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Clinical governance and tissue viability

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VOL: 97, ISSUE: 14, PAGE NO: 54

Nicky Poulain, BSc, RGN, RM, PGCertEd, is associate dean for primary care nursing, University of Hertfordshire

Louise Gibson, BSc, RGN, DipHE, PGCertEd, is lecturer in nursing studies, King's College, London

Clinical governance is at the centre of the NHS quality reforms. It has become an umbrella term for all things that help to maintain and improve high standards of patient care by creating an environment in which clinical care will prosper (Department of Health, 1999).

Clinical governance is at the centre of the NHS quality reforms. It has become an umbrella term for all things that help to maintain and improve high standards of patient care by creating an environment in which clinical care will prosper (Department of Health, 1999).

Primary care groups/trusts (PCG/Ts) will provide a model for commissioning health and health care at local level through assessment of local population needs and by developing existing health care programmes. This process will also include the evaluation of implemented change (RCN, 1998).

All community nurses involved with providing tissue viability services need to have an appreciation of the role and functions of PCG/Ts and should examine the impact these new organisations may have on their work. The needs of the local population in relation to the existing tissue viability services may need highlighting to the local PCG/T in order to secure the existing quality service or to provide comprehensive evidence of a shortfall.

Partnerships in care
The aim of clinical governance is to develop an open learning culture based on collaborative, multiprofessional working (RCN, 2000). It offers a coherent framework for nurses involved in tissue viability to improve clinical standards for the benefit of their patients. One of the key principles underpinning the implementation of a clinical governance framework is the value placed on partnerships between clinicians and patients, between clinicians themselves and between clinicians and managers.

The original white paper (Department of Health, 1997) identified 10 component processes of clinical governance (Table 1) and suggested that each element would need addressing if an organisation was to be considered of high quality.

Taking a proactive role
Nurses with skills and expertise in tissue viability can legitimately take a lead for wound management services due to their extensive level of knowledge and experience. Tissue viability nurses should identify themselves to the PCG/T and work collaboratively with other practitioners involved in wound management. An identified lead practitioner can act as an advocate for patients by representing the views of colleagues in a structured manner, particularly when there are areas of concern that require discussion.

Tissue viability nurses should take an active role and assume responsibility for their area of care. It is essential to identify key members of PCG/Ts and to determine any relevant subgroups that may assist the tissue viability nurse to develop equal partnerships, which may influence others towards a common vision (RCN, 1998). There are many ways of getting involved to improve patient care (Table 2).

Conclusion
Collaborative and interprofessional working within the PCG/T will depend on building a reciprocal understanding of PCG/T priorities and will require nurses to be proactive and assertive in establishing evidence-based proposals to improve an aspect of their service. Building team and individual capacity with common goals will also increase self-esteem and enable nurses to influence the clinical governance agenda.

The latest white paper (Department of Health, 1999) has ambitious plans for future nursing services. However, nurses will need to provide local evidence of how their contribution will improve patient services.

Castledine (2000) argued that nursing lacks direction, is unable to articulate its purpose, goals and objectives, is usually aimless and subject to manipulation from outside forces. However, this old image is set for change, and nurses are ready to work together and address the fact that we are all accountable for improving the quality of services we provide, personally and as part of a PCG/T team.

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