The Sussman Wound Healing Tool - Essay Example

THE SUSSMAN WOUND HEALING TOOL: ASSESSING VALIDITY, RELIABILITY, AND USABILITY IN WOUND CARE CONTEXTS By 25 January The Sussman Wound Healing Tool (SWHT): Assessing Validity, Reliability, and Usability in Wound Care Contexts Introduction That pressure ulcers is one of the most serious and controversial problems today no one can deny. In the present day medical and nursing contexts, pressure ulcers present one of the most serious wound care challenges. Pressure ulcers are fairly regarded as one of the major sources of morbidity among patients (Cuddigan, Berlowitz & Ayello 2001). For the purpose of enhancing the overall efficiency of wound care, numerous assessment tools have been developed to support nursing and medical professionals in wound care and to increase the probability of positive health outcomes in different groups of patients. The multitude of assessment tools, on the one hand, presents medical professionals with a unique opportunity to choose and use the tools that fit their needs and the needs of their patients. On the other hand, the multiplicity of tools creates conditions, in which variations in wound care practices may work against the principles of effective monitoring and measurement of ulcer healing. The Pressure Ulcer Scale for Healing (PUSH) and the Bates-Jensen Wound Assessment Tool (BWAT/ PSST) are the two most popular assessment tools in wound care, but it is more important and even interesting to reconsider the validity and reliability (if possible) of other wound assessment instruments. This paper will seek to evaluate and investigate the reliability and validity of the Sussman Wound Healing Tool (SWHT). Pressure ulcers in wound care Pressure ulcers or pressure sores present a ‘chronic problem of debilitated elders who are mainly bed or chair bound or unable to reposition themselves. The pressure ulcer is a localized area of tissue necrosis that develops when soft tissue is compressed against a bony prominence and an external surface for a long period of time” (Ebersole, Hess & Luggen 2004, p. 144). Pressure ulcers are usually the results of pressure, skin breakdown, maceration, or shearing (Baranoski & Ayello 2003; Ebersole, Hess & Luggen 2004). They can range from simple reddening to severe craters with exposed bone or muscle (Bluestein & Javaheri 2008). They are staged in four different categories: stage I can heal rapidly; stage II is treated effectively if patients avoid pressure and other risk factors; stage III requires using antiinfective agents and sometimes enzymatic debridement, whilst stage IV is associated with large and deep ulcers that often require surgical debridement of the necrotic tissue (Bates-Jensen et al 2003; Coleman et al 2002; Ebersole, Hess & Luggen, 2004). Given the importance of wound healing in different groups of patients, wound assessment stands out as the critical element of successful wound care, and it is important that medical professionals can choose assessment tools that meet their needs and the needs of their patients. The Sussman Would Healing Tool The Sussman Wound Healing Tool (SWHT) was developed as an effective diagnostic element of wound care, which is used by nurses and medical professionals to monitor the effectiveness and the results of physical therapy with regard to different forms of ulcer healing (Sussman & Bates-Jensen 1998; Sussman & Bates-Jensen 2007). Obviously, in any form of ulcer healing, measuring and assessing the effects and outcomes of physical therapy should be as reliable as possible. Moreover, bearing in mind the impact which assessment results may have on clinical decisions in ulcer healing, the use of assessment tools similar to the SWHT is of vital importance (Sussman & Swanson 1997; Thomas 1997; Thomas 2003). The SWHT is included into the list of the most frequently used wound assessment techniques and is based on the acute wound healing model “that describes the changes in tissue status and size over time, as the wound progresses through the biologic phases of wound healing” (Sussman & Bates-Jensen 2007, p. 151). Depending on the signs and symptoms of the healing progress, different attributes of wound healing can be categorized as “not good for healing” or “good for healing” – for example, tissue necrosis is considered as “not good for healing”, whilst fibroplasia is usually “good for healing” (Bale & Jones 2006; Bates-Jensen 1997; Bergstrom, Bennett & Carlson 1994; Sussman & Bates-Jensen 2007). In the SWHT, the attributes of ulcer healing that are categorized as “not good for healing” should gradually improve to become “good for healing” (Maklebust 1995; Milne, Corbett & Dubuc 2002). In the same way, the attributes that are considered as “good for healing” should increase and improve the overall state of the wound. The SWHT is a qualitative wound assessment tool. The SWHT evaluates the state of the wound by describing the attributes that characterize it (Myers 2004; Sussman & Bates-Jensen 2007; Whitney, Phillips & Aslam 2006). 10 wound attributes are combined with 9 attributes of size, location, extent of tissue damage, and the phase of acute wound healing (Sussman & Bates-Jensen 1007). The 10 basic wound attributes are rated as “present” or “absent”, as well as “good” or “not good” for healing. The “not good for healing attributes” include maceration, hemorrhage, undermining, erythema, and necrosis; those that are “good for healing” cover epithelialization, sustained contraction, appearance of contraction, fibroplasia, and wound edge (Bartolucci & Thomas 1997; Bryant & Niz 2007; Sussman & Bates-Jensen 2007). However, when it comes to using the SWHT in practical environments, it is important that medical professionals know how reliable and valid the SWHT is and whether it is applicable in different wound care environments. The SWHT: reliability, validity, practicality, and usability Despite the relative popularity of the SWHT, information regarding its reliability, validity, and usability is at least scarce. In its current state, the SWHT stands out as an assessment tool in need for further profound practical analysis. Nevertheless, it is possible to see and predict how well the SWHT works in practical settings and how easy and/ or problematic its usability and applicability are. Generally, the SWHT is both practical and easy to use (Livesley & Chow 2002). Each attribute within the SWHT is categorized as “absent” or “present”; the process of wound healing is expected to increase the number of “good for healing” attributes and to decrease the number of the ones that are “not good for healing”; these changes altogether reflect the positive or negative changes in the process of wound healing and shape the basis for taking medical and nursing decisions (Mullins, Thomason & Legro 2005; Szor & Bourguingnon 1999). The SWHT is useful and practical to the extent, which makes it possible (a) to use the changes in the score measures to assess the changing severity of the wound and (b) to use the changes in score measures for the purpose of tracking the progress (or the lack of progress) (Sussman & Bates-Jensen 2007). The SWHT is one of the few assessment tools that present a unique opportunity to track the healing progress through both the changes in the tissue status and the wound’s size (Sussman & Bates-Jensen 2007; Whittington, Patrick & Roberts 2000). As a result, the SWHT can be successfully used to monitor the process of healing different types of wounds, including pressure ulcers. While the usability and practicality of the SWHT are obvious, assessing its reliability and validity is rather difficult. The problem is in that the information about the effectiveness and potential problems in the process of using the SWHT for ulcer pressures and other types of wounds is rather limited. “Concerns have been raised regarding the SWHT’s sensitivity to change in ulcers over time because the end scores reflect factors scored as unfavorable (0) from favorable (5)” (Mullins, Thomason & Legro 2005, p. 99), but little has been published about the quality of the SWHT’s performance in different wound care situations. The reliability of the SWHT was clinically tested in a long-term facility during 5 years and the SWHT was found to be a reliable element of wound assessment, especially in tracking the healing progress of pressure ulcers (Mullins, Thomason & Legro 2005; Sussman & Bates-Jensen 2007). Because wound care professionals do not require any additional mathematical and statistical skills, the SWHT is considered as an easy assessment tool that communicates results clearly well. Medical and nursing professionals do not require any sophisticated analytical skills and do not need complex documentation to work with the SWHT. In practical environments, it takes no more than 5 minutes to complete the assessment (Mullins, Thomason & Legro 2005). The SWHT is a cost-effective element of wound assessment, because physicians and nurses who work with this tool do not need complex training and can easily learn how to use it. Unfortunately, the information about potential and real validity of the SWHT is absent in literature. However, it is easy to see that the SWHT possesses a number of limitations and strengths. The SWHT works through the comprehensive system of assessment factors and the attributes within the SWHT scale are characterized as “present” and “not present”: these are the two major SWHT’s benefits. Unfortunately, the SWHT does not reveal strong relationships between individual variables and outcomes; the SWHT should have a more precise scoring system; the SWHT cannot differentiate healing wounds from the nonhealing ones at second observation; its unusual scoring mechanism makes measurements across time and psychometric measurements difficult; and there is no information about how the SWHT works in disabled populations (Mullins, Thomason & Legro 2005). Does that mean that the SWHT is less reliable and less effective than other wound assessment tools that are currently used in medical and wound care practice? The SWHT: comparing different wound assessment tools That the SWHT was not tested in terms of its reliability and validity in different wound care settings does not necessarily imply that the SWHT is potentially worse or less effective than other wound assessment techniques. However, it would be fair to say that the SWHT is less popular and is not used as often as other assessment tools, including the Pressure Ulcer Scale for Healing (PUSH) and the Bates-Jensen Wound Assessment tool (BWAT/ PSST). Although all wound assessment tools were designed for one and the same purpose – to monitor the changes in wound healing over time – they have different strengths and limitations and the choice of each particular tool depends on the whole number of factors. Measurement of any healing progress requires that the wound is evaluated in more than one setting (Stotts, Rodeheaver & Thomas 2001). For example, the PUSH instrument was tested extensively in long-term care facilities and is well-known for being easy, effective, reliable, and valid (Stotts & Rodeheaver 1997; Thomas, Rodeheaver & Bartolucci 1997). However, the PUSH is neither used for comprehensive assessment as a part of care planning, nor can it work as an effective measure of healing (Bergstrom et al 1998; Gunes 2009; Mullins, Thomason & Legro 2005; Schubert & Zander 1996). Nevertheless, the PUSH instrument often becomes the basic point of analysis in wound care, because it is sensitive to changes “in the wound associated with progression toward wound closure” (Gardner et al 2005, p. 96). The Bates-Jensen Wound Assessment Tool (or PSST) represents another form of wound assessment and analysis, and was developed to evaluate 13 different wound characteristics with the help of a numerical scale (Flock 2003; Maklebust 1997; Sussman & Bayes-Jensen 2007). The PSST is another tool, the validity and reliability of which have been established and which is used to “quantify descriptions of pressure ulcers and changes in pressure ulcers over time” (Berlowitz, Ratliff & Cuddigan 2005, p. 480). However, the PSST is well-known for the difficulties, which medical and nursing professionals face when completing it: it takes longer than other tools to complete it requires specialized mathematical and technical training. Like the SWHT, the PSST was not tested in disabled populations (Ferrell, Artinian & Sessing 1995; Mullins, Thomason & Legro 2005). As a result, the major wound assessment tools that are currently in use require further investigation and analysis, to make sure that they work effectively in different types of healing contexts. Conclusion Given the importance of wound healing in different groups of patients, wound assessment stands out as the critical element of successful wound care, and it is important that medical professionals can choose assessment tools that meet their needs and the needs of their patients. The multitude of assessment tools, on the one hand, presents medical professionals with a unique opportunity to choose and use the tools that fit their needs and the needs of their patients. On the other hand, the multiplicity of tools creates conditions, in which variations in wound care practices may work against the principles of effective monitoring and measurement of ulcer healing. The Sussman Wound Healing Tool (SWHT) was developed as an effective diagnostic element of wound care, which is used by nurses and medical professionals to monitor the effectiveness and the results of physical therapy with regard to different forms of ulcer healing. Apparently, in any form of ulcer healing, measuring and assessing the effects and outcomes of physical therapy should be as reliable as possible. Moreover, bearing in mind the impact which assessment results may have on clinical decisions in ulcer healing, the use of assessment tools similar to the SWHT is of vital importance (Sussman & Swanson 1997; Thomas 1997; Thomas 2003). While the usability and practicality of the SWHT are obvious, assessing its reliability and validity is rather difficult. The problem is in that the information about the effectiveness and potential problems in the process of using the SWHT for ulcer pressures and other types of wounds is rather limited. The SWHT works through the comprehensive system of assessment factors and the attributes within the SWHT scale are characterized as “present” and “not present”: these are the two major SWHT’s benefits. In wound care, pressure ulcers are the major sources of morbidity among different groups of patients. Because of the difficulties, which professionals face in pressure ulcer healing and taking into account the time and effort which it takes for them to evaluate the state and the prospects of wound healing in each particular patient, wound assessment tools can be fairly regarded as the basic components and the starting point in the process of wound healing. The Sussman Wound Healing Tool (SWHT) is frequently used in wound care contexts and is well-known for its relative reliability and effectiveness. The tool is easy in use, does not require sophisticated training and skills, and does not take much time to complete. Unfortunately, the information about its validity is scarce or absent. Compared to other wound assessment tools like the PUSH and the PSST, it is difficult to predict the impact, which the SWHT may have on the quality of clinical decisions. In its current state, there is an urgent need for a profound analysis and evaluation of how different wound assessment tools, including the SWHT, work in disabled populations and whether they can become a reliable source of information about the healing progress. References Bale, S & Jones, V 2006, Wound care: A patient-centered approach, Elsevier Health Sciences. Baranoski, S & Ayello, EA 2003, Wound care essentials: Practice principles, Lippincott Williams & Wilkins. Bartolucci, AA & Thomas, DR 1997, ‘Using principal components analysis to describe wound status’, Advances in Wound Care, vol. 10, pp. 93-95. Bates-Jensen, BM 1997, ‘The Pressure Sore Status Tool a few thousand assessments later’, Advances in Wound Care, vol. 10, no. 5, pp. 65-73. 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Whittington, K, Patrick, M & Roberts, JL 2000, ‘A national study of pressure ulcer prevalence and incidence in acute care hospitals’, Journal of Wound Ostomy Continence Nursing, vol. 27, no. 4, pp. 209-215. Read More