Efectividad de la Enfermera de Práctica Avanzada en el cuidado de las Heridas Crónicas Complejas en Andalucía

Abstract

IntroductionChronic wounds are a majorhealth problem, with serious consequences for patients, caregivers, family members and health professionals who work with them. In epidemiological terms of prevalences and incidences, they have a great importance in the health economy and in the quality of life in relation to health, affecting multiple physical and psychosocial factors, in addition to all the legal and institutional repercussions they can cause.For all of these, some of the proposals to help alleviate and solve part of the problem are the ones created by the International Council ofNursing and the one carried out by certain countries on the creation and implementation of the Advanced Practice Nurse in Complex Chronic Wounds, in all its different terminologies.In Spain, the figure of the Advanced Practice Nurse in Complex Chronic Wounds (EPA-HCC) began its journey in Andalusia in 2015, responding to the specific needs of the population that suffered from chronic injuries, providing a safe environment which would facilitate health prevention and promotion, patient recovery and improvement of the quality of life, being regulated within a framework document about the competence development of nurses.ObjetivesTo evaluate the impact of the implementation and the launch of the EPA-HCC in Andalusia from the perspective of its competencies and leadership in optimizing the specific needs of people with HCC and their families, guaranteeing the continuity of healthcare.To analyze the effectiveness of the advanced practice nurse in the care of complex chronic wounds in Andalusia Material and methods.A pre-post multicenter quasi-experimental study was proposed with three measurements without a control group, in which it was intended to measure the effectiveness of the EPA-HCC in Andalusia in three consecutive phases, evaluating the pre-implantation, the situation after one year and after two years.Data were extracted by each of the EPA-HCCs and independently verified by the EPA-HCC coordinator. The doubts and discrepancies in the different variables before the EPA-HCC were discriminated by the coordinator.Descriptive, clinical, independent and dependent variables were analyzed, calculating the frequency and percentage measures for the qualitative variables and central tendency and dispersion meausures for the quantitative variables, depending on whether they had a normal distribution, and the median together with the range when they did not follow this distribution, as well as the mean differences and their levels of statistical significance.Results.During the time that elapsed between 2015 and 2017, there was a substantial improvement in terms of better follow-up of patients with chronic wounds, a more continuous training, an increase in knowledge and an increase in both healing and improvement rates, contemplated in thewound records and in the significant reduction during these months of the injuries’ evolution.The nurses expressed a high level of satisfaction with the EPA-HCC in terms of recognition from the clinical, care, training and doubts and expectations pointof view, which provided a great help to many health professionals. It was worth mentioning the increase in the volume of queries the EPA-HCC received by professionals from different healthcare levels, while the referrals of patients with chronic wounds from the EPA-HCC to hospital specialists were minimal. It caused an effective management and significant cost savings in terms of hospital admissions, with good profitability and rationalization of the dressings cost.Conclusions.It has been possible to evaluate the impact on the care of patients with chronic wounds, through the training and the increase of the professionals’ knowledge about chronic wounds, the development of roles and functions that coincide with the care demands of nurses and the degree of satisfaction of the staff since it was created.The effectiveness of the EPA in the development of the different competencies has been analyzed, which has helped to improve healing rates, with a decrease in hospital referrals. It has helped to optimize the resources and to achieve savings in the materials cost of the districts where they are generally implemented