Introduction
Healthcare institutions nationwide are facing critical nursing shortages, impacting specialized units like burn centers. This scarcity of consistently available, qualified nursing staff can pose significant challenges to delivering optimal wound care. Recognizing the scope of practice of physical therapists (PTs) and identifying an opportunity for practice expansion, our burn center explored integrating PTs into daily wound care management. This initiative aimed to address staffing limitations while leveraging the expertise of PTs to enhance patient care. This article outlines the steps we undertook to develop a successful burn wound care program involving physical therapists, providing a practical guide for other institutions seeking similar solutions.
Assessing Needs and Gathering Best Practices
The initial phase of developing our wound care program involved understanding current practices and identifying best approaches. We initiated a dialogue with other burn centers through the American Burn Association (ABA) PT/OT Special Interest Group (SIG) online forum. By posting inquiries about PT involvement in daily wound care, we gathered insights from various institutions. This outreach helped us understand different models of care and identify centers with established PT-integrated wound care programs. We followed up with online question and answer sessions with responding burn centers to delve deeper into their program structures, training methods, and challenges faced. Complementing this peer-learning approach, we reviewed existing educational resources and considered our institution’s nursing practice model to tailor a program that would effectively integrate with our existing workflows and standards of care.
Designing a Competency-Based Training Program
Based on the information gathered and our institutional context, we focused on creating a robust and standardized training program to ensure PT competency in burn wound care. We developed a comprehensive PT checklist that detailed the theoretical knowledge and practical skills required for competent burn wound management. Our program incorporated several key components:
- Immersive Orientation: New PTs underwent a 3-4 week orientation within the burn unit, providing them with firsthand exposure to the specific environment and patient population.
- Direct Supervision: During training, PTs were directly supervised by experienced burn PTs during actual wound care procedures and dressing changes. This hands-on mentorship was crucial for skill development and confidence building.
- Knowledge Assessment: To validate theoretical understanding, trainees were required to complete a knowledge-based quiz covering key aspects of burn wound care principles and protocols.
- Skills Checklist Demonstration: Competency was formally assessed through the skills checklist, where PTs demonstrated proficiency in practical wound care techniques under observation.
Two experienced burn PTs piloted this training program, undergoing a four-week training period under the guidance of nurse clinical coordinators and advanced practice providers (APPs). Upon successful completion of all program components, they were deemed competent in burn wound care. The program and competency validation process received formal approval from the attending physicians, ensuring medical oversight and integration within the burn center’s clinical framework. Following this initial success, we formalized the training program to facilitate the onboarding of additional PTs, thereby expanding the pool of qualified wound care providers within our burn center.
Implementing and Evaluating Program Effectiveness
Our experience highlighted the variability in burn wound care practices across different centers, despite adherence to ABA guidelines. This variation stemmed from factors such as regional practices, physician preferences, availability of specific wound dressings, and differing approaches to staff training. Our newly developed program aimed to standardize wound care delivery within our institution by ensuring all trained PTs met a defined competency level. The implementation of the PT-led wound care program yielded several positive outcomes. Notably, it fostered increased trust and collaboration between PTs, physicians, and APPs. This enhanced interprofessional collaboration has empowered PTs to provide high-quality wound care and integrate it seamlessly with aggressive functional mobility interventions, without concerns about compromising wound dressings. Directly visualizing wounds during care allows PTs to deliver more targeted patient education and tailor range of motion and stretching exercises to the specific wound characteristics and healing progress.
Conclusion and Recommendations
Integrating physical therapists into burn wound care is not only feasible but also offers significant benefits for burn centers facing staffing challenges and seeking to optimize patient care. Our experience demonstrates that a structured, competency-based training program can effectively equip PTs to deliver high-quality wound care within a burn center setting. We encourage other physical therapy departments to advocate for their involvement in burn wound care. Leveraging PTs’ in-depth understanding of soft tissue healing and functional rehabilitation can be a valuable asset in comprehensive burn patient management, ultimately improving patient outcomes and enhancing the scope of PT practice.
