patient Enablement and Satisfaction Survey
(PESS) (Desborough, Banfield, & Parker, 2014).
All clinics operated by appointment only. Patients received edu-
cation and wound treatment, which was documented; patients
eral practitioners and practice nurses in evidence based wound management at on-site wound clinics. Collegian (2018),
https://doi.org/10.1016/j.colegn.2018.03.004
ARTICLE IN PRESSG Model
COLEGN-518; No. of Pages 7
K. Innes-Walker et al. / Collegian xxx (2018) xxx–xxx 3
implementation of the intervention. The outcome measures
included health professionals’ knowledge, confidence and prac-
tices re evidence based wound management, and patient outcome
measures of wound healing and prevention measures and satis-
faction with care. The health professional survey collected data on
demographics, education, clinical practice details, confidence lev-
els and barriers and limitations in assessment, management and
prevention of wounds. Patient data collected when attending the
wound clinic at the first visit with a wound or for prevention strate-
gies included demographic, medical history, wound characteristics,
wound management and prevention strategies; and then further
data (wound characteristics) were collected from patients attend-
ing the clinic at least every two weeks or until healing for open
wounds.
3.2. Procedure
Nine nurse-led CWCs were established in a variety of GP
practices which were located across three Australian states
(Queensland, Victoria and Tasmania). A local wound expert in each
state was employed to assist health professionals to consult with
patients and to provide training and coaching at each of these sites.
The role of the expert trainer was to provide evidence-based wound
management training and coaching for general health profession-
als as well as playing an active clinical role in the clinic for the time
that they were there. The expert trainer was in most cases a Nurse
Practitioner in wound management.
The expert trainer as part of the intervention in this study was
involved in the initial training of health professionals within each
of the clinics and then attended the clinic once/fortnight to coach
and mentor staff in clinical practice. The initial training in the prac-
tice included a workshop that covered the implementation of the
model of care, wound aetiologies, wound assessment, management
and prevention principles and evidence based practice including
the need for good documentation. The need for a multidisciplinary
approach to wound care was enforced and a referral pathway was
provided to health professionals in chart form that included details
of specialist clinics and health professionals within the area that
could offer specialist wound care advice. This workshop utilised
PowerPoint presentations that also included case studies and real
life scenarios. To assist with staff education, a wound education
and training material package named the CWC Resource Kit was
developed as part of the project and was made available to health
professionals and patients. The training content was also specifi-
cally directed towards GP with the necessary incorporation of the
relevant MBS item numbers that may be relevant to wound care
practice.
This was followed up by the wound expert attending wound
care appointments once/fortnight where the wound expert worked
with the health professional staff to treat the patients using a coach-
ing model of teaching. The wound expert would work with the
health professionals to complete an assessment of a patient with a
wound followed by the planning and implementation of evidence
based care for that patient. The health professionals were encour-
aged over time to complete all skills themselves with the ability to
ask questions and discuss options with the wound expert. Sociali-
sation of patients and carers was encouraged by scheduling at least
two visits at the same time and in the same room. Referral path-
ways were developed in consultation with GP health professionals
and utilised for referral on to specialists as appropriate.
Follow up attendance at clinical appointments by the wound
expert, in conjunction with the health professional staff, ensured
repetitive coaching in a nurturing, safe non-judgemental learn-
ing environment while incorporating the patient and family/carer
within the plan of care.
3.3. Sample
As places were limited, General Practices were invited to sub-
mit expressions of interest and were recruited if they fitted the
following inclusion criteria:
– Clinic was large enough to accommodate two or more wound
patients simultaneously
– Clinic had an interest in wound management and support from
GPs and practice managers.
– Clinic was willing to collect patient clinical and satisfaction data
and health professional surveys
Patients were recruited if they fitted the inclusion criteria:
– Patients with an open wound of any type or who visited the clinic
specifically for prevention of a wound
3.4. Data collection and measures
3.4.1. Health professionals
Data were collected from March 2013 to June 2015 to gather
information before implementation of the CWC model and after
implementation of the CWC model. The health professional survey
was developed to obtain data including demographic information
(i.e. age and gender) and qualifications (i.e. what is the highest level
of school you have completed or the highest qualification you have
received) and current wound practices (i.e. what percentage of your
work time is currently taken up with providing clinical care or pre-
ventative management to patients at risk of developing wounds or
with current wounds). The survey also asked questions in relation
to evidence based practice based on the validated Self-Efficacy in
Evidence Based Practice scale (Chang & Crowe, 2011) and included
items on attitudes (i.e. please indicate your level of agreement or
disagreement with the following statement: An interprofessional
collaborative approach to wound management results in better
patient outcomes), confidence levels in assessment, management
and prevention of wounds as well as transfer of learning and evi-
dence based wound management guidelines (i.e., please rate your
confidence level to undertake the following: Finding evidence on
wound management and clinical practice) and barriers to education
and training.
3.4.2. Patients
Data were collected from March 2013 to June 2015 and con-
tained baseline and follow up data for up to 24 weeks obtained from
medical records, clinical assessment and surveys. This informa-
tion included demographic (age, gender, medical characteristics),
health (medical history, medications, nutrition), clinical charac-
teristics of any wounds (aetiology, area, tissue type, progress in
healing), management and socioeconomic information. The Pres-
sure Ulcer Scale for Healing (PUSH) tool (National Pressure Ulcer
Advisory Panel, 2013) was used to document ulcer severity in all
wounds as this scale has demonstrated reliability and found to be
responsive in different types of leg ulcers and diabetic ulcers (Hon
et al., 2010; Ratliff & Rodeheaver, 2005; Santos, Sellmer, & Massulo,
2007). The PUSH tool takes into account the area, the amount of
exudate and wound bed tissue type/surface appearance as deter-
mined by the clinician. The PUSH scale was scored from 0 to 17 with
an increasing score indicating deterioration of a wound (National
Pressure Ulcer Advisory Panel, 2013). Self-reported survey data
were collected on health-related quality of life (SF-12 v2) (Ware
et al., 1996) and the Patient Enablement and Satisfaction Survey
(PESS) (Desborough, Banfield, & Parker, 2014).
All clinics operated by appointment only. Patients received edu-
cation and wound treatment, which was documented; patients
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