For our Wound Research Voices feature in November, we are pleased to share a short summary of a PhD thesis by Raquel Marques Silva, Universidade Católica Portuguesa, Faculdade de Ciências da Saúde e Enfermagem, Porto, Portugal. The thesis explores clinical algorithms to support nursing decision-making in the care of individuals with complex wounds. The thesis was defended in May 2025.  

The aim of this research was to create and test a digital tool to assist nurses in making safer and more consistent decisions in the care of adults with complex wounds. 

The study used a mixed-methods design across three phases. First, information was gathered through a literature review, focus groups with nurses (13 participants, thematic analysis), and a six-month patient follow-up using a mobile app. Next, clinical decision algorithms were designed using “if–then” logic” and the Outcome-Present State-Test model. The algorithms were validated with 105 experts (via an online questionnaire). Finally, the algorithms were integrated into an app and tested in real clinical settings over another six months to see how well they supported care.

The results show that computerised clinical algorithms embedded in a mobile application are a feasible and effective strategy to strengthen nurses’ clinical reasoning and decision-making in the management of complex wounds. Nurses frequently followed the treatment suggestions, and there was a reasonable level of agreement between the nurse’s judgment and the wound type suggested by the application. By enabling earlier risk recognition, more consistent diagnostic classification and individualized therapeutic planning, they contribute to safer, more reliable and outcome-oriented care. 

Overall, the study suggests that this type of digital tool can assist nurses in monitoring complex wounds, standardising care, and potentially improving wound healing and patient safety. 

Published articles

• Marques, Raquel, Mira, Helena I. M. F., Lopes, Marcos V. O., Neves-Amado, João D., Ramos, Paulo A. S., Alves, Paulo J. P. (2024). Applying mHealth for Assessment of Complex Wounds: Insights from a Focus Group. Nursing Forum, 2024, 6932442, 12 pages. https://doi.org/10.1155/2024/6932442
• Marques, R., Lopes, M. V. O., Neves-Amado, J. D., Ramos, P. A. S., Sá, L. O., Oliveira, I. M. S., Amado, J. M. C., Vasconcelos, M. J. M., Salgado, P. M. F., & Alves, P. J. P. (2024). Integrating factors associated with complex wound healing into a mobile application: Findings from a cohort study. International Wound Journal, 21(1), e14339. https://doi.org/10.1111/iwj.14339
• Marques, R., Lopes, M., Ramos, P., Neves-Amado, J., & Alves, P. (2023). Prognostic factors for delayed healing of complex wounds in adults: A scoping review. International Wound Journal, 20(7), 2869–2886. https://doi.org/10.1111/iwj.14128 
• Marques, R., Lopes, M., Ramos, P., Neves-Amado, J., & Alves, P. (2022). Prognostic factors for delayed healing of complex wounds in adults: A scoping review protocol. Nursing Reports, 12(4), 904–911. https://doi.org/10.3390/nursrep12040087

The full thesis is only available upon request, as this includes information about a commercial product.