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Why doesn’t knowledge of skin care translate into nursing actions for patients?

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Why doesn’t knowledge of skin care translate into nursing actions for patients?

David Voegeli, Janice Bianchi, Patricia Grocott, Theresa Hurd, Trudie Young
1 December 2009

The title of this debate is clearly contentious. Is it true that we are not caring for patients’ skin or is this an unfair generalisation? My response to my own question is that we are not seeing the care of patients’ skin as a core, routine component of nursing patients with vulnerable skin and wounds. I am basing my response on clinical observations, a series of conference papers, and conversations with a number of well-known nurses working in the field of tissue viability. They say the following: ‘we are not getting the basics right’. I have observed patients being nursed on pressure-relieving devices who have pressure ulcers together with continence problems, and whose skin across the buttocks is damaged to the point where the clinicians caring for them believe the situation is irreversible; septicaemia is predicted. An alternative opinion has been proposed that the skin damage is due to maceration and a set of nursing actions taken (barrier products, wound debridement, selection of moisture wicking dressings, diversion of faeces and urine into collection devices and so forth). The maceration has quickly resolved and the wounds have progressed to healing. These patients were dying of their underlying conditions, but death from septicaemia is clearly not acceptable. The purpose of this debate is to raise questions as to why experienced nurses are saying: ‘we are not getting the basics right’, and to find solutions.

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