the underlying cause of venous leg ulceration is venous hypertension. Effective treatment of this condition requires clinicians to undertake appropriate, thorough investigation of the underlying pathology, reversal of this venous backflow and engorgement through increasing the velocity of venous return (by surgical correction of the venous tree and/or application of effective sustain compression). None of this can be classed as "passive treatment".
While these results may herald a positive new approach to venous ulceration, the findings need to be viewed with caution; trial subject numbers are very low, there seems to be a number of unanswered questions regarding how the technology influences the healing process and it is unclear whether these findings are repeatable in a larger study cohort.
Chronic wounds pose a significant financial burden to health care providers and can bring misery to individual sufferers, in some cases for decades. Technological advances may bring the hope of effective treatment (and that may be the case here) but only time and the results of appropriately designed, methodologically sound studies will tell us if the outcomes witnessed are truly positive and are attributable to such hi-tech interventions.
I fully agree with Carol that 10 minutes is insufficient time to fully assess a patient with a chronic wound, let alone initiate appropriate treatment.
This lack of time, and possibly the understanding of the underlying aetiology of common chronic wound altered physiology explains the data identified by Guest et al (JWC 21 (8): 389-98). This group accessed the information available on The Health Improvement Network (THIN) database. Although their study was looking at the cost effectiveness of a skin barrier product in treating VLU's it is somewhat worrying that the database revealed that only 6-9% of patients treated for VLU in the community healed within 6 months. This is despite multiple national and international guidelines on best practice in VLU management being available (e.g. NICE, SIGN, CREST, EWMA etc)
When are we going to accept that simply "slapping on a dressing" is never going to improve the outcome in managing these wounds and those clinicians guilty of doing so are simply throwing valuable money down the drain? Every £ wasted is money which could and should be spent on improving services and patient outcomes.
Nurses are all too quick to point the finger of blame at NHS managers, but this is something which is within their power to make a difference. Yes, it's not without problems but these clinicians have the patient data and outcome measures to prove that simple 10 minute slots don't work.
What clinicians need to do is present the facts, the research and the outcomes of their service and educate, inform and negotiate appropriate cost-effective management approaches to chronic wound care.
Nurses need to take action and not just accept what has always been done otherwise they may just find themselves being called to account. Lack of time is never an excuse for poor and/or negligent practice - Failure to implement "best practice" care could land the clinician with having to answer serious (and potentially career-threatening) questions should their wound management practices be put under the spotlight of a professional standards committee or civil/criminal court.
Comment on: Trainee nurse drop-outs 'waste' £100m
One of the biggest issues that we face is the way in which pre-reg nurse education is delivered and managed. In the pre-university days, selection of potential candidates was undertaken by a mixture of clinical and educational nurses from schools of nursing based within hospitals. High priority was given to candidates with the perceived attitudes and compassion required of the profession. Now, university selectors are pressurised to ensure places are filled and the Uni maintains a positive income stream; the emphasis appears to be on numbers of applications and the pre-course educational achievement of the potential students (the number of GCSE's and A levels the candidate has) rather than whether they are really suited for the course, or more importantly the profession.
In addition, in the past all students had to clearly demonstrate (and were assessed on) practical ability throughout their training. Whilst such assessment still exist, there are huge pressures placed on clinical environments to "rubber-stamp" them. I'm sure many clinical assessors have faced the problems encountered when they have tried to "fail" or "refer" students who just don't "cut the mustard".
The upshot of this is we now all-too-frequently see newly registered nurses nurses with few practical skills and even less confidence in their ability to deliver care in the whirlwind paced healthcare system in which we now operate.Students need support and guidance; invariably it is not their fault that these problems exist, rather it's the system in which education is delivered.
While I wholeheartedly believe we should be aiming for a degree-based profession, I believe we need to seriously reconsider how that education is provided and by whom. After all, what is more important; how a reference is cited in an essay or whether vulnerable individuals receive the care they so rightly deserve
I agree with Andrew's comments but also see where Craig is coming from. There are undoubtedly different approaches required for different situations; I would hope for instance that the preparation of IV fluids would be undertaken in strictly controlled environments with rigid aseptic procedures as the risk to a patient of delivering contaminated fluid directly into a patients bloodstream is so great. However, when treating a chronic wound we are working in an already bacterially colonised environment.
But I do see where Craig is going - I too have witness what can only be described as "septic procedures" among staff (medical/nursing and paramedical) when managing wounds. All too frequently clinicians are not brought to task when their actions put patients at risk.
When I think back to my training I smile when I think of all the time and effort I spent learning how to clean my dressing trolley the "right way" and yet in over 30 years of practice I have never actually dressed a wound with a stainless steel trolley, simply used it to provide a work surface. Procedures have to be realistic to the environment in which they are undertaken and the needs and risks of our client groups. However that does not give us a "get-out" for poor and/or sloppy practice.
The findings of this research need to be carefully considered. Having read the paper there are a number of points which need to be highlighted:
*this is NOT a UK study - it was carried out in India where healthcare practice differs greatly from that seen in the UK. Interestingly the NT headline and text doesn't state this
*the researchers do not state what post-op care regimes were in place; they simply state that post op dressings need regular re-dressing - how relevant is this to UK practice where we recommend they remain intact? What effect does regular contact with healthcare workers hands have on infection rates? Remember that the majority of pathogenic bacteria do not originate from the patient but from cross infection
*the researchers do not say how the dressed wounds were managed. As has previously been highlighted (Aindow & Butcher (2005)Films or fabrics: is it time to re-appraise postoperative dressings? British Journal of Nursing 14(19 Suppl): S15 - S20), post op dressings need to be selected carefully and it is necessary to understand the role the external environment might have on their effectiveness. It is interesting that the authors state that sweating is a major problem with post op dressings which leads to maceration. I wonder how relevant that is to the UK market?
As always, research has to be critically reviewed and put within its appropriate context - do not accept statements until you've looked at all the facts!