After seeing injuries from drug use, Jackie Hatfield set up a wound care clinic for substance users.
A home visit to a substance user inspired district nurse team leader Jackie Hatfield to start a wound care clinic in her home town of Dewsbury.
“When I saw the client with terrible wounds from injecting drugs and the environment that surrounded me, I felt uneasy and vulnerable - mainly through my own ignorance,” says Ms Hatfield.
“All I wanted to do was get out. It was only when I came away that I realised - due to the amount of people around and coming in and out - there had been drug-dealing going on. I had been too naive to realise.”
Disappointed in her ability to identify what was happening, and focusing only on the wounds and overlooking the injecting habit made Ms Hatfield realise she had not offered a holistic assessment but merely dressed wounds.
She resolved to set up a clinic to treat this group.
“Everyone deserves to get treatment in a non-judgemental environment,” she says. “I wanted to attract not just the people who were in treatment for their drug habit but also those who had never engaged in any treatment. If I could have, I’d have stuck a big sign on a lamppost saying: ‘Come to me. I’ll look after you and dress your wounds.’ But it wasn’t quite that simple.”
So Ms Hatfield and tissue viability nurse Tracy Conroy set up a drop-in wound care clinic at the premises of a local substance misuse agency.
“I went to user forums and talked to ex-users, who thought it was a wonderful idea as many of this group tend to treat themselves in often unhygienic conditions, causing more harm,’” she says.
“The user forum advertised the word out on the street, informing others that there was a place you could get treated in a safe environment.”
Word spread, and the regular Thursday afternoon clinic sees between five and seven clients, with patients often requiring quite intense 45-minute appointments to attend to their wounds.
“We’ve had to run a clinic on a Monday afternoon, too,” says Ms Hatfield. “We make appointments but sometimes the erratic lifestyles of these clients make it hard for them to commit to the times.”
She says it can be hard tending to this client group because often you can nearly get the wounds and ulcers healed then you don’t see the client for weeks until they are ready again to attend.
“We do have cases where the clients have got better, thanks to the intervention of the clinic,” she says.
“We once had two friends come into the clinic who were struggling with heroin addiction. They had chronic leg wounds caused by constant injecting, then one developed leg ulcers.
“Black and inflamed, the pain of their ulcers was dulled yet again by the next fix. One of their acquaintances, who had lost his friend six months previously from a thrombosis, advised the two friends to get treatment in accident and emergency.”
They avoided thrombosis and were referred to mainstream healthcare. They began a methadone programme at the substance misuse agency and were referred to a district nurse for treatment for leg ulcers.
But the treatment took two nurses 40 minutes and cost £197 in dressings and each visit. Often, the two friends were unreliable and missed appointments. So they were referred to the drop-in wound clinic.
The clinic provided holistic wound care and non-judgemental listening. The collaborative approach of the substance misuse agency and the clinic supported the friends in complying with treatment programmes and attending appointments. Eventually their leg ulcers healed.
The clinic is saving thousands of pounds in district nurse resources each year, and is now offering bloodborne virus screenings.
“The nurses are going to look at opportunistic health promotion by offering clients hepatitis B injections. Nursing should be holistic, and we shouldn’t just focus on the wound, but the whole patient. That is what integrated community nursing at its best can do,” says Ms Hatfield.