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Nursing Publications Faculty of Nursing

7-1-2022

Wound management provided by advanced practice nurses: a

scoping review protocol.
Sherry Morrell

Gina Pittman

Adam Mulcaster

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Morrell, Sherry; Pittman, Gina; and Mulcaster, Adam. (2022). Wound management provided by advanced
practice nurses: a scoping review protocol.. JBI Evid Synth, 20 (7), 1806-1813.
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 PROOF
S YS T E M AT I C R E V I E W P R O T O C O L

Wound management provided by advanced practice

nurses: a scoping review protocol
Sherry Morrell 1,2  Gina Pittman 1,2  Adam Mulcaster 2,3
1
Faculty of Nursing, University of Windsor, Windsor, ON, Canada, 2Queen’s Collaboration for Health Care Quality: A JBI Centre of Excellence,
Kingston, ON, Canada, and 3Leddy Library, University of Windsor, Windsor, ON, Canada
Downloaded from http://journals.lww.com/jbisrir by BhDMf5ePHKav1zEoum1tQfN4a+kJLhEZgbsIHo4XMi0hCywCX1AWnYQp/IlQrHD3i3D0OdRyi7TvSFl4Cf3VC1y0abggQZXdgGj2MwlZLeI= on 03/13/2022

ABSTRACT

Objective: The objective of this review is to examine the current state of the literature regarding wound care
provided by advanced practice nurses globally. Specifically, this review will examine the similarities and differences in
the wound care practice of nurse practitioners, clinical nurse specialists, advanced practice nurses, and advanced
practice registered nurses.
Introduction: Advanced practice nurses have graduate education and advanced scope of practice. The addition of
advanced wound care training provides unique opportunities for advanced practice nurses to provide wound care.
Inclusion criteria: This review will consider advanced practice nurses who are nurse practitioners or registered
nurses with graduate education and advanced training (certification/education) in wound care. The wound care can
be provided independently or as a part of a team, in any setting.
Methods: The proposed review will be conducted in accordance with the JBI methodology for scoping reviews. The
databases searched will include MEDLINE, CINAHL, ProQuest Nursing and Allied Health, Cochrane Database of
Systematic Reviews, and Scopus. To reflect changes in advanced practice nursing scope of practice, searches will be
limited to articles published from 2011. Articles in languages other than English will be translated. Titles and abstracts
will be independently reviewed by two reviewers, relevant sources will be retrieved in full and reviewed. Any
disagreements will be resolved through discussion or with an additional reviewer. The similarities and differences in
wound care practice (type of wound, practice setting, treatments) will be extracted using a data extraction tool. Any
modifications will be detailed in the scoping review. Extracted data will be presented in a descriptive format.
Keywords: advanced practice nurse; clinical nurse specialist; nurse practitioner; wound care; wound
management
JBI Evid Synth 2022; 20(0):1–8.

Introduction an umbrella term that includes nurse practitioners

mproving health care systems requires the use of (NP) and registered nurses (RN) who have graduate
I innovative models of care globally. Advanced prac-
tice nurses (APN) have additional graduate education1
education and specialized clinical expertise, and
who provide comprehensive care through direct
and advanced scope of practice.1,2 The addition of and indirect activities.1 According to the Interna-
advanced wound care education provides APNs with tional council of Nurses, APNs are NPs and clinical
the ability to provide wound care independently or as nurse specialists (CNS) who have a minimum of a
part of a interprofessional team. This review seeks to master’s level of education, a protected title, and
examine the current state of the literature regarding country-specific regulatory mechanisms for prac-
wound care provided by APNs globally. tice.3 In the United States, APNs are also referred
Advanced practice nurses are defined differently to as advanced practice registered nurses (APRN).3
based on geographical location. The term APN is The APN competencies focus on comprehensive
care, optimizing health system, education, research,
leadership, and consultation or collaboration.1
Correspondence: Sherry Morrell, [email protected] Although the role varies by country, APNs have
There authors declare no conflict of interest. practice regulations authorizing them to diagnose
DOI: 10.11124/JBIES-21-00196 conditions, prescribe medications, order diagnostic

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SYSTEMATIC REVIEW PROTOCOL S. Morrell et al.

testing and therapeutic treatments, make referrals, coordinators of patient care in acute settings to com-
and admit and discharge patients.3 munity care.17 They function as consultants, educa-
tors, and researchers,12 thereby making NPs a vital
Nurse practitioners component in multidisciplinary wound care teams.18
The role of the NP is recognized globally. Countries Globally, NPs provide wound care in various settings,
with NP include Australia, Botswana, Canada, Dom- including emergency departments (EDs),19-21 long-
inica, Ghana, Grenadines, Hungary, Israel, Jamaica, term care facilities,22 military,23 urology clinics,24 pri-
Kenya, New Zealand, the Republic of Ireland, Oman, mary care,25 and community settings.9
St Lucia, St Vincent, Tanzania, Uganda, the United
Kingdom, and the United States.3-6 Regulatory bodies Clinical nurse specialists
define the practice standards and controlled acts that Clinical nurse specialists are RNs who have a mas-
authorize NPs to provide wound care independently ter’s3 or doctoral degree.26 The CNS has clinical
or collaboratively; the authority granted by regula- expertise to support and educate interdisciplinary
tory bodies varies depending on the country. In some staff and facilitate innovation in the health care
countries, NPs have been given the authority to diag- system.3 Competencies specific to CNS include
nose conditions, order and interpret diagnostic tests, requirements for clinical care, systems leadership,
prescribe medications (including controlled substan- advancement of nursing practice, evaluation of pro-
ces), provide treatments, and consult or refer to spe-
cialists.2,3

F
grams, and support research.27 Additionally, CNSs
provide clinical care in a specialized field of nursing,
Globally, roles vary and NPs most often perform
O providing health promotion, risk reduction, and
advanced health assessments, diagnostic testing, management of disease or illness, including diagno-
screenings, and prescribe medications.6 In these coun- sis and treatment. Likewise, CNSs design, imple-
tries, the role of the NP is directed towards prevention, ment, and evaluate programs of care and research.3
O
health education, monitoring chronic disease, and Literature regarding CNSs often interchange the
coordination of care.6 Nurse practitioners work terms ‘‘CNS’’ and ‘‘specialist.’’3 Additionally, nurses
autonomously with client populations in various without graduate education (master’s/doctoral
PR

health care settings, including clinics, primary care, degree), but who have additional training in a special-
acute care facilities, rehabilitative, curative and palli- ized field, such as wound care, are often called special-
ative, private physician practices, nursing homes, ized nurses, further confusing the use of the term
schools, colleges, and public health departments.4,7,8 ‘‘CNS.’’3 Furthermore, there are global variations in
Nurse practitioner specialization in wound care is APN credentialing and not all countries have included
most evident in Australia. Flinders Medical Centre in CNS as a protected title.28 Role uncertainty and an ill-
Australia was the first hospital in the state to develop defined scope of practice result when there is not a
and support the NP as a wound management consul- defined process for education and credentialing.1,3 The
tant in 1997.9 The NP provided wound care to inpa- result is confusion for nurses and the public.
tients throughout their hospitalization and provided The variations in the CNS/specialist terms make it
outpatient and community consultation at discharge. difficult to determine which countries have a defined
The NP used a multidisciplinary approach to meet the CNS role. Examples of countries with established
complex wound care needs of these patients. In March CNS roles include sub-Saharan African countries,
1999, 11 NP models, including wound care, were Canada, Iceland, Japan, the Republic of Ireland,
funded by the Victorian Ministry for Health. In 2001, South Korea, Switzerland, Taiwan, Thailand, and
the Australian Capital Territory funded a trial involv- the United States. Chile, New Zealand, Turkey, and
ing an NP wound care model of care.10 the United Kingdom do not have an established CNS
The literature demonstrates that NPs provide acces- role or use the title ‘‘specialist.’’3
sible,11 cost-effective,11,12 evidenced-based, safe, and
effective care.13 They practice collaboratively within a Wound care education
health care team.14 Nurse practitioners have the skillset There are variations in education specific to wound
to evaluate and treat wounds while managing the care ranging from workshops to undergraduate or
patient’s overall care and making specialist referrals graduate education.29 An example of a certification,
as appropriate.15,16 Nurse practitioners can act as available in the United States and Canada, is a

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SYSTEMATIC REVIEW PROTOCOL S. Morrell et al.

certified wound ostomy continence nurse (CWOCN). and iii) treatments provided (eg, laboratory, diag-
This additional wound care education can result in nostic tests, medication, dressing).
improved clinical outcomes which will ultimately
reduce costs.30 A CWOCN provides direct care and Context
may be an educator, researcher, or consultant.30 The context is APNs who provide wound care in
Improving global wound care requires innovative any setting.
use of health care providers and models of care.
Advanced practice nurses specializing in wound care Types of sources
are an ideal choice to help fill gaps in services and to This scoping review will consider both experimental
provide evidence-informed wound management. and quasi-experimental study designs, including ran-
The information from this review will provide domized controlled trials, non-randomized con-
insight into APNs’ practice of wound care globally. trolled trials, before and after studies, and
Global recognition and development of the APN interrupted time-series studies. In addition, analyti-
wound care practice may lead to certification cal observational studies including prospective and
through regulatory boards. A preliminary search retrospective cohort studies, case-control studies,
of MEDLINE, the Cochrane Database of Systematic and analytical cross-sectional studies will be consid-
Reviews, and JBI Evidence Synthesis was conducted ered for inclusion. This review will also consider
and no current or in-progress systematic reviews or
scoping reviews on the topic were identified.

F
descriptive observational study designs including
case series, individual case reports, and descriptive
This scoping review will examine and map the
O cross-sectional studies for inclusion.
emerging evidence and provide an overview of this Qualitative studies that focus on qualitative data
important topic. The objective of this scoping review including, but not limited to, designs such as phe-
is to examine the current state of the literature nomenology, grounded theory, ethnography, quali-
O
regarding wound care provided by APNs globally. tative description, action research, and feminist
research will be considered. In addition, systematic
Review question reviews that meet the inclusion criteria, and text and
PR

What are the similarities and differences for APNs’ opinion papers will also be considered for inclusion
(NP, CNS, APN, APRN) wound care practice in this scoping review.
regarding i) types of wounds, ii) practice settings,
Methods
and iii) treatments provided?
The proposed review will be conducted in accordance
Inclusion criteria with the JBI methodology for scoping reviews,31 and
Participants in accordance with the Preferred Reporting Items for
This scoping review will examine and map the Systematic Reviews and Meta-analyses extension for
emerging evidence to provide an overview of wound Scoping Reviews (PRISMA-ScR).32
care provided by APNs. Participants will include
APNs who are NPs or RNs with graduate education Search strategy
(minimum of a master’s level education), a protected The search strategy will aim to locate both published
title, and country-specific regulatory mechanisms for and unpublished studies. An initial limited search of
practice. Additionally, they require advanced train- MEDLINE (Ovid) and CINAHL (EBSCO) was
ing (certification/education) in wound care. This undertaken to identify articles on the topic. The text
review will not consider RNs who have an under- words contained in the titles and abstracts of rele-
graduate education only as they do not have an vant articles, and the index terms used to describe the
advanced scope of practice. articles, were used to develop a full search strategy
for MEDLINE (Ovid; see Appendix I). The search
Concept strategy, including all identified keywords and index
The review will examine the similarities and differ- terms, will be adapted for each included database
ences of APNs’ wound care practice regarding i) and/or information source. The reference list of all
types of wounds (eg, ulcer, abrasion, post-opera- included sources of evidence will be screened for
tive), ii) practice settings (eg, hospital, community), additional studies.

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SYSTEMATIC REVIEW PROTOCOL S. Morrell et al.

Advanced practice nurses have a protected title scoping review and presented in a PRISMA flow
and country-specific regulatory mechanisms for diagram.33
practice.3 There are global differences in the imple-
mentation of APN roles, with some countries imple- Data extraction
menting the role in the 1960s or 1970s (United Data will be extracted from papers included in the
States, Canada, United Kingdom), while other coun- scoping review. Pilot testing will be undertaken by
tries are still in the initial phases of implementation.6 two or more members of the review team on at least
Additionally, regulatory changes for APNs impact three studies to ensure accuracy in capturing data.
the provision of wound care. Specifially regulations Once selected, papers will be reviewed by two or
to prescribe medications is continually evolving more independent reviewers using a data extraction
worldwide, with countries such as Canada making tool developed by the reviewers. The extraction tool
changes as recently as 2018.2 Likewise, technology is will allow comparison of the similarities and differ-
continually evolving with regular advancements in ences of APN wound care practice globally.
products that impact treatment plans. Therefore, to Extracted data will include specific details regard-
reflect the more recent practice, searches will be ing the characteristics of the APN, participants,
limited to articles published from 2011. Articles that concept, context, study methods, and specific details
are not written in English will be translated. regarding similarities and differences for APNs’
The databases to be searched include MEDLINE
(Ovid), CINAHL (EBSCO), ProQuest Nursing and

F
wound care practice regarding types of wounds,
practice settings, and treatments provided. A draft
Allied Health (ProQuest), Cochrane Database of
O extraction form is provided (see Appendix II). The
Systematic Reviews (Ovid), and Scopus (Elsevier). draft data extraction tool will be modified and
Sources of unpublished studies/gray literature to be revised as necessary during the process of extracting
searched include ProQuest Dissertations and Theses. data from each included evidence source. Modifica-
O
The trial registers to be searched include Cochrane tions will be detailed in the scoping review. Any
Central Register of Controlled Trials (Ovid). disagreements that arise between the reviewers will
be resolved through discussion or with an additional
PR

Study selection reviewer(s). If appropriate, authors of papers will be

Following the search, all identified citations will be contacted to request missing or additional data,
collated and uploaded into Zotero v.5.0.96.2 (Cor- where required.
poration for Digital Scholarship and Roy Rosenweig
Center for History and New Media, VA, USA) and Data analysis and presentation
duplicates will be removed. Potentially relevant The findings will be examined for relevance by mem-
sources will be retrieved in full, and their citation bers of the review team who are advanced practice
details imported into Covidence (Veritas Health nurses with wound care expertise. Extracted data will
Innovation, Melbourne, Australia). Tiitles, be presented in a descriptive format with tables used to
abstracts, and full texts will be screened in Covi- summarize the findings. Presentation will align with
dence by two or more independent reviewers, with the objective of this scoping review, which is to to
an additional reviewer available to resolve any dis- examine the current state of the literature regarding
agreements. All reviewers screening every article wound care provided by APNs globally. The table will
negates the need for pilot testing of a few articles. outline characteristics of APNs, and similarities and
The full text of selected citations will be reviewed differences of APNs’ wound care practice related to
against the inclusion criteria by two or more inde- ‘‘wound type,’’ ‘‘setting,’’ and ‘‘treatment.’’
pendent reviewers. Reasons for exclusion of full
texts that do not meet the inclusion criteria will
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32. Tricco AC, Lillie E, Zarin W, et al. PRISMA extension for 33. Page MJ, McKenzie JE, Bossuyt PM, Boutron I, Hoffmann TC,
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0850. 372:n71.

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Appendix I: Search strategy

MEDLINE(R) and Epub Ahead of Print, In-Process, In-Data-Review & Other Non-Indexed Citations, Daily and
Versions(R) <1946 to May 17, 2021> (Ovid)

Date searched: May 2021, 18

Results
# Query retrieved
1 wound healing/ or ‘‘wounds and injuries’’/ or (‘‘wound care’’ or ‘‘care, wound’’ or ‘‘wound 401,444
management’’ or ‘‘management, wound’’ or ‘‘wound treatment’’ or ‘‘treatment, wound’’ or
ulcer or wound or wounds).ti,ab,kw.
2 exp nurse practitioners/ or advanced practice nursing/registerd nurse or nurse clinicians/ or 33,943
(‘‘nurse practitioner’’ or ‘‘nurse practitioners’’ or ‘‘nursing practitioner’’ or ‘‘nursing practi-
tioners’’ or ‘‘practitioner, nurse’’ or ‘‘practitioners, nurse’’ or ‘‘practitioners, nurses’’ or
‘‘advanced practice nurse’’ or ‘‘advanced practices nurses’’ or ‘‘advanced practice nursing’’ or

F
‘‘nurse, advanced practice’’ or ‘‘nurses, advanced practice’’ or ‘‘nursing, advanced practice’’ or
‘‘nursing practice, advanced’’ or ‘‘clinical nurse specialist’’ or ‘‘clinical nurse specialists’’ or
‘‘clinician, nurse’’ or ‘‘clinicians, nurse’’ or ‘‘nurse clinician’’ or ‘‘nurse clinicians’’ or ‘‘nurse
O
specialist, clinical’’ or ‘‘nurse specialists, clinical’’ or ‘‘specialist, clinical nurse’’ or ‘‘specialists,
clinical nurse’’).ti,ab,kw.
3 1 and 2 637
O
4 Limit 3 to english language and yr¼‘‘2011 – Current’’ 195
PR

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Appendix II: Draft data extraction instrument

Scoping review details

Scoping review title
Review objective/s
Review question/s
Inclusion/exclusion criteria
Population
Concept
Context
Type of study
Study details and characteristics
Study citation details (eg, author/s, date, title,
F
journal, volume, issue, pages)
O
Country
O
Context
Participants’ details (eg age/sex and number and
characteristics of APN)
PR

Details/results extracted from study (in relation to the concept of the scoping review)
Global similarities and difference in APN global
wound care regarding:
1. types of wounds
2. APN practice setting
3. treatment provided
APN, advanced practice nurse.

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