District nurses' experiences of wound care in primary health care : management and knowledge

Aim: The overall aim of this thesis was to deepen the knowledge of wound management in primary healthcare from district nurses' (DNs) perspective. The thesis includes one pilot study (I) and two qualitative studies (II, III). The specific aims were to: investigate wound appearance, assignment of responsibilities for diagnosis and care, guidelines for wound treatment and co-operation with other professional groups (I); describe DNs' experiences of nursing actions in wound care (II); describe DNs' experiences of knowledge development in wound management when treating patients with different types of wounds (III).

Methods: DNs received a questionnaire (I). Descriptive statistical analysis and content analysis of the textual data were conducted. For study II-III qualitative interviews were performed with eight DNs (II) and with 16 DNs (III). Content of interviews were analyzed using qualitative content analysis (II-III).

Results: The results of study I show that DNs' wound management cases consisted in total of 310 wounds in 283 patients. The most common acute wounds were traumatic wounds while pressure ulcers and venous leg ulcers dominated of hard-to-heal wounds. The area of responsibility of different professional groups was not defined and guidelines for wound treatment were often lacking. Co-operation with the GPs was lacking while co-operation with ANs was rated highly. Interprofessional co-operation was regarded as important for wound healing. The results of study II identified the aspirations of DNs to provide expert wound care while working independently. These aspirations were aggravated by organisational shortcomings, such as lack of authority and resources required to carry out their nursing actions optimally. In study III the DNs describe their knowledge development as based on experiences of learning along side with clinical practice. Informants had various channels for knowledge, such as colleagues and contact with the dermatologist. Organizational structures hindered the DNs' development in wound care knowledge.

Conclusions: The result shows that DNs treat many different types of wounds and take responsibility for wound management. They strive to be practitioners of professional care but are hampered by organizational factors. The present study is a contribution to the development of DNs' wound management and the results of the thesis can be used as a basis for further research and discussions on the topic.

List of scientific papers

I. Friman, A., Klang, B., Ebbeskog, B. (2010). Wound care in primary health care: District nurses’ needs for co-operation and well-functioning organization. Journal of Interprofessional Care. 24(1), 90-9.
https://doi.org/10.3109/13561820903078249

II. Friman, A., Klang, B., Ebbeskog, B. (2011). Wound care by district nurses at primary healthcare centres: a challenging task without authority or resources. Scandinavian Journal of Caring Sciences. 25(3), 426-34.
https://doi.org/10.1111/j.1471-6712.2010.00839.x

III. Friman, A., Wahlberg, A. C., Mattiasson, A-C., Ebbeskog, B. District nurses' wound care knowledge in wound management - ongoing learning without organizational support. [Submitted]