EDITORIAL
Editorial Board Irene Anderson
Principal Lecturer Tissue Viability, Reader in Learning and Teaching in Healthcare Practice, University of Hertfordshire
Martyn Butcher
Independent Tissue Viability & Wound Care Consultant; Associate Lecturer, University of Plymouth; Research Nurse (Tissue Viability), Northern Devon Healthcare Trust (Honorary post)
Keith Cutting
Visiting Professor, Buckinghamshire New University, Uxbridge
Jemell Geraghty
Clinical Nurse Specialist, Tissue Viability, Royal Free Hamstead NHS Trust
Steve Jeffery
Professor, Wound Study, Birmingham City University, Fellow of the Royal College of Surgeons of Edinburgh, England and Glasgow
Editor/Associate Publisher Julie Smith Deputy Editor Aysha Mendes Da Mata Subeditors Daniel Davies Vicqui Stuart-Jones MedEd Manager Tracy Cowan Associate Publisher Chloe Benson Publishing Director Anthony Kerr If you would like to submit an article for publication in this supplement please contact Julie Smith on 020 7738 5454 or [email protected] MA Healthcare Ltd is part of the Mark Allen Group
www.markallengroup.com The British Journal of Nursing is published by MA Healthcare Ltd, St Jude’s Church, Dulwich Road, London SE24 0PB Tel: 020 7738 5454 Editorial: 020 7501 6716 Sales: 020 7501 6726 Subscriptions: 0800 137201 Email: [email protected] Websites: www.britishjournalofnursing.com
© MA Healthcare Ltd, 2013. All rights reserved. No part of the British Journal of Nursing may be reproduced, stored in a retrieval system, or transmitted in any form or by any means electronic, mechanical, photocopying, recording, or otherwise without prior written permission of the Publishing Director. Print: Pensord Press Ltd, Blackwood, NP12 2YA Cover picture: istockphoto.com
The paper used within this publication has been sourced from Chain-of-Custody certified manufacturers, operating within international environmental standards, to ensure sustainable sourcing of the raw materials, sustainable production and to minimise our carbon footprint.
Education saves lives
I
was asked recently to run a one-day leg ulcer course.The expectation was that participants could do patient assessment and Doppler in the morning, bandaging in the afternoon and a competency test at the end (and could we finish by 3.30, please). It is increasingly difficult to make time for continuing professional development (CPD) in tissue viability. There is so much to be done and increasingly pressured clinical environments. Even in high-priority areas such as pressure ulcer prevention it is difficult to release staff to ensure learning about clinical issues, underpinning principles and clinical skills are understood in sufficient depth to make a sustained and fundamental difference to patient care. This is not through any lack of effort; indeed many organisations are working extremely hard to ensure their staff have every opportunity to develop patient care. However, training budgets are being reduced and even if funding is available it is a real challenge to release staff from practice. Where once nurses attended educational courses focused on theory and practice perhaps over a period of days or weeks there are now many half days, an hour or two, or online resources. In some cases an update may be all that is required and many events and resources can be beneficial and well planned. We want to improve and make safer the care we give to patients but if we are not practising in a way that is robustly underpinned by knowledge and understanding then we risk working in a taskfocused way. Yes, I want a nurse that can change my dressing or bandage and place me on an appropriate mattress when I need it, but I also want that person to recognise when I am deteriorating, that I need a referral or a change of therapy and is able to justify these decisions. The ‘knowing how’ and the ‘knowing why’ are inextricably linked and make a difference to patient safety and outcomes. Undoubtedly nurses would learn something in a short session, any mentor would tell you that every activity is a learning opportunity, but is such activity enough for sustained improvements and development of patient care? My sense is that decisions are being made on the basis of what money, staff and time is available rather than what is needed for sustained and effective tissue viability services. I have had many conversations with nurses concerned about the increasing role that non-qualified staff have in wound care. Everyone in the health team has a role in patient care but many procedures are entwined with assessment and carry with them risks to the patient, for instance when determining the ankle brachial pressure index with a Doppler, or applying compression bandages. Doppler is not about a number, it is an assessment of the patient and his or her limbs, arterial sounds, waveforms and individual pulses; an important
British Journal of Nursing, 2014 (Tissue Viability Supplement), Vol 23, No 6
and skilled procedure. Applying compression bandages is fundamentally about assessment of the patient; his or her leg, any signs of damage, clinical decision making during the application and recognising the effects of therapy.To leave skills such as these to the least qualified and least accountable member of the team is risky for the patient and unfair on non-qualified staff. If qualified nurses are too busy or do not have the skills then it is evident that non-qualified staff are not receiving the supervision and support required and professional issues of delegation and responsibility arise for the qualified nurse. This is not patientcentred care and may not necessarily lead to the best outcome for the patient. The right person with the right skills is vital. Tissue viability and leg ulcer specialist nurses should be role models in the specialty and specifically supported to develop the necessary clinical, teaching and business skills required in order to carry out their role effectively. Sometimes it appears people are moved into specialist roles with an expectation that they will learn ‘on the job’ and perhaps have only attended a short course or have accumulated a portfolio of study days relevant to tissue viability. Some clinical areas have development roles for new and aspiring TVNs and such investment in tissue viability practice will benefit patients and the organisation, especially if there is a robust appraisal and staff development structure in place. In community leg ulcer management all too often nurses without leg ulcer skills are left to deal with vulnerable patients who then suffer delays and worsening of their condition. This is a concern given the number of people affected by ulceration and chronic oedema. The current emphasis on pressure ulcer prevention is having a huge positive impact on reducing patient harm but there is concern that this is detracting from the needs of patients with other wound types. Patients are complex and are affected by a diverse range of tissue viability issues. It is important not to lose sight of the CPD needs of staff to recognise and manage a range of tissue viability conditions. We need more investment in education and whether it comes from a university or a healthcare setting is less important than being part of a planned and structured programme with skilled teachers and clear expectations of outcomes from the participants. The one-day leg ulcer course did not happen but a structured and clinically focused programme emerged which is resulting in knowledgeable and skilled practitioners who are prepared and supported, and are BJN making a difference in practice.
Irene Anderson
Principal Lecturer Tissue Viability, Reader in Learning and Teaching in Healthcare Practice, University of Hertfordshire
S3
British Journal of Nursing. Downloaded from magonlinelibrary.com by 138.253.100.121 on December 6, 2015. For personal use only. No other uses without permission. . All rights reserved.
Editorial Board Irene Anderson
Principal Lecturer Tissue Viability, Reader in Learning and Teaching in Healthcare Practice, University of Hertfordshire
Martyn Butcher
Independent Tissue Viability & Wound Care Consultant; Associate Lecturer, University of Plymouth; Research Nurse (Tissue Viability), Northern Devon Healthcare Trust (Honorary post)
Keith Cutting
Visiting Professor, Buckinghamshire New University, Uxbridge
Jemell Geraghty
Clinical Nurse Specialist, Tissue Viability, Royal Free Hamstead NHS Trust
Steve Jeffery
Professor, Wound Study, Birmingham City University, Fellow of the Royal College of Surgeons of Edinburgh, England and Glasgow
Editor/Associate Publisher Julie Smith Deputy Editor Aysha Mendes Da Mata Subeditors Daniel Davies Vicqui Stuart-Jones MedEd Manager Tracy Cowan Associate Publisher Chloe Benson Publishing Director Anthony Kerr If you would like to submit an article for publication in this supplement please contact Julie Smith on 020 7738 5454 or [email protected] MA Healthcare Ltd is part of the Mark Allen Group
www.markallengroup.com The British Journal of Nursing is published by MA Healthcare Ltd, St Jude’s Church, Dulwich Road, London SE24 0PB Tel: 020 7738 5454 Editorial: 020 7501 6716 Sales: 020 7501 6726 Subscriptions: 0800 137201 Email: [email protected] Websites: www.britishjournalofnursing.com
© MA Healthcare Ltd, 2013. All rights reserved. No part of the British Journal of Nursing may be reproduced, stored in a retrieval system, or transmitted in any form or by any means electronic, mechanical, photocopying, recording, or otherwise without prior written permission of the Publishing Director. Print: Pensord Press Ltd, Blackwood, NP12 2YA Cover picture: istockphoto.com
The paper used within this publication has been sourced from Chain-of-Custody certified manufacturers, operating within international environmental standards, to ensure sustainable sourcing of the raw materials, sustainable production and to minimise our carbon footprint.
Education saves lives
I
was asked recently to run a one-day leg ulcer course.The expectation was that participants could do patient assessment and Doppler in the morning, bandaging in the afternoon and a competency test at the end (and could we finish by 3.30, please). It is increasingly difficult to make time for continuing professional development (CPD) in tissue viability. There is so much to be done and increasingly pressured clinical environments. Even in high-priority areas such as pressure ulcer prevention it is difficult to release staff to ensure learning about clinical issues, underpinning principles and clinical skills are understood in sufficient depth to make a sustained and fundamental difference to patient care. This is not through any lack of effort; indeed many organisations are working extremely hard to ensure their staff have every opportunity to develop patient care. However, training budgets are being reduced and even if funding is available it is a real challenge to release staff from practice. Where once nurses attended educational courses focused on theory and practice perhaps over a period of days or weeks there are now many half days, an hour or two, or online resources. In some cases an update may be all that is required and many events and resources can be beneficial and well planned. We want to improve and make safer the care we give to patients but if we are not practising in a way that is robustly underpinned by knowledge and understanding then we risk working in a taskfocused way. Yes, I want a nurse that can change my dressing or bandage and place me on an appropriate mattress when I need it, but I also want that person to recognise when I am deteriorating, that I need a referral or a change of therapy and is able to justify these decisions. The ‘knowing how’ and the ‘knowing why’ are inextricably linked and make a difference to patient safety and outcomes. Undoubtedly nurses would learn something in a short session, any mentor would tell you that every activity is a learning opportunity, but is such activity enough for sustained improvements and development of patient care? My sense is that decisions are being made on the basis of what money, staff and time is available rather than what is needed for sustained and effective tissue viability services. I have had many conversations with nurses concerned about the increasing role that non-qualified staff have in wound care. Everyone in the health team has a role in patient care but many procedures are entwined with assessment and carry with them risks to the patient, for instance when determining the ankle brachial pressure index with a Doppler, or applying compression bandages. Doppler is not about a number, it is an assessment of the patient and his or her limbs, arterial sounds, waveforms and individual pulses; an important
British Journal of Nursing, 2014 (Tissue Viability Supplement), Vol 23, No 6
and skilled procedure. Applying compression bandages is fundamentally about assessment of the patient; his or her leg, any signs of damage, clinical decision making during the application and recognising the effects of therapy.To leave skills such as these to the least qualified and least accountable member of the team is risky for the patient and unfair on non-qualified staff. If qualified nurses are too busy or do not have the skills then it is evident that non-qualified staff are not receiving the supervision and support required and professional issues of delegation and responsibility arise for the qualified nurse. This is not patientcentred care and may not necessarily lead to the best outcome for the patient. The right person with the right skills is vital. Tissue viability and leg ulcer specialist nurses should be role models in the specialty and specifically supported to develop the necessary clinical, teaching and business skills required in order to carry out their role effectively. Sometimes it appears people are moved into specialist roles with an expectation that they will learn ‘on the job’ and perhaps have only attended a short course or have accumulated a portfolio of study days relevant to tissue viability. Some clinical areas have development roles for new and aspiring TVNs and such investment in tissue viability practice will benefit patients and the organisation, especially if there is a robust appraisal and staff development structure in place. In community leg ulcer management all too often nurses without leg ulcer skills are left to deal with vulnerable patients who then suffer delays and worsening of their condition. This is a concern given the number of people affected by ulceration and chronic oedema. The current emphasis on pressure ulcer prevention is having a huge positive impact on reducing patient harm but there is concern that this is detracting from the needs of patients with other wound types. Patients are complex and are affected by a diverse range of tissue viability issues. It is important not to lose sight of the CPD needs of staff to recognise and manage a range of tissue viability conditions. We need more investment in education and whether it comes from a university or a healthcare setting is less important than being part of a planned and structured programme with skilled teachers and clear expectations of outcomes from the participants. The one-day leg ulcer course did not happen but a structured and clinically focused programme emerged which is resulting in knowledgeable and skilled practitioners who are prepared and supported, and are BJN making a difference in practice.
Irene Anderson
Principal Lecturer Tissue Viability, Reader in Learning and Teaching in Healthcare Practice, University of Hertfordshire
S3
British Journal of Nursing. Downloaded from magonlinelibrary.com by 138.253.100.121 on December 6, 2015. For personal use only. No other uses without permission. . All rights reserved.
