An Application of Knowles' Six Principles of Adult Learning to Develop
a Wound Care Program about Assessment & Management of
Pressure Injuries at Runnymede Healthcare Centre
Gryan Garcia, MScN RN GNCC CPMHNC
Medically Complex Care Unit, Runnymede Healthcare Centre
Introduction
The Medically Complex Care Unit at Runnymede Healthcare
Centre (Runnymede) provides care for patients with multiple
medical needs that may result from acute injury, chronic
illnesses or disabilities.
At Runnymede, patients benefit from an inter-professional
approach and leading practices in wound care along with
chronic disease management and prevention.
Runnymede addresses the growing need for specialized care
such as to treat complex wounds, but not limited to pressure
injuries, diabetic foot ulcers and surgical and lower extremity
wounds.
A Standardized inter-professional Skin & Wound Assessment
Team (SWAT) are taking the lead in addressing complex
wounds needing advanced management. SWAT comprised of
a Wound Care Nurse Practitioner, Advanced Practice Nurse,
Clinical Educator and an Occupational and Physiotherapist.
Problem
Pressure injury (commonly known as bed sores/pressure
ulcers) can cause severe pain and have a significant impact
on a patients quality of life.
Runnymedes Quality Indicator (QI) Plan is to reduce
occurrence of new pressure injuries to 0%. QI plan for 2016/17
benchmark showed 1.49% of residents having new pressure
injuries (more than Stage 2).
A needs assessment was conducted in October December
2016 among front-line clinicians (Nurses, Clinical Dietitians,
Occupational and Physiotherapist). The results indicated a
need for an educational curriculum about the new National
Pressure Ulcer Advisory Panel (NPUAP) Pressure Injury staging
guidelines.
3% 5%
5% 5%
10%
10% 1%
32% 30%
20%
50% 40%
Objectives
To identify possible ways on how to improve skin and wound
assessments among front-line clinicians.
To develop an educational curriculum based on Knowles' six
principles of adult learning for front-line clinicians at the
Medically Complex Care Unit at Runnymede Healthcare
Centre.
To increase the knowledge, skills, and clinical judgement of
front-line clinicians about skin and wound health through a
poster presentation and an Educational program about
Assessment and Management of Pressure Injury.
At the end of the educational curriculum, participants will:
Demonstrate evidence-based best practices.
Demonstrate an understanding of wound assessment and
management for patients with pressure injury.
Integrate and reflect on wound care principles into their clinical
practice.
Application
Adult Learners are: Application to Wound Care Program
Motivated and Self-Directed Set up the program that moves from more to less
structure, from less to more responsibility and from
more to less direct supervision, at an appropriate
pace that is challenging yet not overloading for
the participants.
Establish an environment where participants feel
safe and comfortable expressing themselves
have open lines of communication, involve all
participants and encourage group based
problem solving.
Bring Life Experience and Find out about the participants interests and
Knowledge past experiences (personal, work and study
related).
Goal Orientated Provide real case-studies (through patient
contact and reporting) as a basis from which to
learn about the theory. *Participants value
anecdotes of the facilitators own experience.
Relevancy Orientated Asking the participants to do some pre and post
reflection and on how it will help them to meet
their learning goals.
Practical Through clinical placement, interacting with real
clients and their real life situations, participants
move from theory knowledge to hands-on
problem solving where they can recognize
firsthand how and what they are learning applies
to life and work context.
Like to Respected Acknowledging the wealth of experiences that
the participants bring to the educational
program.
Discussion
Strengths
Provide support to the Quality Improvement Plan to reduce
incidence of new pressure injuries among admitted patients.
Highly trained healthcare workforce.
High growth rate in professional practice and education.
Reduction of labor costs by capitalizing appropriate wound care
products use by knowledgeable front-line clinicians.
Weaknesses
94% Curriculum is limited to pressure injury prevention. Many other
advanced wound care managements maybe needed for
advancement of wound prevention program at Runnymede
Healthcare Centre.
No training program exist for pressure injury prevention and
management at Runnymede Healthcare Centre.
Opportunities
Growing economy and demand to professionals having a sound
knowledge in advanced wound care management.
Recognizing Clinical Quality Indicators (CQI) by Local Health
Integration Network (LHIN). Increasing the knowledge, and clinical
judgment of healthcare clinicians will improve CQI ratings, hence,
resources can be used to different related opportunities.
Annual national wound conference meetings.
Threats
Governmental cutbacks to support wound care management.
Legal and ethical implications for pressure injuries to the nurses and
facility.
Nurses are held accountable for hospital-acquired pressure injuries
that develop and worsen during admission.
The reputation of the hospital is at stake.
References
1. Knowl es, M.S. (19 70 ). The modern practiceof adul teducation: Androgogy versus pedagogy. New York: New York Associati on Press.
2. Kaufmann, D. (2 00 3). ABC of Learnin gand Teachin gi n Medi cineApply n i gE ducational Theory i n Practice. Briti sh Medi cal Journal,
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3 2 6 , 2 1 3-2 16.
Lei b, S. (2 0 0 8 ). Pri nciples of Adul t Learn in g. Retri eved from:
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4. NPUAP Press Release New Stagi ng Sy stem For PressureI nju y r Apri l 1 3, 2 01 6.
5. Regi stered NursesAssociati on ofO ntario (20 16 ). Assessmentand Managementof Pressure n I j uri es for theI nter-professional Team,
Thi rd E di ti on. Toronto, ON: RegisteredNurses Associati on of Ontari o.
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