The process of clinical decision-making in chronic wound care: A scenario-based think-aloud study

Steven Smet; Sofie Verhaeghe; Dimitri Beeckman; Anika Fourie; Hilde Beele

doi:10.1016/j.jtv.2024.03.002

The process of clinical decision-making in chronic wound care: A scenario-based think-aloud study

J Tissue Viability. 2024 May;33(2):231-238. doi: 10.1016/j.jtv.2024.03.002. Epub 2024 Mar 1.

Authors

Steven Smet¹, Sofie Verhaeghe², Dimitri Beeckman³, Anika Fourie⁴, Hilde Beele⁵

Affiliations

¹ Wound Care Centre, Ghent University Hospital, Ghent, Belgium; Skin Integrity Research Group (SKINT), University Centre for Nursing and Midwifery (UCVV), Department of Public Health and Primary Care, Ghent University, Ghent, Belgium. Electronic address: Steven.Smet@uzgent.be.
² University Centre for Nursing and Midwifery (UCVV), Department of Public Health and Primary Care, Ghent University, Ghent, Belgium. Electronic address: Sofie.Verhaeghe@ugent.be.
³ Skin Integrity Research Group (SKINT), University Centre for Nursing and Midwifery (UCVV), Department of Public Health and Primary Care, Ghent University, Ghent, Belgium; Swedish Centre for Skin and Wound Research (SCENTR), School of Health Sciences, Örebro University, Örebro, Sweden. Electronic address: https://twitter.com/DimitriBeeckman.
⁴ Skin Integrity Research Group (SKINT), University Centre for Nursing and Midwifery (UCVV), Department of Public Health and Primary Care, Ghent University, Ghent, Belgium. Electronic address: https://twitter.com/anika_fourie.
⁵ Wound Care Centre, Ghent University Hospital, Ghent, Belgium; Department of Dermatology, Ghent University Hospital, Ghent, Belgium. Electronic address: Hilde.Beele@uzgent.be.

PMID: 38461069
DOI: 10.1016/j.jtv.2024.03.002

Abstract

Aims: To undertake a comprehensive investigation into both the process of information acquisition and the clinical decision-making process utilized by primary care nurses in the course of treating chronic wounds.

Design: Scenario-based think-aloud method, enriched by the integration of information processing theory. The study was conducted within the framework of home care nursing organizations situated in Flanders, the Flemish speaking part of Belgium. A cohort of primary care nurses (n = 10), each possessing a minimum of one year of nursing experience, was recruited through the collaboration of three home care nursing organizations.

Methods: Two real-life clinical practice scenarios were employed for the interviews, with the researcher adopting the roles of either the patient or another clinician to enhance the realism of the think-aloud process. Each think-aloud session was promptly succeeded by a subsequent follow-up interview. The Consolidated criteria for Reporting Qualitative research checklist was followed to guarantee a consistent and complete report of the study.

Results: Amidst noticeable variations, a discernible pattern surfaced, delineating three sequential concepts: 1. gathering overarching information, 2. collecting and documenting wound-specific data, and 3. interpreting information to formulate wound treatment strategies. These concepts encompassed collaborative discussions with stakeholders, while the refinement of wound treatment strategies was interwoven within both concepts 2 and 3.

Conclusions: Evident variations were identified in chronic wound care clinical decision-making, regardless of educational background or experience. These insights hold the potential to inform the development of clinical decision support systems for chronic wound management and provide guidance to clinicians in their decision-making endeavours.

Keywords: Chronic wounds; Clinical decision making; Decision support systems; Primary care nursing; Qualitative research; Wound assessment.

MeSH terms

Adult
Belgium
Chronic Disease / therapy
Clinical Decision-Making* / methods
Female
Humans
Male
Qualitative Research
Wounds and Injuries* / therapy