Exploring the Perception of Nursing Undergraduates in Chronic wound care Management of Sri Lanka, qualitative study

Exploring the Perception of Nursing Undergraduates in Chronic wound care Management of Sri Lanka, qualitative study | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Exploring the Perception of Nursing Undergraduates in Chronic wound care Management of Sri Lanka, qualitative study Ulluvis Hewage Tharushi Uthpala This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-7911732/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Background Wounds are a type of challenging clinical problem. Chronic wounds are classified as wounds that have not progressed through the normal process of healing. As nursing undergraduates play a pivotal role in facilitating patient facing challenges during chronic wound management; their perception in chronic wound management significantly impact patient outcomes and quality of life, yet gaps in perception of nursing undergraduates in chronic wound care management of Sri Lanka are not well-documented. Objective(s): This study was aimed at exploring perceptions of nursing undergraduates caring for Chronic wounds in Sri Lanka. Methods A descriptive qualitative study was conducted among 13 final year nursing undergraduates from 2 government universities in western province and southern province in Sri Lanka. Participants were selected using a purposive sampling method until theoretical data saturation was achieved. Data was collected through a validated semi structured interviewer guide questionnaire, with demographic characteristics, experiences of nursing undergraduates caring for chronic wounds, and practices of nursing undergraduates caring for chronic wounds. Data was analyzed using the thematic analysis by identifying patterns and themes related to the perceptions of final-year nursing students on chronic wound care management. Results Interviews were performed with 13 final year nursing undergraduates from 2 government universities in western province and southern province in Sri Lanka between November 2024 to January 2025. The main themes that emerged were initial exposure and emotional reactions to chronic wound care, challenges in chronic wound management, evolution of skills and knowledge in wound care practice, positive outcomes and factors contributing to success, preparedness and confidence in chronic wound care, emotional and mental challenges in caregiving, practices and procedures in chronic wound care, assessment and use of tools in wound care, communication and health education with patients, importance of teamwork and multidisciplinary collaboration. Conclusions The multifaceted experiences of final year nursing undergraduates involved in chronic wound care management. Emotional and sensory challenges such as fear, anxiety and discomfort during early exposure and progress toward growing confidence and skill acquisition. Resource limitations and patient non-compliance, participants demonstrate adaptability and resilience, bridging theoretical knowledge with practical realities. Emotional strain from witnessing patient suffering is profound, requiring both empathy and professionalism. Effective wound care was shown to rely heavily on multidisciplinary collaboration, patient education, and adherence to infection control protocols. Nursing Experiences Final year nursing undergraduates Nursing education Perception Practice Wound care Introduction Wounds are a type of challenging clinical problem, and a wound is defined as an alteration of the anatomic integrity of the skin or any interruption of its continuity, as a consequence of trauma (Haththotuwa and Wijesundara, 2018 ). Chronic wounds are classified as wounds that have not progressed through the normal process of healing and are open for more than a month and patients who are suffering from diabetes and obesity are at a high risk of developing chronic wounds (Sen, 2019 ) and the most common chronic disease of patients with chronic wounds is hypertension (Mokgethi, 2019 ) Chronic wounds aren’t a major problem in a healthy population. Even though a wide range of conditions from malnutrition to stress and factors such as metabolic syndrome, lead patients to experience chronic, nonhealing wounds (Sen, 2019 ). As well chronic wounds affect lifestyle and psychological issues are linked with the etiology and development of chronic wounds as the risks of non-compliance to treatment in ‘lifestyle’ diseases such as type 2 diabetes, the ignorance of medical advice on diet, and smoking (Upton, 2015 ). Approximately 200,000 people in the United Kingdom had chronic wounds, 0.37% prevalence of wounds in Europe, and a majority of patients with pressure ulcers suffer from symptoms of wounds including pain (Cook and Leanne, 2013 ) Wound-related pain is a complex feeling involving physiological, psychological, emotional, and social factors such as culture, personality, meanings, and expectations of patients. And also, pain in the patient contributes to stress and reduces the quality of life (Pra, 2012 ). As well literature says that patients with painful venous ulcers experience nociceptive pain which is associated with other certain pain descriptors, such as sharp and stabbing, that accompanies tissue injury. Pain descriptors, such as burning, stinging, and tingling, are also associated with neuropathic pain (Krasner, 1998 ). Also, the literature says that nearly a quarter of patients in low and middle-income countries may acquire at least one infection while hospitalized and a limited number of research investigating nursing wound care practices in low and middle-income countries regarding the prevention of hospital-acquired infections (Timmins et al., 2018 ). As well the developed educational program will assist student nurses in their care of patients with wounds (Davies et al., 2016 ). And also, negative attitudes in wound care attributes to inadequate training, suboptimal update of knowledge and lack of interest among nursing undergraduates in Colombo district, Sri Lanka (Kumarasinghe, Hettiarachchi and Wasalathanthri, 2015). In the Sri Lankan context, the literature says that there are gaps in nursing students' knowledge regarding different wound cleaning solutions and techniques, management of special wounds such as burn wounds, venous/diabetic ulcers, neonatal/infant wounds, and newly available dressing products in the market (Haththotuwa and Wijesundara, 2018 ). Also, nurses use reframing’ strategy to deep act, ‘pretending’ and ‘restraining’ strategies to surface act, ‘releasing’ and ‘outpouring’ strategies, receiving organizational support to use proactive coping strategies, spiritual renewal, building an awareness of their own spirituality, trying to identify concepts such as God and death, engaging in prayer meetings and treating their profession a to cope with emotional challenges as coping strategies in nursing procedures including wound care ( Wanninayake, 2017 ). As well literature says that the adapted Champions for Skin Integrity model of wound care effectively facilitated the uptake of evidence-based Based Practice in Diabetic Foot Ulcer care in the participating hospitals in Sri Lanka (Lokeesan, 2023 ). Also, it’s difficult to treat patients in clinical settings including chronic wounds for a student nurse in Sri Lanka without having much experience, practice, and coping strategies (Youhasan, 2017 ). The majority of wounds are of peacetime origin and traumatic wounds such as burns cause life-changing disfigurement in some cases (Upton, 2015 ). As well nociceptive pain associated with venous ulcers is explained by the patients as discomfort arising from the stimulation of intact afferent nerve endings and neuropathic pain is defined as discomfort arising from peripheral nerve injury (Krasner, 1998 ). The surgical wound healing process requires a collaborative team approach and nurses are one of the most important members of this multidisciplinary team (Surme, 2021 ). Even though as a result of lack of nurse-physician collaboration in wound care affects prolonged healing times for patients (Friman, Edström and Edelbring, 2017 ). Institutional policies help to promote best practices, clarify nursing roles and responsibilities, and foster interdisciplinary collaboration in patient care. According to the literature conducted in Haiti, Greater financial investment in health care, continuous education, self-regulation, and development of the nursing role, including more autonomy, help to elevate the professional status of nurses which helps to increase the quality of caring for patients with wounds (Timmins et al., 2018 ). As well factors that cause difficulties in treating are infection threats such as biofilms, and in the global context, diabetes, and obesity make chronic wounds that cause clinical, social, and economic challenges, increasing costs of health care in the aging population (Sen, 2019 ). According to the literature which was conducted at Peradeniya University, Sri Lanka, wound cleaning and dressing is a main responsibility of nurses and nursing undergraduates, and awareness of wound cleaning and dressing helps to minimize wound infections, healing time, pain during the procedure and duration of hospital stay, the government expenditure on wound management and enhances the patient’s quality of life (Haththotuwa and Wijesundara, 2018 ). As well according to the literature, which was conducted in United States, resilience in nursing students including resilience of the discipline of psychology help to prepare students for the role of the professional nurse who caring patients with hardiness, emotional resilience (Jean and Hunter, 2016 ). Literature says that reflective practice is widely used in critical thinking skills, nursing education, psychology, clinical practice and the sciences including coping strategies related to patient care (Smith, 2021 ). As well, the literature says that the Champions for Skin Integrity model which includes prevention strategies in clinical practice in hospitals in Sri Lanka improves healthcare professionals’ levels of confidence in Evidenced Based Diabetic Foot ulcer assessment and management of the Champions for Skin Integrity model for facilitating the uptake of evidence-based diabetic foot ulcer care among healthcare professionals in Sri Lanka and (Lokeesan, 2023 ). Internationally those factors were well studied globally but in the Sri Lankan context, this matter is not well addressed. Assessment of tissue viability and management of skin integrity by nurses including nursing students based on their experience is an important area in the management of wounds (Cook and Leanne, 2013 ). Also, there is also a need for allocation of resources to understand the mechanistic basis of complications of cutaneous wounds (Sen, 2019 ). The literature says that, clinical placement experiences present undergraduate nursing students with unique challenges, and it facilitates the growth of both professional and personality (Halcomb et al., 2017 ). However, literature based on the experiences of nursing undergraduates in wound care is limited (Timmins et al., 2018 ). Also, the literature says that nursing undergraduates’ knowledge of and experience with chronic wounds and skill practices are not at a satisfactory level (Sengul et al., 2024). According to the literature conducted in Maryland, there are some in patients’ complications such as complications related to respiratory system, cardiovascular complications, coagulopathy, renal complications, hepatic complications, infections, gastro intestinal complications and neurologic complications develop in the patients who are treated for surgical wounds (Matsushima. K, et al., 2010). In global context, surgical site infections significantly burden health- care systems which cause additional healthcare costs and consumption of antibiotics, leads to increased length of hospital stay, readmission rates, and the need for re-operation or intensive care, as it leads up to 20% of postoperative complications in colorectal surgery, 45% in head and neck cancer surgery. And also, surgical site infections are the second most common healthcare-associated infection in Europe, with a prevalence of 19.6% (Kalingamudali and Jalini, 2023 ). Also, the knowledge and applications of nursing students about surgical wound healing aren’t sufficient (Surme, 2021 ). Also, the literature says that final-year diploma nursing students are more confident and competent than final-year nursing undergraduates in England as diploma nursing students have more clinical exposure and teaching hours in wound care (Cook and Leanne, 2013 ) and undergraduates have lack of knowledge in the prevention of pressure ulcers (Gill, Manager and Moore, 2013 ). Also, according to the literature, which was conducted in Scotland, wound care practice among health care professionals including nursing students needs further development, including the conduction of independent studies and research of qualitative design to explore patient and clinician experiences of all aspects of wound management (Welsh, 2018 ). According to the literature, which was conducted in South Asian countries including Sri Lanka, poor quality of care including surgical wound care due to lack of experience and resources for health care professionals including nurses is a leading cause of excess morbidity and mortality in low- and middle- income countries (Beane et al., 2019 ). Competence is a multidimensional concept in health care, and its assessment as part of health care professionals’ education and clinical practice including nursing undergraduates is essential for improving patient safety and quality of care (Kielo-viljamaa et al, 2021 ). In the global context, clinical skills are a fundamental component of nursing education and lack of clinical skills competency leads to compromise patient care and safety (Davies et al., 2016 ). As well as wound care practices such as using gloves to remove dressings, applying sterile dressings, properly disposing of soiled materials, inspecting wounds for signs of infection, maintaining comfort and privacy measures and improving aseptic technique, hand hygiene, pain assessments, patient education, and documentation is important (Timmins et al., 2018 ). In the global context, the TIME framework that includes tissue viability, infection or inflammation, moisture imbalance, and wound edges is a practical tool for wound care assessment (Mahmoud et al., 2023 ). Also, according to the literature, which was conducted in Irish among nursing undergraduates, inadequacy of preparation of undergraduate nurses for the clinical skill of wound care leads to deficits in the skills related to biological sciences and expectations associated with wound management have significantly with decision making in wound practice of nurses. As well the treatment and caring methods for patients with wounds are based on a good knowledge of the formation and healing process of wounds. According to previous literature, nursing students who care for patients without evidence-based knowledge affect wound healing adversely and it leads to increasing patient suffering, pain, and delayed healing and ultimately it leads to an increase in the cost of care (Davies et al., 2016 ). Also, the literature says that continuous professional development programs on wound care practice with time assessment tools are an effective intervention for improving nurses' performance in wound care (Mahmoud et al., 2023 ). Also, reflective practice toward wound care improves the competence of undergraduate nursing students in wound care (Redmond et al., 2020 ). As well surgical wounds require specific nursing care both in the clinic and after discharge (Surme, 2021 ). Even though the competence of graduating student nurses' wound care was inadequate (Redmond et al., 2020 ) and graduating student nurses’ theoretical wound care competence is limited (Kielo, Salminen and Stolt, 2018 ). As well reflection is a tool which is used to provide better nursing care including wound care for patients by improving coping strategies in wound care (Gustafsson, 2004 ) and reflective practice is a learning tool in nursing education which enhance nursing students’ critical thinking skills and patient care which help to uplift coping ability of nurses and student nurses ( Simpson E and Courtney M, 2007 ). In the Sri Lankan context, the application of fluid to remove exudates, loosely adherent debris, necrotic tissues, or contaminants from the wound surface without causing further tissue damage is called wound cleansing and wound cleansing involves washing which helps loosen the wound debris/necrotic tissues and debridement which help to remove adherent necrotic or slough materials (Haththotuwa and Wijesundara, 2018 ). Also, the literature says that the advanced nursing skills of nursing students in Sri Lanka are in the weakest area even though they have a positive level of confidence in their clinical competency. Also, male nursing students have high competency in advanced & core nursing skills (Youhasan, 2017 ). Objective(s) This study was aimed at exploring perceptions of nursing undergraduates caring for Chronic wounds in Sri Lanka. Method Study Design and Setting This descriptive qualitative study aimed to explore Final year nursing undergraduates' perceptions including experiences and practices regarding chronic wound care in 2 selected government universities in western province and southern province, Sri Lanka. Study Population The study population included both male and female final-year undergraduate nursing students studying in nursing departments in two selected government universities in western province and southern province, Sri Lanka. Both male and female final-year undergraduate nursing students studying in nursing departments in two selected government universities in western province and southern province, Sri Lanka were eligible to participate, regardless of gender. Final year nursing undergraduates on absent during the data collection period and those who were refuse to participate for the study were excluded. Sample Size and Sampling Technique Data was collected until the saturation point is achieved which no new themes or information emerge from additional data, indicating that a comprehensive understanding of the phenomenon has been reached. A purposive sampling technique was employed. All eligible final year nursing undergraduates were listed and assigned numbers, and participants were selected based on inclusion and exclusion criteria. Data Collection Techniques and Tools Data was collected using a semi structured interviewer guide questionnaire designed by the researchers. The questionnaire comprised three sections: Section A comprised Sociodemographic details, including age, gender, university. Section B was dedicated to exploring the experiences of nursing undergraduates caring for chronic wounds in Sri Lanka, assessed through six questions. Section C explored the practices of nursing undergraduates caring for chronic wounds in Sri Lanka, measured using six open ended questions. The questionnaire underwent a thorough validation process to ensure its effectiveness and reliability. Content validity was established through a detailed review by an expert panel, ensuring the tool's alignment with the study objectives. Their feedback was incorporated to enhance clarity and relevance, making the questions more practical and user-friendly. Data Analysis The data collected from the semi-structured interviews was analyzed using thematic analysis to identify patterns and themes related to the perceptions of final-year nursing students on chronic wound care management. The audio recordings of the interviews were first transcribed verbatim, ensuring that all relevant details are captured. Once transcription was complete, the data was reviewed multiple times to ensure familiarity with the content. Initial coding was then conducted, where meaningful segments of the data were labeled to capture key concepts. These codes were organized into broader categories, and similar codes were grouped together to form initial themes. Thematic analysis was following the six-step process outlined by Braun and Clarke (2006), which includes: familiarization with the data, generating initial codes, searching for themes, reviewing themes, defining and naming themes, and producing the final report. The research team was collaborating throughout the process, discussing emerging themes to ensure consensus. Software such as NVivo or ATLAS.ti were used to assist in organizing and managing the data, but manual coding will also be employed to ensure immersion in the data. The themes were reviewed and refined to ensure that they accurately represent the underlying patterns in the data. Any discrepancies or ambiguities were discussed and resolved by the research team. The final themes were presented with supporting quotes from the participants to provide a rich, detailed understanding of the students’ experiences and perceptions in chronic wound care management. Findings Among the total study sample, (n = 13), 7.7%, 7.7%, 23.1% and 61.5% of final year nursing undergraduates were 24 years, 25 years, 26 years and 27 years in age respectively. Also, 84.62% and 15.38% of final year nursing undergraduates were females and males respectively. More than 2/3 of them belonged to the University of Colombo. As a percentage it was 69.2% (Table 1 ). Table 1 Sociodemographic characteristics Category Total n = 13 N Percentage Age (Years) 24 1 7.7% 25 1 7.7% 26 3 23.1% 27 8 61.5% Gender Male 2 15.38% Female 11 84.62% University University of Colombo 9 69.2% University of Ruhuna 4 30.8% Qualitative findings are presented in this paper under 2 major sections: (1) experiences of final year nursing undergraduates caring for chronic wounds in Sri Lanka and (2) practices of final year nursing undergraduates in managing chronic wounds in Sri Lanka. Experiences of final year nursing undergraduates caring for chronic wounds in Sri Lanka Based on the views of final year nursing undergraduates caring for chronic wounds in Sri Lanka, six principal themes and interrelated subthemes were elicited from the experiences of final year nursing undergraduates (Table 2 ). Table 2 Themes & subthemes of final year nursing undergraduates’ experiences caring for chronic wounds, Sri Lanka No Subthemes Themes 1 Fear Initial emotional responses 2 Shock 3 Disgust 4 Empathy 5 Lack of preparedness Practical challenges in clinical management 6 Smell and appearance 7 Instrument handling 8 Hygiene issues 9 Progressive skill development Evolving competency and learning 10 Supervised practice 11 Knowledge gaps 12 Non-compliant patients Barriers to effective care 13 Resource constraints 14 Lack of continuity 15 Emotional support Positive outcomes and contributions 16 Health education 17 Team collaboration 18 Empathy Emotional and mental impact 19 Burnout risk 20 Sadness 21 Resilience The majority of final year nursing undergraduates broadly described the initial emotional response of them during chronic wound care as the first theme, while some nursing undergraduates further explained that their first encounters with chronic wounds using emotionally intense language with fear , especially when faced with maggots or severely infected wounds, and some were shocked by foul odors or the visual severity. Emotional distress was sometimes compounded by personal associations (e.g., imagining family members in similar conditions). Fear was the most commonly cited view among them and screened as first subtheme. The number of final year nursing undergraduates concerned with shock as an emotional response during chronic wound care. As example, one final year nursing undergraduate said that “I can't bear it... and then that... ahh... scared... oh...shocked…” (Response 06, 26 years, female, University of Colombo) “I feel afraid that... I miss my dad... I get scared…” (Response 02, 27 years, female, University of Colombo) Some expectant final year nursing undergraduates further explained that disgust during chronic wound care affects stress and discomfort among them and quality of life of the patients with wounds, so this was defined as the third subtheme under the main reflective view. Empathy towards patients with chronic wounds is derived as the fourth subtheme out of (five) undergraduates’ concerns. As an example, one final year nursing undergraduate said that, “Ahhh... I thought like at that time... Actually, according to my experience, even our father has it, then now I am a human... When someone has a diabetic wound... amputated or something like that. I feel like... I will miss my dad. That means I imagine what if this happens to him too... then I get scared... then... even when we clean a wound.... patient hurts. Then when that happens again... they say it hurts... However, we need to clean anyway, we need to remove the debridement. So, after explaining it... then I feel sad too... So, when that happens, after having a good conversation.... We shouldn't be harsh... after having a good conversation... hmmm... and then if the patient wants to cope with pain. After prescribing something from the doctor and asking for something... he is taught and, in the ward, he can show patients who are being rehabilitated to increase his emotional support... that's all” (Response 02, 27 years, female, University of Colombo) According to the above specified views, “initial emotional responses” was drawn as the first main theme. Although participants realized the importance of maintaining initial emotional responses during wound care, insufficient knowledge regarding emotional responses was an apparent feature among the study sample. All the final year nursing undergraduates in the study sample did not have a clear, comprehensive understanding of the impact of initial emotional responses on chronic wound care. Furthermore, none of the participants articulate the idea about the role of initial emotional response in malignant wounds due to cancers. Even if participants had optimistic insight and positive attitudes about initial emotional responses in chronic wound care management, final year nursing undergraduates usually did not have a tendency to maintain practical challenges in clinical management due to certain barriers. Yet, they have heard about the requirement of showing empathy towards patients with chronic wounds, but they were not received proper direction from the hospitals they trained or health professionals. While the majority of clarified final year nursing undergraduates lack of preparedness derived as the fifth subtheme had contrasting views and perceptions. One undergraduate expressed his ideas, “One of the patients accidentally met a train accident. He was ... ahh... he was suffering with ahh... the wounds were terrible... he.... he was suffering from Gram-Positive wound.” (Response 05, 27 years, male, University of Colombo) Furthermore, “When I was in 1st year... during 1st year... we didn't even have those procedures... One day in ward 12... I met a patient... A diabetic wound is infected. There are worms. The wound was infested with maggots. That is my 1st experience. It was given to me to clean it...assistance...” (Response 02, 27 years, female, University of Colombo) For instance, one undergraduate said, “Chronic wound.... I haven't done anything... but... I've just been waiting. I have assisted. This is how I helped with caring... when we say we have a chronic wound, medicine has been given for those wounds that are usually there... like diabetic wounds.” (Response 03, 27 years, female, University of Colombo) On their verbalizations, the second theme was constructed as practical challenges in clinical management . When discussing practical challenges in clinical management, some undergraduates elaborated about their insufficient enthusiasm to manage the practical challenges in clinical setting due to several causes. Among nursing undergraduates, six of them stated about smell and appearance where, smell and appearance that present during chronic wound care was elicited as the sixth subtheme based on their views. For example, “Ahh... a chronic wound was seen for the first time... ahh... in our first rotation... that is in the first fundamental... then we were put in a surgical proof unit. Ward 25 in Kalubowila... I have never seen that... never seen a chronic wound before... that was my 1st experience. It's just that... when I see it, it's just that... there are these strange patterns in those wounds... It's not just like a normal wound. Strange drug that they are putting in... as medicine... I had not even learned about it yet. This... So that, this... I felt a very unpleasant feeling when I saw it... This... that... It was the same chronic wound that was in that ward. That... on the wound side... Wound care... that side was the same.... Ahh... That was the 1st experience.” (Response 11, 26 years, female, University of Colombo) ‘ Instrument handling ’ was recognized as the seventh subtheme based on final year nursing undergraduates’ (3) verbalization about their inability of proper handling of instruments. As an example, “Hmm... what tools... ah... in wound assessment... we use a scale... we use a disposable scale... ah... it would be good to have a scale because we can assess the wound exactly to what extent. I think it's a good tool to see if it's spread, and how is the depth... it's a good tool. I think it's better to use a tool. It is a disposable scale like the pain scale.” (Response 12, 26 years, female, University of Ruhuna) Some final year nursing undergraduates (3) expressed that hygiene issues are the main practical challenges in caring for chronic wounds in clinical settings. Through their views, hygiene issues is derived as the eighth subtheme. As we know “I have not been appointed to the surgical wards... ahh... however, I have only assisted with wound dressing. Once there was a wound, a diabetic wound, it was a big wound on the foot... that was the wound that was managed at that time... a wound that was infested by worms.” (Response 01, 26 years, female, University of Colombo) “Ahh... during the 1st year... ahh... I found a patient's wound.... it was not treated properly...... very worms.... a big.... wound that was hit by worms... that... it was not treated as it seemed to me... it was untreated... there was a malodor... What I found was an unpleasant-looking wound. The first wound experience was in the surgical ward.” (Response 10, 25 years, female, University of Colombo) “Mm... Mm... Most of the time, these... Ahh... Patients don't think about their hygiene... The wound hurt... Mm... It doesn't matter if we put medicine, they are not hygienic. If they don't maintain it... the biggest challenge, I found is that they don't maintain hygiene properly. They don't adhere to our instructions...” (Response12, 26 years, female, University of Ruhuna) ‘ Progressive skill development ’ was recognized as the nineth subtheme based on final year nursing undergraduates’ (3) verbalization about their enthusiasm for learning skills in wound care management. As an example, “Now... when we first went, we haven't even done procedures. I don't know then... that means that... the way to clean a surgical wound... The way to clean an infected wound is different. Even though we knew the theory of bandages, we had not used them practically. So, at that time, there was a little doubt about the way of cleaning.... in the beginning.... and then for a while.... Now we are professionals... we do the procedures and let them assist us. Now it's like 3rd year.... they let us do the dressing by ourselves without assisting....and after that...bandaging...and then...hmm...to maintain the sterility so as not to cause contamination... After that alone... in the whole ward... we were allowed to do wound dressing... that was the experience... the improvement...” (Response 02, 27 years, female, University of Colombo) Some of them (5) identified supervised practice as useful for the improvement of the skills of nursing undergraduates in chronic wound care. So, it can be specified as another subtheme. “That means that usually... challenging happens when he has a chronic wound...it is difficult to understand exactly what kind of treatment is being given to him now...that means how the wound dressing should be done...they are... In such places... in such places... as a student nurse, supervision is needed because... how should we do this...” (Response 10, 25 years, female, University of Colombo) Some final year nursing undergraduates (3) expressed that knowledge gaps are the main problems in caring for chronic wounds in clinical settings. Through their views, knowledge gaps is derived as the eleventh subtheme. “Ahhh... Then I want to tell you about the experience... I mean, the experience I saw for the first time... I want to tell you about the wound... I mean, that care is not good...... ahh... when I was ahh... 1st... 1st year, when we did clinical for the first time, I was fallen into this... ahh... medical ward... and there was this... diabetic wound. There was a patient who had one wound. The whole wound of that patient was oozing. It means not good... that... he had not received good care... with a very odour... this... very unpleasant feeling.... ahh... this... I felt very unpleasant... That patient is so... a big wound is very infected... this... very... this is what I found unpleasant... firstly as a chronic wound, that's it.” (Response12, 26 years, female, University of Ruhuna) Evolving competency and learning in chronic wound care is derived as the third theme through their perceptions of the above three subthemes. As the next subtheme caring for non-compliant patients was elicited based on final year undergraduates’ perceptions (5), one of them described as follows for example. According to the way I think “Mm... when consider the side of patients, but the patients do not care much about the wound. If the patient is diabetic, diabetic control is not done. Then the precautions are like... they don't maintain things like infection control properly. Then it becomes an issue for us. Nurses are not doing it right. It was a bad experience for me... not being able to control the patients properly.” (Response 07, 24 years, female, University of Ruhuna) ‘Resource constraints’ was recognized as the 13th subtheme based on final year nursing undergraduates’ (3) verbalization about their enthusiasm for managing difficulties in wound care management in clinical settings. As an example, “Ah... I have heard verbally... about the pain... I haven't used any tool except that... the other one is from his... ah... complaints. ... from the appearance... to the assessments... what was done was... and... yes... that was...” (Response 09, 27 years, female, University of Ruhuna) Some final year nursing undergraduates (3) expressed that lack of continuity in chronic wound care management are the main problems in caring for chronic wounds in clinical settings. Through their views, lack of continuity in chronic wound care management is derived as the 14th subtheme. “Because of my care... ahh... oh... now that... a positive outcome... that means in two days... it's hard to see the outcome. We don't go to the same wards for more than a week. So... um... I haven't seen this big... um... positive. However, I think the wound dressing we are doing will help that patient. That means um... first we maintain the sterility... then we clean it well... we put medication on the wound... ahh... we put the dressing so that the germs don't go.” (Response 06, 26 years, female, University of Colombo) Through the above three subthemes, the fourth theme can be merged as ‘ Barriers to effective care ’. Some expectant final year nursing undergraduates further explained that emotional support during chronic wound care affects stress and discomfort among them and quality of life of the patients with wounds, so this was defined as the 15th subtheme under the main reflective view. According to the way I think “Hmm... there were some patients who were newly amputated... some people have wounds like that after an amputation. For them... when we go to do wound dressing, with their emotional state, with the way they talk, we are a little challenging there.” (Response 01, 26 years, female, University of Colombo) Some of them (5) identified health education as useful for the improvement of the knowledge and skills of nursing undergraduates in chronic wound care. So, it can be specified as another subtheme. “Ahh... mmm... told him what he should do for a patient with cellulitis in the chronic stage... that is, he should do his antibiotic course properly... and he should keep his hygiene well... these... such a good health education session... after teaching the patient to manage his wound, the chronic wound was managed properly...” (Response 10, 25 years, female, University of Colombo) Some final year nursing undergraduates (3) expressed that team collaboration in chronic wound care management are the main challenges affecting positive outcomes in caring for chronic wounds in clinical settings. Through their views, team work collaboration in chronic wound care management is derived as the 17th subtheme. “Teamwork usually means... wound dressing... there should be at least two people... because one person does the wound dressing, wearing surgical gloves. Then some things cannot be touched. Then he needs to have someone to help him... then... that person to help... It is better if he is an experienced person so... otherwise, he has to say everything so... do this... that... um... and then... That's why... more... um... patients also need to help the team work because some patients don't like it... it takes a long time for the injury... to do these things... they need to have their support too... Um... then a nutritionist does these things... He should have his support from there... ah... doctors should be knowledgeable. Also, whoever is doing wound dressing should be knowledgeable... the care should be right... only then will the wound heal properly.” (Response 13, 27 years, male, University of Ruhuna) Positive outcomes and contributions in chronic wound care management is derived as the fifth theme through their perceptions of the above three subthemes. When emotional impact of final year nursing undergraduates in chronic wound care management, some undergraduates elaborated about their insufficient enthusiasm to manage the emotional challenges during chronic wound care due to several causes. Among nursing undergraduates, six of them stated empathy , that present during chronic wound care which was elicited as the 18th subtheme based on their views. For example, “Ah... there we need to talk about something I took care of... we need to talk about progression.... ah... when I was in the ah... cardio thoracic .... unit... Ahh... there was a patient who had CABG... hmm... somehow... the wound got infected, and he was in the ward for a long time... even though he was there, he had big... ... ah...bed sore... mmm... for a long time... ahh... bystander... also... ah... with that patient is not a person with good... knowledge... it is difficult to do that position change... that patient is a bit... a fat patient. ... Ahh... exactly... ahh... that... his... changing position has been done... ah... just... ahh... we have given wound care.... his... Botox was right there... then... these... the ones that change the pumps... I helped them do that... At the same time, the wound did not heal well... However, during my stay in that wound... um... I mean... I think I can heal his wound to a considerable level. It happened... I helped him... that bystander and I advised him to... um... do this... do this... do this... and motivate him too... Anyway, I was more than he had. That wound... um... ah... help heal it because I had a patient who was met for me in the elective appointment.” (Response12, 26 years, female, University of Ruhuna) ‘Burnout risk’ was recognized as the 19th subtheme based on final year nursing undergraduates’ (3) verbalization about their inability to cope with stress during wound care management. As an example, According to the above specified views “Ahh... the first one is this... now when I say challenge this... I usually smell that... rather than seeing this... That strange bad odour is very unpleasant for me... Then I didn't even want to approach that side. It means this... It made me feel like I was tired of everything... Then that... This... It means... Ahh... The wound itself was unpleasant... So then… It's hard to care... that smell... it's hard to get close to that person because of that smell... it's a big challenge at that time...” (Response 11, 26 years, female, University of Colombo) Some final year nursing undergraduates (3) expressed that sadness during chronic wound care management is the main emotional challenge in caring for chronic wounds in clinical settings. Through their views, sadness during chronic wound care management is derived as the 20th subtheme. As we know “Hm... after seeing a chronic wound... ah... how do you say... oh... oh... that bad smell comes like that. I can't bear it... and then that... ahh... scared... oh...shocked... there is... that diabetic wound was the first thing I saw. That has happened. There were chronic wounds.” (Response 06, 26 years, female, University of Colombo) “One of the patients accidentally met a train accident. He was ... ahh... he was suffering with ahh... the wounds were terrible... he.... he was suffering from Gram-Positive wound.” (Response 05, 27 years, male, University of Colombo) Resilience for chronic wound management was elicited as the last subtheme under this section according to two final year nursing undergraduates’ opinions, for example, “Hmmm...the thumb is amputated...in a younger patient...he didn't like the surgery at first...he got sepsis....and then he... liked amputation...... a younger patient is... in Ruhuna... an undergraduate... accident ah... met with an accident... run over bus... ah.... went to the shock stage was extremely high.... then... for the lifesaving purpose, He has to go for an amputation surgery... So... ah... first he didn't like to.... He didn't give consent and..... and then ... Ahh. Then... he had to go for that. So... after that, he lived with that. That is the thing.” (Response 09, 27 years, female, University of Ruhuna) Through the above four subthemes. It can be merged with the sixth main theme ‘ emotional and mental impact ’ in chronic wound management. So, it is obvious that a substantial percentage of participants endorsed misconceptions and conflicting views on experiences of final year nursing undergraduates including practical and emotional challenges and barriers in chronic wound care management mainly due to knowledge deficit and lack of experience. Certain gaps in knowledge and societal myths could be detected through these observations. Analytically, it is clear that lack of proper guidance and support, inadequate information sources and not receiving appropriate stimulation by healthcare providers for the effective management of chronic wounds were frequently acknowledged as potential barriers to suffering patients from pain due to chronic wounds, while diabetes-related complications is another specified significant issue. Practices of final year nursing undergraduates in managing chronic wounds in Sri Lanka In the study sample, the majority of final year nursing undergraduates caring for chronic wounds in Sri Lanka expressed their practices in managing chronic wounds in Sri Lanka. Basically, six themes were derived through their opinions and grouped into three categories as follows (Table 3 ). Table 3 Themes & subthemes of final year nursing undergraduates’ practices caring for chronic wounds, Sri Lanka No Subthemes Themes Category 1 Step-by-step procedure Basic wound care practices Knowledge and understanding of wound care principles 2 Sterility 3 Use of forceps/gloves 4 Dressing materials 5 Resource limitations Gap between theory and clinical practice 6 Improvisation 7 Variability between wards 8 Visual inspection Assessment of wound condition Approaches to wound care assessment 9 Granulation 10 Infection signs 11 Systemic factors 12 Limited tool usage Use of tools and products 13 Physician-recommended products 14 Pain scale 15 Health literacy Patient education and communication Effective communication and teamwork influencing wound care management 16 Cultural/language barriers 17 Emotional challenges 18 Multi-disciplinary team Interprofessional collaboration 19 Role of physiotherapists 20 Supervision 21 Peer assistance Knowledge and understanding of wound care principles Through their verbalizations (8), it is identified that perceptions regarding basic wound care practices as a most prevalent viewpoint among them and stated as the first theme. One undergraduate said, “Ah... yes... when we are managing a patient's chronic wound, um... when maintaining sterility, we need to use infection control strategies... we need to wear gloves... we need to maintain hand hygiene practices... then the patient's wound... medical history, A good idea about that... um... undergraduates need to know... because now if patients have diabetes... it's like that Patient has a delay in wound healing... then I think that such things should be controlled... then ah... I need to learn my hand skill experience to take care of a wound... then betadine when dressing the precautions pyretic wound. When putting it like that, there should be good assistance, I think that at that time, assistance and support are needed... and there should be good communication... the patient needs to be supported emotionally as well as psychologically. When giving care to the wound.” (Response 10, 25 years, female, University of Colombo) Through the above first main theme, It can be merged with the four subthemes as follows. step by step procedure in chronic wound management, maintaining sterility during chronic wound care, use of forceps/gloves when caring for chronic wounds to prevent infections, use of dressing materials as needed to improve healing of wound. As we know “Specific steps... um... if steps come... first they look at the ticket and identify the patient... then... um... they see if the patient has any allergies... if a specific drug needs to be given... After that, the wound is observed and how much area is there... it is assessed like that... are there any other wounds on the body... and also checked... ah... the patient is prepared... check whether patient needs go to the toilet like that... and ask him to me to start the wound dressing... ah... After that, I prepare the things... ah... wash my hands... ah... maintain sterility... and then they do the wound dressing. So... first the wound dressing... they clean it. After that, it dried... ah... after that, if something is applied, betadine or any other powder is applied, then it is dressed and closed.” (Response 13, 27 years, male, University of Ruhuna) According to the way I think “Um... specific management...... Um... that means the procedure... the procedure we have been taught is wound dressing... in the same way... if you put on sterile gloves and do it manually... If it is done with forceps, it is not put like that... Mainly infection control is what is mainly done. The procedure is done in the same way. Mm... just put on disposable gloves if you are doing it with forceps... or... put on sterile gloves if you are cleaning the wound bed by hand.” (Response 07, 24 years, female, University of Ruhuna) Gap between theory and clinical practice among final year nursing undergraduates (7) and identified as the second key theme. Through the above main theme, It can be merged with the three subthemes as follows. Resource limitations in chronic wound management, improvisation of chronic wound care, variability between wards when caring for chronic wounds. It was well noted by their verbalizations such as an undergraduate said ‘The differences are that... if it's a clean wound, it's the way we clean it... that means an infected one... there is a difference in the cleaning. After that, there is a difference in the medication we apply... it changes from wound to wound... there is a difference in the dressing we put... ah... it's hard for us to do it with that theory alone... that means clinical. In the setting, that... changes... I think there is a slight difference. We have to manage that... um... according to the situation’ for instance. (Response 06, 26 years, female, University of Colombo) Approaches to wound care assessment Assessment of wound condition was elucidated as the third theme based on their views (8). Through the above main theme, it can be merged with the four subthemes as follows. Visual inspection of chronic wounds, granulation tissue formation of chronic wounds, infection signs of chronic wounds which are observed during chronic wound care, systemic factors affecting chronic wound healing. As an example, one undergraduate said ‘That means... then you need to see... age... and then his... This... that means the social side... see... what is his occupation... like that. Things need to be considered. Are these... and then his role.... and if he is amputated, it's okay to wait a little longer without doing it, we should think about rehabilitation for him... mmm... and then after this. After that, no matter what he does, it doesn't matter if he doesn't have diabetic management, if his disease condition isn't managed if he doesn't control it, then he needs to do these things. The patient's pain level should be assessed. That means before wound dressing, after, after dressing and then if he has pain... if he is given any drugs for pain... then we need to see... From this... now he... absent... pain too... have to see if something has happened... like that. I want to see that. I want to see if there is a risk. I want to see a pulse. I want to see vitals. When the pain increases, BP and these also increase... If we patients say something, it is not good to neglect anything. That means if something says pain... now let's imagine a patient... a patient with a fracture has a chronic wound... even if we put POP... if he says something irritated or something, we should ignore it. It is not good. We want to see even a small thing’ (Response 02, 27 years, female, University of Colombo) According to the way I think “It has... the colour... the smell... granulocyte... granulose tissue... is there... the pink colour is good... the black colour is not good...” (Response 04, 27 years, female, University of Colombo) According to the above specified views “Ah... chronic wound... that means assessing... the colour, how far it has spread... like the depth... that means today how much is there... pus like things... how much is there... The granulation tissue is good... how much... is their growth... the prognosis of the chronic wound is seen from such things.” (Response 07, 24 years, female, University of Ruhuna) The fourth major theme emerged as ‘ use of tools and products ’ for chronic wound care management according to the final year undergraduates’ explanations (5). Through the above main theme, it can be merged with the three subthemes as follows. Limited tool usage for the assessment of chronic wounds, usage of physician-recommended products for the management of chronic wounds, use of pain scale for the assessment of chronic wounds. One of them said, “A tool... first of all that pain scale... we use it to see the pain... it... in the wound... it looks at the patient's pain... as far as I know... that's all I can remember... no Ah... now we are assessing the pain... the effectiveness... um... properly... that means the pain the patient feels before we take care of the wound... after taking care. If there is a difference between the pain... or if it progresses... we can get an idea about the care, we are doing... and we can also get an idea about the patient's... um... wound.” (Response 06, 26 years, female, University of Colombo) Effective communication and teamwork influencing wound care management ‘Patient education and communication’ was derived as the fifth main theme and presented below with an example according to six undergraduates’ verbalizations. As we know “That mean wound care related... Actually... now when I get diabetic patients... when I have someone like that... tell him... anyway, you need to focus on his diabetes control... that's... risk. To prevent infection... take a diet of protein. So, when that happens, some patients have their wound... sometimes... now there is no sensation... some patients. When that happens, it is too much for them... they neglect it... that is, they neglect it because they don't care. Sometimes uneducated people say they don't care about them... when they go to the washroom... wet wounds... those germs are inserted to the wound... next... those non-educated people are expected to be a bit more educated and be with technology. Look... I mean... it's easy to say something to a person who understands something like that... Some people don't have that.” (Response 02, 27 years, female, University of Colombo) Through the above main theme, it can be merged with the three subthemes as follows. Health literacy among patients with chronic wounds, cultural/language barriers of patients with chronic wounds, emotional challenges of them during caring for chronic wounds. According to the way I think “Yes. There are difficulties. In places like that... that... That means with the patient's emotional state. When I go to talk with it, sometimes... The patients cry like that. If there are patients in a place where it is difficult to heal an amputation or a chronic wound, difficulties will arise when I talk to the patients in such places.” (Response 01, 26 years, female, University of Colombo) Interprofessional collaboration during chronic wound care was derived as the last theme based on undergraduates’ concerns (04) and presented below with an example. According to the above specified views “Teamwork and collaboration is a very important wound ahh... while managing... then… from the doctor's point of view it is a multi-disciplinary team approach so there too... Now the doctor himself recommends... and then looks at a chronic wound. If patients’... emotional state low... he will probably have to go to counselling for that too. After that, if the functional state is taken, he will have to undergo physiotherapy. Bring him back to ahh... normal... to bring him back to a normal functional state, we need to do physiotherapy, occupational therapy and all that. In addition, from the nursing side, nurses need the help of other curlicues. Because... this… even we can't do wound dressing by ourselves... in any case, we have an assistant in the wound... dressing procedure. It is not something that can be done alone. They are there, so it is not something that can be done alone. They must have an assistant. If we do it properly as full sterile.” (Response 01, 26 years, female, University of Colombo) Through the above main theme, it can be merged with the four subthemes as follows. Multi-disciplinary team among staff in the ward for caring patients with chronic wounds, role of physiotherapists for caring patients with chronic wounds, supervision of senior nurses during caring for chronic wounds by undergraduates and peer assistance while caring patients with chronic wounds. According to the way I think “Those contractures... these can come like that... then... physiotherapy... occupational therapy... they will come. They come and help us... keep the legs elevated like this... they tell us how to move them... even though they are occupational, they look at rehabilitation... how can a patient deal with a wound... the pain nurse comes... then... the pain consultant comes and gives him the management... ahh... such support from others... now we are doing wound dressing according to the consultant's opinion. So... there is support so... I think there is a multi-disciplinary support.” (Response 02, 27 years, female, University of Colombo) Discussion The current study investigated the perception toward chronic wound care among final year nursing undergraduates including their experiences and practices regarding chronic wound care. Through the present study, it is distinctly recognized that the majority of final year nursing undergraduates expressed the initial emotional responses including fear, and they had negative aspects of facing emotional responses while wound care while few of them verbalized positive attitudes towards maintaining emotional responses while caring wounds including showing empathy towards patients. These themes correspond with the qualitative research on the international clinical placement experiences present undergraduate nursing students with unique challenges and facilitate both professional and personal growth (1) and they found that even though the majority of undergraduates faced challenges during the clinical placement in ways that they never expected (1). These challenges helped them to grow both professionally and personally from experience regarding wound care and exposing students to primary health care in practice helped to demonstrate the value and importance of improving experiences among undergraduates in this area of nursing (1). Although the majority of final year undergraduates realized the challenges of emotional responses during chronic wound care, they had positive attitudes towards chronic wound care similarly in previous qualitative study findings among students experience genuine caregiving in putting their experiences into practice with real patients in a clinical setting (2) by experiencing real patient care in a clinical setting, being a competent student, and being a novice student (2). Among less knowledgeable areas, the knowledge and applications of intern students about surgical wound healing weren’t sufficient similarly in earlier descriptive cross sectional research done in Turkey (3). These gaps may be due to less exposure to educational sessions and lack of clinical exposure with adequate facilities to perform wound care in clinical setting. Furthermore, the descriptive cross-sectional study which was done among Ireland nursing students (4) found similar findings regarding the competence of nursing undergraduates regarding chronic wound care, highlighting that virtual patient simulation is an effective pedagogy to increase clinical competence in wound care and it allows nursing students the opportunity to practice skills and utilize theory repetitively in a safe environment, unhampered by lack of resources such as clinical placement availability and declining faculty (4). Moreover, some negative attitudes and lack of confidence regarding chronic wound care were detected in this study and the results are comparable with previously published literature that indicated the students had a positive attitude towards wound care (1). Subthemes of the above-mentioned literature were wound care knowledge, attitudes towards wound care, wound care preparedness and wound care education which created the main theme Graduating nurses' wound care competence (1). It seems that lack of preparedness and lack of facilities may possibly cause some challenges during chronic wound care for undergraduates resulting in these embedded challenges and difficulties in chronic wound care that cause suffering for patients with chronic wounds. Conclusions Through the present study, certain barriers to provide wound care were screened out as difficulty to maintain emotional responses, knowledge deficit regarding wound care, insufficient guidance and support from staff during clinical setting, and lack of confidence for chronic wound care similar in earlier published studies, (1;5) which included both challenges and practical barriers. The absence of scheduled clinical guidelines for chronic wound care in the clinical setting in Sri Lanka and healthcare providers’ dearth of support (especially nursing officers) to encourage nursing undergraduates to provide chronic wound care under strict aseptic conditions remained potential significant factors in the studied context. Specific attention on chronic wound care should be made among clinical settings by empowering final year nursing undergraduates with sufficient training sessions to initiate training programmes. Along with that nursing education among nursing undergraduates regarding chronic wound care should be increased through health conferences, discussions and practical demonstrations in clinical setting for patients with chronic wounds focusing on final year nursing undergraduates. Knowledge deficits and lack of confidence for chronic wound care for undergraduates might be diminished through educational programmes while empowering undergraduates with sufficient knowledge, skills, positive attitudes and self-motivation for chronic wound care. Furthermore, the impact of the chronic wound care under standard protocols needs to be stressed in the undergraduate period (5). Since numerous negative attitudes and malpractices were formed due to a lack of preparedness and lack of confidence in chronic wound care, it can be suggested providing adequate training and disseminating knowledge about chronic wound care through staff nurses as a practicable approach. This could be well accomplished by numerous collective functions such as offering proper training for final year nursing undergraduates through focus group discussions, delegating responsibility of chronic wound care in the patients with chronic wounds and to motivate undergraduates who lack confidence to care a chronic wound alone and frequent reviewing the practices. Abbreviations BSc Bachelor of Science Declarations Ethics approval and consent to participate The current study was ethically cleared by one of the Ethics review committees established at the Faculty of Medicine, University of Colombo under the reference number EC24108. Written informed consent was obtained from each participant before data collection. Consent for publication Not applicable Competing interests The authors declared no competing interest. Funding The current study is self-funded and did not receive any funding support Authors' contributions UHTU were responsible for the study's conceptualization, project administration, and methodology. UHTU was involved in the study's implementation and data collection processes. UHTU conducted the formal analysis, interpreted the findings, and authored the initial draft of the manuscript. UHTU revised the manuscript, ensured its organization, and contributed to refining its content. All authors reviewed the manuscript thoroughly and provided their approval for the final version, ensuring its accuracy and quality. Acknowledgments We extend our heartfelt gratitude to the Dean of the Faculty of Nursing, University of Colombo, for granting permission to conduct this study. Additionally, we sincerely thank the administration of the selected hospital and the nursing officers for their support and cooperation. Availability of data and materials Not applicable References Timmins B et al (2018) O. ‘Nursing wound care practices in Haiti: facilitators and barriers to quality care’, pp. 1–8. Available at: https://doi.org/10.1111/inr.12438 Beane A et al (2019) ‘A learning health systems approach to improving the quality of care for patients in South Asia A learning health systems approach to improving the quality of care for’, Global Health Action, 12(1). Available at: https://doi.org/10.1080/16549716.2019.1587893 Bozkul G, Karahan S (2024) ‘European Journal of Oncology Nursing Experiences, difficulties and coping methods of female nurses caring for breast cancer surgery patients : A qualitative study’, 69(March 2023). Available at: https://doi.org/10.1016/j.ejon.2024.102511 Cook, Leanne (2013) ‘University of Huddersfield Repository’ Davies C et al (2016) ‘Teaching and learning in the biosciences: the development of an educational programme to assist student nurses in their assessment and management of patients with wounds’ Friman A, Edström DW, Edelbring S (2017) ‘Attitudes and perceptions from nursing and medical students towards the other profession in relation to wound care’, Journal of Interprofessional Care, 00(00), pp. 1–8. Available at: https://doi.org/10.1080/13561820.2017.1336991 Gill EC, Manager V, Moore Z (2013) An exploration of fourth-year undergraduate nurses. knowledge of and attitude towards pressure ulcer prevention’ Gustafsson C (2004) ‘Reflection, the way to professional development ?’ Halcomb EJ et al (2017) ‘The experiences of Australian undergraduate nursing students of a clinical placement in Cambodia’ Haththotuwa TN, Wijesundara WMCC (2018) Awareness on wound cleaning and dressing among nursing undergraduates in University of Peradeniya. Sri Lanka’, pp 2–4 Jean L, Hunter S (2016) ‘Nurse Education Today Resilience in nursing students: An integrative review ☆’, YNEDT, 36, pp. 457–462. Available at: https://doi.org/10.1016/j.nedt.2015.10.016 Kalingamudali YT, Jalini P (2023) ‘Knowledge, attitudes, and practices on the usage of antiseptics prior to invasive medical procedures : Evidence from Sri Lankan Healthcare Professionals’, (249). Available at: https://doi.org/10.1177/20503121231199654 Kielo-viljamaa E, Salminen L, Stolt M (2021) ‘The development and testing of the C / WoundComp instrument for assessing chronic wound-care competence in student nurses and podiatrists’, (July 2020), pp. 62–78. Available at: https://doi.org/10.1111/iwj.13495 Kielo E, Salminen L, Stolt M (2018) ‘Nurse Education in Practice Graduating student nurses ’ and student podiatrists ’ wound care competence – An integrative literature review’, 29(November 2017), pp. 1–7 Krasner D (1998) ‘Poinfu VENOUS Ulcers Themes and Stories about L vJncJ with the Pain and Suffering’, pp. 158–168 Youhasan P, ‘PERCEIVED LEVEL OF CLINICAL COMPETENCY AMONG GRADUATE NURSING STUDENTS IN EASTERN UNIVERSITY, SRI LANKA (2017) : A COMPARATIVE STUDY BETWEEN MALE AND FEMALE’, 1(1), pp. 80–86 Lokeesan V, - (2023) BASED DIABETIC FOOT ULCER CARE AMONG HEALTHCARE’ Mahmoud A et al (2023) ‘Nurses Application of the TIME Framework in the Wounds Assessment and Its Impact on the Wound Care Competences’, 8(1), pp. 11–17. Available at: https://doi.org/10.13189/nh.2023.080102 Mokgethi MJT (2019) WOUND ASSESSMENT AND PATIENTS’ KNOWLEDGE OF WOUND CARE AT A RURAL COMMUNITY HEALTH CENTRE IN THE BOJANALA DISTRICT. RUSTENBURG.’ Courtney M (2007) ‘A framework guiding critical thinking through reflective journal documentation: A Middle Eastern experience’, pp. 203–208. Available at: https://doi.org/10.1111/j.1440-172X.2007.00629.x Pra AMA (2012) ‘e x tra’ 25(1):38–44 Redmond C et al (2020) ‘Nurse Education in Practice Increasing competence in wound care: A cross-sectional study to evaluate use of a virtual patient by undergraduate student nurses’, 44(March) Sen CK (2019) ‘Human Wounds and Its Burden: An Updated Compendium of Estimates’, 8(2), pp. 39–48. Available at: https://doi.org/10.1089/wound.2019.0946 Sengul T et al (2024a) ‘Exploring Nursing Students ’ First Experiences Providing Wound and Ostomy Care to Patients: A Qualitative Study’, (June), pp. 304–310. Available at: https://doi.org/10.1097/ASW.0000000000000151 Sengul T et al (2024b) ‘Exploring Nursing Students ’ First Experiences Providing Wound and Ostomy Care to Patients: A Qualitative Study’, (June). Available at: https://doi.org/10.1097/ASW.0000000000000151 Smith T (2021) ‘Guided reflective writing as a teaching strategy to develop nursing student clinical judgment’, (September 2020), pp. 241–248. Available at: https://doi.org/10.1111/nuf.12528 Matsushima MDK et al (2010) ‘Injured Adolescents, Not Just Large Children : Difference in Care and Outcome between Adult and Pediatric Trauma Centers’, pp. 267–273. Available at: https://doi.org/10.1177/000313481307900325 Surme Y (2021) ‘Knowledge and Practices of the Intern Nursing Students on Wound Care’, 14(2) Upton D (2015) and Upton.P, Psychology of Wounds and Wound Care in Clinical Practice Wanninayake SDK (2017) ‘05. Human Resource Management Competitive (refereed delivered) Session Nursing Nurses ’ Emotions : The Coping Strategies of Sri Lankan Nurses 05. Human Resource Management Competitive Session Nursing Nurses ’ Emotions : The Coping Strategies of Sri Lankan Nurses’, pp. 1–22 Wasalathanthri S, Id O, Article O (2015) ‘DR. SUDHARSHANI WASALATHANTHRI (Orcid ID: 0000-0002-6387-3509) Article type : Original Article’, pp. 0–2. Available at: https://doi.org/10.1111/ijlh.12426 Welsh L (2018) ‘Wound care evidence, knowledge and education amongst nurses : a semi-systematic literature review’, pp. 53–61. Available at: https://doi.org/10.1111/iwj.12822 Additional Declarations The authors declare no competing interests. Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-7911732","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":532696515,"identity":"c01a3656-35a0-413c-b467-a9ecbe3dbfd3","order_by":0,"name":"Ulluvis Hewage Tharushi Uthpala","email":"data:image/png;base64,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","orcid":"","institution":"Faculty of Nursing, University of Colombo, Sri Lanka","correspondingAuthor":true,"prefix":"","firstName":"Ulluvis","middleName":"Hewage Tharushi","lastName":"Uthpala","suffix":""}],"badges":[],"createdAt":"2025-10-21 07:39:07","currentVersionCode":1,"declarations":{"humanSubjects":true,"vertebrateSubjects":false,"conflictsOfInterestStatement":false,"humanSubjectEthicalGuidelines":true,"humanSubjectConsent":true,"humanSubjectClinicalTrial":false,"humanSubjectCaseReport":false,"vertebrateSubjectEthicalGuidelines":false},"doi":"10.21203/rs.3.rs-7911732/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-7911732/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":94056428,"identity":"7524191a-c0f1-4e8d-90b5-a6f4fee8cded","added_by":"auto","created_at":"2025-10-22 04:02:47","extension":"docx","order_by":0,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":76539,"visible":true,"origin":"","legend":"","description":"","filename":"qualitativepaper1.docx","url":"https://assets-eu.researchsquare.com/files/rs-7911732/v1/3624f92e532a74f12dfaf15f.docx"},{"id":94056425,"identity":"926ddaaa-6169-4127-8620-148e35fd07e4","added_by":"auto","created_at":"2025-10-22 04:02:46","extension":"json","order_by":1,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":342,"visible":true,"origin":"","legend":"","description":"","filename":"rs7911732.json","url":"https://assets-eu.researchsquare.com/files/rs-7911732/v1/49e5ed36a1b778ace656faa9.json"},{"id":94056426,"identity":"aa1ff2a3-ec7b-42bd-b11f-c02050cb0d4c","added_by":"auto","created_at":"2025-10-22 04:02:47","extension":"xml","order_by":2,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":117574,"visible":true,"origin":"","legend":"","description":"","filename":"rs79117320enriched.xml","url":"https://assets-eu.researchsquare.com/files/rs-7911732/v1/dfea6c084c7dfb7fd50777ce.xml"},{"id":94056429,"identity":"3c54e51c-71bd-4ec9-ae2c-7ee3af6c744f","added_by":"auto","created_at":"2025-10-22 04:02:47","extension":"xml","order_by":3,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":113775,"visible":true,"origin":"","legend":"","description":"","filename":"rs79117320structuring.xml","url":"https://assets-eu.researchsquare.com/files/rs-7911732/v1/92f57c40eb36258f6413b6ed.xml"},{"id":94056536,"identity":"90e6bbbd-3897-45c8-8565-d25c53269bf0","added_by":"auto","created_at":"2025-10-22 04:10:47","extension":"html","order_by":4,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":124407,"visible":true,"origin":"","legend":"","description":"","filename":"earlyproof.html","url":"https://assets-eu.researchsquare.com/files/rs-7911732/v1/9d8d474dc3b7db55a3e3c6cb.html"},{"id":94056545,"identity":"f8242fe6-578e-4528-abf9-911e6ebb134a","added_by":"auto","created_at":"2025-10-22 04:10:51","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":864786,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-7911732/v1/96c4ca1d-30c6-418d-a602-67987234f494.pdf"}],"financialInterests":"The authors declare no competing interests.","formattedTitle":"\u003cp\u003eExploring the Perception of Nursing Undergraduates in Chronic wound care Management of Sri Lanka, qualitative study\u003cbr\u003e\n\u003c/p\u003e","fulltext":[{"header":"Introduction","content":"\u003cp\u003eWounds are a type of challenging clinical problem, and a wound is defined as an alteration of the anatomic integrity of the skin or any interruption of its continuity, as a consequence of trauma (Haththotuwa and Wijesundara, \u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e2018\u003c/span\u003e). Chronic wounds are classified as wounds that have not progressed through the normal process of healing and are open for more than a month and patients who are suffering from diabetes and obesity are at a high risk of developing chronic wounds (Sen, \u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e2019\u003c/span\u003e) and the most common chronic disease of patients with chronic wounds is hypertension (Mokgethi, \u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e2019\u003c/span\u003e) Chronic wounds aren\u0026rsquo;t a major problem in a healthy population. Even though a wide range of conditions from malnutrition to stress and factors such as metabolic syndrome, lead patients to experience chronic, nonhealing wounds (Sen, \u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e2019\u003c/span\u003e). As well chronic wounds affect lifestyle and psychological issues are linked with the etiology and development of chronic wounds as the risks of non-compliance to treatment in \u0026lsquo;lifestyle\u0026rsquo; diseases such as type 2 diabetes, the ignorance of medical advice on diet, and smoking (Upton, \u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e2015\u003c/span\u003e). Approximately 200,000 people in the United Kingdom had chronic wounds, 0.37% prevalence of wounds in Europe, and a majority of patients with pressure ulcers suffer from symptoms of wounds including pain (Cook and Leanne, \u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e2013\u003c/span\u003e)\u003c/p\u003e\u003cp\u003eWound-related pain is a complex feeling involving physiological, psychological, emotional, and social factors such as culture, personality, meanings, and expectations of patients. And also, pain in the patient contributes to stress and reduces the quality of life (Pra, \u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e2012\u003c/span\u003e). As well literature says that patients with painful venous ulcers experience nociceptive pain which is associated with other certain pain descriptors, such as sharp and stabbing, that accompanies tissue injury. Pain descriptors, such as burning, stinging, and tingling, are also associated with neuropathic pain (Krasner, \u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e1998\u003c/span\u003e). Also, the literature says that nearly a quarter of patients in low and middle-income countries may acquire at least one infection while hospitalized and a limited number of research investigating nursing wound care practices in low and middle-income countries regarding the prevention of hospital-acquired infections (Timmins et al., \u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e2018\u003c/span\u003e). As well the developed educational program will assist student nurses in their care of patients with wounds (Davies et al., \u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e2016\u003c/span\u003e). And also, negative attitudes in wound care attributes to inadequate training, suboptimal update of knowledge and lack of interest among nursing undergraduates in Colombo district, Sri Lanka (Kumarasinghe, Hettiarachchi and Wasalathanthri, 2015).\u003c/p\u003e\u003cp\u003eIn the Sri Lankan context, the literature says that there are gaps in nursing students' knowledge regarding different wound cleaning solutions and techniques, management of special wounds such as burn wounds, venous/diabetic ulcers, neonatal/infant wounds, and newly available dressing products in the market (Haththotuwa and Wijesundara, \u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e2018\u003c/span\u003e). Also, nurses use reframing\u0026rsquo; strategy to deep act, \u0026lsquo;pretending\u0026rsquo; and \u0026lsquo;restraining\u0026rsquo; strategies to surface act, \u0026lsquo;releasing\u0026rsquo; and \u0026lsquo;outpouring\u0026rsquo; strategies, receiving organizational support to use proactive coping strategies, spiritual renewal, building an awareness of their own spirituality, trying to identify concepts such as God and death, engaging in prayer meetings and treating their profession a to cope with emotional challenges as coping strategies in nursing procedures including wound care ( Wanninayake, \u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e2017\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eAs well literature says that the adapted Champions for Skin Integrity model of wound care effectively facilitated the uptake of evidence-based Based Practice in Diabetic Foot Ulcer care in the participating hospitals in Sri Lanka (Lokeesan, \u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e2023\u003c/span\u003e). Also, it\u0026rsquo;s difficult to treat patients in clinical settings including chronic wounds for a student nurse in Sri Lanka without having much experience, practice, and coping strategies (Youhasan, \u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e2017\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eThe majority of wounds are of peacetime origin and traumatic wounds such as burns cause life-changing disfigurement in some cases (Upton, \u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e2015\u003c/span\u003e). As well nociceptive pain associated with venous ulcers is explained by the patients as discomfort arising from the stimulation of intact afferent nerve endings and neuropathic pain is defined as discomfort arising from peripheral nerve injury (Krasner, \u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e1998\u003c/span\u003e). The surgical wound healing process requires a collaborative team approach and nurses are one of the most important members of this multidisciplinary team (Surme, \u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e2021\u003c/span\u003e). Even though as a result of lack of nurse-physician collaboration in wound care affects prolonged healing times for patients (Friman, Edstr\u0026ouml;m and Edelbring, \u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e2017\u003c/span\u003e). Institutional policies help to promote best practices, clarify nursing roles and responsibilities, and foster interdisciplinary collaboration in patient care. According to the literature conducted in Haiti, Greater financial investment in health care, continuous education, self-regulation, and development of the nursing role, including more autonomy, help to elevate the professional status of nurses which helps to increase the quality of caring for patients with wounds (Timmins et al., \u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e2018\u003c/span\u003e). As well factors that cause difficulties in treating are infection threats such as biofilms, and in the global context, diabetes, and obesity make chronic wounds that cause clinical, social, and economic challenges, increasing costs of health care in the aging population (Sen, \u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e2019\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eAccording to the literature which was conducted at Peradeniya University, Sri Lanka, wound cleaning and dressing is a main responsibility of nurses and nursing undergraduates, and awareness of wound cleaning and dressing helps to minimize wound infections, healing time, pain during the procedure and duration of hospital stay, the government expenditure on wound management and enhances the patient\u0026rsquo;s quality of life (Haththotuwa and Wijesundara, \u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e2018\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eAs well according to the literature, which was conducted in United States, resilience in nursing students including resilience of the discipline of psychology help to prepare students for the role of the professional nurse who caring patients with hardiness, emotional resilience (Jean and Hunter, \u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e2016\u003c/span\u003e). Literature says that reflective practice is widely used in critical thinking skills, nursing education, psychology, clinical practice and the sciences including coping strategies related to patient care (Smith, \u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e2021\u003c/span\u003e). As well, the literature says that the Champions for Skin Integrity model which includes prevention strategies in clinical practice in hospitals in Sri Lanka improves healthcare professionals\u0026rsquo; levels of confidence in Evidenced Based Diabetic Foot ulcer assessment and management of the Champions for Skin Integrity model for facilitating the uptake of evidence-based diabetic foot ulcer care among healthcare professionals in Sri Lanka and (Lokeesan, \u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e2023\u003c/span\u003e). Internationally those factors were well studied globally but in the Sri Lankan context, this matter is not well addressed.\u003c/p\u003e\u003cp\u003eAssessment of tissue viability and management of skin integrity by nurses including nursing students based on their experience is an important area in the management of wounds (Cook and Leanne, \u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e2013\u003c/span\u003e). Also, there is also a need for allocation of resources to understand the mechanistic basis of complications of cutaneous wounds (Sen, \u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e2019\u003c/span\u003e). The literature says that, clinical placement experiences present undergraduate nursing students with unique challenges, and it facilitates the growth of both professional and personality (Halcomb et al., \u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e2017\u003c/span\u003e). However, literature based on the experiences of nursing undergraduates in wound care is limited (Timmins et al., \u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e2018\u003c/span\u003e). Also, the literature says that nursing undergraduates\u0026rsquo; knowledge of and experience with chronic wounds and skill practices are not at a satisfactory level (Sengul et al., 2024). According to the literature conducted in Maryland, there are some in patients\u0026rsquo; complications such as complications related to respiratory system, cardiovascular complications, coagulopathy, renal complications, hepatic complications, infections, gastro intestinal complications and neurologic complications develop in the patients who are treated for surgical wounds (Matsushima. K, et al., 2010). In global context, surgical site infections significantly burden health- care systems which cause additional healthcare costs and consumption of antibiotics, leads to increased length of hospital stay, readmission rates, and the need for re-operation or intensive care, as it leads up to 20% of postoperative complications in colorectal surgery, 45% in head and neck cancer surgery. And also, surgical site infections are the second most common healthcare-associated infection in Europe, with a prevalence of 19.6% (Kalingamudali and Jalini, \u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e2023\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eAlso, the knowledge and applications of nursing students about surgical wound healing aren\u0026rsquo;t sufficient (Surme, \u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e2021\u003c/span\u003e). Also, the literature says that final-year diploma nursing students are more confident and competent than final-year nursing undergraduates in England as diploma nursing students have more clinical exposure and teaching hours in wound care (Cook and Leanne, \u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e2013\u003c/span\u003e) and undergraduates have lack of knowledge in the prevention of pressure ulcers (Gill, Manager and Moore, \u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e2013\u003c/span\u003e). Also, according to the literature, which was conducted in Scotland, wound care practice among health care professionals including nursing students needs further development, including the conduction of independent studies and research of qualitative design to explore patient and clinician experiences of all aspects of wound management (Welsh, \u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e2018\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eAccording to the literature, which was conducted in South Asian countries including Sri Lanka, poor quality of care including surgical wound care due to lack of experience and resources for health care professionals including nurses is a leading cause of excess morbidity and mortality in low- and middle- income countries (Beane et al., \u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2019\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eCompetence is a multidimensional concept in health care, and its assessment as part of health care professionals\u0026rsquo; education and clinical practice including nursing undergraduates is essential for improving patient safety and quality of care (Kielo-viljamaa et al, \u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e2021\u003c/span\u003e). In the global context, clinical skills are a fundamental component of nursing education and lack of clinical skills competency leads to compromise patient care and safety (Davies et al., \u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e2016\u003c/span\u003e). As well as wound care practices such as using gloves to remove dressings, applying sterile dressings, properly disposing of soiled materials, inspecting wounds for signs of infection, maintaining comfort and privacy measures and improving aseptic technique, hand hygiene, pain assessments, patient education, and documentation is important (Timmins et al., \u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e2018\u003c/span\u003e). In the global context, the TIME framework that includes tissue viability, infection or inflammation, moisture imbalance, and wound edges is a practical tool for wound care assessment (Mahmoud et al., \u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e2023\u003c/span\u003e). Also, according to the literature, which was conducted in Irish among nursing undergraduates, inadequacy of preparation of undergraduate nurses for the clinical skill of wound care leads to deficits in the skills related to biological sciences and expectations associated with wound management have significantly with decision making in wound practice of nurses. As well the treatment and caring methods for patients with wounds are based on a good knowledge of the formation and healing process of wounds. According to previous literature, nursing students who care for patients without evidence-based knowledge affect wound healing adversely and it leads to increasing patient suffering, pain, and delayed healing and ultimately it leads to an increase in the cost of care (Davies et al., \u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e2016\u003c/span\u003e). Also, the literature says that continuous professional development programs on wound care practice with time assessment tools are an effective intervention for improving nurses' performance in wound care (Mahmoud et al., \u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e2023\u003c/span\u003e). Also, reflective practice toward wound care improves the competence of undergraduate nursing students in wound care (Redmond et al., \u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e2020\u003c/span\u003e). As well surgical wounds require specific nursing care both in the clinic and after discharge (Surme, \u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e2021\u003c/span\u003e). Even though the competence of graduating student nurses' wound care was inadequate (Redmond et al., \u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e2020\u003c/span\u003e) and graduating student nurses\u0026rsquo; theoretical wound care competence is limited (Kielo, Salminen and Stolt, \u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e2018\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eAs well reflection is a tool which is used to provide better nursing care including wound care for patients by improving coping strategies in wound care (Gustafsson, \u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e2004\u003c/span\u003e) and reflective practice is a learning tool in nursing education which enhance nursing students\u0026rsquo; critical thinking skills and patient care which help to uplift coping ability of nurses and student nurses ( Simpson E and Courtney M, \u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e2007\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eIn the Sri Lankan context, the application of fluid to remove exudates, loosely adherent debris, necrotic tissues, or contaminants from the wound surface without causing further tissue damage is called wound cleansing and wound cleansing involves washing which helps loosen the wound debris/necrotic tissues and debridement which help to remove adherent necrotic or slough materials (Haththotuwa and Wijesundara, \u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e2018\u003c/span\u003e). Also, the literature says that the advanced nursing skills of nursing students in Sri Lanka are in the weakest area even though they have a positive level of confidence in their clinical competency. Also, male nursing students have high competency in advanced \u0026amp; core nursing skills (Youhasan, \u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e2017\u003c/span\u003e).\u003c/p\u003e\n\u003ch3\u003eObjective(s)\u003c/h3\u003e\n\u003cp\u003eThis study was aimed at exploring perceptions of nursing undergraduates caring for Chronic wounds in Sri Lanka.\u003c/p\u003e\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e\u003cdiv id=\"Sec4\" class=\"Section3\"\u003e\u003c/div\u003e\u003c/div\u003e"},{"header":"Method","content":"\u003ch2\u003eStudy Design and Setting\u003c/h2\u003e\u003cp\u003e This descriptive qualitative study aimed to explore Final year nursing undergraduates' perceptions including experiences and practices regarding chronic wound care in 2 selected government universities in western province and southern province, Sri Lanka.\u003c/p\u003e\n\u003ch3\u003eStudy Population\u003c/h3\u003e\n\u003cp\u003eThe study population included both male and female final-year undergraduate nursing students studying in nursing departments in two selected government universities in western province and southern province, Sri Lanka. Both male and female final-year undergraduate nursing students studying in nursing departments in two selected government universities in western province and southern province, Sri Lanka were eligible to participate, regardless of gender. Final year nursing undergraduates on absent during the data collection period and those who were refuse to participate for the study were excluded.\u003c/p\u003e\n\u003ch3\u003eSample Size and Sampling Technique\u003c/h3\u003e\n\u003cp\u003eData was collected until the saturation point is achieved which no new themes or information emerge from additional data, indicating that a comprehensive understanding of the phenomenon has been reached. A purposive sampling technique was employed. All eligible final year nursing undergraduates were listed and assigned numbers, and participants were selected based on inclusion and exclusion criteria.\u003c/p\u003e\n\u003ch3\u003eData Collection Techniques and Tools\u003c/h3\u003e\n\u003cp\u003eData was collected using a semi structured interviewer guide questionnaire designed by the researchers. The questionnaire comprised three sections: Section A comprised Sociodemographic details, including age, gender, university. Section B was dedicated to exploring the experiences of nursing undergraduates caring for chronic wounds in Sri Lanka, assessed through six questions. Section C explored the practices of nursing undergraduates caring for chronic wounds in Sri Lanka, measured using six open ended questions.\u003c/p\u003e\u003cp\u003eThe questionnaire underwent a thorough validation process to ensure its effectiveness and reliability. Content validity was established through a detailed review by an expert panel, ensuring the tool's alignment with the study objectives. Their feedback was incorporated to enhance clarity and relevance, making the questions more practical and user-friendly.\u003c/p\u003e\u003cdiv id=\"Sec8\" class=\"Section2\"\u003e\u003ch2\u003eData Analysis\u003c/h2\u003e\u003cp\u003eThe data collected from the semi-structured interviews was analyzed using thematic analysis to identify patterns and themes related to the perceptions of final-year nursing students on chronic wound care management. The audio recordings of the interviews were first transcribed verbatim, ensuring that all relevant details are captured. Once transcription was complete, the data was reviewed multiple times to ensure familiarity with the content. Initial coding was then conducted, where meaningful segments of the data were labeled to capture key concepts. These codes were organized into broader categories, and similar codes were grouped together to form initial themes.\u003c/p\u003e\u003cp\u003eThematic analysis was following the six-step process outlined by Braun and Clarke (2006), which includes: familiarization with the data, generating initial codes, searching for themes, reviewing themes, defining and naming themes, and producing the final report. The research team was collaborating throughout the process, discussing emerging themes to ensure consensus. Software such as NVivo or ATLAS.ti were used to assist in organizing and managing the data, but manual coding will also be employed to ensure immersion in the data.\u003c/p\u003e\u003cp\u003eThe themes were reviewed and refined to ensure that they accurately represent the underlying patterns in the data. Any discrepancies or ambiguities were discussed and resolved by the research team. The final themes were presented with supporting quotes from the participants to provide a rich, detailed understanding of the students\u0026rsquo; experiences and perceptions in chronic wound care management.\u003c/p\u003e\u003c/div\u003e"},{"header":"Findings","content":"\u003cp\u003eAmong the total study sample, (n\u0026thinsp;=\u0026thinsp;13), 7.7%, 7.7%, 23.1% and 61.5% of final year nursing undergraduates were 24 years, 25 years, 26 years and 27 years in age respectively. Also, 84.62% and 15.38% of final year nursing undergraduates were females and males respectively. More than 2/3 of them belonged to the University of Colombo. As a percentage it was 69.2% (Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e).\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eSociodemographic characteristics\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"3\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003eCategory\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e\u003cp\u003eTotal n\u0026thinsp;=\u0026thinsp;13\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eN\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003ePercentage\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"3\" nameend=\"c3\" namest=\"c1\"\u003e\u003cp\u003eAge (Years)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e24\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e7.7%\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e25\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e7.7%\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e26\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e3\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e23.1%\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e27\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e8\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e61.5%\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"3\" nameend=\"c3\" namest=\"c1\"\u003e\u003cp\u003eGender\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eMale\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e2\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e15.38%\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eFemale\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e11\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e84.62%\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"3\" nameend=\"c3\" namest=\"c1\"\u003e\u003cp\u003eUniversity\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eUniversity of Colombo\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e9\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e69.2%\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eUniversity of Ruhuna\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e4\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e30.8%\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003eQualitative findings are presented in this paper under 2 major sections: (1) experiences of final year nursing undergraduates caring for chronic wounds in Sri Lanka and (2) practices of final year nursing undergraduates in managing chronic wounds in Sri Lanka.\u003c/p\u003e\n\u003ch3\u003eExperiences of final year nursing undergraduates caring for chronic wounds in Sri Lanka\u003c/h3\u003e\n\u003cp\u003eBased on the views of final year nursing undergraduates caring for chronic wounds in Sri Lanka, six principal themes and interrelated subthemes were elicited from the experiences of final year nursing undergraduates (Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e).\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eThemes \u0026amp; subthemes of final year nursing undergraduates\u0026rsquo; experiences caring for chronic wounds, Sri Lanka\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"3\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eNo\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eSubthemes\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003eThemes\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eFear\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\" morerows=\"3\" rowspan=\"4\"\u003e\u003cp\u003eInitial emotional responses\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e2\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eShock\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e3\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eDisgust\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e4\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eEmpathy\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e5\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eLack of preparedness\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\" morerows=\"3\" rowspan=\"4\"\u003e\u003cp\u003ePractical challenges in clinical management\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e6\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eSmell and appearance\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e7\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eInstrument handling\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e8\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eHygiene issues\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e9\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eProgressive skill development\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\" morerows=\"2\" rowspan=\"3\"\u003e\u003cp\u003eEvolving competency and learning\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e10\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eSupervised practice\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e11\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eKnowledge gaps\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e12\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eNon-compliant patients\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\" morerows=\"2\" rowspan=\"3\"\u003e\u003cp\u003eBarriers to effective care\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e13\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eResource constraints\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e14\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eLack of continuity\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e15\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eEmotional support\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\" morerows=\"2\" rowspan=\"3\"\u003e\u003cp\u003ePositive outcomes and contributions\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e16\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eHealth education\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e17\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eTeam collaboration\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e18\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eEmpathy\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\" morerows=\"3\" rowspan=\"4\"\u003e\u003cp\u003eEmotional and mental impact\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e19\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eBurnout risk\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e20\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eSadness\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e21\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eResilience\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003eThe majority of final year nursing undergraduates broadly described the \u003cem\u003einitial emotional response\u003c/em\u003e of them during chronic wound care as the first theme, while some nursing undergraduates further explained that their first encounters with chronic wounds using emotionally intense language with \u003cem\u003efear\u003c/em\u003e, especially when faced with maggots or severely infected wounds, and some were \u003cem\u003eshocked\u003c/em\u003e by foul odors or the visual severity. \u003cem\u003eEmotional distress\u003c/em\u003e was sometimes compounded by personal associations (e.g., imagining family members in similar conditions).\u003c/p\u003e\u003cp\u003e\u003cem\u003eFear\u003c/em\u003e was the most commonly cited view among them and screened as first subtheme.\u003c/p\u003e\u003cp\u003eThe number of final year nursing undergraduates concerned with \u003cem\u003eshock\u003c/em\u003e as an emotional response during chronic wound care.\u003c/p\u003e\u003cp\u003eAs example, one final year nursing undergraduate said that \u0026ldquo;I can't bear it... and then that... ahh... scared... oh...shocked\u0026hellip;\u0026rdquo; (Response 06, 26 years, female, University of Colombo)\u003c/p\u003e\u003cp\u003e\u0026ldquo;I feel afraid that... I miss my dad... I get scared\u0026hellip;\u0026rdquo; (Response 02, 27 years, female, University of Colombo)\u003c/p\u003e\u003cp\u003eSome expectant final year nursing undergraduates further explained that \u003cem\u003edisgust\u003c/em\u003e during chronic wound care affects stress and discomfort among them and quality of life of the patients with wounds, so this was defined as the third subtheme under the main reflective view.\u003c/p\u003e\u003cp\u003eEmpathy towards patients with chronic wounds is derived as the fourth subtheme out of (five) undergraduates\u0026rsquo; concerns. As an example, one final year nursing undergraduate said that,\u003c/p\u003e\u003cp\u003e\u0026ldquo;Ahhh... I thought like at that time... Actually, according to my experience, even our father has it, then now I am a human... When someone has a diabetic wound... amputated or something like that. I feel like... I will miss my dad. That means I imagine what if this happens to him too... then I get scared... then... even when we clean a wound.... patient hurts. Then when that happens again... they say it hurts... However, we need to clean anyway, we need to remove the debridement. So, after explaining it... then I feel sad too... So, when that happens, after having a good conversation.... We shouldn't be harsh... after having a good conversation... hmmm... and then if the patient wants to cope with pain. After prescribing something from the doctor and asking for something... he is taught and, in the ward, he can show patients who are being rehabilitated to increase his emotional support... that's all\u0026rdquo; (Response 02, 27 years, female, University of Colombo)\u003c/p\u003e\u003cp\u003eAccording to the above specified views, \u0026ldquo;initial emotional responses\u0026rdquo; was drawn as the first main theme. Although participants realized the importance of maintaining initial emotional responses during wound care, insufficient knowledge regarding emotional responses was an apparent feature among the study sample. All the final year nursing undergraduates in the study sample did not have a clear, comprehensive understanding of the impact of initial emotional responses on chronic wound care. Furthermore, none of the participants articulate the idea about the role of initial emotional response in malignant wounds due to cancers.\u003c/p\u003e\u003cp\u003e Even if participants had optimistic insight and positive attitudes about initial emotional responses in chronic wound care management, final year nursing undergraduates usually did not have a tendency to maintain practical challenges in clinical management due to certain barriers. Yet, they have heard about the requirement of showing empathy towards patients with chronic wounds, but they were not received proper direction from the hospitals they trained or health professionals.\u003c/p\u003e\u003cp\u003eWhile the majority of clarified final year nursing undergraduates \u003cem\u003elack of preparedness\u003c/em\u003e derived as the fifth subtheme had contrasting views and perceptions.\u003c/p\u003e\u003cp\u003eOne undergraduate expressed his ideas, \u0026ldquo;One of the patients accidentally met a train accident. He was ... ahh... he was suffering with ahh... the wounds were terrible... he.... he was suffering from Gram-Positive wound.\u0026rdquo; (Response 05, 27 years, male, University of Colombo)\u003c/p\u003e\u003cp\u003eFurthermore, \u0026ldquo;When I was in 1st year... during 1st year... we didn't even have those procedures... One day in ward 12... I met a patient... A diabetic wound is infected. There are worms. The wound was infested with maggots. That is my 1st experience. It was given to me to clean it...assistance...\u0026rdquo; (Response 02, 27 years, female, University of Colombo)\u003c/p\u003e\u003cp\u003eFor instance, one undergraduate said, \u0026ldquo;Chronic wound.... I haven't done anything... but... I've just been waiting. I have assisted. This is how I helped with caring... when we say we have a chronic wound, medicine has been given for those wounds that are usually there... like diabetic wounds.\u0026rdquo; (Response 03, 27 years, female, University of Colombo)\u003c/p\u003e\u003cp\u003eOn their verbalizations, the second theme was constructed \u003cem\u003eas practical challenges in clinical management\u003c/em\u003e.\u003c/p\u003e\u003cp\u003eWhen discussing practical challenges in clinical management, some undergraduates elaborated about their insufficient enthusiasm to manage the practical challenges in clinical setting due to several causes. Among nursing undergraduates, six of them stated about \u003cem\u003esmell and appearance\u003c/em\u003e where, \u003cem\u003esmell and appearance\u003c/em\u003e that present during chronic wound care was elicited as the sixth subtheme based on their views. For example,\u003c/p\u003e\u003cp\u003e\u0026ldquo;Ahh... a chronic wound was seen for the first time... ahh... in our first rotation... that is in the first fundamental... then we were put in a surgical proof unit. Ward 25 in Kalubowila... I have never seen that... never seen a chronic wound before... that was my 1st experience. It's just that... when I see it, it's just that... there are these strange patterns in those wounds... It's not just like a normal wound. Strange drug that they are putting in... as medicine... I had not even learned about it yet. This... So that, this... I felt a very unpleasant feeling when I saw it... This... that... It was the same chronic wound that was in that ward. That... on the wound side... Wound care... that side was the same.... Ahh... That was the 1st experience.\u0026rdquo; (Response 11, 26 years, female, University of Colombo)\u003c/p\u003e\u003cp\u003e\u0026lsquo;\u003cem\u003eInstrument handling\u003c/em\u003e\u0026rsquo; was recognized as the seventh subtheme based on final year nursing undergraduates\u0026rsquo; (3) verbalization about their inability of proper handling of instruments. As an example,\u003c/p\u003e\u003cp\u003e\u0026ldquo;Hmm... what tools... ah... in wound assessment... we use a scale... we use a disposable scale... ah... it would be good to have a scale because we can assess the wound exactly to what extent. I think it's a good tool to see if it's spread, and how is the depth... it's a good tool. I think it's better to use a tool. It is a disposable scale like the pain scale.\u0026rdquo; (Response 12, 26 years, female, University of Ruhuna)\u003c/p\u003e\u003cp\u003eSome final year nursing undergraduates (3) expressed that hygiene issues are the main practical challenges in caring for chronic wounds in clinical settings. Through their views, \u003cem\u003ehygiene issues\u003c/em\u003e is derived as the eighth subtheme.\u003c/p\u003e\u003cp\u003eAs we know \u0026ldquo;I have not been appointed to the surgical wards... ahh... however, I have only assisted with wound dressing. Once there was a wound, a diabetic wound, it was a big wound on the foot... that was the wound that was managed at that time... a wound that was infested by worms.\u0026rdquo; (Response 01, 26 years, female, University of Colombo)\u003c/p\u003e\u003cp\u003e\u0026ldquo;Ahh... during the 1st year... ahh... I found a patient's wound.... it was not treated properly...... very worms.... a big.... wound that was hit by worms... that... it was not treated as it seemed to me... it was untreated... there was a malodor... What I found was an unpleasant-looking wound. The first wound experience was in the surgical ward.\u0026rdquo; (Response 10, 25 years, female, University of Colombo)\u003c/p\u003e\u003cp\u003e\u0026ldquo;Mm... Mm... Most of the time, these... Ahh... Patients don't think about their hygiene... The wound hurt... Mm... It doesn't matter if we put medicine, they are not hygienic. If they don't maintain it... the biggest challenge, I found is that they don't maintain hygiene properly. They don't adhere to our instructions...\u0026rdquo; (Response12, 26 years, female, University of Ruhuna)\u003c/p\u003e\u003cp\u003e\u0026lsquo;\u003cem\u003eProgressive skill development\u003c/em\u003e\u0026rsquo; was recognized as the nineth subtheme based on final year nursing undergraduates\u0026rsquo; (3) verbalization about their enthusiasm for learning skills in wound care management. As an example,\u003c/p\u003e\u003cp\u003e\u0026ldquo;Now... when we first went, we haven't even done procedures. I don't know then... that means that... the way to clean a surgical wound... The way to clean an infected wound is different. Even though we knew the theory of bandages, we had not used them practically. So, at that time, there was a little doubt about the way of cleaning.... in the beginning.... and then for a while.... Now we are professionals... we do the procedures and let them assist us. Now it's like 3rd year.... they let us do the dressing by ourselves without assisting....and after that...bandaging...and then...hmm...to maintain the sterility so as not to cause contamination... After that alone... in the whole ward... we were allowed to do wound dressing... that was the experience... the improvement...\u0026rdquo; (Response 02, 27 years, female, University of Colombo)\u003c/p\u003e\u003cp\u003eSome of them (5) identified \u003cem\u003esupervised practice\u003c/em\u003e as useful for the improvement of the skills of nursing undergraduates in chronic wound care. So, it can be specified as another subtheme.\u003c/p\u003e\u003cp\u003e\u0026ldquo;That means that usually... challenging happens when he has a chronic wound...it is difficult to understand exactly what kind of treatment is being given to him now...that means how the wound dressing should be done...they are... In such places... in such places... as a student nurse, supervision is needed because... how should we do this...\u0026rdquo; (Response 10, 25 years, female, University of Colombo)\u003c/p\u003e\u003cp\u003eSome final year nursing undergraduates (3) expressed that knowledge gaps are the main problems in caring for chronic wounds in clinical settings. Through their views, \u003cem\u003eknowledge gaps\u003c/em\u003e is derived as the eleventh subtheme.\u003c/p\u003e\u003cp\u003e\u0026ldquo;Ahhh... Then I want to tell you about the experience... I mean, the experience I saw for the first time... I want to tell you about the wound... I mean, that care is not good...... ahh... when I was ahh... 1st... 1st year, when we did clinical for the first time, I was fallen into this... ahh... medical ward... and there was this... diabetic wound. There was a patient who had one wound. The whole wound of that patient was oozing. It means not good... that... he had not received good care... with a very odour... this... very unpleasant feeling.... ahh... this... I felt very unpleasant... That patient is so... a big wound is very infected... this... very... this is what I found unpleasant... firstly as a chronic wound, that's it.\u0026rdquo; (Response12, 26 years, female, University of Ruhuna)\u003c/p\u003e\u003cp\u003e\u003cem\u003eEvolving competency and learning\u003c/em\u003e in chronic wound care is derived as the third theme through their perceptions of the above three subthemes.\u003c/p\u003e\u003cp\u003eAs the next subtheme caring for \u003cem\u003enon-compliant patients\u003c/em\u003e was elicited based on final year undergraduates\u0026rsquo; perceptions (5), one of them described as follows for example.\u003c/p\u003e\u003cp\u003eAccording to the way I think \u0026ldquo;Mm... when consider the side of patients, but the patients do not care much about the wound. If the patient is diabetic, diabetic control is not done. Then the precautions are like... they don't maintain things like infection control properly. Then it becomes an issue for us. Nurses are not doing it right. It was a bad experience for me... not being able to control the patients properly.\u0026rdquo; (Response 07, 24 years, female, University of Ruhuna)\u003c/p\u003e\u003cp\u003e\u0026lsquo;Resource constraints\u0026rsquo; was recognized as the 13th subtheme based on final year nursing undergraduates\u0026rsquo; (3) verbalization about their enthusiasm for managing difficulties in wound care management in clinical settings. As an example,\u003c/p\u003e\u003cp\u003e\u0026ldquo;Ah... I have heard verbally... about the pain... I haven't used any tool except that... the other one is from his... ah... complaints. ... from the appearance... to the assessments... what was done was... and... yes... that was...\u0026rdquo; (Response 09, 27 years, female, University of Ruhuna)\u003c/p\u003e\u003cp\u003eSome final year nursing undergraduates (3) expressed that lack of continuity in chronic wound care management are the main problems in caring for chronic wounds in clinical settings. Through their views, \u003cem\u003elack of continuity\u003c/em\u003e in chronic wound care management is derived as the 14th subtheme.\u003c/p\u003e\u003cp\u003e\u0026ldquo;Because of my care... ahh... oh... now that... a positive outcome... that means in two days... it's hard to see the outcome. We don't go to the same wards for more than a week. So... um... I haven't seen this big... um... positive. However, I think the wound dressing we are doing will help that patient. That means um... first we maintain the sterility... then we clean it well... we put medication on the wound... ahh... we put the dressing so that the germs don't go.\u0026rdquo; (Response 06, 26 years, female, University of Colombo)\u003c/p\u003e\u003cp\u003eThrough the above three subthemes, the fourth theme can be merged as \u0026lsquo;\u003cem\u003eBarriers to effective care\u003c/em\u003e\u0026rsquo;.\u003c/p\u003e\u003cp\u003eSome expectant final year nursing undergraduates further explained that \u003cem\u003eemotional support\u003c/em\u003e during chronic wound care affects stress and discomfort among them and quality of life of the patients with wounds, so this was defined as the 15th subtheme under the main reflective view.\u003c/p\u003e\u003cp\u003eAccording to the way I think \u0026ldquo;Hmm... there were some patients who were newly amputated... some people have wounds like that after an amputation. For them... when we go to do wound dressing, with their emotional state, with the way they talk, we are a little challenging there.\u0026rdquo; (Response 01, 26 years, female, University of Colombo)\u003c/p\u003e\u003cp\u003eSome of them (5) identified \u003cem\u003ehealth education\u003c/em\u003e as useful for the improvement of the knowledge and skills of nursing undergraduates in chronic wound care. So, it can be specified as another subtheme.\u003c/p\u003e\u003cp\u003e\u0026ldquo;Ahh... mmm... told him what he should do for a patient with cellulitis in the chronic stage... that is, he should do his antibiotic course properly... and he should keep his hygiene well... these... such a good health education session... after teaching the patient to manage his wound, the chronic wound was managed properly...\u0026rdquo; (Response 10, 25 years, female, University of Colombo)\u003c/p\u003e\u003cp\u003eSome final year nursing undergraduates (3) expressed that team collaboration in chronic wound care management are the main challenges affecting positive outcomes in caring for chronic wounds in clinical settings. Through their views, \u003cem\u003eteam work collaboration\u003c/em\u003e in chronic wound care management is derived as the 17th subtheme.\u003c/p\u003e\u003cp\u003e\u0026ldquo;Teamwork usually means... wound dressing... there should be at least two people... because one person does the wound dressing, wearing surgical gloves. Then some things cannot be touched. Then he needs to have someone to help him... then... that person to help... It is better if he is an experienced person so... otherwise, he has to say everything so... do this... that... um... and then... That's why... more... um... patients also need to help the team work because some patients don't like it... it takes a long time for the injury... to do these things... they need to have their support too... Um... then a nutritionist does these things... He should have his support from there... ah... doctors should be knowledgeable. Also, whoever is doing wound dressing should be knowledgeable... the care should be right... only then will the wound heal properly.\u0026rdquo; (Response 13, 27 years, male, University of Ruhuna)\u003c/p\u003e\u003cp\u003e\u003cem\u003ePositive outcomes and contributions\u003c/em\u003e in chronic wound care management is derived as the fifth theme through their perceptions of the above three subthemes.\u003c/p\u003e\u003cp\u003e When emotional impact of final year nursing undergraduates in chronic wound care management, some undergraduates elaborated about their insufficient enthusiasm to manage the emotional challenges during chronic wound care due to several causes. Among nursing undergraduates, six of them stated \u003cem\u003eempathy\u003c/em\u003e, that present during chronic wound care which was elicited as the 18th subtheme based on their views. For example,\u003c/p\u003e\u003cp\u003e\u0026ldquo;Ah... there we need to talk about something I took care of... we need to talk about progression.... ah... when I was in the ah... cardio thoracic .... unit... Ahh... there was a patient who had CABG... hmm... somehow... the wound got infected, and he was in the ward for a long time... even though he was there, he had big... ... ah...bed sore... mmm... for a long time... ahh... bystander... also... ah... with that patient is not a person with good... knowledge... it is difficult to do that position change... that patient is a bit... a fat patient. ... Ahh... exactly... ahh... that... his... changing position has been done... ah... just... ahh... we have given wound care.... his... Botox was right there... then... these... the ones that change the pumps... I helped them do that... At the same time, the wound did not heal well... However, during my stay in that wound... um... I mean... I think I can heal his wound to a considerable level. It happened... I helped him... that bystander and I advised him to... um... do this... do this... do this... and motivate him too... Anyway, I was more than he had. That wound... um... ah... help heal it because I had a patient who was met for me in the elective appointment.\u0026rdquo; (Response12, 26 years, female, University of Ruhuna)\u003c/p\u003e\u003cp\u003e\u0026lsquo;Burnout risk\u0026rsquo; was recognized as the 19th subtheme based on final year nursing undergraduates\u0026rsquo; (3) verbalization about their inability to cope with stress during wound care management. As an example,\u003c/p\u003e\u003cp\u003eAccording to the above specified views \u0026ldquo;Ahh... the first one is this... now when I say challenge this... I usually smell that... rather than seeing this... That strange bad odour is very unpleasant for me... Then I didn't even want to approach that side. It means this... It made me feel like I was tired of everything... Then that... This... It means... Ahh... The wound itself was unpleasant... So then\u0026hellip; It's hard to care... that smell... it's hard to get close to that person because of that smell... it's a big challenge at that time...\u0026rdquo; (Response 11, 26 years, female, University of Colombo)\u003c/p\u003e\u003cp\u003eSome final year nursing undergraduates (3) expressed that sadness during chronic wound care management is the main emotional challenge in caring for chronic wounds in clinical settings. Through their views, \u003cem\u003esadness\u003c/em\u003e during chronic wound care management is derived as the 20th subtheme.\u003c/p\u003e\u003cp\u003eAs we know \u0026ldquo;Hm... after seeing a chronic wound... ah... how do you say... oh... oh... that bad smell comes like that. I can't bear it... and then that... ahh... scared... oh...shocked... there is... that diabetic wound was the first thing I saw. That has happened. There were chronic wounds.\u0026rdquo; (Response 06, 26 years, female, University of Colombo)\u003c/p\u003e\u003cp\u003e\u0026ldquo;One of the patients accidentally met a train accident. He was ... ahh... he was suffering with ahh... the wounds were terrible... he.... he was suffering from Gram-Positive wound.\u0026rdquo; (Response 05, 27 years, male, University of Colombo)\u003c/p\u003e\u003cp\u003e\u003cem\u003eResilience\u003c/em\u003e for chronic wound management was elicited as the last subtheme under this section according to two final year nursing undergraduates\u0026rsquo; opinions, for example,\u003c/p\u003e\u003cp\u003e\u0026ldquo;Hmmm...the thumb is amputated...in a younger patient...he didn't like the surgery at first...he got sepsis....and then he... liked amputation...... a younger patient is... in Ruhuna... an undergraduate... accident ah... met with an accident... run over bus... ah.... went to the shock stage was extremely high.... then... for the lifesaving purpose, He has to go for an amputation surgery... So... ah... first he didn't like to.... He didn't give consent and..... and then ... Ahh. Then... he had to go for that. So... after that, he lived with that. That is the thing.\u0026rdquo; (Response 09, 27 years, female, University of Ruhuna)\u003c/p\u003e\u003cp\u003eThrough the above four subthemes. It can be merged with the sixth main theme \u0026lsquo;\u003cem\u003eemotional and mental impact\u003c/em\u003e\u0026rsquo; in chronic wound management.\u003c/p\u003e\u003cp\u003eSo, it is obvious that a substantial percentage of participants endorsed misconceptions and conflicting views on experiences of final year nursing undergraduates including practical and emotional challenges and barriers in chronic wound care management mainly due to knowledge deficit and lack of experience. Certain gaps in knowledge and societal myths could be detected through these observations. Analytically, it is clear that lack of proper guidance and support, inadequate information sources and not receiving appropriate stimulation by healthcare providers for the effective management of chronic wounds were frequently acknowledged as potential barriers to suffering patients from pain due to chronic wounds, while diabetes-related complications is another specified significant issue.\u003c/p\u003e\u003cdiv id=\"Sec11\" class=\"Section2\"\u003e\u003ch2\u003ePractices of final year nursing undergraduates in managing chronic wounds in Sri Lanka\u003c/h2\u003e\u003cp\u003eIn the study sample, the majority of final year nursing undergraduates caring for chronic wounds in Sri Lanka expressed their practices in managing chronic wounds in Sri Lanka. Basically, six themes were derived through their opinions and grouped into three categories as follows (Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e).\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab3\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eThemes \u0026amp; subthemes of final year nursing undergraduates\u0026rsquo; practices caring for chronic wounds, Sri Lanka\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"4\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eNo\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eSubthemes\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003eThemes\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003eCategory\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eStep-by-step procedure\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\" morerows=\"3\" rowspan=\"4\"\u003e\u003cp\u003eBasic wound care practices\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\" morerows=\"6\" rowspan=\"7\"\u003e\u003cp\u003eKnowledge and understanding of wound care principles\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e2\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eSterility\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e3\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eUse of forceps/gloves\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e4\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eDressing materials\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e5\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eResource limitations\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\" morerows=\"2\" rowspan=\"3\"\u003e\u003cp\u003eGap between theory and clinical practice\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e6\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eImprovisation\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e7\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eVariability between wards\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e8\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eVisual inspection\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\" morerows=\"3\" rowspan=\"4\"\u003e\u003cp\u003eAssessment of wound condition\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\" morerows=\"6\" rowspan=\"7\"\u003e\u003cp\u003eApproaches to wound care assessment\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e9\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eGranulation\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e10\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eInfection signs\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e11\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eSystemic factors\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e12\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eLimited tool usage\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\" morerows=\"2\" rowspan=\"3\"\u003e\u003cp\u003eUse of tools and products\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e13\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003ePhysician-recommended products\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e14\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003ePain scale\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e15\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eHealth literacy\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\" morerows=\"2\" rowspan=\"3\"\u003e\u003cp\u003ePatient education and communication\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\" morerows=\"6\" rowspan=\"7\"\u003e\u003cp\u003eEffective communication and teamwork influencing wound care management\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e16\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eCultural/language barriers\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e17\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eEmotional challenges\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e18\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eMulti-disciplinary team\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\" morerows=\"3\" rowspan=\"4\"\u003e\u003cp\u003eInterprofessional collaboration\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e19\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eRole of physiotherapists\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e20\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eSupervision\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e21\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003ePeer assistance\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec12\" class=\"Section2\"\u003e\u003ch2\u003eKnowledge and understanding of wound care principles\u003c/h2\u003e\u003cp\u003eThrough their verbalizations (8), it is identified that perceptions regarding \u003cem\u003ebasic wound care practices\u003c/em\u003e as a most prevalent viewpoint among them and stated as the first theme. One undergraduate said,\u003c/p\u003e\u003cp\u003e\u0026ldquo;Ah... yes... when we are managing a patient's chronic wound, um... when maintaining sterility, we need to use infection control strategies... we need to wear gloves... we need to maintain hand hygiene practices... then the patient's wound... medical history, A good idea about that... um... undergraduates need to know... because now if patients have diabetes... it's like that Patient has a delay in wound healing... then I think that such things should be controlled... then ah... I need to learn my hand skill experience to take care of a wound... then betadine when dressing the precautions pyretic wound. When putting it like that, there should be good assistance, I think that at that time, assistance and support are needed... and there should be good communication... the patient needs to be supported emotionally as well as psychologically. When giving care to the wound.\u0026rdquo; (Response 10, 25 years, female, University of Colombo)\u003c/p\u003e\u003cp\u003eThrough the above first main theme, It can be merged with the four subthemes as follows.\u003c/p\u003e\u003cp\u003e\u003cem\u003estep by step procedure\u003c/em\u003e in chronic wound management, maintaining \u003cem\u003esterility\u003c/em\u003e during chronic wound care, \u003cem\u003euse of forceps/gloves\u003c/em\u003e when caring for chronic wounds to prevent infections, use of \u003cem\u003edressing materials\u003c/em\u003e as needed to improve healing of wound.\u003c/p\u003e\u003cp\u003eAs we know \u0026ldquo;Specific steps... um... if steps come... first they look at the ticket and identify the patient... then... um... they see if the patient has any allergies... if a specific drug needs to be given... After that, the wound is observed and how much area is there... it is assessed like that... are there any other wounds on the body... and also checked... ah... the patient is prepared... check whether patient needs go to the toilet like that... and ask him to me to start the wound dressing... ah... After that, I prepare the things... ah... wash my hands... ah... maintain sterility... and then they do the wound dressing. So... first the wound dressing... they clean it. After that, it dried... ah... after that, if something is applied, betadine or any other powder is applied, then it is dressed and closed.\u0026rdquo; (Response 13, 27 years, male, University of Ruhuna)\u003c/p\u003e\u003cp\u003eAccording to the way I think \u0026ldquo;Um... specific management...... Um... that means the procedure... the procedure we have been taught is wound dressing... in the same way... if you put on sterile gloves and do it manually... If it is done with forceps, it is not put like that... Mainly infection control is what is mainly done. The procedure is done in the same way. Mm... just put on disposable gloves if you are doing it with forceps... or... put on sterile gloves if you are cleaning the wound bed by hand.\u0026rdquo; (Response 07, 24 years, female, University of Ruhuna)\u003c/p\u003e\u003cp\u003e\u003cem\u003eGap between theory and clinical practice\u003c/em\u003e among final year nursing undergraduates (7) and identified as the second key theme. Through the above main theme, It can be merged with the three subthemes as follows.\u003c/p\u003e\u003cp\u003e\u003cem\u003eResource limitations\u003c/em\u003e in chronic wound management, \u003cem\u003eimprovisation\u003c/em\u003e of chronic wound care, \u003cem\u003evariability between wards\u003c/em\u003e when caring for chronic wounds.\u003c/p\u003e\u003cp\u003eIt was well noted by their verbalizations such as an undergraduate said \u0026lsquo;The differences are that... if it's a clean wound, it's the way we clean it... that means an infected one... there is a difference in the cleaning. After that, there is a difference in the medication we apply... it changes from wound to wound... there is a difference in the dressing we put... ah... it's hard for us to do it with that theory alone... that means clinical. In the setting, that... changes... I think there is a slight difference. We have to manage that... um... according to the situation\u0026rsquo; for instance. (Response 06, 26 years, female, University of Colombo)\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec13\" class=\"Section2\"\u003e\u003ch2\u003eApproaches to wound care assessment\u003c/h2\u003e\u003cp\u003e\u003cem\u003eAssessment of wound condition\u003c/em\u003e was elucidated as the third theme based on their views (8). Through the above main theme, it can be merged with the four subthemes as follows.\u003c/p\u003e\u003cp\u003e\u003cem\u003eVisual inspection\u003c/em\u003e of chronic wounds, granulation tissue formation of chronic wounds, \u003cem\u003einfection signs\u003c/em\u003e of chronic wounds which are observed during chronic wound care, \u003cem\u003esystemic factors\u003c/em\u003e affecting chronic wound healing.\u003c/p\u003e\u003cp\u003eAs an example, one undergraduate said \u0026lsquo;That means... then you need to see... age... and then his... This... that means the social side... see... what is his occupation... like that. Things need to be considered. Are these... and then his role.... and if he is amputated, it's okay to wait a little longer without doing it, we should think about rehabilitation for him... mmm... and then after this. After that, no matter what he does, it doesn't matter if he doesn't have diabetic management, if his disease condition isn't managed if he doesn't control it, then he needs to do these things. The patient's pain level should be assessed. That means before wound dressing, after, after dressing and then if he has pain... if he is given any drugs for pain... then we need to see... From this... now he... absent... pain too... have to see if something has happened... like that. I want to see that. I want to see if there is a risk. I want to see a pulse. I want to see vitals. When the pain increases, BP and these also increase... If we patients say something, it is not good to neglect anything. That means if something says pain... now let's imagine a patient... a patient with a fracture has a chronic wound... even if we put POP... if he says something irritated or something, we should ignore it. It is not good. We want to see even a small thing\u0026rsquo; (Response 02, 27 years, female, University of Colombo)\u003c/p\u003e\u003cp\u003eAccording to the way I think \u0026ldquo;It has... the colour... the smell... granulocyte... granulose tissue... is there... the pink colour is good... the black colour is not good...\u0026rdquo; (Response 04, 27 years, female, University of Colombo)\u003c/p\u003e\u003cp\u003eAccording to the above specified views \u0026ldquo;Ah... chronic wound... that means assessing... the colour, how far it has spread... like the depth... that means today how much is there... pus like things... how much is there... The granulation tissue is good... how much... is their growth... the prognosis of the chronic wound is seen from such things.\u0026rdquo; (Response 07, 24 years, female, University of Ruhuna)\u003c/p\u003e\u003cp\u003eThe fourth major theme emerged as \u0026lsquo;\u003cem\u003euse of tools and products\u003c/em\u003e\u0026rsquo; for chronic wound care management according to the final year undergraduates\u0026rsquo; explanations (5). Through the above main theme, it can be merged with the three subthemes as follows.\u003c/p\u003e\u003cp\u003e\u003cem\u003eLimited tool usage\u003c/em\u003e for the assessment of chronic wounds, usage of \u003cem\u003ephysician-recommended products\u003c/em\u003e for the management of chronic wounds, use of \u003cem\u003epain scale\u003c/em\u003e for the assessment of chronic wounds.\u003c/p\u003e\u003cp\u003eOne of them said, \u0026ldquo;A tool... first of all that pain scale... we use it to see the pain... it... in the wound... it looks at the patient's pain... as far as I know... that's all I can remember... no Ah... now we are assessing the pain... the effectiveness... um... properly... that means the pain the patient feels before we take care of the wound... after taking care. If there is a difference between the pain... or if it progresses... we can get an idea about the care, we are doing... and we can also get an idea about the patient's... um... wound.\u0026rdquo; (Response 06, 26 years, female, University of Colombo)\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec14\" class=\"Section2\"\u003e\u003ch2\u003eEffective communication and teamwork influencing wound care management\u003c/h2\u003e\u003cp\u003e\u003cem\u003e\u0026lsquo;Patient education and communication\u0026rsquo;\u003c/em\u003e was derived as the fifth main theme and presented below with an example according to six undergraduates\u0026rsquo; verbalizations.\u003c/p\u003e\u003cp\u003eAs we know \u0026ldquo;That mean wound care related... Actually... now when I get diabetic patients... when I have someone like that... tell him... anyway, you need to focus on his diabetes control... that's... risk. To prevent infection... take a diet of protein. So, when that happens, some patients have their wound... sometimes... now there is no sensation... some patients. When that happens, it is too much for them... they neglect it... that is, they neglect it because they don't care. Sometimes uneducated people say they don't care about them... when they go to the washroom... wet wounds... those germs are inserted to the wound... next... those non-educated people are expected to be a bit more educated and be with technology. Look... I mean... it's easy to say something to a person who understands something like that... Some people don't have that.\u0026rdquo; (Response 02, 27 years, female, University of Colombo)\u003c/p\u003e\u003cp\u003eThrough the above main theme, it can be merged with the three subthemes as follows.\u003c/p\u003e\u003cp\u003e\u003cem\u003eHealth literacy\u003c/em\u003e among patients with chronic wounds, \u003cem\u003ecultural/language barriers\u003c/em\u003e of patients with chronic wounds, \u003cem\u003eemotional challenges\u003c/em\u003e of them during caring for chronic wounds.\u003c/p\u003e\u003cp\u003eAccording to the way I think \u0026ldquo;Yes. There are difficulties. In places like that... that... That means with the patient's emotional state. When I go to talk with it, sometimes... The patients cry like that. If there are patients in a place where it is difficult to heal an amputation or a chronic wound, difficulties will arise when I talk to the patients in such places.\u0026rdquo; (Response 01, 26 years, female, University of Colombo)\u003c/p\u003e\u003cp\u003e\u003cem\u003eInterprofessional collaboration\u003c/em\u003e during chronic wound care was derived as the last theme based on undergraduates\u0026rsquo; concerns (04) and presented below with an example.\u003c/p\u003e\u003cp\u003eAccording to the above specified views \u0026ldquo;Teamwork and collaboration is a very important wound ahh... while managing... then\u0026hellip; from the doctor's point of view it is a multi-disciplinary team approach so there too... Now the doctor himself recommends... and then looks at a chronic wound. If patients\u0026rsquo;... emotional state low... he will probably have to go to counselling for that too. After that, if the functional state is taken, he will have to undergo physiotherapy. Bring him back to ahh... normal... to bring him back to a normal functional state, we need to do physiotherapy, occupational therapy and all that. In addition, from the nursing side, nurses need the help of other curlicues. Because... this\u0026hellip; even we can't do wound dressing by ourselves... in any case, we have an assistant in the wound... dressing procedure. It is not something that can be done alone. They are there, so it is not something that can be done alone. They must have an assistant. If we do it properly as full sterile.\u0026rdquo; (Response 01, 26 years, female, University of Colombo)\u003c/p\u003e\u003cp\u003eThrough the above main theme, it can be merged with the four subthemes as follows.\u003c/p\u003e\u003cp\u003e\u003cem\u003eMulti-disciplinary team\u003c/em\u003e among staff in the ward for caring patients with chronic wounds, \u003cem\u003erole of physiotherapists\u003c/em\u003e for caring patients with chronic wounds, \u003cem\u003esupervision\u003c/em\u003e of senior nurses during caring for chronic wounds by undergraduates and \u003cem\u003epeer assistance\u003c/em\u003e while caring patients with chronic wounds.\u003c/p\u003e\u003cp\u003eAccording to the way I think \u0026ldquo;Those contractures... these can come like that... then... physiotherapy... occupational therapy... they will come. They come and help us... keep the legs elevated like this... they tell us how to move them... even though they are occupational, they look at rehabilitation... how can a patient deal with a wound... the pain nurse comes... then... the pain consultant comes and gives him the management... ahh... such support from others... now we are doing wound dressing according to the consultant's opinion. So... there is support so... I think there is a multi-disciplinary support.\u0026rdquo; (Response 02, 27 years, female, University of Colombo)\u003c/p\u003e\u003c/div\u003e"},{"header":"Discussion","content":"\u003cp\u003eThe current study investigated the perception toward chronic wound care among final year nursing undergraduates including their experiences and practices regarding chronic wound care.\u003c/p\u003e\u003cp\u003e Through the present study, it is distinctly recognized that the majority of final year nursing undergraduates expressed the initial emotional responses including fear, and they had negative aspects of facing emotional responses while wound care while few of them verbalized positive attitudes towards maintaining emotional responses while caring wounds including showing empathy towards patients. These themes correspond with the qualitative research on the international clinical placement experiences present undergraduate nursing students with unique challenges and facilitate both professional and personal growth (1) and they found that even though the majority of undergraduates faced challenges during the clinical placement in ways that they never expected (1). These challenges helped them to grow both professionally and personally from experience regarding wound care and exposing students to primary health care in practice helped to demonstrate the value and importance of improving experiences among undergraduates in this area of nursing (1). Although the majority of final year undergraduates realized the challenges of emotional responses during chronic wound care, they had positive attitudes towards chronic wound care similarly in previous qualitative study findings among students experience genuine caregiving in putting their experiences into practice with real patients in a clinical setting (2) by experiencing real patient care in a clinical setting, being a competent student, and being a novice student (2). Among less knowledgeable areas, the knowledge and applications of intern students about surgical wound healing weren\u0026rsquo;t sufficient similarly in earlier descriptive cross sectional research done in Turkey (3). These gaps may be due to less exposure to educational sessions and lack of clinical exposure with adequate facilities to perform wound care in clinical setting.\u003c/p\u003e\u003cp\u003eFurthermore, the descriptive cross-sectional study which was done among Ireland nursing students (4) found similar findings regarding the competence of nursing undergraduates regarding chronic wound care, highlighting that virtual patient simulation is an effective pedagogy to increase clinical competence in wound care and it allows nursing students the opportunity to practice skills and utilize theory repetitively in a safe environment, unhampered by lack of resources such as clinical placement availability and declining faculty (4). Moreover, some negative attitudes and lack of confidence regarding chronic wound care were detected in this study and the results are comparable with previously published literature that indicated the students had a positive attitude towards wound care (1). Subthemes of the above-mentioned literature were wound care knowledge, attitudes towards wound care, wound care preparedness and wound care education which created the main theme Graduating nurses' wound care competence (1). It seems that lack of preparedness and lack of facilities may possibly cause some challenges during chronic wound care for undergraduates resulting in these embedded challenges and difficulties in chronic wound care that cause suffering for patients with chronic wounds.\u003c/p\u003e"},{"header":"Conclusions","content":"\u003cp\u003eThrough the present study, certain barriers to provide wound care were screened out as difficulty to maintain emotional responses, knowledge deficit regarding wound care, insufficient guidance and support from staff during clinical setting, and lack of confidence for chronic wound care similar in earlier published studies, (1;5) which included both challenges and practical barriers. The absence of scheduled clinical guidelines for chronic wound care in the clinical setting in Sri Lanka and healthcare providers\u0026rsquo; dearth of support (especially nursing officers) to encourage nursing undergraduates to provide chronic wound care under strict aseptic conditions remained potential significant factors in the studied context.\u003c/p\u003e\u003cp\u003eSpecific attention on chronic wound care should be made among clinical settings by empowering final year nursing undergraduates with sufficient training sessions to initiate training programmes. Along with that nursing education among nursing undergraduates regarding chronic wound care should be increased through health conferences, discussions and practical demonstrations in clinical setting for patients with chronic wounds focusing on final year nursing undergraduates.\u003c/p\u003e\u003cp\u003eKnowledge deficits and lack of confidence for chronic wound care for undergraduates might be diminished through educational programmes while empowering undergraduates with sufficient knowledge, skills, positive attitudes and self-motivation for chronic wound care. Furthermore, the impact of the chronic wound care under standard protocols needs to be stressed in the undergraduate period (5). Since numerous negative attitudes and malpractices were formed due to a lack of preparedness and lack of confidence in chronic wound care, it can be suggested providing adequate training and disseminating knowledge about chronic wound care through staff nurses as a practicable approach. This could be well accomplished by numerous collective functions such as offering proper training for final year nursing undergraduates through focus group discussions, delegating responsibility of chronic wound care in the patients with chronic wounds and to motivate undergraduates who lack confidence to care a chronic wound alone and frequent reviewing the practices.\u003c/p\u003e"},{"header":"Abbreviations","content":"\u003cdiv class=\"DefinitionList\"\u003e\u003cdiv class=\"DefinitionListEntry\"\u003e\u003cdiv class=\"Term\"\u003eBSc\u003c/div\u003e\u003cdiv class=\"Description\"\u003e\u003cp\u003eBachelor of Science\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003c/div\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003ch2\u003eEthics approval and consent to participate\u003c/h2\u003e\u003cp\u003e The current study was ethically cleared by one of the Ethics review committees established at the Faculty of Medicine, University of Colombo under the reference number EC24108. Written informed consent was obtained from each participant before data collection.\u003c/p\u003e\u003c/p\u003e\u003cp\u003e\u003cstrong\u003eConsent for publication\u003c/strong\u003e\u003cp\u003eNot applicable\u003c/p\u003e\u003c/p\u003e\u003cp\u003e\u003ch2\u003eCompeting interests\u003c/h2\u003e\u003cp\u003eThe authors declared no competing interest.\u003c/p\u003e\u003c/p\u003e\u003ch2\u003eFunding\u003c/h2\u003e\u003cp\u003eThe current study is self-funded and did not receive any funding support\u003c/p\u003e\u003ch2\u003eAuthors' contributions\u003c/h2\u003e\u003cp\u003eUHTU were responsible for the study's conceptualization, project administration, and methodology. UHTU was involved in the study's implementation and data collection processes. UHTU conducted the formal analysis, interpreted the findings, and authored the initial draft of the manuscript. UHTU revised the manuscript, ensured its organization, and contributed to refining its content. All authors reviewed the manuscript thoroughly and provided their approval for the final version, ensuring its accuracy and quality.\u003c/p\u003e\u003ch2\u003eAcknowledgments\u003c/h2\u003e\u003cp\u003e We extend our heartfelt gratitude to the Dean of the Faculty of Nursing, University of Colombo, for granting permission to conduct this study. Additionally, we sincerely thank the administration of the selected hospital and the nursing officers for their support and cooperation.\u003c/p\u003e\u003ch2\u003eAvailability of data and materials\u003c/h2\u003e\u003cp\u003eNot applicable\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eTimmins B et al (2018) O. \u0026lsquo;Nursing wound care practices in Haiti: facilitators and barriers to quality care\u0026rsquo;, pp. 1\u0026ndash;8. Available at: \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1111/inr.12438\u003c/span\u003e\u003cspan address=\"10.1111/inr.12438\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eBeane A et al (2019) \u0026lsquo;A learning health systems approach to improving the quality of care for patients in South Asia A learning health systems approach to improving the quality of care for\u0026rsquo;, Global Health Action, 12(1). Available at: \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1080/16549716.2019.1587893\u003c/span\u003e\u003cspan address=\"10.1080/16549716.2019.1587893\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eBozkul G, Karahan S (2024) \u0026lsquo;European Journal of Oncology Nursing Experiences, difficulties and coping methods of female nurses caring for breast cancer surgery patients : A qualitative study\u0026rsquo;, 69(March 2023). Available at: \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1016/j.ejon.2024.102511\u003c/span\u003e\u003cspan address=\"10.1016/j.ejon.2024.102511\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eCook, Leanne (2013) \u0026lsquo;University of Huddersfield Repository\u0026rsquo;\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eDavies C et al (2016) \u0026lsquo;Teaching and learning in the biosciences: the development of an educational programme to assist student nurses in their assessment and management of patients with wounds\u0026rsquo;\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eFriman A, Edstr\u0026ouml;m DW, Edelbring S (2017) \u0026lsquo;Attitudes and perceptions from nursing and medical students towards the other profession in relation to wound care\u0026rsquo;, Journal of Interprofessional Care, 00(00), pp. 1\u0026ndash;8. Available at: \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1080/13561820.2017.1336991\u003c/span\u003e\u003cspan address=\"10.1080/13561820.2017.1336991\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eGill EC, Manager V, Moore Z (2013) An exploration of fourth-year undergraduate nurses. knowledge of and attitude towards pressure ulcer prevention\u0026rsquo;\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eGustafsson C (2004) \u0026lsquo;Reflection, the way to professional development ?\u0026amp;#8217\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eHalcomb EJ et al (2017) \u0026lsquo;The experiences of Australian undergraduate nursing students of a clinical placement in Cambodia\u0026rsquo;\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eHaththotuwa TN, Wijesundara WMCC (2018) Awareness on wound cleaning and dressing among nursing undergraduates in University of Peradeniya. Sri Lanka\u0026rsquo;, pp 2\u0026ndash;4\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eJean L, Hunter S (2016) \u0026lsquo;Nurse Education Today Resilience in nursing students: An integrative review ☆\u0026rsquo;, YNEDT, 36, pp. 457\u0026ndash;462. Available at: \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1016/j.nedt.2015.10.016\u003c/span\u003e\u003cspan address=\"10.1016/j.nedt.2015.10.016\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eKalingamudali YT, Jalini P (2023) \u0026lsquo;Knowledge, attitudes, and practices on the usage of antiseptics prior to invasive medical procedures : Evidence from Sri Lankan Healthcare Professionals\u0026rsquo;, (249). Available at: \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1177/20503121231199654\u003c/span\u003e\u003cspan address=\"10.1177/20503121231199654\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eKielo-viljamaa E, Salminen L, Stolt M (2021) \u0026lsquo;The development and testing of the C / WoundComp instrument for assessing chronic wound-care competence in student nurses and podiatrists\u0026rsquo;, (July 2020), pp. 62\u0026ndash;78. Available at: \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1111/iwj.13495\u003c/span\u003e\u003cspan address=\"10.1111/iwj.13495\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eKielo E, Salminen L, Stolt M (2018) \u0026lsquo;Nurse Education in Practice Graduating student nurses \u0026rsquo; and student podiatrists \u0026rsquo; wound care competence \u0026ndash; An integrative literature review\u0026rsquo;, 29(November 2017), pp. 1\u0026ndash;7\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eKrasner D (1998) \u0026lsquo;Poinfu VENOUS Ulcers Themes and Stories about L vJncJ with the Pain and Suffering\u0026rsquo;, pp. 158\u0026ndash;168\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eYouhasan P, \u0026lsquo;PERCEIVED LEVEL OF CLINICAL COMPETENCY AMONG GRADUATE NURSING STUDENTS IN EASTERN UNIVERSITY, SRI LANKA (2017) : A COMPARATIVE STUDY BETWEEN MALE AND FEMALE\u0026rsquo;, 1(1), pp. 80\u0026ndash;86\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eLokeesan V, - (2023) BASED DIABETIC FOOT ULCER CARE AMONG HEALTHCARE\u0026rsquo;\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eMahmoud A et al (2023) \u0026lsquo;Nurses Application of the TIME Framework in the Wounds Assessment and Its Impact on the Wound Care Competences\u0026rsquo;, 8(1), pp. 11\u0026ndash;17. Available at: \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.13189/nh.2023.080102\u003c/span\u003e\u003cspan address=\"10.13189/nh.2023.080102\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eMokgethi MJT (2019) WOUND ASSESSMENT AND PATIENTS\u0026rsquo; KNOWLEDGE OF WOUND CARE AT A RURAL COMMUNITY HEALTH CENTRE IN THE BOJANALA DISTRICT. RUSTENBURG.\u0026rsquo;\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eCourtney M (2007) \u0026lsquo;A framework guiding critical thinking through reflective journal documentation: A Middle Eastern experience\u0026rsquo;, pp. 203\u0026ndash;208. Available at: \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1111/j.1440-172X.2007.00629.x\u003c/span\u003e\u003cspan address=\"10.1111/j.1440-172X.2007.00629.x\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003ePra AMA (2012) \u0026lsquo;e x tra\u0026rsquo; 25(1):38\u0026ndash;44\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eRedmond C et al (2020) \u0026lsquo;Nurse Education in Practice Increasing competence in wound care: A cross-sectional study to evaluate use of a virtual patient by undergraduate student nurses\u0026rsquo;, 44(March)\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eSen CK (2019) \u0026lsquo;Human Wounds and Its Burden: An Updated Compendium of Estimates\u0026rsquo;, 8(2), pp. 39\u0026ndash;48. Available at: \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1089/wound.2019.0946\u003c/span\u003e\u003cspan address=\"10.1089/wound.2019.0946\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eSengul T et al (2024a) \u0026lsquo;Exploring Nursing Students \u0026rsquo; First Experiences Providing Wound and Ostomy Care to Patients: A Qualitative Study\u0026rsquo;, (June), pp. 304\u0026ndash;310. Available at: \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1097/ASW.0000000000000151\u003c/span\u003e\u003cspan address=\"10.1097/ASW.0000000000000151\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eSengul T et al (2024b) \u0026lsquo;Exploring Nursing Students \u0026rsquo; First Experiences Providing Wound and Ostomy Care to Patients: A Qualitative Study\u0026rsquo;, (June). Available at: \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1097/ASW.0000000000000151\u003c/span\u003e\u003cspan address=\"10.1097/ASW.0000000000000151\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eSmith T (2021) \u0026lsquo;Guided reflective writing as a teaching strategy to develop nursing student clinical judgment\u0026rsquo;, (September 2020), pp. 241\u0026ndash;248. Available at: \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1111/nuf.12528\u003c/span\u003e\u003cspan address=\"10.1111/nuf.12528\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eMatsushima MDK et al (2010) \u0026lsquo;Injured Adolescents, Not Just Large Children : Difference in Care and Outcome between Adult and Pediatric Trauma Centers\u0026rsquo;, pp. 267\u0026ndash;273. Available at: \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1177/000313481307900325\u003c/span\u003e\u003cspan address=\"10.1177/000313481307900325\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eSurme Y (2021) \u0026lsquo;Knowledge and Practices of the Intern Nursing Students on Wound Care\u0026rsquo;, 14(2)\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eUpton D (2015) and Upton.P, Psychology of Wounds and Wound Care in Clinical Practice\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eWanninayake SDK (2017) \u0026lsquo;05. Human Resource Management Competitive (refereed delivered) Session Nursing Nurses \u0026rsquo; Emotions : The Coping Strategies of Sri Lankan Nurses 05. Human Resource Management Competitive Session Nursing Nurses \u0026rsquo; Emotions : The Coping Strategies of Sri Lankan Nurses\u0026rsquo;, pp. 1\u0026ndash;22\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eWasalathanthri S, Id O, Article O (2015) \u0026lsquo;DR. SUDHARSHANI WASALATHANTHRI (Orcid ID: 0000-0002-6387-3509) Article type : Original Article\u0026rsquo;, pp. 0\u0026ndash;2. Available at: \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1111/ijlh.12426\u003c/span\u003e\u003cspan address=\"10.1111/ijlh.12426\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eWelsh L (2018) \u0026lsquo;Wound care evidence, knowledge and education amongst nurses : a semi-systematic literature review\u0026rsquo;, pp. 53\u0026ndash;61. Available at: \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1111/iwj.12822\u003c/span\u003e\u003cspan address=\"10.1111/iwj.12822\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":true,"hideJournal":true,"highlight":"","institution":"faculty of Nursing, University of Colombo","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"Experiences, Final year nursing undergraduates, Nursing education, Perception, Practice, Wound care","lastPublishedDoi":"10.21203/rs.3.rs-7911732/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-7911732/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eBackground\u003c/h2\u003e\u003cp\u003eWounds are a type of challenging clinical problem. Chronic wounds are classified as wounds that have not progressed through the normal process of healing. As nursing undergraduates play a pivotal role in facilitating patient facing challenges during chronic wound management; their perception in chronic wound management significantly impact patient outcomes and quality of life, yet gaps in perception of nursing undergraduates in chronic wound care management of Sri Lanka are not well-documented.\u003c/p\u003e\u003ch2\u003eObjective(s):\u003c/h2\u003e\u003cp\u003eThis study was aimed at exploring perceptions of nursing undergraduates caring for Chronic wounds in Sri Lanka.\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e\u003cp\u003eA descriptive qualitative study was conducted among 13 final year nursing undergraduates from 2 government universities in western province and southern province in Sri Lanka. Participants were selected using a purposive sampling method until theoretical data saturation was achieved. Data was collected through a validated semi structured interviewer guide questionnaire, with demographic characteristics, experiences of nursing undergraduates caring for chronic wounds, and practices of nursing undergraduates caring for chronic wounds. Data was analyzed using the thematic analysis by identifying patterns and themes related to the perceptions of final-year nursing students on chronic wound care management.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e\u003cp\u003eInterviews were performed with 13 final year nursing undergraduates from 2 government universities in western province and southern province in Sri Lanka between November 2024 to January 2025. The main themes that emerged were initial exposure and emotional reactions to chronic wound care, challenges in chronic wound management, evolution of skills and knowledge in wound care practice, positive outcomes and factors contributing to success, preparedness and confidence in chronic wound care, emotional and mental challenges in caregiving, practices and procedures in chronic wound care, assessment and use of tools in wound care, communication and health education with patients, importance of teamwork and multidisciplinary collaboration.\u003c/p\u003e\u003ch2\u003eConclusions\u003c/h2\u003e\u003cp\u003eThe multifaceted experiences of final year nursing undergraduates involved in chronic wound care management. Emotional and sensory challenges such as fear, anxiety and discomfort during early exposure and progress toward growing confidence and skill acquisition. Resource limitations and patient non-compliance, participants demonstrate adaptability and resilience, bridging theoretical knowledge with practical realities. Emotional strain from witnessing patient suffering is profound, requiring both empathy and professionalism. Effective wound care was shown to rely heavily on multidisciplinary collaboration, patient education, and adherence to infection control protocols.\u003c/p\u003e","manuscriptTitle":"Exploring the Perception of Nursing Undergraduates in Chronic wound care Management of Sri Lanka, qualitative study","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-10-22 04:02:42","doi":"10.21203/rs.3.rs-7911732/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"42458121-e770-4fde-9bce-9a6b48bfed7d","owner":[],"postedDate":"October 22nd, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[{"id":56622693,"name":"Nursing"}],"tags":[],"updatedAt":"2025-10-22T04:02:42+00:00","versionOfRecord":[],"versionCreatedAt":"2025-10-22 04:02:42","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-7911732","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-7911732","identity":"rs-7911732","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}