Enhanced nurse training needed to manage chronic wounds, according to UK expert

She was speaking at the annual Wound Care Academy (WCA) event in the region, held recently in Dubai for 30 experienced senior nurses selected from across the GCC, Turkey, Iran and Libya.

Now in its third year in the region, the WCA is an educational initiative fully sponsored by Smith & Nephew FZE, with a focus on the practical, clinical and theoretical aspects of Advanced Wound Management.

"Education and training, a lack of critical appraisal skills, information overload and a need to keep up to date with research are some of the barriers to healing and effective wound care management by nurses," said Ms Flanagan,

The treatment of chronic, hard to heal wounds is a significant challenge for the medical - and especially the nursing - profession, which often has to deal with the problems. These range from burns and post operative wounds, to leg ulcers, pressure ulcers and diabetic foot ulcers, which are increasingly common in a region plagued by a rising incidence of diabetes.

Chronic wounds are often difficult to heal, impacting on the quality of life of patients and can be a cost burden to healthcare providers. Acute wounds can be life threatening with abnormal scarring and infection potential issues.

The WCA's comprehensive, one-week course is designed to enhance the knowledge levels of wound management amongst the region's specialist nurses and ultimately, to improve patient care. 90 nurses from the region have attended the Wound Care Academy over the last three years, since it was launched in the Middle East to help improve wound care skills and to establish protocols and standards for wound care that do not currently exist in the region.

"This programme is about more than just the clinical aspects of wound care management," Madeleine Flanagan explained. "It's also about the context in which care is delivered. For example, the high incidence of diabetes in the region raises specific wound care challenges - the occurrence of diabetic foot ulcers, which can result in infection and amputation, are difficult to treat and poor patient compliance adds to the problem."

About a third of people with diabetes will develop foot ulceration within a year of diagnosis. 'Diabetic foot' refers to the infection, ulceration and possible amputation of a foot or leg in diabetic patients. In this region it is usually diagnosed in its late stages and can have devastating socio-economic consequences for patients and their families.

Extensive surveys indicate that between 40% and 70% of all lower extremity amputations are related to diabetes. This means that every 30 seconds a lower limb is lost to diabetes. The vast majority (85%) of all diabetes-related amputations are preceded by foot ulceration. Many amputations can be prevented with early intervention, appropriate management and long term follow-up.

"We are seeing relatively young diabetics here with ulcers more commonly associated with an older patient in the UK and there is a worry that diabetic patients are hiding their wounds with potentially very serious consequences," commented Ms Flanagan.

Diabetes prevalence in the Middle East is among the highest in the world, estimated at around 12-20 per cent of the population in the Middle East. The prevention and treatment of diabetic foot ulcers results in increased quality of life for patients and ultimately, saved limbs.

"The UK is a leader in chronic wound management care and the nursing profession took the lead in developing these specialist services. The WCA is one way of effectively sharing this experience," added Ms Flanagan. "The WCA in the Middle East brings together very experienced groups of nurses who are willing and able to share best practice - their knowledge and experience is at an advanced level and they are well placed within their organizations to develop new services."

The principles and practices of wound care are well established and so the WCA aims to help these specialist nurses go back to their hospitals feeling focused, empowered, and confident in their abilities and knowledge, looking to lead their colleagues in the important area of chronic wound care, with the support of a new network of professionals in the region, created through the Wound Care Academy.

The participating nurses were selected via a rigorous application process and the number restricted to 30 nurses to allow each nurse to benefit from the intensive combination of theoretical and practical course work. All participants sat a comprehensive written exam covering the taught component of the course, on the last day of the course and each successful student will receive a Certificate of Attendance from the University of Hertfordshire in the UK.

In addition to the week-long Academy, a special Wound Care Academy Day was arranged at Dubai Hospital for 80 nurses.

Wendy Hewitt-Sayer, Director of Nursing, Dubai Hospital commented, "Wound Care Link nurses play a significant role in wound care in the wards of this hospital and this day-long event was part of our ongoing programme of education and development, following the launch of our Wound Care Guidance in April 2008. Madeleine Flanagan has a huge reputation and it was a privilege to hear her speak, her commonsense approach underpinned by scientific theory was very refreshing. The hospital has come a long way in this area already and our patients - many of whom are diabetics with special needs - are certainly benefitting."

The WCA is also facilitating new career development pathways for nurses in the region: students who register and successfully complete the coursework following the WCA will be awarded 30 master's level credits from the University of Hertfordshire, which equates to a new academic award; University Certificate in Professional Development.

Once students have completed their University Certificate in Professional Development and achieved the prerequisite grade they may transfer these credits into the MSc Advancing Practice in Wound Management programme at the University.

Fatma Al-Dhabari, a wound care specialist and Deputy of the Nursing Quality Management Department at Sultan Qaboos University Hospital and a graduate of the WCA, is now studying the Master's programme at the University of Hertfordshire, "The WCA certainly increased my knowledge as a new specialist to this area and gave me the confidence to participate in other activities relating to wound care, with the support of other specialists in wound care in the region. It also created the opportunity for me to advance my own career through the Master's programme."