Recent Vanguard MSN graduate and wound care specialist at St. Jude Medical Center, Alicia-Perez Varela, MSN, RN, PHN and CWCN (Certified Wound Care Nurse) investigated an evidence-to-practice gap for her Thesis Research. As her thesis advisor, I encouraged Alicia to submit the abstract, AN EDUCATIONAL INTERVENTION DIFFERENTIATING PRESSURE INJURIES FROM END-OF-LIFE WOUNDS to the CACNS Annual Conference. Only Clinical Nurse Specialists can submit abstracts, I am a CNS and acted as co-author. The abstract was accepted for poster presentation.

Alicia and I attended the conference together. This was a tremendous professional opportunity for this MSN alum to disseminate her thesis research results to advanced practice nurses statewide, while also advancing her own career goals.

Alicia discovered a knowledge gap in the assessment, identification, classification, and treatment of end-of-life (EOL) wounds among healthcare professionals. The misclassification of EOL wounds as pressure injuries results in an overinflated rate of Hospital Acquired Pressure Injuries (HAPIs), hospital fines and lower reimbursement rates, and less than optimal EOL wound management.

The literature is replete with evidence related to EOL wound identification. The skin is an organ and may fail at end of life, similar to how other organs fail. In contrast pressure injuries are preventable soft tissue damage (You may have heard pressure injuries referred to as decubiti or bed sores).

• The purpose of Alicia’s research was to assist nurses in the identification and differentiation of pressure injuries from EOL wounds.
• The sample consisted of employed RNs (N=42) from 14 specialties and various settings: the Hispanic Nurses’ Association, RN to BSN / MSN students, professors, direct care nurses, and wound care nurses.
• A quasi-experimental design facilitated participation in an educational intervention on EOL wounds with a pre and post-test. Medical Center and Vanguard IRB approvals were obtained.
• Dependent variables measured were confidence in assessing PIs and differentiating PIs from EOL wounds. Independent variables: age, gender, ethnicity, years of experience, specialty, educational level, employment status, wound training, End of Life Nurse Education Consortium training, and familiarity with EOL wounds were measured in relationship to dependent variables.

Participants with prior wound training had higher survey scores and the older the participant the more confidence they reported in staging PIs.

• Pre-intervention:
  • most participants were unfamiliar with EOL wounds (71.4%, n=30)
  • 6 % of participants were a little bit confident staging PIs
  • 7% were not at all confident in differentiating PIs from EOL wounds
• Post Intervention:
  • 65% were somewhat confident in staging PIs
  • 5 % were somewhat confident in differentiating PIs from EOL wounds
  • Confidence on both above stated items increased significantly

The Clinical Nurse Specialist (CNS) is 1 of the 4 Advanced Practice Registered Nurse roles: (1) Nurse Practitioner (2) Clinical Nurse Specialist (3) Nurse Anesthetist, and (4) Nurse Midwifery.

• The CNS is authorized to order tests, diagnose, administer treatments, and in most US States, prescribe medications. They help create practice changes within an organization and ensure evidence-based care to bring about best practices.
• The five primary roles of a clinical nurse specialist are: Expert Clinician, Educator, Researcher, Consultant, and Collaborator/Patient Advocacy.
• CNSs are educated to identify shortcomings or gaps in healthcare. They might provide consultation services, communicate with patients and families, monitor care, design and implement interventions, and evaluate general delivery of healthcare.

California Clinical Nurse Specialists were highly interested in Alicia’s study due to its implications. Further nurse education related to EOL wounds and equipping direct care nurses and other healthcare professionals to perform EOL wound assessments may have significantly favorable outcomes related to nursing practice, medical diagnosis, patient care, and hospital expenditures.

Alicia’s professional conference presentation is a stellar example of how a graduate nursing student’s research can promote optimal care among a patient population.