Assessment |
- Assess comprehensive factors affecting wounds
- Psychosocial factors affecting care (e.g., patient and caregiver ability to learn and perform care, economic implications, education, mental status, family dynamics, cultural beliefs)
- Factors affecting wound healing (e.g., nutrition, comorbidities, medications, age, pain, mobility)
- Skill in identifying need for diagnostic studies (e.g., biopsy, blood values, imaging, vascular, toe-brachial index, ankle-brachial index, duplex scanning)
- Obtain patient health history through interviews, established medical records, and questionnaires to determine the patient’s current health and risk status
- Interview processes
- Basic diagnostic test results (e.g., lab values, imaging studies, vascular studies, wound cultures)
- Performing initial assessment (e.g., history and presentation, comorbidities, cultural diversity, age, medications, psychological issues)
- Interpreting nutritional status (e.g., lab values, diet history, BMI, appearance)
- Interpreting pain using verbal and nonverbal tools
- Perform focused assessments to determine current skin status and wound etiology (pressure, venous, arterial, neuropathic, other)
- Dermatological etiology (e.g., contact dermatitis, fungal infection, herpetic lesions)
- Wound etiology (e.g., pressure, lower extremity arterial disease, lower extremity venous disease, neuropathic, trauma, surgical, atypical, burns)
- Skin and wound classification systems (e.g., pressure injury stages, medical adhesive-related skin injury, moisture-associated skin damage, skin tears, Wagner)
- Periwound characteristics (e.g., induration, temperature, fluctuation, denudation, maceration, cellulitis)
- Wound characteristics (e.g., tissue type, dimensions, location, exudate, odor, wound edges, color, epibole)
- Phases of wound healing (e.g., hemostasis, inflammation, proliferation, maturation)
- Characteristics of healing wounds (e.g., granulation, decreased dimensions, resurfacing)
- Characteristics of non-healing wounds (e.g., infection, biofilm, closed edge)
- Indications and side effects of medications affecting wound healing
- Skill in utilizing risk assessment tools (e.g., Braden Scale, Braden Q Scale, Norton Plus Scale)
- Lower extremity assessment (e.g., quality of pulses, capillary refill, appearance of skin, elevational pallor, hair and nails, edema, protective sensation, proprioception)
- Identifying the need for wound culture and choosing the most appropriate method
| 26 | 23.5% |
Intervention |
- Recommend and/or provide appropriate interventions to promote optimal wound management
- Principles of wound care (e.g., filling of dead space, moisture balance, periwound skin protection)
- Wound bed preparation (e.g., debridement, infection management, moisture management, wound edge optimization)
- Determining interventions to manage wounds (e.g., adjunctive modalities, offloading, support surfaces, protective footwear, tight glucose control, total contact casting)
- Types, indications, and contraindications of debridement (e.g., biologic, autolytic, chemical, mechanical, surgical, conservative sharp, excisional)
- Recommending appropriate pain management modalities
- Obtaining wound cultures (e.g., aspirate, Levine, punch biopsy)
- Recommending and/or performing appropriate studies (e.g., biopsy, laboratory, radiography, toe-brachial index, ankle-brachial index, transcutaneous oxygen pressure, duplex scanning)
- Implement prevention measures to promote optimal skin health and prevent injury
- Preventive measures based on risk assessment (e.g., moisture management, pressure redistribution, offloading, friction and shear management, nutrition)
- Types of support surfaces
- Implementing interventions based on risk assessment (e.g., moisture management, pressure redistribution, nutrition, cognition, mobility, offloading)
- Utilizing appropriate skin care products
- Preventing complications of wound healing (e.g., infection, maceration, inappropriate product use)
- Selecting support surfaces
| 18 | 16.6% |
Treatment |
- Recommend and/or perform wound bed preparation
- Recommending appropriate wound cleansing regimen
- Wound bed preparation (e.g., infection management, moisture management, wound edge optimization)
- Recommend and/or perform debridement to promote wound healing
- Types of debridement (e.g., biologic, autolytic, chemical, mechanical, surgical, conservative sharp, excisional)
- Identifying indications and contraindications for debridement
- Identifying wounds that require chemical cauterization
- Selecting appropriate debridement modalities
- Recommending appropriate topical treatment to maintain periwound integrity
- Selecting and applying topical therapies for moist wound healing (e.g., containment of drainage, eliminate dead space, reduce bioburden, control odor)
- Knowledge and application of advanced/adjunctive therapies to promote wound healing
- Types, indications, and contraindications for compression therapy
- Types of advanced modalities for treatment (e.g., leech therapy, bioengineered tissue, negative pressure wound therapy, hyperbaric oxygen therapy)
- Types of adjunctive modalities (e.g., hydrotherapy, hyperbaric oxygen therapy, pulsed lavage, mist therapy, maggot therapy)
- Recommending compression therapy to manage edema (e.g., dynamic and static compression therapy)
- Applying compression therapy (e.g., dynamic and static compression therapy)
- Recommending and/or performing advanced wound therapies (e.g., leech therapy, bioengineered tissue, negative pressure wound therapy, hyperbaric oxygen therapy)
- Recommending and/or performing adjunctive modalities (e.g., hydrotherapy, hyperbaric oxygen therapy, pulsed lavage, mist therapy, maggot therapy)
- Recommending and/or performing total contact casting
| 32 | 29.5% |
Care Planning |
- Develop a patient-centered plan of care using health history and assessments to establish skin and wound management goals
- Principles of patient-centered care (e.g., psychosocial issues, access to care, cultural beliefs)
- Identifying and supporting patient and caregiver goals (e.g., preventive, palliative, maintenance, curative)
- Setting patient-focused goals (e.g., preventive, palliative, maintenance, curative)
- Evaluate the patient-centered plan of care using periodic assessments to promote optimal skin and wound management
- Evaluating the effectiveness of the current treatment plan
- Interpreting patient responses to interventions
- Modifying interventions based on revised patient needs and goals
| 13 | 11.8% |
Education and Referral |
- Educate patients and caregivers by using the individualized skin and wound care plan to prevent complications, maintain optimal skin and wound health, and encourage patient autonomy
- Educate patients and caregivers on wound management and prevention
- Education based on health literacy and patient/caregiver goals
- Factors affecting wound management (e.g., infection control, nutrition, moisture management, repositioning, tobacco cessation, glycemic control, compliance)
- Available resources (e.g., support and advocacy, supply access, post-acute care)
- Educating the patient and family on procedures, rationale, and significance of diagnostic test results
- Educating the patient and caregivers on wound care procedures and skin care
- Educating patients and caregivers about modifiable risk factors (e.g., tobacco cessation, exercise, safety awareness, diet, offloading)
- Recommending non-invasive and invasive interventions (e.g., pharmacological, walking program, surgical)
- Educate healthcare professionals on skin and wound care management
- Factors affecting wound management (e.g., infection control, nutrition, moisture management, repositioning, tobacco cessation, glycemic control, compliance, trauma avoidance)
- Educating healthcare clinicians and providers on skin and wound care principles, procedures, and treatment goals
- Facilitate multidisciplinary care collaboration and referrals
- Available resources (e.g., support and advocacy, supply access, post-acute care)
- Referrals for other services (e.g., rehabilitation, nutrition, diabetic education, social services, mental health)
- Referral for appropriate studies (e.g., biopsy, laboratory, radiography, toe-brachial index [TBI], ankle-brachial index [ABI], transcutaneous oxygen pressure [TcPO2], duplex scanning)
- Facilitating appropriate consultations (e.g., surgery, infectious disease, dermatology, podiatry)
- Providing handoff communication
| 21 | 18.6% |
