Sue Bale

Aneurin Bevan University Health Board; South East Wales Academic Health Science Partnership · Research & Development

Background The acute hospital setting has become a key site of care for people living with dementia. The Department of Health and Social Care recognises that as many as one in four acute hospital beds in the UK will be occupied by a person living with dementia at any given time. However, people living with dementia are a highly vulnerable group wit...

Background: the acute hospital setting has become a key site of care for people living with dementia. The Department of Health recognises that as many as one in four acute hospital beds in the UK will be occupied by a person living with dementia at any given time. However, people living with dementia are a highly vulnerable group within the hospita...

Over the years there has been an incredible technological evolution of different products for skin care in patients at risk of pressure ulcers. The materials applied today are more comfortable for the patient and more user friendly for the caregiver. The surrounding skin to pressure ulcers must be considered as an integral part of the management pr...

This study quantifies relationships between hand hygiene and the frequency with which healthcare workers (HCWs) touch surfaces in patient rooms. Surface contacts and hand hygiene were recorded in an NHS single-bed UK hospital ward for six care types. Surface contacts often formed non-random patterns, but hygiene before or after patient contact depe...

Conclusions: Care type was highly influential on the HCWs' surface contact distribution and hand hygiene. This knowledge could be used to inform cleaning routines for HCWs. It could also form the basis of an educational intervention that could be tested in the future?

In order to obtain the best patient outcomes in community nursing, practice needs to be underpinned by robust research-based evidence. This article describes a Community Nursing Research Strategy developed and implemented in Wales to provide the nursing profession with the evidence to support future organisational and professional change in achievi...

The number of older people living the UK is rising and with this comes an increasing complexity of care needs. In terms of increases to the number and proportion of older people in the UK population, the percentage of persons aged 65 and over rose from 15% in 1985 to 17% in 2010 (an increase of 1.7 million people) (Office for National statistics[ON...

Several models of GP out-of-hours provision exist in the UK but there is little detail about their effectiveness to meet users' needs and expectations. To explore users' needs, expectations, and experiences of out-of-hours care, and to identify proposals for service redesign. Service providers in urban (GP cooperative), mixed (hospital based), rura...

In the light of recent changes in the structure and provision of out-of-hours service in the UK, there is a need to re-assess the quality of care. One way to assess the quality of care is through patient experience. This study aimed to explore patient expectations and help-seeking behaviour, in order to understand their relationship with satisfacti...

Twenty elderly patients who attended the wound-healing research unit for treatment of a chronic leg ulcer took part in this pilot study. Nutritional analysis showed the diet to be poor generally, with mean energy, zinc and vitamin C intakes falling below the EAR and/or RNI for people of this age-group. Iron intake and quality of protein in the diet...

This short paper presents a qualitative study, reported in detail elsewhere (Hopkins et al, 2006) that investigated the experience of older people with pressure ulcers. The researchers were surprised to find how significant pain associated with the pressure ulcer was to patients or the impact it had on their lives. All quotes from the participants...

This paper reports the findings of a pilot study exploring the experience of older people living with pressure ulcers. Pressure ulcers are known to be a significant health burden, but little is known of the impact on the quality of life of the sufferer. They mainly affect older people, and this is a neglected group in previous studies of this topic...

Apressure ulcer is an area of localized damage to the skin and underlying tissue caused by pressure or shear and/or a combination of these. The identification of pressure damage is an essential and integral part of clinical practice and pressure ulcer research. Pressure ulcer classification is a method of determining the severity of a pressure ulce...

Patients with malodorous wounds often experience social isolation, depression, shame, embarrassment and poor appetite, all of which can have a negative impact on their quality of life. The healthcare professionals caring for them face difficult clinical challenges in terms of treating the cause and managing the symptoms. This study employed a rando...

Patients with malodorous wounds often experience social isolation, depression, shame, embarrassment and poor appetite, all of which can have a negative impact on their quality of life. The healthcare professionals caring for them face difficult clinical challenges in terms of treating the cause and managing the symptoms. This study employed a rando...

This study explored the extent to which a new skin care protocol comprising a skin cleanser, barrier cream and barrier film could be implemented in nursing homes, and its effects on patients' skin condition, staff time and associated costs. A pre- and post-intervention study design was used. Data were collected on current skin condition and skin ca...

Wounds are common, expensive to treat and prevent patients from returning to their normal activities. Wound healing as a clinical specialty has only developed over the past 20 years, and this is an area of practice where there is a very strong impetus towards ensuring that, as far as possible, all health care is evidence based. Scientific wound hea...

Managing patients with venous ulceration who are unable to tolerate therapeutic compression bandaging is a challenging clinical problem. This study followed a group of 28 such patients who were treated with three layers of graduated Tubigrip as an alternative to therapeutic compression. It also investigated factors that influenced nurses in decidin...

Malodorous, exuding wounds can cause problems for patients in terms of discomfort and social isolation. A prospective, noncomparative, multicenter study was conducted to evaluate the effectiveness of an odor-controlling dressing in the management of patients with chronic and acute exuding, malodorous wounds. Forty-six patients with various malodoro...

Reports on a study that focuses on the specific roles of the nurse within the interdisciplinary team as an example of how nursing contributes to developing clinical effectiveness in wound healing. The multidisciplinary team approach used here builds on recommendations by Edmonds as the most effective method of delivering care to patients with diabe...

This article reports the findings of a survey and an audit undertaken to investigate the provision of foot support in a university teaching hospital. Phase I surveyed strategies employed to support feet and phase II audited the use of the Repose Foot Protector, manufactured by Frontier Therapeutics, specifically designed to provide pressure support...

Few studies have investigated the use of dressings on patients with diabetic foot ulceration. This paper reports the results of a non-comparative, two-centre study investigating the performance characteristics of SeaSorb dressing in patients with this condition. This was an exploratory study to determine the potential use of this dressing, and not...

The use of heat in wound healing has been demonstrated to aid oxygen flow and hence healing in acute wounds. However, the situation in chronic wounds is less clear. This study was designed to investigate the benefits of using a radiant heat therapy system in the treatment of Stage 3 and 4 pressure ulcers. Despite randomisation, patients receiving r...

In introducing a new mattress into practice it is important to evaluate its performance from both the patient's and nurse's perspective. A total of 20 patients admitted to the integrated medical unit were recruited and nursed on a new pressure-relieving mattress offering two modes of pressure relief (Duo). All patients had been recently admitted to...

This article describes the use of phase 1 studies in the research process when developing new dressing technology. A phase 1 study refers to the first time that humans are exposed to a new therapy. In general, participation is open to healthy volunteers only. Phase 1 studies are an essential element in the research process and are used to test the...

Hydrocolloid dressings have been widely used since the late 1970s. This article compares two hydrocolloid dressings--3M Tegasorb dressing and ConvaTec's Granuflex (E)--and highlights their similarities and differences when used in the clinical situation. Both hydrocolloids were reported to perform favourably by users in most situations. 3M Tegasorb...

This study determines the effectiveness of a new low-unit-cost support system in patients at very high risk of developing pressure sores. In a prospective randomised controlled trial, a low-pressure inflatable mattress and cushion system (Repose) was compared to a dynamic support mattress (Nimbus II) used in conjunction with an alternating-pressure...

The aim of this open, non-comparative study was to assess the potential benefit of tissue-engineered human dermis (Dermagraft) in healing long-standing, difficult-to-heal diabetic foot ulcers, and the practicality of its use in the UK. Six patients with full-thickness neuropathic diabetic foot ulcers which extended into subcutaneous tissue and had...

This study compares the costs of dressings used in the treatment of patients with a variety of wound aetiologies. The two dressings investigated were a hydrocolloid dressing and a hydrocellular dressing. Secondary objectives included a comparison of dressing durability, time to complete healing, ease of wound cleansing and dressing removal. The stu...

This study compared the efficacy of two hydrogel dressings in the debridement of necrotic pressure sores. This randomised, controlled, assessor-blind, clinical trial involved 50 patients whose wounds were assessed weekly using computerised wound analysis for four weeks or until debrided. Debridement was identified when there was 80% red granulation...

This study compared a polyurethane foam dressing with a hydrocolloid dressing for ease of application and removal, adhesion, conformability, absorbency and wear time. A randomised study was carried out, including 61 patients with stage two or three pressure sores in five centres in the UK. Dressings were applied for up to 30 days and assessments we...

A hydropolymer dressing (Tielle) and a hydrocolloid dressing (Granuflex) were compared In a randomised controlled clinical study involving 100 patients with leg ulcers and 99 patients with pressure sores in the community. Statistically significant differences in favour of the hydropolymer dressing were detected for dressing leakage and odour produc...

Dressings manufactured from adhesive polymeric films have been used extensively in wound management for about 20 years. This report describes the results of a trial designed to compare the performance of two such dressings, used as secondary dressings, in a multi-centre randomised controlled community study involving 100 patients. Independent analy...

Dressings manufactured from adhesive polymeric films have been used extensively in wound management for about 20 years. This report describes the results of a trial designed to compare the performance of two such dressings, used as secondary dressings, in a multi-centre randomised controlled community study involving 100 patients. Independent analy...

The treatment of moderately to heavily exuding wounds requires a dressing that will remove excess exudate while ensuring optimum conditions at the wound site and preventing maceration of the surrounding skin tissue. This prospective, stratified, randomised clinical trial was designed to assess the performance and safety of a new polyurethane foam d...

This update reviews some of the techniques that are available for the removal of necrotic tissue and slough from wounds

A case report describing the management of a patient presenting with severe skin excoriation and neglected pressure sores

An update on the problems associated with managing children with wounds and their families

The safety and efficacy of Collagenase ABC® ointment (containing 250 units/g white petrolatum clostridiopeptidase A) in the debridement of stage III pressure sores in 50 patients were examined in a phase II, prospective, open, uncontrolled study. Ulcer size, odour, pus, inflammation and necrosis were assessed prior to study entry and after a maximu...

Two treatment protocols for the management of patients with non-infected cavity wounds were studied, using data obtained from both the community and the outpatients clinic. Patients were treated with either a polyurethane foam hydrophilic dressing (Allevyn) or a calcium sodium alginate dressing (Kaltostat). Although alginate fibres were found to be...

Two treatment protocols for the management of patients with non-infected cavity wounds were studied, using data obtained from both the community and the outpatients clinic. Patients were treated with either a polyurethane foam hydrophilic dressing (Allevyn) or a calcium sodium alginate dressing (Kaltostat). Although alginate fibres were found to be...

This study investigated the influence on the number of pressure sores developing in patients nursed in a hospice when three levels of pressure support were used in association with a risk assessment tool. The study was designed as phase one of an epidemiological study examining the use of a modified Norton scoring system. This was followed by a sec...

Since its publication, this paper has been referred to frequently. It has formed the basis for the setting up of leg ulcer clinics in the community, the principles of patient assessment, and the use of four-layer bandages as the first-line treatment for patients with venous and mixed disease. The figure most frequently quoted is 69% healing at 12 w...

Evidence is growing that wound care has emerged as the newest area of specialisation. In recent years developments have taken place in a number of key areas. Several books written by doctors, nurses and pharmacists have been published which cover a broad range of subjects from different professional perspectives. In addition, new journals keep prof...

An outline of the responsibility and function of the clinical nurse specialist in wound care

An investigation of the clinical and microbiological outcomes of a new stent disinfection regime using an improved silicone foam cavity dressing

EDrrOR,-R K Vohra and C N McCollum's review of pressure sores is a timely reminder of the continuing silent epidemic of pressure sores both in hospital and in the community.' Pressure sores impose two main penalties, financial and human. The financial costs are high and result from additional treatment, a prolonged stay in hospital, and a further d...

Full textFull text is available as a scanned copy of the original print version. Get a printable copy (PDF file) of the complete article (273K), or click on a page image below to browse page by page. Links to PubMed are also available for Selected References. 1436 Selected References These references are in PubMed. This may not be the complete li...

A review of the difficulties of evaluating dressings in the community, and the value of community-based clinical trials.

A report of a study in which a semi-permeable polyurethane dressing was compared with a hydrocolloid dressing in the treatment of grade 2 and 3 pressure sores.

A comparison of an absorbent semi-permeable polyurethane dressing and a hydrocolloid dressing for the treatment of moderately exuding stage 2 and 3 pressure sores in hospitalised patients.

A discussion of the potential value of quality of life studies in patients with granulating wounds

A report of a study that evaluated the performance of Lyofoam A, compared with NA dressing and Tegaderm in treating superficial pressure sores.

Three case studies illustrating the benefits of calcium alginate dressings over ribbon gauze in the treatment of deep sinus wounds.

A case study of the treatment of a 10-month-old baby with necrotic perineal and abdominal wounds.

A study of the treatment of axillary hidradenitis suppurativa by surgical excision.

A study of the use of hyperbaric oxygen on the pressure sores of a patient with multiple sclerosis and several other medical problems

An assessment by staff and patients of two cavity wound dressings in the treatment of surgical granulating cavity wounds

Foam dressings provide an excellent healing environment for granulating wounds, but have been overshadowed by the development of new materials. Their easy application means they are still valuable to both patients and nurses.

Nurses must take care that the wide range of wound dressings now available does not distract them from patients' holistic needs. Dressings must be applied to suit individual requirements.

The main concern in managing surgical wounds is preventing infection. Nurses need to be able to interpret research on the subject and adapt their practice accordingly.

Before sloughy or necrotic wounds can begin to heal, they must be debrided. Some of the modern wound dressings are not only extremely effective in this, but they do not damage surrounding tissue.

When patients with cavity wounds are discharged from hospital, they may need to pay for some of the items needed for their wound care. This can be a financial strain, which nurses may be able to ease.

The management of a patient with a pressure sore is a complex and difficult problem. Even with excellent nursing care, pressure sores can develop in the severely debilitated patient with malignancy. To reduce the likelihood of this happening three issues need to be considered: pressure relief, nutritional status and local management.

Background: Compression hosiery was originally designed to manage venous disease for patients without ulceration, and to prevent ulceration or its recurrence. However, there is now a view that compression hosiery has a role to play in managing patients with active venous leg ulcers. Aims: Primary objectives were to assess the ease of application an...

Introduction As nursing has developed and its body of knowledge has grown, specialised nursing practice has evolved into a range of nursing specialisms. Clinical Nurse Specialists (CNS) were first described in the North American nursing literature in 1938, and North America has led the field in developing this area of nursing. CNS posts were create...