Study On The Constrction Of A Wound Assessment Tool For Orthopedic Trauma

Objective: To construct an orthopedic wound assessment tool according to the clinical characteristics of orthopedic trauma wounds and Levin’s conservation model,and test its reliability and validity,so as to evaluate the healing process of orthopedic trauma wounds scientifically,systematically and comprehensively,and provide guidance for the nursing intervention in promoting early wound healing.Methods:1.Literature research was used to realize the current status of wound assessment tools at home and abroad is understood to clarify the influencing factors of orthopedic wound healing,and on this basis,the compilation and application of relevant tools as well as the influencing factors of orthopedic wound healing are combed and analyzed.2.Based on levin’s conservation model and referring to relevant wound assessment tools in the field,the framework and entry pool of orthopedic wound assessment tools were constructed based on the characteristics of orthopedic wound healing.3.Select and adjust the tool indexes through expert consultation,and finally conduct two rounds of expert consultation to form the orthopedic trauma wound evaluation tool index system,and establish the first draft of orthopedic trauma wound evaluation tool.4.Data of 178 orthopedic trauma patients were collected with the first draft tool for analysis,and items of the first draft tool were screened by project analysis and exploratory factor analysis to establish the final draft of orthopedic trauma wound assessment tool.5.The orthopedic trauma wound evaluation tools were used to evaluate 211orthopedic trauma patients,and the reliability and validity of orthopedic trauma wound evaluation tools were tested by confirmatory factor analysis,content validity,internal consistency reliability and responsiveness.Results:1.We realize both at home and abroad has eight kinds of wound assessment tools through the literature research,analysis the reliability of the tools and application of clear the influence factors of orthopaedic trauma wound healing with age,smoking,obesity,whether open injury,fracture site,all the causes,the merger disease,nutritional status,drug used,mental state,etc.,and refer to levin conservation mode from structural integrity,power integrity,individual integrity and social integrity overall assessment in four dimensions.2.This research domain experts invited 35 wound Delphi expert consultation,the two rounds of consulting established the first draft orthopaedic trauma wound assessment tools,including structural integrity,power integrity,individual integrity and social integrity 4 first-level indicators,wound patients with local characteristics,the basic situation,merge disease conditions,current medications,nutrition,sleep condition,cultural background,depression,anxiety,and family support system 10 secondary indicators and 31 tertiary indicators.After two rounds of expert consultation,the effective recovery rate of the questionnaire was 100% and 94% respectively,the coefficient of expert authority was 0.911 and 0.913 respectively,and the degree of expert coordination was 0.357 and 0.413 respectively,all of which were statistically significant.3.Through project analysis and exploratory factor analysis,the orthopedic trauma wound evaluation tool was established,including 18 scoring items and one nonscoring item,with a total score of 100 points.The higher the score,the worse the wound and the patient’s overall condition.Four common factors were extracted by exploratory factor analysis,and the cumulative variance contribution rate was70.721%.4.According to the test,the total Cronbach’s alpha coefficient of the tool is 0.813,and the Cronbach’s alpha coefficient of the four dimensions is 0.638～0.807,indicating that the tool has good internal consistency reliability.Content validity was 0.842,indicating good tool content validity.Confirmatory factor analysis proves that the model fits well.The scores of patients at the first dressing change and 7 days after the dressing change,as well as the scores at the 7th day and the 14 th day were respectively compared in response degree.The differences between the two groups were statistically significant,indicating that the tool could reflect the changes of wounds over time.Conclusion: This study constructed the orthopaedic trauma wound assessment tool has good,reliability and validity of suitable for orthopaedic trauma wound assessment,applies not only to the orthopaedic acute traumatic wound,also applies to orthopaedic surgery not heal the wound,not only provide guidance to assess the wound local characteristics for intervention,also evaluates the factors influencing the wound healing of the body,provide the basis for orthopedic trauma patients to provide comprehensive care.