Chang Shing-Li, Chung Chi Feng, Liou Yueh Guo, Lo Shu Fen, Hu Sophia H
Institute of Clinical Nursing, National Yang Ming Chiao Tung University, Hsinchu City, Taiwan.
Department of Medical Oncology, Koo Foundation Sun Yat-Sen Cancer Center, Taipei, Taiwan.
JBI Evid Implement. 2025 Jan 1;23(1):33-41. doi: 10.1097/XEB.0000000000000430.
Appropriate malignant fungating wound (MFW) care is challenging for oncology nurses, leading to increased stress, compromised care quality, and poor patient outcomes.
This study aimed to address best practice barriers and develop evidence-based guidelines for MFW care.
This project was guided by the JBI Evidence Implementation Framework, which follows a seven-phase process. Both nurses' skills and patient charts were audited to determine compliance with best practices for comprehensive MFW assessment, wound photo records, use of validated wound assessment tools, appropriate wound care, and patient pain and satisfaction. Bandura's social learning theory was used to guide the development of an online education program and an objective structured clinical examination for skill improvement to prompt behavior change in nurses. A follow-up audit was conducted to measure improvements in knowledge, skills, and self-efficacy among nurses to validate the effectiveness of the intervention.
The project resulted in improvements in all four evidence-based practice criteria: (1) comprehensive MFW assessments increased from 27% to 98%; (2) the inclusion of wound photos in medical records increased from 50% to 100%; (3) use of a validated wound assessment tool increased from 0% to 100%; and (4) appropriate interventions to manage wounds and maintain patients' quality of life increased from 50% to 90%.
The project integrated a flexible education program, multidisciplinary collaboration, and leadership support to empower nurses to effectively manage MFWs. In addition, Bandura's social learning theory was used to influence nurses' behavior and bring about sustainable changes to organizational culture and practices.
对于肿瘤护理人员而言，妥善护理恶性溃疡伤口（MFW）颇具挑战性，这会导致压力增加、护理质量受损以及患者预后不佳。
本研究旨在解决最佳实践障碍，并制定基于证据的MFW护理指南。
本项目以JBI证据实施框架为指导，该框架遵循七个阶段的流程。对护士的技能和患者病历进行审核，以确定是否符合全面MFW评估、伤口照片记录、使用经过验证的伤口评估工具、适当的伤口护理以及患者疼痛和满意度等最佳实践。运用班杜拉的社会学习理论来指导在线教育项目的开发以及用于技能提升的客观结构化临床考试，以促使护士的行为发生改变。进行了一次后续审核，以衡量护士在知识、技能和自我效能方面的改进情况，从而验证干预措施的有效性。
该项目在所有四项基于证据的实践标准方面均取得了改进：（1）全面MFW评估从27%增至98%；（2）病历中包含伤口照片的比例从50%增至100%；（3）使用经过验证的伤口评估工具的比例从0%增至100%；（4）用于处理伤口和维持患者生活质量的适当干预措施从50%增至90%。
该项目整合了灵活的教育项目、多学科协作和领导支持，使护士有能力有效管理MFW。此外，班杜拉的社会学习理论被用于影响护士的行为，并给组织文化和实践带来可持续的变革。
