Date of Award
2025
Document Type
Doctor of Nursing Practice (DNP)
Degree Name
Doctor of Nursing Practice (DNP)
Department
Nursing
Committee Chair
Azita Amiri
Committee Member
Shika Modi
Committee Member
Andrea Holmes
Subject(s)
Leg--Ulcers--Nursing, Wounds and injuries--Nursing, Wound healing
Abstract
Venous leg ulcerations (VLUs) commonly affect older adults, rural residents, and those with multiple health conditions, leading to high healthcare costs and significant physical and social challenges. The gap between demand for VLU management and available advanced practice providers (APPs) extends healing time and delays access to specialized care, increasing the risk of complications and patient dissatisfaction. This quality improvement project was designed to understand the effect of implementing a nurse-led service using the TIME tool and the Wound, Ostomy, Continence Nurses Association (WOCN) guidelines in VLUs healing time and time to access care over twelve weeks as compared to pre-intervention. A nurse-led intervention involves wound clinic nurses (WCN) being trained in wound assessment, treatment planning, and patient management under the supervision of a nurse practitioner. After teaching two WCNs the TIME tool and WOCN guidelines before the start of the project, WCNs delivered weekly care to VLU patients during the project implementation. Thirty-nine patients ages 50-65 with no concomitant peripheral arterial disease, type II diabetes, cognitive impairment, or rheumatological disorders such as mixed connective tissue disease immunocompromised were included in the intervention. The twelve-week timeline was chosen based on evidence that successfully utilized a nurse-led service. The wound was considered healed when the size was less than 1 cm2 or had 100% new skin tissue. For the pre-intervention group, the project lead extracted wound size at weeks 4, 8, and 12 and healing and access times for 16 newly referred patients who met inclusion criteria 12 weeks before the intervention. Fifty percent and 82% of patients had a wound healed at 12 weeks for pre-intervention and intervention groups (mean = 104.19 and 47.85 days), respectively (p < .001). Furthermore, the pre-intervention access time to the wound clinic mean was 19.31 days, which was reduced to 7.68 days after intervention (p < .001). A Friedman test indicated that the decrease in wound size was statistically significant across different periods within the intervention group. This QI project demonstrated positive results consistent with the literature, significantly reducing wound healing time and improving access to expert care with a nurse-led wound service.
Recommended Citation
Akinade, Amaka, "Implementation of a nurse-led service to improve venous ulcer healing time and access" (2025). Doctor of Nursing Practice (DNP). 136.
https://louis.uah.edu/uah-dnp/136