Managing acute skin reactions to radiotherapy treatment.

Promoting tissue viability and caring for skin damaged as a result of radiotherapy are critical to the quality of care patients receive. However, few nurses recognise fully the effect of radiotherapy on tissue viability and wound healing. This article considers the causes and types of skin damage resulting from radiotherapy treatment that nurses may encounter, and how this damage can be graded.

Challenges in protecting peri-wound skin.

Effective management of vulnerable wound margins and fragile skin in the area peripheral to wounds is challenging. Maceration by chronic wound exudate and skin stripping, as a result of removing traditional or adhesive dressings, are common causes of damage to peri-wound skin. This article identifies the potential causes of macerated or adhesive damaged peri-wound skin, and critically reviews products and strategies that can be used to minimise the risk or manage established peri-wound trauma.

An educational partnership to enhance evidence-based wound care.

This article describes an educational initiative that aimed to raise the knowledge and practice of nurses at one hospital where staff had become deskilled in wound care. An audit questionnaire was used to determine nurses' knowledge before and 4 months after an educational workshop, part of which considered pain issues. Following the educational initiative, nurses within the Trust were knowledgeable about when to take a wound swab and could recognize the signs of wound infection, but there were still issues around the clinical practice of taking a wound swab.

The management of patients' pain in wound care.

This article raises professional awareness of patients' experiences of pain at wound dressing change, and provides nurses with practical strategies that enable them to minimise the pain and trauma experienced by patients during wound care procedures.

The wearing of compression hosiery for leg problems other than leg ulcers.

Many people have leg problems other than ulceration. Practitioners from one primary care trust in Suffolk considered nursing assessment of these patients and the fitting of prescribed compression hosiery where appropriate as a health promotion initiative. However, ongoing assessment adds to heavy clinical demands on community practitioners.

Understanding the arousal of anger: a patient-centred approach.

The aim of this article is to enable reflection on practice by exploring a nurse-patient scenario and identifying what factors trigger anger and aggressive behaviour. It recommends strategies that can be used to tackle anger among patients, and emphasises the importance of the therapeutic relationship. Anger management, which usually refers to cognitive behavioural therapy designed to enable people to manage anger, is not explored.

A pilot study to determine whether a static magnetic device can promote chronic leg ulcer healing.

Objective: To determine if UlcerCare, a specialised self-securing static magnetic device, can promote the healing of chronic leg ulcers.

Method: This double-blind placebo-controlled pilot study involved 26 patients with chronic leg ulcers, receiving care consistent with RCN guidelines, who were randomly allocated to receive either UlcerCare leg wrap (treatment) or an identical sham non-magnetic device (control). Wounds were assessed for 12 weeks at four weekly intervals using digital photography, Verge Videometer analysis and patient questionnaires to determine changes in ulcer size, level of pain and function.

Professional holistic care of the person with a stoma: online learning.

Stoma care nurse specialists are valued for their diverse expertise, but it is essential that all practitioners who regularly care for people with stomas have the opportunity to develop professionally and influence this important area of practice. The vision of a clinical and educational team from Suffolk and south Norfolk led to the development of innovative web-based learning material. The aim is to inspire nurses to engage actively with people who have a stoma.

Assessing pain at wound dressing-related procedures.

This article is an abstract from a new guide, Principles of Best Practice: Minimising Pain at Wound Dressing-Related Procedures. It is an educational initiative of the World Union of Wound Healing Societies (WUWHS). The guide has been inspired by two seminal documents: the European Wound Management Association's position document, Pain at Wound Dressing Changes (EWMA, 2002), and Practical Treatment of Wound Pain and Trauma: A Patient-centred Approach (Reddy et al, 2003).

Sharing the burden: the complex practice of wound care in the community.

Wound care in the community setting is often far from simple. Chronic wounds are the product of a complex interplay of processes that must all be addressed if healing, or an improvement in quality of life, is to be achieved. This case study highlights some of the complex issues faced in the community, and reinforces the need for all health professionals to continuously update their knowledge and skills.

Living theory: enhancing the psychological support of patients.

This article explores how nurses, involved in a research project incorporating teaching psychological theories and counselling skills to enhance the psychological support of patients with wounds, had, one year on, changed their professional practice. This inquiry was framed by living theory, a concept previously only used in education, which is based on the integration of known knowledge, newly taught knowledge and increased self-awareness. The major principle of living theory is that one's values are questioned, modified, clarified and sometimes changed completely in striving to improve one's professional practice.

Teaching nurses psychological support of patients with wounds.

Concerns about lack of professional empathy with psychological aspects of wound care provided the springboard for this study. Forty-three qualified nurses who regularly care for patients with wounds recorded in research diaries how they supported patients holistically before and after attending a counselling skills workshop. Thirty-nine nurses then attended focus groups to share their experiences.

Professional concerns in wound care: a discussion of questionable practice recorded by nurses.

Despite the growth of wound care as a specialty and the expansion of education in wound care to all grades of nurses, there is still evidence of outdated practice in both community and acute care settings. This article reports secondary data from a study into psychological support for patients with wounds (Hollinworth and Hawkins, 2002) that highlights examples of these poor practices. The professional implications of these practices are discussed, and suggestions made for improving practice.

Pain and tissue trauma during dressing change.

Background: Preventing patient pain and tissue trauma to the wound and surrounding skin are key considerations for nurses at the time of dressing changes. Mark Collier and Helen Hollinworth present the preliminary findings from a recent survey among nurses with an interest in wound care on the selection of dressing types.

Conclusion: Education of student and post-registration nurses about the properties of dressing products, with an understanding of the potential detrimental effects as a result of pain and trauma, is needed to help promote quality wound care.

Nurses' views about pain and trauma at dressing changes: results of a national survey.

Research findings and professional concerns that patients still experience pain and tissue trauma at dressing changes led specialist nurses to develop a postal questionnaire to elicit the views of 1000 nurses with an interest in wound management. The questionnaire asked practitioners to identify the primary considerations underpinning their approach to pain and tissue trauma at dressing changes, the strategies they adopted, and the factors which determined their treatment choices. The higher than anticipated response rate (37%) illustrates the importance nurses attach to this aspect of practice.

Venous leg ulcers. Part 1: Aetiology.

A sound knowledge of the physiology of the venous system is necessary to understand how venous leg ulcers develop. The main risk factors are thrombus formation and venous incompetence and nurses should be alert to the signs of these conditions.

The management of infected wounds.

There is a lack of empirical evidence on the most effective management of infected wounds. The principles for cleansing infected wounds are similar to those for any wound, with emphasis on control of infection. Modern dressings that promote a moist environment are effective in the management of infected wounds.