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Impact of a decision tree on chronic wound care
1Capital Health Region, Alberta Health, Edmonton, Alberta, Canada.
Objective:
To examine the use of a decision tree and its impact on the accuracy of decision making for chronic wound care.
Design:
Descriptive comparative design; replication study.
Settings And Subjects:
Data were collected from 2 groups of home care nurses in large urban centers. One group was measured after initial contact with the decision tree, and the other group was measured 2 years after implementation of the decision tree.
Instruments:
The chronic wound management decision tree (CWMDT) designed by Knight was used, in combination with pictorial case studies developed by Willey and Swords.
Methods:
Edmonton Home Care Program nurses, having used a decision tree for 2 years, completed 3 pictorial case studies without the aid of a written copy of the CWMDT. Current accuracy of wound care staging and treatment was compared with the Melchior-MacDougall and Lander results. After this procedure, Calgary Health Services home care nurses completed 3 pictorial case studies to assess the accuracy of wound care staging and treatment between 2 groups: with the CWMDT and without the CWMDT. A questionnaire was completed on factors identified to influence decision making in wound care.
Main Outcome Measure:
Accuracy and confidence of decision making in wound care staging and treatment.
Results:
Accuracy of decision making with use of the CWMDT improved over time, as did accuracy of decision making after initial contact with the decision tree. Age, experience in nursing and home care, number of in-services attended, and number of chronic wounds treated, were not found to correlate with accuracy of decision making.
Conclusion:
A decision tree can assist with decision making by guiding the nurse through assessment and treatment options.