{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,11,26]],"date-time":"2025-11-26T14:19:50Z","timestamp":1764166790193,"version":"3.46.0"},"reference-count":22,"publisher":"MDPI AG","issue":"12","license":[{"start":{"date-parts":[[2025,11,26]],"date-time":"2025-11-26T00:00:00Z","timestamp":1764115200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Nursing Reports"],"abstract":"<jats:p>Objective: This study aims to validate a referral model for specialised nursing consultation in the treatment of patients with complex wounds. Methods: A sequential mixed-methods design was used. First, a focus group with national wound care experts was conducted to identify and discuss potential referral indicators based on current clinical practice and the existing literature. The preliminary criteria were then evaluated and refined through a two-round Delphi survey involving a multidisciplinary panel of specialists. Consensus was defined as \u226570% agreement among participants. Results: Fourteen referral criteria achieved expert consensus, with several, such as the need for advanced therapies, multidisciplinary management, and the presence of peripheral vascular disease, reaching over 90% agreement. The most frequently prioritised indicators for referral included wound complexity (exposure of fascia or surgical material, presence of non-viable tissue, or associated vascular pathology) and the need for innovative advanced therapies (e.g., negative-pressure wound therapy, topical oxygen therapy). Conclusions: This validated set of referral criteria offers a structured, evidence-informed tool to support timely and appropriate referral to specialised nursing consultation, enhancing consistency, quality, and efficiency in wound management. Beyond clinical utility, these criteria may serve as a foundation for national referral policies, interprofessional collaboration, and future digital decision-support systems aimed at optimising complex wound care.<\/jats:p>","DOI":"10.3390\/nursrep15120417","type":"journal-article","created":{"date-parts":[[2025,11,26]],"date-time":"2025-11-26T13:56:34Z","timestamp":1764165394000},"page":"417","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Referencing Criteria for Specialised Consultation in Complex Wound Care"],"prefix":"10.3390","volume":"15","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-0305-1973","authenticated-orcid":false,"given":"Liliana Grilo","family":"Miranda","sequence":"first","affiliation":[{"name":"Institute of Health Sciences, Portuguese Catholic University\u2013Porto, 4169-004 Porto, Portugal"},{"name":"Researcher at the CIIS (Centre for Interdisciplinary Research in Health), Portuguese Catholic University, 4169-004 Porto, Portugal"},{"name":"Higher School of Health, Portuguese Red Cross\u2014Alto T\u00e2mega\u2014Chaves, 5400-673 Chaves, Portugal"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3642-4919","authenticated-orcid":false,"given":"\u00d3scar","family":"Louren\u00e7o","sequence":"additional","affiliation":[{"name":"Faculty of Economics, University of Coimbra, 3004-531 Coimbra, Portugal"},{"name":"Researcher at the CeBER (Centre for Business and Economics Research), Faculty of Economics, University of Coimbra\u2014Coimbra, 3004-512 Coimbra, Portugal"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5330-779X","authenticated-orcid":false,"given":"Jo\u00e3o","family":"Neves-Amado","sequence":"additional","affiliation":[{"name":"Institute of Health Sciences, Portuguese Catholic University\u2013Porto, 4169-004 Porto, Portugal"},{"name":"Researcher at the CIIS (Centre for Interdisciplinary Research in Health), Portuguese Catholic University, 4169-004 Porto, Portugal"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6348-3316","authenticated-orcid":false,"given":"Paulo","family":"Alves","sequence":"additional","affiliation":[{"name":"Institute of Health Sciences, Portuguese Catholic University\u2013Porto, 4169-004 Porto, Portugal"},{"name":"Researcher at the CIIS (Centre for Interdisciplinary Research in Health), Portuguese Catholic University, 4169-004 Porto, Portugal"}]}],"member":"1968","published-online":{"date-parts":[[2025,11,26]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"551","DOI":"10.1097\/01.ASW.0000790468.10881.90","article-title":"The Value of Nurses Specialized in Wound, Ostomy, and Continence: A Systematic Review","volume":"34","author":"Heerschap","year":"2021","journal-title":"Adv. Ski. Wound Care"},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"114","DOI":"10.1111\/wrr.12683","article-title":"The humanistic and economic burden of chronic wounds: A systematic review","volume":"27","author":"Olsson","year":"2019","journal-title":"Wound Rep. Reg."},{"key":"ref_3","first-page":"899","article-title":"Wound care in the UK: Burden, treatment, and costs","volume":"17","author":"Guest","year":"2020","journal-title":"Int. Wound J."},{"key":"ref_4","doi-asserted-by":"crossref","unstructured":"Boulkedid, R., Abdoul, H., Loustau, M., Sibony, O., and Alberti, C. (2011). Using and reporting the Delphi method for selecting healthcare quality indicators: A systematic review. PLoS ONE, 6.","DOI":"10.1371\/journal.pone.0020476"},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"195","DOI":"10.1016\/S0020-7489(00)00044-4","article-title":"A critical review of the Delphi technique as a research methodology for nursing","volume":"38","author":"Keeney","year":"2001","journal-title":"Int. J. Nurs. Stud."},{"key":"ref_6","unstructured":"Krueger, R.A., and Casey, M.A. (2014). Focus Groups: A Practical Guide for Applied Research, Sage Publications. [5th ed.]."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"349","DOI":"10.1093\/intqhc\/mzm042","article-title":"Consolidated criteria for reporting qualitative research (COREQ): A 32-item checklist for interviews and focus groups","volume":"19","author":"Tong","year":"2007","journal-title":"Int. J. Qual. Health Care"},{"key":"ref_8","unstructured":"Bardin, L. (2018). An\u00e1lise de Conte\u00fado, Edi\u00e7\u00e3o Revista e Atualizada, Edi\u00e7\u00f5es."},{"key":"ref_9","first-page":"76","article-title":"Designing a new community lower limb haematoma pathway to prevent hospital admission and reduce cost","volume":"18","author":"Constant","year":"2022","journal-title":"Wounds UK"},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"11","DOI":"10.1097\/01.ASW.0000722740.93179.9f","article-title":"Management of Nonhealable and Maintenance Wounds: A Systematic Integrative Review and Referral Pathway","volume":"34","author":"Boersema","year":"2021","journal-title":"Adv. Ski. Wound Care"},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"560","DOI":"10.1089\/wound.2015.0635","article-title":"Challenges in the Treatment of Chronic Wounds","volume":"4","author":"Frykberg","year":"2015","journal-title":"Adv. Wound Care"},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"S36","DOI":"10.12968\/bjon.2020.29.5.S36","article-title":"An international consensus on device-related pressure ulcers: SECURE prevention","volume":"29","author":"Gefen","year":"2020","journal-title":"Br. J. Nurs. (Mark Allen Publ.)"},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"103033","DOI":"10.1016\/j.iccn.2021.103033","article-title":"Pressure injury prediction models for critically-ill patients should consider both the case-mix and local factors","volume":"65","author":"Deschepper","year":"2021","journal-title":"Intensive Crit. Care Nurs."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"S1","DOI":"10.12968\/jowc.2019.28.Sup3a.S1","article-title":"Implementing TIMERS: The race against hard-to-heal wounds","volume":"23","author":"Atkin","year":"2019","journal-title":"J. Wound Care"},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"S4","DOI":"10.1097\/01.ASW.0000558695.68304.41","article-title":"Computer Modeling of Prophylactic Dressings: An Indispensable Guide for Healthcare Professionals","volume":"32","author":"Gefen","year":"2019","journal-title":"Adv. Ski. Wound Care"},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"e14402","DOI":"10.1111\/iwj.14402","article-title":"The role community-based healthcare providers play in managing hard-to-heal wounds","volume":"21","author":"Beeckman","year":"2024","journal-title":"Int. Wound J."},{"key":"ref_17","unstructured":"World Union of Wound Healing Societies (2025). Implementing Wound Balance: Outcomes and Future Recommendations, Wounds International. Available online: https:\/\/www.woundsinternational.com."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"125","DOI":"10.12707\/RIV16008","article-title":"Modelos de pr\u00e1tica profissional de enfermagem: Revis\u00e3o integrativa da literatura","volume":"IV S\u00e9rie","author":"Ribeiro","year":"2016","journal-title":"Rev. Enferm. Ref."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"104","DOI":"10.1097\/WON.0000000000001154","article-title":"Updating Wound Care Algorithms: A Systematic, Focused Review","volume":"52","author":"Beitz","year":"2025","journal-title":"J. Wound Ostomy Cont. Nurs."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"e062673","DOI":"10.1136\/bmjopen-2022-062673","article-title":"Cohort study of diagnostic delay in the clinical pathway of patients with chronic wounds in the primary care setting","volume":"12","author":"Isoherranen","year":"2022","journal-title":"BMJ Open"},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"245","DOI":"10.1097\/NHH.0000000000001109","article-title":"Back to the Basics: Wound Assessment, Management, and Documentation","volume":"40","year":"2022","journal-title":"Home Healthc. Now"},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"163","DOI":"10.1097\/01.WON.0000347657.02594.36","article-title":"Reducing the risks of wound consultation: Adding digital images to verbal reports","volume":"36","author":"Buckley","year":"2009","journal-title":"J. Wound Ostomy Cont. 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