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NICE guidance falls short

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VOL: 97, ISSUE: 28, PAGE NO: 49

Keith F. Cutting, BSc, PG Cert, RN, is principal lecturer, Buckinghamshire Chilterns University College, Chalfont St Giles

One of the arguments against specialist nurses is that we run the risk of deskilling the bedside nurse; the specialist nurse may embark on a path of care, not include the nurses assigned to that patient and thus avoid the opportunity for them to learn and develop during care delivery.

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One of the arguments against specialist nurses is that we run the risk of deskilling the bedside nurse; the specialist nurse may embark on a path of care, not include the nurses assigned to that patient and thus avoid the opportunity for them to learn and develop during care delivery.

 

 

It is possible that a similar accusation could be levied against the National Institute for Clinical Excellence. If the proclaimed experts at NICE are reviewing the available evidence and issuing pronouncements based on that review then other clinicians - that is, doctors and nurses - may have their powers of research review weakened through lack of exercise as the decision-making process is left to others.

 

 

This accusation would, however, be unfair when considering one of the most recent documents to be published by NICE, The Guidance on the Use of Debriding Agents and Specialist Wound Care Clinics for Difficult-to-Heal Surgical Wounds (NICE, 2001), because in this instance there is very little guidance offered. Within this document NICE admits that a robust research base focussing on debridement is not yet available and consequently indicates to care deliverers the difficulties faced by NICE in making an established pronouncement on this practice and providing the much-needed guidance and leadership. NICE does offer a little support and suggests that choice of debriding agent should consider impact on comfort, odour control and other aspects. Additionally choice of agent should consider ‘total costs’, as wound care costs are very sensitive to dressing change frequency. This statement does little to assist the bedside nurse, however, as cost-effectiveness studies for difficult-to-heal surgical wounds do not exist, as NICE openly admits.

 

 

Although all health professionals are expected to take NICE’S guidance into account, they are also required to use individual judgement in individual circumstances. When considering issues of accountability in the light of this document where does this leave the nurse?

 

 

The main value of this guidance seems to lie in the stimulus that it will provide to the generation of research focusing on the safe, effective and cost-effective use of debriding agents in difficult-to-heal surgical wounds.

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