Social Injustice of Nurses and Wound Champions

Primary health care is referred to as, “essential socially acceptable methods and technology that is made universally accessible to individuals and families in the community” (Stamler, Yiu, Dosani, Etowa, & Van-Daalen, 2020, p. 142). One of the many underlying values of primary health care is social justice. Social justice distributes health care resources to benefit vulnerable populations, while also being aware of the more privileged populations (Smith, 2019). However, at Hillsdale Terraces the nurses lack the access to the technology available to document wounds as they have an insufficiency in their education. Hillsdale Terraces is currently in the process of implementing a new documentation system for wounds through an iPad and the staff are not adapting well creating a socially unjust environment. My experience covered the process of preparing for a wound education day to return equity amongst the staff. I will be focusing on the appropriate technology primary health care principle. This paper uses John’s Model of Structured Reflection to reflect upon the situation I was involved in.

Description of Experience

My student peer and I are highly involved in creating policies, protocols and developing education about pressure injuries for the nursing staff. We are currently planning a wound prevention day in November to provide the staff with education through intriguing activities. In order to provide the education, it was in the best interest of my student peer and I to observe wound care at the bedside. First, I shadowed one of the wound champions who also works on the floor as a RPN; Kim. The day that I shadowed Kim she was on the floor as a RPN, requiring her to administer medications, provide basic treatment care and enter new orders. Throughout the shift, other nurses from other units were continually asking for help with simple wounds and wound documentation which was pulling her off the floor. This is not acceptable for the residents on the unit as they may require medications or treatment. Second, I shadowed the wound champions; Kim and Ewa, on their wound day where they assess patients they have been referred to and provide wound care for complex wounds. The wound champions found many errors in the nurses’ little documentation they did on some wounds which resulted in Kim and Ewa to question the staff, assess and document the wounds themselves, creating extra work. Also, many of the patients that had been referred to them had a simple stage one or two pressure injury. No measures to further prevent the pressure injury or a temporary treatment until Kim and Ewa assess the wound were put into place. A registered staff member could have implemented basic prevention, such as; offloading and a treatment, such as; applying a dressing (RNAO, 2016). This is significant to explore in relation to my practice as Kim and Ewa go above and beyond their roles and take on extra care. This is socially unjust for the wound champions, the other nurses and the residents. The working conditions should be fair and equitable for all workers in the workplace.

I would like to look at this experience in detail to find where the knowledge gap is within the nursing staff to eliminate it by providing the correct education in an efficient manner to make the workplace socially just for everyone. This experience relates to the primary health care principle, appropriate technology which is referred to as having the proper methods of care accessible to everyone based on the communities social, financial and cultural advancement (Stamler et al., 2020). In this case, the nurses lack the education in the technology provided for wound care and documentation. Equity is an important component of appropriate technology in order to allow access to all (Stamler et al., 2020). Furthermore, some nurses may lack the access to receive further education on wounds and technology due to social determinants of health. For example, the lack of social support networks, education, income or employment and working conditions could all contribute to not being able to obtain further knowledge on appropriate technology. This will be further discussed in the analysis of the experience.

Analysis of Experience

A factor that influenced the way I felt, thought, and responded to this experience was my knowledge and current education from learning about socially just communities through school. Additionally, Kim and Ewa’s stress to provide the bedside education and the extreme measures they reach in order to complete the care also influenced how I reacted in this experience. Kim and Ewa agree in that they are always going out of their way, but they continue to do so as they want the best for the residents. They feel the stress on them to provide the education to the staff and to increase their comfort with documentation on the iPad at the beside. This happened because the nurses have a knowledge gap as a lot of them are out of practice and social determinants of health could be impacting this. A lack of social support networks could have an impact as it is highly likely that many of the nurses have small children preventing them from expanding their current education. Also, the extra stress for the nurses to adapt to a new situation may have an effect on their mental health causing them to put up barriers as they may not have the coping skills to adapt to the new technology. Some nurses may not have the background education or the current education in order to learn the new technology. Additionally, other nurses may want to receive the extra education, but may not have the income to afford it. In terms of employment and working conditions, the nurses who would like the further education may not be able to receive it in the home due to the physical environment as the wound champions could be occupied or the floor could be too heavy that day. On the other hand, if the nurse chose to receive the education outside of the home it may not be possible as the nurse’s spot will most likely be unable to be backfilled. Regardless of the barriers, the nurses need the further education to be provided to them to fill this knowledge gap and correct the socially unjust situation.

The consequences for the resident is that they may not get the best care due to the nurse’s knowledge gap and on the other hand, the wound champions have extra care to perform so they may not get to all residents. This also affects Kim and Ewa as they have extra stress on them to provide the extra care and the education which could impact their mental health. The literature confirms the significance of pressure injuries among older adults in nursing homes. Latimer et al. (2019) performed a correlational study on a sample of 1047 participants aged 65 years or older to assess how quickly a pressure injury develops. The result was that 113 out of 1047 (10.8%) older adults were observed to have developed a pressure injury within the first 36 hours (Latimer et al., 2019). Carryer et al. (2017) performed a cross-sectional study of 276 residents aged 65 years or older across 13 nursing homes to study the prevalence of pressure injuries. The prevalence of a pressure injury was found to be 8% and the residents aged 75-84 years were more prone (Carryer et al., 2017). Also, majority of the residents (80%) were identified for being at risk for a pressure injury to develop and 20% of the residents were highlighted as high risk (Carryer et al., 2017). Considering how quickly a pressure injury can develop and how common they are, correct documentation through the iPad allows for faster interventions to be put in place and consistent documentation is important to assist in wound healing. Moreover, there are barriers to access the education, but it is greatly needed among the staff to prevent pressure injuries from developing or worsening.

Personal Areas of Development

This experience definitely impacted me as I was concerned for Kim and Ewa as it is a lot of extra stress on them. Additionally, I was upset for staff who couldn’t access the extra education and for residents who didn’t receive the best care possible. Originally, we were planning on providing the education in a stationary location; however, we decided to make the education more accessible by setting it up on a cart and bringing it to each unit. We realized that nurses respond more effectively to education on the spot that is brought to them as they most likely would not have time during their shift or break to attend the education. Also, we have switched the education to include more hands on activities as most nurses learn through a tactile learning style (Hallin, 2014). There is no consequence to switching our education approach as this will benefit the staff, the wound champions and the residents. I definitely feel more content about this experience now knowing that we are providing this education, so this situation can make progress forward in being corrected. This reflection has changed my practiced through the education component as it will assist me in my future practice if I need to provide education to a staff member or patient. Along with the education being provided, resources about iPad documentation that will catch the nurses attention would be beneficial to quickly read so the nurses can reference a document if they are unsure. Additionally, the homes medical supply vendor has a team that focuses on wound education specifically and provides resources to the staff. This would be beneficial to assist Kim and Ewa and take some of the stress off of them. Overall, I believe we have identified the knowledge gap and the education that will be provided will assist in correcting the deficit.

Conclusion

In conclusion, the knowledge gap of lacking access to the wound documentation technology has been identified. Many of the staff lack the knowledge and education of technology due to barriers from the social determinants of health. Education in this area is a necessity as it will allow the nurses to implement interventions quicker to decrease the prevalence of pressure injuries in the home. Once the wound prevention day has occurred, I will be able to look at what I could have done differently to engage all of the community and make it more inclusive. Overall, once education is provided the home can make progress towards creating a socially just environment for all staff.

References

1. Carryer, J., Weststrate, J., Yeung, P., Rodgers, V., Towers, A., & Jones, M. (2017). Prevalence of key care indicators of pressure injuries, incontinence, malnutrition, and falls among older adults living in nursing homes in New Zealand. Research in Nursing & Health, 40(6), pp. 555-563. Retrieved from https://doi-org.uproxy.library.dc-uoit.ca/10.1002/nur.21835
2. Hallin, K. (2014). Nursing students at a university – a study about learning style preferences. Nurse Education Today, 34(12), pp. 1443-1449. Retrieved from https://doi.org/10.1016/j.nedt.2014.04.001
3. Latimer, S., Chaboyer, W., Thalib, L., McInnes, E., Bucknail, T., & Gillespie, B.M. (2019). Pressure injury prevalence and predictors among older adults in the first 36 hours of hospitalisation. Journal of Clinical Nursing, 28(21-22), pp. 4119-4127. Retrieved from https://doi-org.uproxy.library.dc-uoit.ca/10.1111/jocn.14967
4. Registered Nurses’ Association of Ontario (2016). Assessment and management of pressure injuries for the interprofessional team. Third Edition. Toronto, ON. Retrieved from https://rnao.ca/sites/rnao-ca/files/Pressure_Injuries_BPG.pdf
5. Smith, M.A. (2019). The promotion of social justice. Nursing Made Incredibly Easy, 17(2), pp. 26-32. Retrieved from doi: 10.1097/01.NME.0000553091.78584.a9
6. Stamler, l., Yiu, L., Dosani, A., Etowa, J., & Van Daalen-Smith, C. (2020) Community health nursing: A Canadian perspective (5th Ed.). Toronto, ON: Pearson Canada.