Treatment of chronic wounds
Address of information system with evidences of research contribution and evidences of societal impact
Institute of Health Sciences, College of Medical Sciences, University of Rzeszow
Title of societal impact case study
The implementation and realization by nurses of innovative methods of chronic wound treatment in home and outpatient care conditions.
1. Research contribution
The issue of the occurrence and treatment of chronic wounds in the population of people over 60 years of age in non-stationary care conditions is the main direction of research conducted within the Institute of Health Sciences (INoZ). The possibilities of providing professional care, prevention and options for local treatment of chronic wounds can be implemented by nurses who will be professionally prepared for this in terms of qualifications and competences, as well as professional decision-making and independence.
Chronic wounds are a serious problem, both for inter-professional teams and for patients in whom they significantly reduce the quality of life. Worldwide, the problem of difficult-to-heal wounds affects approximately 20 million people. Statistics show that the number of patients with this problem is constantly growing, for example due to the more and more common occurrence of civilization diseases, such as obesity and diabetes. In addition, chronic wounds are much more common in the elderly, in whom tissue regeneration is impaired, and the forecasts indicate that the aging process will continue. Evidence-based practice is now widely recognized as the key to improving the quality of healthcare and treatment outcomes. Evidence from research (effective innovation) must be backed up by effective implementation and a context for achieving meaningful results. An interdisciplinary research team was established ("Wounds is the challenge of the 21st century in Poland"). "Marjolin's ulcer in chronic wounds - review of available literature" Bazaliński et al., (H-index - 4), published in 2017, contributed to the global discussion on chronic wounds and their impact on society. The article has been cited worldwide (Cited by 29 documents, Scopus, Web of Science Core Collection 20 Times Cited), e.g. in Denmark, Portugal, Mozambique, Italy, United States, China, Spain, Australia, Germany, France, Romania, Moldova, United Kingdom, Brazil, Japan, Argentina, Singapore.
The main initiator and originator of the research project is Dariusz Bazaliński, the habilitated doctor of health sciences, specialist of surgical nursing, also a clinician dealing with wound care and professional care for 20 years. The main role he plays in the team is staff training, practical implementation of modern treatment methods, consulting, e-consulting and conducting local treatment of chronic wounds in cooperation with other medical experts (e.g. Prof. Tomasz Banasiewicz, Dr. Marek Kucharzewski, doctor Dorota Kaczmarska). The team members are the following: PhD in Humanities Joanna Przybek-Mita - a specialist in surgical and oncological nursing dealing with wound healing, organizing and conducting postgraduate education. She manages the Postgraduate Education Center for Nurses and Midwives (OKPPiP) in Rzeszów, which is one of the few centers in the country with a high pass rate of specialization exams, employing the best lecturers to teach practical aspects of the profession. Habilitated doctor of health sciences Paweł Wiech, a specialist in emergency nursing, is the team leader. He deals with the assessment of nutritional status using bioimpedance and acts as a scientific expert in the field of preparation of papers for indexed journals. Doctor of health sciences Izabela Sałacińska - a specialist in anaesthesiological nursing is a member of the team, she performs the coordinating function of the student scientific club, prepares speeches and conference presentations, actively participates in scientific works and collecting data from conducted research.
The research effort undertaken began with assessing the knowledge of nurses within the Podkarpackie region and assessing the needs of postgraduate development in fields dealing with advanced specialist care at home (publications by Bazaliński et al. Surgical and Angiological Nursing 2017). The thematic blocks were gradually implemented in the education system (it was possible due to changes in post-graduate education 2015 and 2018) of innovative methods of local wound treatment, training and implementation of these methods in everyday clinical practice (publication; Bazaliński et al: Contemporary Oncology 2017, Treatment of Wounds 2018, chapters in the book; Bazaliński et al. Treatment of chronic wounds 2019 and habilitation monograph; Bazaliński 2019). Initiating and mobilizing nurses to undertake advanced activities in the patient's environment gave the opportunity to increasingly introduce innovative methods for wound healing (wound cleaning using lucilia sericata larvae - MDT (Maggot Therapy Debridement), the use of negative controlled pressure in wound healing - NPWT) (Bazaliński publications et al. 2018, 2019). The above scientific and didactic activities were translated into the creation and functioning of an out-patient clinic, within the Podkarpackie Oncological Center in Brzozów, aimed at chronic wound treatment.
2. Evidence of research contribution
- Bazaliński Dariusz, Zmora Magdalena, Przybek-Mita Joanna, Kózka Maria: Preparation of nurses to care for a patient with a chronic bedsore wound, including the type of their professional qualifications. 2017; 11 (1): 13-19 (20 pkt MNiSW).
- Bazaliński Dariusz, Przybek-Mita Joanna, Barańska Beata, Więch Paweł. Marjolin's ulcer in chronic wounds - review of available literature. Contemporary Oncology 2017; 21 (3): 197-202. DOI: 10.5114/wo.2017.70109 (40 pkt MNiSW).
- Bazaliński Dariusz, Barańska Beata, Kaczmarska Dorota, Wołkowicz Magdalena, Kózka Maria: Usefulness of selected methods of chronic wound cleaning in patients under hospice care at home conditions. Wound Treatment. 2018;15(2); 65-70 (5 pkt MNiSW).
- Dariusz Bazaliński, Maria Kózka, Magdalena Karnas, Paweł Więch: Effectiveness of Chronic Wound Debridement with the Use of Larvae of Lucilia Sericata, Journal of Clinical Medicine. 2019: 8, 1845; doi.org/10.3390/jcm8111845 (140 pkt MNiSW).
Monographs and chapters in books:
- Bazaliński Dariusz, Chmiel Zdzisława, Kózka Maria: Nursing care for a patient with a chronic wound of cancer etiology. In: Szewczyk M. T., Jawień A. (eds.): Treatment of chronic wounds. Warszawa: Wydawnictwo Lekarskie PZWL, 2019 s: 256-292 (ISBN 978-83-200-5737-9) (20 pkt MNiSW).
- Bazaliński Dariusz, Przybek-Mita Joanna, Kózka Maria: "Wound management" at the end of life. In: Szewczyk M. T., Jawień A. (eds.): Treatment of chronic wounds. Warszawa: Wydawnictwo Lekarskie PZWL, 2019 s: 293-317 (ISBN 978-83-200-5737-9) (20 pkt MNiSW).
- Bazaliński Dariusz: Efficacy of biological therapy using Lucilia sericata larvae in the treatment of chronic wounds in patients in long-term and palliative care. Uniwersytet Rzeszowski (rec. dr hab. n. med. Marek Kucharzewski) (ISBN – 978-83-7996-642-4) (80 pkt MNiSW).
3. Characteristic of societal impact
Targeting research related to the treatment of chronic wounds had a significant cause-and-effect relationship with the socio-demographic situation in the Podkarpackie region. Since 2005, the National Health Fund (NFZ) has started financing long-term care and then palliative care at home. When consulting patients at home, it was pointed out that they often require specialized medical activities, whose performance and long-term conduct in home environment is cheaper and at the same time more beneficial for a potential patient. Specialist techniques related to local wound care (specialist dressings, surgical necrectomy, scraping, compression therapy) were gradually implemented, and progress and effects of treatment were observed, far-reaching conclusions were drawn regarding the fact that a prepared and targeted nurse would be a bond between the patient and the doctor in the care of, and also in the performance of therapeutic and diagnostic activities for the patient (assessment of condition and physical examination, compression therapy, wound healing, prescribing medication, prolonging medical prescriptions). During teaching (for the first time in 2009), their own observations were discussed with people who served as family nurses of palliative care who were interested in such a fact. Patient opinions were collected about the willingness to undertake nursing activities, thus initiating the possibility of nursing consultations as part of volunteering, these activities have been implemented since 2010, while in 2017 statutory research and implementation of innovative methods (MDT and NPWT), which in home nursing care were practically unknown. In a series of publications published since 2009, we drew attention and created the advantages of nursing activities in conditions of non-stationary care.
4. Evidence of societal impact
Scientific activity combined with professional practice based on scientific facts (EBM, EBN) determined the increased interest in the problem of chronic wound care at home. Considering the aging of the society of Europe, and thus also of Poland, it is estimated that over 2% of citizens in the country have problems with skin lesions classified as chronic wounds of various etiologies (most often venous, mixed, arterial ulcers, pressure ulcers, complicated difficult to heal surgical and traumatic wounds).
The growing amount of expert knowledge provided to nurses during training, as well as scientific and professional achievements implemented in everyday practice for patients with chronic wounds were the basis for the following social impact activities:
- Initiating free consultation of patients with chronic wounds in the home environment as part of statutory research "Innovative and alternative methods of wound care in long-term and palliative care". From 2017 to the present, the most deprived people requiring care and supervision are assigned to the care of a student research club, directed to a wound care clinic. The systematic implementation of the care model (described in the Bazaliński 2019 habilitation monograph) based on the use of innovative and alternative methods of chronic wound treatment is also carried out in direct care for patients under long-term and palliative care implemented by such units as: Med Dom Sp. ZOO Niebylec 224, Geria med. Home care Brzozów. The number of patients covered by innovative activities since 2017 concerns over 60 chronically ill people. (Individual, difficult cases of treated patients were described in Polish and English-language scientific journals as a case study).
- Conducting and supervising, together with the members of the research team, education in the field of anti-bedsore prevention and treatment of chronic wounds aimed at students associated in the student research club at INoZ. Creating and implementing young professional staff is an indispensable element of the continuation of the intended research goal, students actively participate in statutory research, scientific conferences and practical workshops. Depending on the level of their education (first and second level of studies), they carry out caring and therapeutic activities in the patient's home environment. By gathering experience under the supervision of mentors (D. Bazaliński, J. Przybek-Mita), they enter the path of professional decision-making, which increases their responsibility as well as future decision-making in independent advanced professional practice.
- Conducting training in the field of wound healing, assessment of nurses' competences and knowledge in the field of anti-bedsore prophylaxis and wound treatment based on guidelines of Polish Society for Wound Treatment (PTLR), as part of classes on specializations and courses conducted at OKPPiP in Rzeszów. This last link is aimed at strengthening the professional group of nurses who are interested in the prevention and treatment of wounds. Organized classes are interdisciplinary, and their purpose is to prepare for independent practice related to professional care, diagnostics, prevention, evaluation and local wound treatment in selected disease entities. In the last three years, 1061 nurses and 182 midwives have been trained in specialized training and specialized courses:
Specialist courses in wound treatment for nurses in south-eastern Poland:
Course in wound treatment for nurses - Rzeszów, 28.03.2017 - 01.06.2017 (23 persons)
Course in wound treatment for nurses - Łańcut, 30.06.2017 - 30.09.2017 (17 persons)
Course in wound treatment for nurses - Krosno, 28.06.2017 -21.09.2017 (23 persons)
Course in wound treatment for nurses - Lesko, 30.06.2017 -28.09.2017 (16 persons)
Courses in wound treatment for midwives in south-eastern Poland:
Courses in wound treatment for midwives - Rzeszów, 28.03.2017 - 25.05.2017 (21 persons)
Courses in wound treatment for midwives - Rzeszów, 07.11.2017 - 25.01.2018 (30 persons)
- Establishment of a Chronic Wound Treatment Clinic as part of the Specialist Hospital of the Podkarpackie Cancer Center in Brzozów by resolution of December 2019.
Certificates of the use of prophylactic and therapeutic methods in the treatment of chronic wounds and training conducted in this area:
- Wound healing specialist courses for nurses OKPPiP.pdf [1.84 MB]
- Courses on the prevention and local treatment of chronic wounds Geria Med.pdf [332.35 KB]
- Opinion on Professor D. Bazaliński, MD, issued by the Specialist Hospital In Brzozów Brzozów.pdf [790.98 KB]
- Opinion on Professor D. Bazaliński, MD, issued by „Med.-Dom”–Niebylec Med Dom.pdf [501.26 KB]
In March 2020, an application was submitted to the Vice-Rector of the University of Rzeszów for establishing cooperation with the Podkarpackie Oncological Center and changing the name to a Wound Treatment Clinic, so that it would be possible to conduct scientific research and train medical staff as part of the clinic’s activity. The culmination of many years of activities related to staff education as well as evidence-based professional practice is the formalization of conducting therapeutic activities in the wound care clinic, which for 2020 received the National Health Fund contract in the amount of 40 thousand zł .
The above mentioned scientific-didactic and clinical activities, implemented in recent years by the research team, had the following social impact:
- increasing the role of a nurse in the prevention and treatment of chronic wounds by undertaking independent actions resulting from qualifications and competences in the home environment;
- improving the quality of nursing care (unpublished master's thesis D. Wierzbińska; “Opportunities for self-care and expectations of medical personnel of people with a diagnosed and treated chronic wound in the lower limbs” - supervisor D. Bazaliński, Rzeszów 2018);
- improving access to nursing specialists dealing with chronic wound care (creation of a Wound Care Clinic in Brzozów, which conducts e-consultations and home nursing visits);
- implementing innovative methods of wound cleansing (MDT) and wound healing (NPWT);
- reducing the number of hospitalizations for patients in home care.
5. Justification of interdisciplinarity and breakhrough of the research
Targeting research on wound healing, as part of scientific work at the College of Medical Sciences of the University of Rzeszów, is not a pioneering activity, but on a national scale, especially in Podkarpackie, it is one of the few units that has taken development directions in this field. The leading centers in the country are the Universities in Bydgoszcz and Poznan. Cooperation with prof. Tomasz Banasiewicz (Poznan University of Medical Sciences) - a specialist in surgery, a pioneer in the treatment of wounds of various etiologies with the use of NPWT (conducting workshops at the NPWT conference, exchange of experience), as well as prof. Maria Teresa Szewczyk (Collegium Medicum in Bydgoszcz) - preparation of chapters for textbooks, publications for magazines, presentation of works at conferences and prof. Maria Kózka (Jagiellonian University in Kraków) - presentation of works at scientific conferences, publications of works dealing with various aspects of wound healing in nursing. Considering the use of the MDT method in wound cleansing, the University of Rzeszów is currently a leading university dealing with this issue. We consider establishing contact and future cooperation with prof. Ronald Scherman from the United States (University of California), who is a global expert and pioneer of MDT.