Critical Elements of Performance for Dressing Change Essay

Dressing change is one of the psychomotor skills commonly required in a pre-licensure nursing education program. It is also the selected skill for this paper. The purpose of this paper is to first identify the core practice competencies, and then list the procedure performance for dressing change, followed by the critical element of performance for dressing change. Lastly, the paper shall endeavor to identify the most effective methods for learning and documenting competency in the skill.

The Critical Elements of Performance for Dressing Change

Evaluation in clinical nursing education involves the cognitive, affective, and psychomotor domains. The psychomotor domain involves the performance of tasks. Most nursing education programs have a procedure performance checklist for documenting and evaluating students’ demonstration of competencies for specified skills. However, assessing competency in technical skills entails an adequate understanding of the critical elements of performance. Each element must be successfully demonstrated to arrive at a judgment of competency for the specific tasks.

Dressing change is one of the psychomotor skills commonly required in a pre-licensure nursing education program and it is also the selected skill for this paper. The purpose of this paper is first to identify the core practice competencies, and then list the procedure performance for dressing change, followed by the critical element of performance for dressing change. Lastly, the paper shall endeavor to identify the most effective methods for learning and documenting competency in the skill.

These are the observable and discrete behaviors necessary for the skill in question. They specify the baseline of acceptable performance. The critical element for any given skill guides the content and processes for learning and evaluation (Lenburg, 1999b). The critical element of performance for any skill must consist of a maximum of 4-6 critical elements of performance. The language must be clear, unambiguous, and have common interpretation. Additionally, competency judgment requires meeting 100% of the elements (Lenburg, 1999b). The critical element of performance for dressing change includes:

1. Remove the soiled dressing.
2. Using sterile techniques, clean wound from top to bottom and from center to outside.
3. Apply a layer of dry sterile dressing over the wound.
4. Apply a surgical pad over the gauze as the outermost layer of the dressing.
5. Secure the dressing with tape or roller gauze
6. Label dressing with date and time.

The Core Practice Competencies

In the Competency Outcomes and Performance Assessment model (COPA), Lenburg (1999 a, b) identified eight-core practice competency categories that include the group of abilities nurses need for up to date practice. These competencies are:

1. Assessment and intervention,
2. Communication,
3. Critical Thinking,
4. Human caring relationships,
5. Management,
6. Leadership,
7. Teaching,
8. Knowledge integration.

Basically, one or more of these categories can be labeled as a significant activity that nurses need to achieve. More so, these eight core practice competencies can purposefully include several distinct and precise sub-skills tailored to fit specific and agreed upon settings and populations (Luttrell, et al, 1999; & Redman, et al, 1999).

An example of sub-skills under assessment and intervention skills include safety and protection, assessment and monitoring, therapeutic treatments and procedures, and health care technology. Another example of sub-skills under Humanistic Caring and Relationship Skills include morality, ethics, legality, respectful, cooperative interpersonal relationships, and cultural respect (Lenburg, 1999 a, b)

In summary, These eight-core practice competencies offer an inclusive framework that recognize particular sub-skills under each category that can be used later to assess, develop and document competencies for specific practice. Precisely, specific and compulsory skills can be identified and applied to the precise settings.

The Procedure Performance Checklist for Dressing Change

Taylor, Lillis, LeMone, Lynn and LeBon, (2010) identified twenty-six steps for the procedure performance checklist of dry dressing change. The twenty-six steps are listed below:

1. Review the medical orders for wound care
2. Gather the necessary supplies and bring it to the bedside stand or the overhead table.
3. Perform hand hygiene and put on PPE, if indicated
4. Identify the patient.
5. Maintain privacy by closing curtains around the bed or closing the door to the room if possible. Explain what you are going to do and why you are going to do it to the patient.
6. Assess the patient for possible need for non-pharmacologic pain reducing interventions or analgesic medication before wound care dressing change. Administer the appropriate and prescribed analgesic. Allow enough time for the analgesic to achieve its effectiveness.
7. Place a waste receptacle or bag at a convenient location for use during the procedure.
8. Adjust the bed to a comfortable working height.
9. Assist the patient to a comfortable position that provides easy access to the wound area. Use the bath blanket to cover any exposed area other that the wound. Place a waterproof pad under the wound site.
10. Check the position of drains, tubes, or other adjuncts before removing the dressing. Put on clean, disposable gloves and loosen tape on the old dressing. If necessary, use an adhesive remover to help get the tape off.
11. Carefully remove the soiled dressing. If there is resistance, use a silicone-based adhesive remover to help remove the tape. If any part of the dressing sticks to the underlying skin, use small amount of sterile saline to help loosen and remove.
12. After removing the dressing, note the presence, amount, type, color, and odor of any drainage on the dressing. Place the soiled dressing in the appropriate waste receptacle. Remove your gloves and dispose them of in an appropriate waste receptacle.
13. Inspect the wound site for size, appearance, and drainage. Assess if any pain is present.

Check the status of sutures, adhesive closure strips, staples, and drains or tubes, if present. Note any problems to include in your documentation.

1. Using sterile techniques prepare a sterile work area and open the needed supplies.
2. Open the sterile cleaning solution. Depending on the amount of cleaning needed, the solution might be poured directly over gauze sponges into a container for small cleaning jobs, or into a basin for more complex or larger cleaning.
3. Put on sterile gloves.
4. Clean wound. Clean the wound from top to bottom and from center to outside. Following this pattern, use new gauze for each wipe, placing the used gauze in the waste receptacle.
5. Once the wound is cleansed, dry the area using a gauze sponge in the same manner. Apply ointment or perform other treatment, as ordered.
6. If a drain is in use at the wound location, clean around the drain.
7. Apply a layer of dry, sterile dressing over the wound. Forceps may be used to apply the sterile dressing over the wound site.
8. Place a second layer of gauze over the wound site.
9. Apply a surgical pad over the gauze as the outermost layer of the dressing.
10. Remove and discard gloves. Apply tape or roller gauze to secure the dressing.
11. After securing the dressing, label dressing with date and time. Remove all remaining equipments; place the patient in a comfortable position, with side rail and bed in the lowest position.
12. Remove PPE, if used. Perform hand hygiene.
13. Check all wound dressing on every shift. More frequent checks may be necessary, if the wound is more complex, or the dressing has become saturated quickly.
14. Document time and finding.

The Most Effective Methods for Learning and Documenting Competency in the Skill

The most effective methods of learning competency in the skill are establishing focused outcomes, content, and interactive learning. Without active engagement, it is virtually impossible to achieve practice competency. Demonstration, simulation and role modeling are effective learning strategies that promote competent and confident critical thinking, performance communication, and leadership. The objective performance assessments, along with other types of objective examination techniques that ensure competence in the needed skills, have proved to be the most efficient way to certify skill competence. The objective examinations for performance have to be agreed upon and a set of due date assigned. Additionally, a protocol may be developed in order to evaluate all students in the same way.

Reference List

Billings, D. M., & Halstead, J. A. (2009). Teaching in Nursing. A Guide for Faculty. (3^rd ed). St. Louis, MO: Saunders Elsevier.

Lenburg, C.B. (1999a). Redesigning expectations for initial and continuing competence for contemporary nursing practice. Online Journal of Issues in Nursing. Washington, DC: Amer Nurs Assoc.

Lenburg, C.B. (1999b). The framework, concepts and methods of the competency outcomes and performance assessment (COPA) Model. Online Journal of Issues in Nursing. Washington, DC: Amer Nurs Assoc.

Luttrell, M. F., Lenburg, C.B., Scherubel, J.C., Jacob, S.R., & Koch, R.W. (1999). Competency outcomes for learning and performance assessment: Redesigning a BSN curriculum. Nursing and Healthcare Perspectives, 20, 134-14

O’Connor, A.B. (2006). Clinical Instruction and Evaluation. A Teaching Resource. (2^nd ed). Boston, MA: Jones and Bartlett.

Redman, R., Lenburg, C.B., & Walker, P. (1999). Competency assessment: Methods for development and implementation in nursing education and practice. Online Journal of Issues in Nursing. Washington, DC: Amer Nurs Assoc.

Taylor, C., Lillis, C., LeMone, P., & Lynn, P. (2010). Fundamentals of Nursing: The Art and Science of Nursing Care. Philadelphia: Lippincott Williams & Wilkins.

Taylor, C., Lillis, C., LeMone, P., Lynn, P., & LeBon, M. (2010). Skills Checklists to Accompany Fundamentals of Nursing: The Art and Science of Nursing Care. Philadelphia: Lippincott, Williams & Wilkins.