A Quality Improvement Project: What First-year Nursing Students Include in Their Nursing Care Plans for Patients With Acute or Chronic Wounds

Nursing education research is lacking with regard to nursing care plans for patients who have a wound and use of the nursing diagnosis impaired skin integrity. The purpose of this quality improvement project was to inform teaching about nursing care planning for patients with wounds by examining what first-year nursing students attending a fundamentals of nursing course in a Bachelor of Science in Nursing program included in a nursing process assignment when caring for an assigned patient who had an acute or chronic wound. Because they were in their clinical rotation, students had access to the patients' medical records to facilitate composing the care plan; they also could ask the patient for information. Assessment data were entered on a predetermined form based on Gordon's Functional Patterns. Using this information, students had to provide 3 possible diagnoses and select 1 upon which they developed the care plan intended to include patient description, wound description, dressing, and nursing diagnoses and impressions. The forms then were analyzed for assessment completeness. Thirty-eighty (38) care plans completed by students were collected on patients that included 23 men and 28 African-Americans; mean age of the patients was 60.11 +/- 14.17 (range 20-87) years. Wounds included 25 surgical incisions, 4 pressure ulcers/injuries, 7 "other" wounds, and 2 not identified. None of the students' assessments provided a detailed wound description. The most common wound descriptors were location (n = 19) and drainage (n = 15). For 8 patients, students stated the wound was covered by a dressing. Thirty (30) nursing diagnoses were listed. The most common nursing diagnoses were impaired physical mobility or activity intolerance, impaired comfort, impaired skin integrity, imbalanced nutrition, and risk for infection. These nursing students had beginning skills in patient and wound assessment and writing nursing care plans about patients with impaired skin integrity. Students need to increase their depth of wound assessment and need more experience planning care for patients with wounds.