What influences the inclusion of skin tone diversity when teaching skin assessment? Findings from a survey.

BACKGROUND: Understanding the variances in visual skin changes across all skin tones is important in clinical care. However, the experiences of those teaching skin assessment to pre- and post-registrant nurses are unknown. AIMS: To determine the barriers and facilitators experienced in teaching skin assessment across a range of skin tones to pre- and post-registrant nurses. METHODS: A cross-sectional, mixed-methods online survey was undertaken throughout February and March 2023 based on the Theoretical Domains Framework of behaviour change. FINDINGS: In this self-selecting sample, most participants were aware of why it was important to include all skin tones when teaching skin assessment and were professionally motivated to include this in their practice. However, resources and support are needed to overcome an unconscious bias in teaching skin tone diversity, resulting in a lack of availability of good quality photographs and educator confidence in their own skills. Educators not considering skin tone when selecting patient cases and relying on people with dark skin tones to highlight where practice is not inclusive may also lead to insufficient exposure for students. CONCLUSION: There is some awareness of the importance of including diverse skin tones in teaching, but further education and resources are needed.

Defining palliative wound care: A scoping review by European Association for Palliative Care wound care taskforce.

BACKGROUND: Deciding whether to transition to wound palliation is challenging for health care professionals because there is no agreed definition or understanding of palliative wound care, including the goals, core elements and differences from general wound management. OBJECTIVES: To conduct a scoping review with qualitative synthesis to define palliative wound care in terms of its conceptual framework, goals, principles, components, and differences from general wound management, and provide a new definition of palliative wound care based on this scoping review. ELIGIBILITY CRITERIA: Published literature that refers to the definitions, concept, goals and core elements of palliative wound care using any methodological approach, without any time limits, published in English. SOURCES OF EVIDENCE: The searches were conducted in CINAHL Complete via Ebsco, Medline via Ovid, Cochrane Library, Scopus, and Google Scholar. CHARTING METHODS: A data extraction form was developed by the review team and used independently for data charting purposes. Braun and Clarke's six phases of thematic analysis guided the qualitative synthesis. RESULTS: A total of 133 publications met the inclusion criteria. Three main themes were developed to define palliative wound care and understand its differences from general wound management: 1- Healing potential of wounds and patient vulnerability, 2- Understanding the impact on individuals and family to address needs, 3- Towards new goals and perspectives in approach to care. CONCLUSIONS: Palliative wound care focuses on symptom management, comfort, and dignity, but does not always target the healing of the wound, which is the goal of general wound care. The needs of the individual and their family must be addressed by clinicians through the provision of care and support that takes into account the true meaning of living and dying with a palliative wound. PROTOCOL REGISTRATION: A review protocol was developed but not registered.

Marginalised voices in wound care: Experiences of people who inject drugs living with leg ulceration "The Gutter, the Nick or a Box!!"

Portraying the authentic voice of people who inject drugs (PWID) through narrative means is novel in contemporary literature. The study explored the experiences of PWID living with chronic leg ulceration using qualitative methodology set in a naturalistic paradigm. Led from the perspective of a nurse-researcher in the field of wound management, the study is original from a purist narrative perspective and offers a unique opportunity to gain a rare glimpse into the daily life of PWID as reported in their own words. The methodology chosen was diaries conducted over four weeks, followed by semi-structured interviews. The study was set in North London (UK); participants were recruited from three sites: a general acute NHS hospital, the community and a non-NHS clinical facility. Complete data collection took over 12 months. Open coding was used for word-by-word scrutiny of each diary entry and thematic analysis. The qualitative data software tool NVivo Version-10 was used to support this analysis. Ten participants completed the data collection process: seven males and three females (age range 35-62 years), with heterogeneous socio-economic and cultural backgrounds. The findings revealed the detailed suffering participants endured living with their ulcer: pain, shame and healing were among the emerging themes. The self-blame and punishment triggered by stigma was a detriment to the mental and physical health of participants. Those in contact with specialist wound care services saw a significant improvement in wound healing and this had a positive impact on their wellbeing and their overall outlook on life. This research contributes to science and practice by understanding the lives of PWID living with leg ulceration. It provides a platform from which to engage both generalist and specialist healthcare practitioners and has the potential to inform and improve current service provision of leg ulcer care for this population and to influence medical and social policy-making in this field.

Managing leg ulceration in intravenous drug users.

Chronic venous leg ulceration is a long-term condition commonly associated with lower-limb injecting and chronic venous hypertension caused by collapsed veins, incompetent valves, deep vein thrombosis and reflux. It is not usually a medical emergency, but intravenous (IV) drug users with leg ulcers can attend emergency departments (EDs) with a different primary complaint such as pain or because they cannot access local primary care or voluntary services. Leg ulceration might then be identified during history taking, so it is important that ED nurses know how to assess and manage these wounds. This article explains how to assess and manage chronic venous leg ulcers in patients with a history of IV drug use, and highlights the importance of referral to specialist services when required, and to local primary care or voluntary services, before discharge to prevent admission and re-attendance.

Smoking behaviour and interaction: the observation process in research.

To those starting off on the research journey, the term 'qualitative research' can often seem a daunting prospect. The world of research methodology and theory is emerged in a rich history of its own terminology, meanings and experiences. Research and innovation are integral parts of the nurse practitioner's role, yet many have little understanding of the theoretical frameworks and methodologies surrounding the vast areas of qualitative and quantitative research. As part of a doctorate, the author undertook a small qualitative study, choosing her own method and question. Intrigued by the phenomenon of smoking addiction, she observed the behaviours and interactions of people who smoke. The focus of this article, however, is the process by which the study was carried out, rather than the observations themselves. This paper presents observational research from the perspective of a nurse practitioner embarking on a journey with qualitative designs.

Drug policy, intravenous drug use, and heroin addiction in the UK.

In order to fully understand and appreciate today's drug problem in the UK, the foundations of drug legislation and the history of drug evolution require exploration. This paper critically examines the history of drug policy and the growth of heroin addiction from the perspective of a novice researcher who works closely with intravenous drug users in relation to leg ulceration and wound care in the acute setting. Today's drug policy has come a long way in understanding the problems of heroin addiction and establishing services to meet intravenous drug users' needs and the needs of society. This paper highlights the early warning signs of drug addiction and growth within the UK from an early stage with key areas such as who the early users were and how addiction grew so rapidly between 1920 and 1960. Current policy and decision makers as well as clinicians and researchers in this field must understand the impacts of past policy and embed it within their decisions surrounding drug policy today.

Introducing a new skin-care regimen for the incontinent patient.

Maintaining skin integrity and preventing skin breakdown and moisture lesions in the incontinent patient is an everyday challenge for nurses in the acute setting. The management of incontinence is often a socially or culturally prohibited topic Fletcher (2008); it is frequently attributed to ill health, the aging process or hospitalization, and often overlooked. The concept of cleansing should be commonplace, but it is complicated by the ritualism that underpins this ordinary yet fundamental aspect of patient care (Voegeli, 2010). The use of traditional methods of cleansing with soap and water in the management of skin integrity consumes significant amounts of nursing time. However, this procedure conflicts with infection control measures and predisposes the patient to further skin breakdown. This article looks at the use of an evaluation of a skin-cleansing emollient product in an elderly-care setting to provide evidence enabling an innovation that would lead to a change in practice. It highlights the importance of the implementation of a skin-care regimen as part of basic nursing care for the incontinent patient within the acute setting, and challenges ritualistic practice with evidence-based care.