1. Initial wound assessments are completed by a registered nurse with knowledge of tissue viability and they are responsible for maintaining knowledge of wound care (RCN 2008). However, community healthcare support workers (HCSWs) are having an increasing role in carrying out wound care procedures, as evidence suggests that the number of patients with chronic wounds are increasing (Posnett and Franks 2008). It is important therefore for HCSWs to have an understanding of the physiology of wound healing, be familiar with relevant wound terminology and general wound dressings used, in order to recognise and report changes and to be competent in delivering safe and effective wound care. PHYSIOLOGY OF WOUND HEALING Given the right conditions wounds will heal themselves. A non-healing (chronic) wound is defined as ‘a wound that fails to follow the normal healing process’ (Vuolo 2009). Dressings are used in order to promote a moist wound healing environment. The principle of moist wound healing is to mimic the function of the epidermis, i.e. warm, wet and clean (Bryan 2004). Factors that can affect healing include infection; age; chronic health conditions such as diabetes; inadequate oxygen intake from pulmonary diseases such as COPD; malnutrition; medication; socio-economic factors i.e. income; lifestyle choices such as smoking; psychological factors i.e. anxiety and stress of living with a chronic condition. PROGRESSION OF WOUND HEALING REMOVAL OF SLOUGHY TISSUE (YELLOW/CREAM) MANAGE WOUND INFECTION AND ODOUR GRANULATING TISSUE HAEMOSTASIS EPITHELIALISATION (PROTECTION) Hydrocolloid dressings (support moist wound- healing environment) e.g. Duoderm / Granuflex Helps bring moisture to dry necrotic wounds Hydrofibre dressing e.g. Aquacel / Versiva XC Supports moist wound healing environment and absorbs exudate Anti-microbial dressings e.g. Inadine/ Silver (Ag) dressings Carbon dressings to absorb odour Hyrdocolloid dressings e.g. Aquacel / Versiva / Duoderm Supports a moist healing environment Alginate dressings e.g. Kaltostat Helps stop minor bleeding, supports moist wound healing environment Low Adherent contact layer dressings for protection e.g. Atrauman / NA-Ultra Protective covering whilst wound surface scabs and matures e.g. Mepore HCSW UNDERTAKING WOUND CARE Presently, without professional regulation a HCSWs role in wound care is open to discussion (lloyd-Jones et al 2006, cited in Andrews 2010). Criteria should be in place to ensure a HCSW undertakes wound care safely and effectively including: A HCSWs role within wound care must be dictated by local policies Delegation of a clinical procedure to a HCSW should be appropriate and always in the interest of the patient Appropriate training for a HCSW to obtain the skills and knowledge and be assessed as being competent in the delegated activity Rigorous protocols should be in place to clearly define the HCSWs role and responsibility within this clinical activity The ways in which health services are delivered in the future need to reflect a different skill mix, in order to meet patients’ needs, without compromising patient safety or the quality of care being delivered. The development of HCSW education is supported by policies and reports including the Community Services Framework (WAG 2007), Designed for Life (WAG 2005) and the Wanless Report (WAG 2004) and the Fundamentals of Care (2001) highlights the importance of the need to get essential nursing care right. Education for patient awareness Aim of the ‘Designed for Life’ philosophy is to empower individuals to take some responsibility for their own health (WAG 2005). Patient centred care promotes independence and combines service user involvement with clinical and professional leadership (WAG 2005) REFERENCES: Andrews H (2010) ‘Wound care: crucial clinical skills for support workers’ in British Journal of Healthcare Assistants 4(11): 530-533 Bryan J (2004) ‘Moist wound healing: a concept that changed our practice’ in Journal of Wound Care 13(6): 227-228 ConvaTec Wound Therapeutics (2007) ‘Wound Progression Model’ in Product Reference Guide P48-49 Department of Health (2001) ‘Fundamentals of Care’ [on-line] Available: http://www.google.co.uk/search?q=fundamentals+of+care&rls=com.microsoft:en-gb:IE-SearchBox&ie=UTF-8&oe=UTF-8&sourceid=ie7&rlz=1I7ADRA_en&redir_esc=&ei=FRvQTYyOIcq48gO5naT0DQ [accessed 01.03.110]http://www.google.co.uk/search?q=fundamentals+of+care&rls=com.microsoft:en-gb:IE-SearchBox&ie=UTF-8&oe=UTF-8&sourceid=ie7&rlz=1I7ADRA_en&redir_esc=&ei=FRvQTYyOIcq48gO5naT0DQ Posnett J & Franks P (2008) ‘The burden of chronic wounds in the UK’ Nursing Times 104(3): 44-45 Welsh Assembly Government (2005) ‘Designed for Life’ [on-line] Available: http://www.wales.nhs.uk/documents/designed-for-life-e.pdf [accessed 21.02.11]http://www.wales.nhs.uk/documents/designed-for-life-e.pdf Royal College of Nursing (2008) ’Health Care Assistants and Assistant Practitioners: Delegations and Accountability [on-line] Available: www.rcn.org.uk/development/health_care_support_workers/learning__and_development/publications [accessed 01.03.11]www.rcn.org.uk/development/health_care_support_workers/learning__and_development/publications Vuolo J (2009) ’Wound care made incredibly easy’ London: Lippincott Williams & Wilkins Welsh Assembly Government (2007) ‘Community Services Framework [on-line] Available: http://wales.gov.uk/docrepos/40382/dhss/strategies/Community_Services_Framewor1.pdf;jsessionid=1nQlNQZTLp6VP6HpNhBHT5DcFCrGwpYnKlZJ36NW85ZyLlys1ZNQ!475011280?lang=en [accessed 01.03.11]http://wales.gov.uk/docrepos/40382/dhss/strategies/Community_Services_Framewor1.pdf;jsessionid=1nQlNQZTLp6VP6HpNhBHT5DcFCrGwpYnKlZJ36NW85ZyLlys1ZNQ!475011280?lang=en Welsh Assemble Government (2004) ‘Wanless Report [on-line] Available: http://www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsPolicyAndGuidance/DH_4074426 [accessed 13.03.11]http://www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsPolicyAndGuidance/DH_4074426 SIGNS OF INFECTION: Redness, heat, oedema, pain NUTRITIONAL INTAKE TO AID WOUND HEALING: Nutrients such as protein and calorie intake to promote wound healing ADVERSE REACTION TO DRESSING: Redness around dressing, itching ConvaTec Wound Therapeutics ConvaTec Therapeutics ConvaTec Wound Therapeutics REMOVAL OF NECROTIC TISSUE (BLACK) PATIENT CENTRED CARE