Exploring the role of the wound care clinical nurse consultant in Australia

Abstract

Introduction The Wound Care Nurse (WCN) is a professional whose role has developed haphazardly over the years since the role was first described (in this case as a Tissue Viability Nurse) in the early 1980s. In the Australian context, it is still unclear exactly what this field encompasses and the expectations of what this position should/could entail. Although anecdotally all positions have some common tasks and obligations, the differences among the positions in various institutions lead to individual roles following diverse pathways with significant differences in responsibility. Aim The aim of this descriptive study undertaken between July 2011 and July 2016 was to explore the context, range of practice and impact of the WCN in the Australian context. Method An integrative literature review was used to examine the three areas of inquiry: the context of practice, scope of practice and impact of the WCN. Following this is an exploratory study that uses descriptive research to explore the demographics, context and range of practice and impact of the WCN in the Australian context. This descriptive study was conducted between the 16th of February 2015 and the 7th of April 2015 and uses a quantitative research method. A demographic, context and range of practice questionnaire was designed specifically for use in this study. Results The integrative review included 45 documents in the review. These studies include 35 published research papers, three editorials, two theses (one randomised control trial and one descriptive study), two job description/competency standard documents, and one transcribed panel debate. The results of the exploratory study indicate that a WCN who participated in this questionnaire is primarily female, around 48 years old, has 24 years post graduate experience, has worked for 11 years in a specialist wound care position 38 hours a week with an average of eight hours of unpaid overtime. The primary and secondary practice settings of WCNs are generally in tertiary referral hospitals, community nursing teams and nurse led clinics. WCNs who participated in this questionnaire primarily care for adult and aged patients with a large variety of wound types and co-morbid conditions. Prior to attending a patient the WCN reviews the clinical documentation of the patient and communicates with all involved in the patient’s care. When attending a wound assessment a WCN first gains a patient story and then performs a holistic wound assessment. When interacting with a medical device or pharmacology industry associated with wound management, the WCN is prepared to see an industry representative once every ten weeks for a period of thirty minutes. The results demonstrate that WCNs who participated in this questionnaire collect data on a range of wound management related topics with the most common type of data collected being occasions of service, wound type, and pressure injury. Conclusion The role of the WCN is a relatively new nursing position that has developed due to an ever increasing need for expert wound advice in an increasingly complex health care environment. When examining the existing literature (through an integrative review) surrounding the role of the WCN, it was found that, rather than discussing what care a WCN actually provided in the clinical setting, the qualities that made a good WCN were more often discussed. The impact of the WCN was poorly represented in the literature, providing very little evidence that the WCN role makes any difference outside of the area of pressure injury prevention. The descriptive questionnaire developed after the integrative review (specifically for Australian WCNs) found that the title most commonly used for the WCN is clinical nurse consultant. WCN’s primarily care for adult and aged patients with a large variety of wounds and associated co-morbid conditions. The role of the WCN in Australia is the clinical management and co-ordinated care and prevention of wounds, regardless of the location of their practice or the title of their position. The role of the WCN can, at any time, be a clinician, educator, mentor, budget manager and researcher. While the results of this thesis provide an insight into the WCN in Australia further research is warrant, particularly regarding the impact of the WCN.