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Course Content Related to Chronic Wounds in Nursing Degree PROFESSION AND SOCIETY Course Content Related to Chronic Wounds in Nursing Degree Programs in Spain Angel Romero-Collado, PhD, MSc, RN1, Marta Raurell-Torreda, PhD, MSc, RN2, Edurne Zabaleta-del-Olmo, MSc, RN3, Erica Homs-Romero, RN4, & Carme Bertran-Noguer, PhD, MSc, RN5 1 Professor of Nursing, Nursing Department, University of Girona, Spain 2 Professor of Nursing, Nursing Department, University of Girona, Spain 3 University Institute for Primary Care Research Jordi Gol (Institut Universitari d’Investigacio´ en AtencioPrim´ aria` (IDIAP) Jordi Gol), Barcelona, Spain and Researcher associated with the Universitat Autonoma` de Barcelona, Bellaterra, Spain 4 Figueres Basic Healthcare Area (Area` Basica` de Salut de Figueres) Catalan Health Institute (Institut Catala` de la Salut), Girona, Spain 5 Head of Nursing Department, University of Girona, Spain Key words Abstract Curriculum, nursing education research, nursing students, pressure ulcer, professional Purpose: To analyze content related to chronic wounds in nursing degree competence, Spain, wound healing programs in Spain. Design: Cross-sectional descriptive study. Correspondence Methods: Course descriptions available for online access during June and Dr. Angel Romero-Collado, Professor of July of 2012 were reviewed for the 114 centers in Spain that offer a nursing Nursing, Nursing Department, University of degree, according to the official Registry of Universities, Centers, and Titles. Girona, C/ Emili Grahit, 77, 17071 Girona, Spain. E-mail: [email protected] Findings: Of the 114 centers with degree programs, 95 (83.3%) post course content online, which make it possible to analyze 2,258 courses. In 60 (63.1%) Accepted: July 19, 2014 of these centers, none of the courses included the concept of pressure ulcer prevention, and the course content posted by 36 (37.9%) centers made no doi: 10.1111/jnu.12106 mention of their treatment. None of the course descriptions contained any reference to pain management in patients with chronic wounds. Of the 728 elective courses analyzed, only one was related to chronic wounds. Conclusions: This review of available information about nursing degree programs in Spain indicates that pain management in patients with chronic wounds is not addressed in any course, and more courses consider the treat- ment of pressure ulcers than their prevention. Clinical Relevance: Degree programs responsible for the training of future nurses should be reviewed and revised as needed to ensure that graduates have acquired minimum basic competencies in the prevention and treatment of chronic wounds that help to decrease the theory–practice gap in this field. Chronic wounds are a major factor in morbidity, mortal- would be desirable. The knowledge possessed by health- ity, and healthcare costs (Augustin, Brocatti, Rustenbach, care professionals is one of the key factors most fre- Schafer¨ & Herberger, 2014; Sen et al., 2009). On health- quently identified in efforts to explain the existence of care teams, nurses typically have the responsibility of car- this theory–practice gap, although organizational and ing for patients who have these wounds or are at risk for environmental factors also have an impact (Moore, them (Caron-Mazet, Roth, & Guillaume, 2007; Romero- 2010). Cowman et al. (2012) conducted an international, Collado, Homs-Romero, & Zabaleta-del-Olmo, 2013). multidisciplinary eDelphi study to identify the research Despite increased knowledge about chronic wound and education priorities in wound management and tis- prevention and treatment, scientific evidence is not sue repair. This study offers a point of reference to con- always translated into clinical practice to the extent that sider where we are in this field and what should be Journal of Nursing Scholarship, 2015; 47:1, 51–61. 51 C 2014 Sigma Theta Tau International Course Content Related to Chronic Wounds Romero-Collado et al. done to improve the preparation of healthcare profes- nursing education (Scully, 2011). For example, the lack sionals, thereby improving the prevention and treatment of education about the prevention of pressure ulcers of chronic wounds. (PUs) is cited as a cause of their high prevalence and incidence (Moore, 2010) and of the persistence of care interventions that are not recommended, such as the Background use of “doughnut”-type devices or massaging areas of redness (Iranmanesh, Rafiei, & Foroogh Ameri, 2011; The Bologna Declaration (European Ministers of Ed- Panagiotopoulou & Kerr, 2002; Pancorbo-Hidalgo, ucation, 1999) establishes a new framework for Eu- Garc´ıa-Fernandez,´ Lopez-Medina,´ & Lopez-Ortega,´ 2007; ropean universities and a convergence of university Saleh, Al-Hussami, & Anthony, 2013). In other studies, degrees to facilitate mobility in the European job market the majority of nurses in an intensive care unit had the (Davies, 2008). It also encourages study of the major Eu- perception that their unit could improve its attention ropean Union languages and discipline-specific study in to patients who had or were at risk for developing PUs those languages. (Quesada Ramos & Garc´ıa D´ıez, 2008), and slightly more For the nursing profession in Spain, the new frame- than half of the nurses in 14 long-term care units consid- work has led to the progressive disappearance of the ered their knowledge of chronic wound management to 3-year nursing programs in universities (Zabalegui & be “average” (Caron-Mazet et al., 2007). Cabrera, 2009), which are being expanded to 4 years, The prevalence of PUs in Spain ranges from 5.9% to 240 European Credit Transfer System (ECTS) units, and 13.5%, depending on whether the population is being foreign language competency (level B2.1) in English, treated as part of a primary care home-health program French, German, or Italian. In contrast, nursing degrees or in a hospital or long-term care center (Leyva-Moral & are completed in 3½ years and 210 ECTS in Denmark and Caixal-Mata, 2009; Soldevilla Agreda, Torra Bou, Verdu´ Finland, and 3 years and 180 ECTS in Norway and Swe- Soriano, & Lopez´ Casanova, 2011). These values are den (Raholm,˚ Hedegaard, Lofmark¨ & Slettebø, 2010). Full similar to those of other European countries, such as implementation of the new degree program in Spain will Sweden’s 14.5% prevalence in nursing homes and 16.6% give the nursing profession equivalency with other de- in hospitals (Gunningberg, Hommel, Ba˚ath,˚ & Idvall, grees with respect to future options and opportunities. 2014), the 6.4% reported in a long-term care study in This includes access to higher academic degrees (mas- France (Caron-Mazet et al., 2007), and the 9% observed ter’s and doctoral degrees) by way of their own disci- in a long-term care setting in the Republic of Ireland pline rather than by way of disciplines such as biology (Moore & Cowman, 2012). or psychology. Training nurses in the prevention and treatment of PUs Another substantial impact of the Bologna process is a is of fundamental importance. Nonetheless, there are ma- change in the concept of learning. The previous model jor deficiencies in undergraduate course content related was that learning was based on the knowledge consid- to this type of wounds (Ayello, Zulkowski, Capezuti, & ered necessary to obtain the diploma. This could concur— Sibbald, 2010). In a study of emergency care profession- or not—with what the future professional would need to als in Spain (Hinojosa-Caballero, 2012), just 23% consid- know for success in the workforce, but there sometimes ered their university education about PU prevention to be appeared to be a large gap between the academic and “good,” and the rate decreased to 19% when asked about working worlds. Under the Bologna process, learning is aspects of PU treatment. Other studies have reported that oriented toward skills and competencies and is student 25% of nurses reported never having received any spe- centered (Zabalegui & Cabrera, 2009). To address the cific information about PUs in their professional program theory–practice gap, courses must be designed to achieve (Zamora Sanchez,´ 2006), 53.1% received no training spe- essential competencies, along with knowledge of theory. cific to PU wound care (Romero-Collado et al., 2013), and This aligns with the white paper on the degree in nurs- 70% indicated they did not receive sufficient education ing published by Spain’s national accreditation agency, about chronic wounds in their basic nursing education which indicated that the cross-cutting competency most program (Ayello, Baranoski & Salati, 2005). These defi- valued by practicing nurses, university professors of nurs- ciencies were also observed in textbooks recommended ing, and nursing administrators is “the ability to apply by nursing educators (Wilborn, Halfens & Dassen, 2009), knowledge to practice” (Agencia Nacional de Evaluacion´ and wide variation in PU-related textbook content has de la Calidad y Acreditacion,´ 2004). been reported (Ayello & Meaney, 2003). However, nurs- The theory–practice gap, defined as the lack of match- ing textbooks are not the only element that requires ing textbook descriptions of clinical situations with improvement to develop the needed skills. Educational the reality of practice, is a vitally important topic for programs must combine textbook content with a variety 52 Journal of Nursing Scholarship, 2015; 47:1, 51–61. C 2014 Sigma Theta Tau International Romero-Collado et al. Course Content Related to Chronic Wounds of learning methods, including hands-on experience in centers were excluded from the study.
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