Department of Health and Social Management, University of Eastern Finland, Kuopio, Finland.
J Wound Ostomy Continence Nurs. 2012 Jul-Aug;39(4):397-407; discussion 408. doi: 10.1097/WON.0b013e318259c45b.
The aim of this study was to validate a set of previously developed criteria for wound care documentation and to use the validated criteria as a framework for developing a wound care documentation model. The Skin Integrity component of the Finnish Care Classification, the Finnish Classification of Nursing Diagnosis, and the Finnish Classification of Nursing Interventions serve as the basis for the wound care documentation model.
Finnish wound care specialists, mainly nurses, from different Finnish hospitals, and from the Finnish Wound Care Society having on average 18 years of experience in wound management. Data were collected using electronic survey technology.
A Delphi technique was used to develop and validate the documentation system.
The final model consists of 7 main categories and 25 subcategories of the Skin Integrity component of the Finnish Classification of Nursing Diagnosis and 5 main categories and 25 subcategories of the Skin Integrity component of the Finnish Classification of Nursing Intervention. Based on the results of the Delphi survey, consensus was reached on all elements of the wound care documentation model.
The Delphi process was used to develop a wound care documentation model for use in an electronic record to promote systematic documentation of both wound assessment and wound care. Future research should address the utility of this documentation model for nurses with expertise in wound care and generalist nurses.
本研究旨在验证一套先前开发的伤口护理记录标准，并使用经过验证的标准作为开发伤口护理记录模型的框架。芬兰护理分类的皮肤完整性部分、芬兰护理诊断分类和芬兰护理干预分类是伤口护理记录模型的基础。
来自不同芬兰医院和芬兰伤口护理学会的芬兰伤口护理专家，主要是护士，平均有 18 年的伤口管理经验。使用电子调查技术收集数据。
采用德尔菲技术开发和验证记录系统。
最终模型由芬兰护理诊断分类的皮肤完整性部分的 7 个主要类别和 25 个子类别以及芬兰护理干预分类的皮肤完整性部分的 5 个主要类别和 25 个子类别组成。基于德尔菲调查的结果，在伤口护理记录模型的所有要素上都达成了共识。
使用德尔菲法开发了一种用于电子病历的伤口护理记录模型，以促进对伤口评估和伤口护理的系统记录。未来的研究应针对具有伤口护理专业知识的护士和通科护士对这种记录模型的实用性进行研究。
