Specialist Palliative Care Nurses' knowledge and confidence in assessing and managing malignant fungating wounds

BACKGROUND: Malignant fungating wounds affect between 5-10% of patients with advanced cancer presenting to specialist palliative care services. These wounds are difficult to manage, often presenting significant challenges to specialist palliative care nurses due to the heightened risk of haemorrhage, malodour, pain, and excessive exudate levels, all of which can profoundly impact the patient's quality of life. Symptoms are commonly identified as challenging, affecting not only patients but also specialist palliative care nurses, who often struggle to manage them effectively. DESIGN: This quantitative research study determined and analysed the knowledge and confidence of specialist palliative care nurses in the assessment and management of malignant fungating wounds. Employing a non-experimental, cross-sectional methodology, the study aimed to address gaps in the existing literature and contribute to the broader body of knowledge within this specialist field of nursing practice. METHODS: A convenience sample of 133 specialist palliative care nurses working in a large hospice in the Republic of Ireland were invited to participate in this study. A questionnaire was developed to assess and analyse these nurses' knowledge and confidence regarding the assessment and management of malignant fungating wounds in practice. Fifty-three specialist palliative care nurses completed the questionnaire, yielding a response rate of 40%. The survey findings were analysed using IBM SPSS version 27. FINDINGS: The study found significant deficiencies in specialist palliative care nurses’ confidence and knowledge when caring for patients with malignant fungating wounds, advocating for inclusion of wound management education in specialised postgraduate palliative care programmes and continuous professional development programmes for specialised palliative care nurses. The results also shed light on nuanced ways in which specialist palliative care nurses seek and value support from the Tissue Viability Nurse specialist, and nursing and medical colleagues. In essence, this study significantly contributes to the existing body of knowledge by providing insights into the specific needs of specialist palliative care nurses when managing malignant fungating wounds and lays the foundation for tailored interventions and educational programmes to bridge this specific knowledge and confidence gap in specialist palliative care nursing practice. The distinctiveness of these results lies in their potential to reshape current practices, ensuring a more targeted and effective approach to MFW management within specialist palliative care services. RECOMMENDATIONS: The findings of this study have the potential to inform policy and practice, ensuring patients presenting with malignant fungating wounds to specialist palliative care settings receive quality and evidence-based care. Further and ongoing education on the assessment and management of malignant fungating wounds in specialist palliative care programmes are recommended. In order to guarantee that the care given to these patients is not only medically effective but also emotionally and socially helpful, more research into the lived experiences of specialist palliative care nurses as well as the distinct experiences and requirements of patients with malignant fungating wounds is necessary.