ORIGINAL ARTICLE
NURSING ACADEMIC’S KNOWLEDGE ABOUT WOUND ASSESSMENT: CROSS-CROSS-SECTIONAL RESEARCH
CONOCIMIENTO ACADÉMICO DE ENFERMERÍA SOBRE EVALUACIÓN DE HERIDAS: INVESTIGACIÓN TRANSVERSAL
CONHECIMENTO DE ACADÊMICOS DE ENFERMAGEM SOBRE AVALIAÇÃO DE FERIDAS: PESQUISA TRANSVERSAL
https://doi.org/10.31011/reaid-2025-v.99-n.1-art.2456
1Beatriz Siqueira Costa Lopes
2Letícia dos Santos Cabral
3Maria Luiza de Medeiros Amaro
4Robson Giovani Paes
5Marlise Lima Brandão
1Hospital Angelina Caron, Campina Grande do Sul, Paraná, Brazil; Centro Universitário Autônomo do Brazil, Curitiba, Paraná, Brazil. Orcid: https://orcid.org/0009-0005-5694-681X
2Programa de Residência Multiprofissional em Saúde Mental, Secretaria Municipal de Saúde/Fundação Estatal de Atenção à Saúde, Curitiba, Paraná, Brazil; Centro Universitário Autônomo do Brasil, Curitiba, Paraná, Brazil. Orcid: https://orcid.org/0009-0003-0624-0603
3Faculdade Herrero, Curitiba, Paraná, Brazil. Orcid: https://orcid.org/0000-0001-7880-3258
4Programa de Pós-Graduação em Enfermagem. Universidade Federal do Paraná, Curitiba, Paraná, Brazil. Orcid: https://orcid.org/0000-0001-6899-4054
5Programa de Pós-Graduação em Enfermagem. Universidade Federal do Paraná, Curitiba, Paraná, Brazil; Centro Universitário Autônomo do Brazil, Curitiba, Paraná, Brazil. Orcid: https://orcid.org/0000-0002-2367-2390
Corresponding author
Marlise Lima Brandão
R. Konrad Adenauer, 442 - Tarumã, Curitiba, Paraná – Brazil. CEP: 82820-540 contact; +55 (41)988012990. E-mail: mlblise@gmail.com
Submission: 20-12-2024
Approval: 29-01-2025
Introduction: The assessment, staging, and prevention of skin injuries are activities that require interest, dedication, responsibility, and appropriate concern. Therefore, it is essential to encourage nursing undergraduates to engage in a continuous pursuit of knowledge. Objective: To identify the knowledge of final-year nursing undergraduates regarding wound assessment. Method: This is a cross-sectional, descriptive quantitative study, with data collection carried out between April and May 2023 using an electronic Google Forms® questionnaire containing 64 questions. Participants included students enrolled in the Supervised Nursing Internship I or II at a private university center in southern Brazil, aged 18 or older. Sampling was conducted using the Snowball method, supported by the social networks WhatsApp® and Instagram®. Data were analyzed using simple and relative frequencies, means, and standard deviations. Results: A total of 32 students participated; 81.3% were female, with an average age of 28 years. Of these, 28.1% had a technical nursing background, and 15.6% had specialized training in wound assessment. Additionally, 71.9% reported feeling confident in assessing wounds without the presence of a professor and/or supervisor. Conclusion: Despite feeling confident and having experienced wound assessment in theoretical classes, laboratory, and field practices, students still face limitations related to etiology, pulse evaluation, and adjacent skin assessment.
Keywords: Knowledge; Students Nursing; Wounds.
RESUMEN
Introducción: El conocimiento sobre la evaluación, estadificación y prevención de lesiones en la piel es una actividad que requiere interés y dedicación, de manera responsable y con la debida preocupación que le es necesaria. De esta forma, es fundamental fomentar la búsqueda constante de conocimiento en los estudiantes de enfermería. Objetivo: Identificar el conocimiento acerca de la evaluación de heridas en estudiantes del último año de la carrera de enfermería. Método: Investigación descriptiva cuantitativa de corte transversal, con recolección de datos realizada en los meses de abril y mayo de 2023, a través de un formulario electrónico de Google Forms®, que contenía 64 preguntas. Se incluyeron estudiantes matriculados en la asignatura de Práctica Supervisada de Enfermería I o II en una universidad privada del sur de Brasil, mayores de 18 años. El muestreo se realizó por el método de Bola de Nieve, con apoyo de las redes sociales WhatsApp® e Instagram®. Los datos fueron analizados mediante frecuencia simple, relativa, media y desviación estándar. Resultados: Participaron 32 estudiantes; el 81,3% eran mujeres; la edad promedio fue de 28 años; el 28,1% tenía formación técnica en enfermería; el 15,6% contaba con capacitación en evaluación de heridas; el 71,9% se sentía seguro para evaluar heridas sin la presencia de un profesor y/o tutor. Conclusión: Se verificó que, aunque los estudiantes presentan seguridad y han experimentado la evaluación de heridas en clases teóricas, prácticas de laboratorio y de campo, aún tienen limitaciones relacionadas con la etiología, los pulsos y la piel adyacente.
Palabras clave: Conocimiento; Estudiantes de Enfermería; Heridas.
RESUMO
Introdução: O conhecimento sobre avaliação, estadiamento e prevenção de lesões de pele, é uma atividade que requer interesse e dedicação, de forma responsável e com a devida preocupação que lhe é necessária, desta forma, é necessário fomentar a busca constante do conhecimento ao graduando. Objetivo: Identificar o conhecimento acerca da avaliação de feridas de acadêmicos do último ano da graduação de enfermagem. Método: Pesquisa descritiva quantitativa de recorte transversal, com coleta de dados ocorrida nos meses de abril e maio de 2023, por meio de formulário eletrônico do Google Forms®, contendo 64 questões. Foram incluídos acadêmicos matriculados na disciplina Estágio Supervisionado de Enfermagem I ou II de Centro Universitário Privado do Sul do Brasil, maiores de 18 anos. A amostragem deu-se por Bola de Neve, com apoio das redes sociais WhatsApp® e Instagram®. Os dados foram analisados por frequência simples, relativa, média e desvio padrão. Resultados: Participaram 32 acadêmicos; 81,3% do sexo feminino; idade média 28 anos; 28,1% possuíam formação técnico de enfermagem; 15,6% possuíam aperfeiçoamento em avaliação de feridas; 71,9% sentem-se seguros para avaliar feridas sem a presença de um professor e/ou orientador. Conclusão: Verificou-se que embora possuam segurança e tenham vivenciado a avaliação de feridas em aulas teóricas, práticas de laboratório e de campo, ainda possuem limitações relacionadas a etiologia, pulsos e pele adjacente.
Palavras-chaves: Conhecimento; Estudantes de Enfermagem; Feridas.
INTRODUCTION
Nurses are professionals responsible for providing wound care, from patient reception, assessment, and choice of treatment to regression and/or healing(1). To this end, they must be familiar with the structure and function of the skin, as well as the basic principles for prevention, assessment of lesions, and choice of treatment(2).
It is important to note that nurses have autonomy(1) and legal support for wound assessment and treatment, through Resolution 567/2018(3), as well as clinical reasoning(4) and professional skills to perform anamnesis and physical examination, and provide unique interventions to maintain tissue integrity, alleviate discomfort, promote self-acceptance, and provide guidance on skin care and prevention of complications(5).
To this end, professional qualifications must be acquired throughout training, as well as the development of skills necessary for critical-reflective thinking, in addition to the context in which they are inserted(6-7).
However, wound assessment is a subject that is addressed in a generalized manner and sometimes in a specific or even random manner in undergraduate nursing courses, since most curricula do not have an exclusive discipline for this discussion, making knowledge fragmented and deficient(8).
Regarding the advancement of scientific and practical knowledge about assessment, staging and prevention of skin lesions, it is an activity that requires interest and dedication, in a responsible manner and with the due concern that is necessary(9). Therefore, it is necessary to encourage the constant search for knowledge among undergraduate students, so that they can find new meanings to face the challenges of everyday life, in a conscious manner and committed to the changes linked to the health context(10).
Therefore, the research question is: What is the knowledge about wound assessment of nursing students enrolled in the last year of the nursing undergraduate course at a University Center in Southern Brazil?
The objective was to identify knowledge about wound assessment among final-year nursing students.
METHODS
This is a descriptive, quantitative, cross-sectional study(11) that followed the guidelines of The Strengthening the Reporting of Observational Studies in Epidemiology (STROBE)(12).
The study was conducted at a university center located in the northeast region of the city of Curitiba, Paraná. The university center was recognized by the Ministry of Education in 2014, but it was created as a college in 2000. The university center has approximately 6,000 students enrolled in 34 courses offered in the following modalities: in-person, distance learning, and smart(13).
Data collection took place in April and May 2023, using an electronic questionnaire prepared by the authors in Google Forms®.
The inclusion criteria were: nursing students, 18 years of age or older, regularly enrolled in the Supervised Internship in Nursing I or II discipline at the higher education institution where the research was developed. The exclusion criteria were: not filling out the e-mail field on the electronic form, abandoning the form before completing 50% of the questions, and the students responsible for the research (who were enrolled in the Supervised Internship I course) were excluded from the research.
To construct the electronic form, organized into 15 pages and 64 questions, with questions on etiology, size, type of healing and tissues, possible treatment and debridement, as well as learning, experiences and safety related to the topic of wound evaluation (supplementary material), references were used that included books, scientific articles, protocols and even societies that study the subject.
The nursing student had only one attempt to respond, which was considered by filling out the institutional e-mail, used exclusively as a basis for counting the questionnaires answered, since it does not allow the identification of the participant, as it consists of a sequential number known only to the student and the course coordinator, allowing the anonymity of the participant.
On the first page of the electronic form, the Free and Informed Consent Form (FICF) was made available. After reading it, the student had to select between two possible options: “I agree to participate in the research”, which directed him/her to the questions that make up the form or “I am not interested in participating in the research”, which then directed him/her to the closing and acknowledgments.
At the time of the research, the educational institution had 96 nursing students enrolled in the Supervised Internship I and II disciplines, according to the research authorization provided by the coordinator. For this purpose, an intentional sample of 54 participants was sought(11), considering a sampling error of 9.9% and a confidence level of 95%(14).
Participants were recruited using a snowball method(11). The link to the questionnaire was made available to class representatives via the WhatsApp® social network, who forwarded it to their peers, and so on. This strategy was carried out for six consecutive weeks, with a seven-day interval between each approach, starting in the first week of April 2023.
Due to the low number of responses, less than 40% of the sample, the researchers contacted the internship supervisors and went to the weekly meeting of the discipline, which takes place with the students at the educational institution. Three face-to-face approaches were carried out, one for each class of students enrolled in Supervised Internship I or II, inviting them to participate in the research via an electronic form.
Still without obtaining a sample that represented 40% of the population, after seven consecutive weeks, the researchers made the last attempt to approach the research, which was done by disseminating the research on social media, WhatsApp® and Instagram®, carried out for three consecutive days and posted on the profile of each of the researchers in the three shifts (morning, afternoon and evening) and sharing with the profile of the nursing undergraduate program of the educational institution. The data collection was completed after eight weeks of attempts to obtain the sample, at the end of May 2023.
To organize the data, a Microsoft Excel® 2016 spreadsheet was used to allow descriptive analysis of the data, presented through absolute and relative frequency, mean and standard deviation.
The research is in accordance with the ethical precepts of the National Health Council Resolution 466/2012(15), was submitted to the Research Ethics Committee of the aforementioned university center and was approved by Opinion No. 5.817.855.
RESULTS
The survey received 34 responses, but two participants were excluded because they did not select the option stating that they were enrolled in the Supervised Internship I or II course. The 32 participants included represent 33.3% of the total number of students enrolled in the aforementioned subjects.
It was found that 26 (81.3%) participants were female and 10 (31.3%) were male. The age of the participants ranged from 20 to 49 years old, with an average age of 28 years old and a standard deviation of 7.8. When organized by age group, it was observed that 15 (46.9%) participants were between 20 and 24 years old, six (18.8%) between 25 and 29 years old, seven (21.9%) between 30 and 34 years old, two (6.3%) between 40 and 44 years old and two (6.3%) between 45 and 49 years old.
Regarding training, 23 (71.9%) had no training in nursing, nine (28.1%) were nursing technicians, of which one (11.1%) had between 1 and 4 years of training; three (33.3%) had between 5 and 9 years of training; three (33.3%) had between 10 and 14 years of training and two (22.2%) had between 15 and 19 years of prior training in nursing. In the question about advanced training courses in wounds, 27 (84.4%) indicated that they had no advanced training and five (15.6%) had advanced training in wounds and/or wound assessment.
Regarding the answers to the questions related to opportunities, skills and safety, of the 32 participants in the survey, 30 (93.8%) stated that wound assessment was addressed in the classroom; 22 (68.8%) stated that in practical laboratory classes they experienced situations related to wound assessment and treatment; 25 (78.1%) experienced situations related to wound assessment and treatment in practical field classes; 23 (71.9%) stated that they were confident in performing wound assessment without the support of a teacher; 26 (81.3%) felt capable of deciding on the treatment of a wound without the support of a teacher; 20 (62.5%) stated that they were capable of guiding their work team without the support of a teacher.
Regarding wound healing, 28 (87.5%) students indicated the correct definition of the healing process being affected by local and systemic factors and/or inadequate topical treatment, and 20 (62.5%) indicated the phases of wound healing correctly. Of the 32 participants, 8 (25%) indicated the correct definition of the maturation phase and 13 (40.6%) indicated the correct definition of healing by primary intention.
Table 1 shows the responses related to wound measurement. Regarding the definition of height, 23 (71.9%) of the participants indicated the correct definition and three (9.4%) did not know how to answer the question; 25 (78.1%) indicated the correct definition for wound width, and it is worth noting that two (6.3%) did not know how to answer the question; regarding depth, 25 (78.1%) indicated the correct definition, while five (15.6%) did not know the answer.
Another important piece of information is about what the ruler should be for measuring the wound; the responses showed similar values, that is, 11 (34.4%) believed that one ruler for each wound was the correct indication, while seven (21.9%) believed that one ruler per patient was needed, nine (28.1%) believed that one ruler allowed for disinfection, and five (15.6%) did not know the indication (Table 1).
Table 1 – Knowledge about wound measurement
|
ITEMS |
n |
% |
|
To measure a wound, one must |
||
|
Use a disposable ruler for each wound |
11 |
34,4% |
|
Use disposable ruler for each patient |
7 |
21,9% |
|
Use a ruler that allows disinfection |
9 |
28,1% |
|
Don't know |
5 |
15,6% |
|
Height is |
||
|
Greater distance between the upper and lower edges of the lesion |
23 |
71,9% |
|
Greater distance between the lateral/medial and/or right/left edges of the lesion |
6 |
18,8% |
|
Don't know |
3 |
9% |
|
Width is |
||
|
Greater distance between the upper and lower edges of the lesion |
5 |
15,6% |
|
Greater distance between the lateral/medial and/or right/left edges of the lesion |
25 |
78,1% |
|
Don't know |
2 |
6% |
|
Depth is |
||
|
Measure tunnels, cavities and/or tissue loss of deep skin structures |
25 |
78,1% |
|
Measure tunnels, cavities and/or tissue loss of adjacent skin structures |
2 |
6,3% |
|
Don't know |
5 |
16% |
Source: Prepared by the authors (2023).
Table 2 shows the responses regarding the items to be evaluated in a wound, 32 (100%) participants indicated edges, location, and size. Regarding the items that the participants considered not necessary to evaluate, 31 (96.6%) students indicated Glasgow, 27 (84.4%) axillary temperature and 20 (62.5%) pulses. The students did not know whether they should evaluate edema with five (15.6%) responses, pain with four (12.5%) and blood glucose with three (9.4%).
Table 2 – Knowledge about the items that make up the wound assessment
|
ITEMS |
TRUE |
FALSE |
DON'T KNOW |
TOTAL |
|||
|
n |
% |
n |
% |
n |
% |
||
|
Edges |
32 |
100% |
0 |
0 |
0 |
0 |
32 |
|
Dextro (capillary blood glucose) |
10 |
31,3% |
19 |
59,4 |
3 |
9,4 |
32 |
|
Pain |
25 |
78,1% |
3 |
9,4 |
4 |
12,5 |
32 |
|
Edema |
26 |
81,3% |
1 |
3,1 |
5 |
15,6 |
32 |
|
Etiology |
23 |
71,9% |
7 |
21,9 |
2 |
6,3 |
32 |
|
Exudate |
31 |
96,9% |
0 |
0 |
1 |
3,1 |
32 |
|
Glasgow |
0 |
0% |
31 |
96,9 |
1 |
3,1 |
32 |
|
Localization |
32 |
100% |
0 |
0 |
0 |
0 |
32 |
|
Smell |
31 |
96,9% |
1 |
3,1 |
0 |
0 |
32 |
|
Adjacent skin |
30 |
93,8% |
1 |
3,1 |
1 |
3,1 |
32 |
|
Wrists |
11 |
34,4% |
20 |
62,5 |
1 |
3,1 |
32 |
|
Blush |
31 |
96,9% |
0 |
0 |
1 |
3,1 |
32 |
|
Sensibility |
31 |
96,9% |
0 |
0 |
1 |
3,1 |
32 |
|
Size |
32 |
100% |
0 |
0 |
0 |
0 |
32 |
|
Axillary temperature |
3 |
9,4% |
27 |
84,4 |
2 |
6,3 |
32 |
|
Skin Temperature |
25 |
78,1% |
5 |
15,6 |
2 |
6,3 |
32 |
|
Tissue in the wound bed |
29 |
90,6% |
1 |
3,1 |
2 |
6,3 |
32 |
|
Humidity |
32 |
100% |
0 |
0 |
0 |
0 |
32 |
Source: Prepared by the authors (2023).
Regarding the knowledge of students about the etiology of wounds, it was observed that 32 (100%) recognized pressure injuries as a possible cause of wounds; 30 (93.8%) indicated laceration and diabetic foot; 28 (87.5%) identified oncological and surgical injuries; 21 (65.6%) and 20 (62.5%) stated that venous ulcers and arterial ulcers, respectively, were etiologies for wounds. Meanwhile, 17 (53.1%) indicated closed fractures and 14 (43.8%) indicated plaster splints as false regarding the etiology of wounds. It is noteworthy that 21 (65.6%) students did not know whether skin tears can be considered an etiology of wounds, as well as seven (21.9%) did not know whether dehiscence is a possible cause of skin lesions. Regarding the wound bed, 23 (41.8%) students correctly identified the definition of viable tissue and 19 (34.5%) the correct description for non-viable tissue. It is worth noting that eight (14.5%) did not know the answer and five (15.6%) indicated the incorrect definition.
Regarding the classification of the wound edges, Table 3 shows that 30 (93.8%) participants indicated the regular option, 27 (84.4%) irregular and 22 (68.8%) macerated, with only three (9.4%) indicating the I do not know option.
Regarding the characteristics of the adjacent skin, 25 (14.0%) students indicated that signs of inflammation should be observed, 24 (75.0%) indicated coloration, 23 (71.9%) indicated hydration conditions, and it is worth noting that 18 (10.1%) students indicated that the presence of pus in the adjacent skin should be observed (Table 3).
Table 3 – Knowledge about characteristics of the wound edges, bed and adjacent skin
|
CLASSIFICATION |
n |
% |
|
As for the edges * |
||
|
Adhered |
18 |
56,3 |
|
Contracted |
8 |
25,0 |
|
Discreet |
5 |
15,6 |
|
Raised |
15 |
46,9 |
|
Firm |
9 |
28,1 |
|
Loose |
6 |
18,8 |
|
Inverted |
7 |
21,9 |
|
Intense |
3 |
9,4 |
|
Irregular |
27 |
84,4 |
|
Macerated |
22 |
68,8 |
|
Regular |
30 |
93,8 |
|
Don't know |
3 |
9,4 |
|
As for the adjacent skin* |
|
|
|
Color (normal/hyperemia/pale/hyperpigmentation) |
24 |
75,0 |
|
Hydration conditions (hydrated/dry) |
23 |
71,9 |
|
Skin integrity |
22 |
68,8 |
|
Maceration (excess moisture) |
17 |
9,6 |
|
Presence of eczema (blisters/crusts) |
15 |
8,4 |
|
Presence of hyperkeratosis |
7 |
3,9 |
|
Presence of pus |
18 |
10,1 |
|
Sensation of regeneration |
7 |
3,9 |
|
Signs of inflammation (heat, redness, pain and edema) |
25 |
14,0 |
|
Type of dressing |
15 |
8,4 |
|
Dont know |
5 |
2,8 |
|
About the appearance of the exudateǂ |
|
|
|
Pyuric, serosanguineous, bloody, seropurulent |
1 |
|
|
Bloody, purulent, transparent |
2 |
|
|
Serous, serosanguinous, sanguineous, seropurulent |
1 |
|
|
Serous, serosanguinous, bloody, seropurulent, purulent |
22 |
68,8 |
|
Don't know |
6 |
18,8 |
|
About the amount of exudateǂ |
|
|
|
Absent, lower, upper, medium |
0 |
|
|
Absent, small, moderate, intense |
22 |
68,8 |
|
Lower, upper and medium |
2 |
|
|
Small, medium, large. |
2 |
|
|
Don't know |
6 |
18,8 |
|
Pulse assessment ǂ |
|
|
|
Checking the presence, intensity, rhythmicity and type of pulse after the injury |
9 |
28,1% |
|
Checking the presence, intensity, rhythmicity and type of pulse before and after the injury |
9 |
28,1% |
|
Checking the presence, intensity, rhythmicity and type of pulse before the injury |
3 |
9,4% |
|
Don't know |
11 |
34,4% |
Source: Prepared by the authors (2023).
Note: *Questions accepted more than one answer; ǂQuestions accepted only one answer.
Table 3 also shows the responses related to knowledge about exudate. Specifically, regarding quantity, 23 (71.9%) of the participants marked the option “absent, small, moderate, intense”, and only five (15.6%) students did not know how to quantify the exudate. Regarding appearance, 22 (68.8%) participants marked the option “serous, serosanguineous, bloody, seropurulent”, while six (18.8%) had no knowledge about the classification of the appearance of exudate in wound assessment. When asked about pulse checking, Table 3 shows that nine (28.1%) students responded that “it consists of checking the presence, intensity, rhythm and type of pulse after the injury”, another nine (28.1%) students indicated that “it consists of checking the presence, intensity, rhythm and type of pulse before and after the injury”, while 11 (34.4%) did not know how to answer the question.
Graph 1 shows that 22 (23.7%) students recognize surgical/instrumental debridement, 18 (19.4%) chemical/enzymatic, 16 (17.2%) autolytic, another 16 (17.2%) mechanical and 10 (10.8%) did not know how to answer.
Graph 1 – Knowledge about the types of wound debridement
Source: Prepared by the authors (2023).
When asked about the types of dressings available for wound treatment, the students indicated how many options they considered to be true, the following stand out: Calcium alginate and Hydrogel with 21 (65.6%) responses each; Collagenase, Hydrocolloid and Activated charcoal plate with 19 (59.4%) each; Calcium alginate, Barrier cream and Silver foam with 17 (53.1%) responses each, seven (21.9%) of the students did not know how to answer (Graph 2).
Graph 2 – Knowledge about the types of dressings available for wound treatment
Source: Prepared by the authors (2023).
Note: *Question accepted more than one answer.
DISCUSSION
Regarding the gender of the research participants, studies conducted with undergraduate nursing students at colleges in the cities of Curitiba / PR(16), Londrina / PR(17), Salvador / BA(18), Maceió / AL(19), and Sobral / CE(20), corroborate the number of female participants, indicating respectively 87.2%, 91.5%, 82.2%, 85.2% and 78.6%.
The age range of the participants was similar to that found in Salvador (BA)(18), where 43.1% of the participants were between 20 and 30 years old, as well as in a study conducted in the city of Aracaju / SE(21), where 72.6% of the students were between 20 and 30 years old.
In other studies, the percentage of students who already have training and/or work in the health area was 18.8% in Salvador/BA(18), and 33.3% in a college in Curitiba/PR(14).
A study conducted in Curitiba/PR(16) indicated that 7.7% of nursing students have extracurricular training in wound assessment, with a similar percentage in a study conducted with students from the Federal University of Rio Grande do Norte(22), where 88.0% of participants indicated that they had not participated in training and/or courses on the subject. Additionally, a study conducted in Ontario/Canada(23) indicated that training in wound assessment is a condition for decision-making in wound treatment among health professionals, corroborating a study conducted in the South of Brazil(24), where nurses stated that they felt the need for improvement and specific training to assess wounds.
Most of the participating students felt capable and confident of continuing and guiding a nursing team to perform assessment, care and treatment of wounds without the help and support of a teacher/advisor, which demonstrates the importance of completing specific subjects covered in the classroom. It is important to highlight that improving scientific and practical knowledge about assessment, staging and prevention of skin lesions requires interest and dedication(9). In a study conducted at a public university in the Northeast region(22), 53.0% of the students reported not having had the opportunity to care for or observe the care of a person with a lesion, data different from those found in this study.
Regarding knowledge about the phases of wound healing, they generally recognize that the healing process can be affected by local and systemic factors and/or inadequate topical treatment. It was identified that more than half of the participants had doubts about the maturation phase, which is characterized by the reduction and strengthening of the scar(25). A study published in 2019(21) indicated that the lack of or inadequate assessment of wounds can affect treatment results and compromise professionals' decision-making. Therefore, it is extremely necessary for nursing students to be adequately prepared to assess wounds, given the impact on professional performance.
Regarding knowledge about measuring wounds, it was noticeable that students responded assertively regarding the use of the ruler and the measurement of the height, width, and depth of wounds, indicating the answer according to manuals(25-26), protocols(27), and national literature(28-31) used in teaching about wound assessment.
It was understood that the students presented knowledge about the items necessary in the assessment of wounds, according to the literature(25, 27-28), the assessment should be recorded in detail about the wound, describing the location, etiology, size, type, tissue color in the wound bed, quantity, exudate characteristics, odor, and appearance of the surrounding skin. Proper assessment enables the adoption of measures to intervene in situations that may be harmful and thus allow complete healing to be achieved. For this reason, the importance of using instruments that address all elements of the healing process is highlighted, in addition to the comprehensive assessment of the individual(32).
The multidisciplinary team may choose to use methods such as the RYB and TIMERS acronyms to assess the lesions, since these alternatives are dynamic for directing practical actions in the assessment and conduct of treatment. The RYB color system is widely used in the treatment of pressure ulcers and helps to easily identify the types of skin tissue and their respective treatment(25,27-28,31), while the TIMERS acronym deals with six components that guide the decisions of health professionals, aiming at good healing in their patients(33).
Related to changes in skin integrity, it was highlighted that the students presented knowledge regarding the etiology in the evaluation of wounds that, according to studies(34), can be traumatic, surgical, necrotizing or infectious, pressure wounds in diabetic patients, vascular wounds, inflammatory wounds due to vasculitis, radiation wounds, oncological wounds and congenital wounds such as hypodermolysis bullosa. However, there was a relevant result regarding the Skin Tears approach, since the participants did not have knowledge about the concept. The term Skin Tears is known internationally as a traumatic wound resulting from friction and/or shearing, while in Brazil the term is defined as laceration. The lack of specificity in its own nomenclature becomes a barrier to the implementation of appropriate interventions and techniques for treatment(35).
Regarding knowledge about the characteristics of the edges and bed of the wound, the research demonstrated that the participating students are prepared to perform the appropriate assessments. Regarding the adjacent skin, the area surrounding the wound, only four items are above expectations. It is noteworthy that only 3.9% evaluated the presence of hyperkeratosis, which can evolve into fissures or other lesions. Regarding the presence of pus, it is not evaluated in the adjacent skin, it is considered a bacterial content and present only in the bed of the infected wound(25,27-28,31).
Adequate evaluation of a wound allows for more appropriate decision-making about the best treatment. Based on the assumption of the fundamental role of future nurses, research conducted at a university in Paraná(36) indicated that nursing students have significant knowledge limitations on the subject. The data show that students have basic knowledge about wound edges and beds, but it is necessary to seek to improve this knowledge based on the topic addressed.
According to the manual of guidelines for the technical-scientific, ethical and legal competence of nursing professionals, the students presented positive results regarding the understanding of the terms used in the evaluation of the quantity and characteristics of the exudate in the wound(37).
The evaluation and control of moisture are fundamental for healing, which can be impaired by dryness and excess exudate. The choice of ideal dressings for the treatment of wounds is linked to the objectives to be achieved, as well as the phase of the healing process, in addition to promoting adequate management of the exudate(37).
Regarding the evaluation of pulses, divergence was identified among the students, as well as a high percentage who did not know how to respond. Analyzed mainly in venous and arterial ulcers, its verification before and after the injury is of utmost importance, since the bloodstream is responsible for the adequate nutrition and oxygenation of the tissues. Therefore, the absence of pulses indicates changes in circulation, which can result in cell death and, consequently, delayed wound healing(28,38).
Regarding the debridement of devitalized tissue with the necessary resources, it was highlighted that future nurses are aware of the existing types of wound debridement. It is worth noting that the intervention should only be performed when there is adequate wound perfusion(25). It is important to emphasize that according to Resolution No. 502 of 2015(39), it is part of the nurse's competencies to perform autolytic, instrumental, chemical and mechanical debridement. A study carried out in Amapá(40) indicates that the most predominantly used debridement is mechanical and enzymatic, however, no mention was made of instrumental and autolytic debridement. Regarding the present study, it is noteworthy that the academics correctly indicated the items, however, the two most marked in the question are not the most recurrent ones today.
Regarding the choice of appropriate coverage for wound treatment, it is believed that participants have the necessary knowledge to obtain a significant result, in order to reduce tissue repair time, minimize complications and improve the patient's quality of life(37). The nursing professional performs the function of defining strategies for prevention, evaluation and treatment, supported by Federal Nursing Council regulation no. 567/2018(3).
The correct choice of medications and dressings should aim at both healing and infection prevention. To this end, it is important for professionals to have knowledge of the various dressings available, since this knowledge implies fewer dressing manipulations and, consequently, less pain and a lower risk of contamination(41).
Over 50% of participants indicated the use of hydrogel, silver alginate, hydrocolloid, activated charcoal sheets and collagenase as treatments used for wounds. A survey conducted using a database(42) surveyed the most commonly used dressings, and the findings point to essential fatty acids, hydrocolloid sheets, hydrogel, transparent film, silver sulfadiazine and collagenase. The participants' knowledge on the subject is lacking in terms of depth based on the types of dressings available. The academics have basic experience, but they need continuous improvement, due to product updates on the market, which allows them to be more efficient in treating wounds.
CONCLUSIONS
The research allowed us to identify the knowledge about wound assessment among nursing students enrolled in the discipline of Supervised Internship in Nursing I and II. However, it was evident that although they are confident and have experienced wound assessment in theoretical classes, laboratory practices and field practices, they still have limitations on the subject, essentially in some assessment items such as etiology, pulses and adjacent skin, as well as in the choice of debridement.
Among the advantages of the study, we can especially mention the format of dissemination of the research, which used social networks, WhatsApp and Instagram, which allowed reaching students easily and quickly.
One limitation of the study is the low participation of students in the research, which may have occurred due to a lack of interest and/or availability to complete the questionnaire, compromising the generalization of the results, since only 33.3% of the enrolled students participated in the research. In time, another limitation revolved around the dissemination of the research by class representatives and the lack of face-to-face contact with the research participants, which may have hindered student participation.
It is considered that this research contributed positively to the professional practice of future nurses, despite the limitations presented. It is suggested that higher education institutions seek ways to adapt their curricula to provide training that allows future nurses to assess, monitor and treat wounds appropriately, as well as that new research seeks to identify the knowledge of students and/or nurses about wound assessment, considering the role of this professional in skin lesions.
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Authorship criteria (author contributions)
Lopes BSC, Cabral LS - 1. contributed substantially to the design and/or planning of the study; 2. to obtaining, analyzing and/or interpreting the data; 3. as well as to the writing and/or critical review and final approval of the published version.
Amaro MLM, Paes RG - contributed substantially to the writing and/or critical review and final approval of the published version. Brandão ML – 1. contributed substantially to the design and/or planning of the study; 2. to obtaining, analyzing and/or interpreting the data; 3. as well as to the writing and/or critical review and final approval of the published version. Study coordinator.
Funding and funding
Nothing to declare.
Declaration of conflict of interest
Nothing to declare.
Scientific Editor: Francisco Mayron Morais Soares. Orcid: https://orcid.org/0000-0001-7316-2519
Rev Enferm Atual In Derme 2025;99(1): e025023
Atribuição
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