Wound education, the subject everyone wants, from novice to expert, but where so many barriers exist to getting it just right. In this episode we burrow down into a recent Australian publication discussing recommendations for undergraduate wound education. This is another prickly concept our listeners will have dealt with and have opinions on, no matter what your discipline, experience level or clinical setting. So let's know what your thoughts are because we will talk more in future episodes about the status of wound education.

Timestamps:

00:00 Intro

00:34 Wound education for novice clinicians

01:34 Novices desperate for education

03:35 The needs of wound management education for medical staff

05:15 The assumption that everyone in the healthcare workforce has basic wound care knowledge

06:45 Critiquing research on wound education

09:32 How is the term wound expert defined

10:36 Academic wound education models versus clinical realities and the needs of clinicians

11:10 Irony of clinicians requesting advanced wound education when the basics are not understood

12:08 Fragmented, illogical, or misrepresented content

14:02 Polysemy in healthcare

14:32 What is a simple wound?

14:44 What is a wound?

15:34 Challenges of developing clinically realistic educational wound frameworks

15:47 A tiny wound

17:15 Sterile versus clean technique. Really really?

17:39 Coveting and naval gazing

19:35 Translating academic wound educational models into clinical practice

20:42 When “new” evidence is based on superseded guidelines

21:59 Clinically relevant undergraduate education

22:26 What about foundational content for consistent safe practice

23:04 What’s on the wall of your treatment room that can guide you

23:31 When foundational content is advanced in clinical reality

24:44 Recommended foundational content

26:54 Need for real-world research

28:10 Opportunities for nurse coaching/mentorship

29:10 Are wound management standards and expectations too high?

30:35 When non wound “experts” talk on expert wound topics

31:31 Profiling what wound management experts do

33:06 Read the antibiofilm and International Wound Infection documents for clinical pearls

Resources mentioned:

• The Australian Guidelines for the Prevention and Control of Infection in Healthcare 2019 are published on the MAGICapp allowing for ‘point of care’ use where the guidelines can be viewed on any tablet, phone or computer (updated multiple times a year).
• Haesler E. and Carville K. (2023). Australian Standards for Wound Prevention and Management. Australian Health Research Alliance, Wounds Australia and WA Health Translation Network.
• Murphy C, Atkin L, Vega de Ceniga M, Weir D, Swanson T. International consensus document. Embedding Wound Hygiene into a proactive wound healing strategy. J
• Wound Care 2022;31:S1–S24
• International Wound Infection Institute (IWII) Wound Infection in Clinical Practice. Wounds International. 2022.
• Clegg H, Fetherston C & Wei R. Required wound care content for nursing curricula in Australia: a Delphi study. Wound Practice and Research 2023; 31(4):190-196.

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Disclaimer:

The views expressed in this podcast are our own. This podcast is intended specifically for healthcare professionals. Always follow your organisation's policies and procedures. Please consult your own healthcare provider for individual wound advice.

Welcome to the 2Echidnae podcast.

You're with Mon and Don, two advanced.

Practice nurses with decades of experience in hard to heal wounds burrowing into prickly conversations.

Welcome to another episode of the TUA Kidney podcast with Mon and Don.

We last episode we got a little bit into the topic of education and we wanted to pick up on that for our next episode, this one on wound education and specifically focus more on those newer nurses grads and students and the undergraduate education because it's a common theme that comes up for us.

But I'm sure we'll get into other periphery topics and just wound education in general.

But we wanted to put it out there that we're not sure where this is going to go.

So it is quite raw and authentic.

It's a massive topic.

I know on my socials I've had a number of posts blow up in areas that I didn't expect because you have a whole heap of followers and you don't know where they're from and what context also.

And everyone approaches things differently.

But I'm frequently told on my socials and I know I have a large following of 25 to 34 age group.

Ah, okay, okay.

Predominantly female.

Where their bottom line is their reason.

I'm not gonna say the excuse, but the culture is we're so desperate there'll be systemic issues in nursing that they're overwhelmed and all of that.

We're not gonna get into that.

That's not about wound care so much.

But we didn't learn enough about wounds in undergraduate education.

And I think there's a few cultural issues there as well that people are buying into and that's a bit of a mentality that could be adjusted.

But we want to just open up that topic of undergraduate wound education.

Would you like to set off?

I've got some thoughts further on that, but.

Well, just as.

And I really, you know, we were trying to do a little mini preparation before we started this episode and we were going all over the place.

I think as you were talking and I can't remember I've said this in a previous episode, but I'm going to repeat it again.

You know what, I'll kind of segue.

We repeat ourselves a lot and I.

That's a good thing.

Oh, probably, yeah.

We're reinforcing.

It's a good thing because if when we do start repeating ourselves a lot and I'll often say that in education it's because it's that important and people aren't getting it.

Yeah.

So repeat away.

Yeah.

Yeah, Please repeat away and not make an excuse for it.

Yeah, I.

So I've taught across multiple program areas, undergraduate postgraduate courses in both pain and wound management, and I've taught allied health professionals, intern doctors, registrars, GP registrars, and I know we're going to be talking about nursing education, I suppose.

Well, education, undergraduate education.

That's a really good point, though, because not everyone's a nurse.

We shouldn't own it.

That's another topic for another day, who owns it?

But I remember when I started this role, just before I left my role in acute care, on my last day, a surgical intern emails me and asks me whether I've got a subject on wound management because he learned nothing in his undergraduate medical degree and yet all he does as a surgical intern is wound management.

And I often repeat that story and I essentially say I don't ask for a paper on dermatology or orthopedic surgery.

And I think that's where we're often seen.

And that was many years ago, but I don't think things have changed much.

And.

And I know I said this story previous episode where I was teaching interns and their supervising physician was in the room and I taught them for two hours and at the end the physician came up to me and said, look, I'm about to retire and I've worked as an ed physician most of my life, I'm about to retire and I've learned more in this two hours than I've learned in my entire career.

And I think to start off with.

And going back to undergraduate nurse education, I think the assumption when we leave and enter the workforce is that our colleagues around us, our clinical colleagues around us, they actually have a basic understanding of wound management, have done at least some formal education in their undergraduate degrees.

And I know, I think I was saying to you just before we start, I think Western Australia now, and there are some universities who are either about to start already currently have a whole semester on wound management.

Maybe I've been dreaming that, I don't know.

But I suppose that's where we're at.

This tension in wound management education occurs where certain undergraduate course degrees do teach a bit more of it, some a lot less, and then there's anything in between amongst the other professions.

And I suppose while we're here is because we've recently read a paper, maybe you want to segue into that.

And that got us thinking, it did.

Get us thinking, I don't know, that we reached the end.

It's still a very much an open topic.

So yeah, there was a paper.

And look, topic raising is fantastic.

There was a.

And I've mentioned this on my socials as well.

There was a recent paper in Wound Practice and Research, which is our peer reviewed wound management journal in Australia, that did a Delphi study on recommended topics for undergraduate wound education divided into year levels.

They did also include postgraduate and there was 74 topics and the vast majority of the.

The majority of them had agreement, I think over 70%.

But you know, gee, in reading some of those topics and.

Can we just stop there?

Go ahead, you're going on the fly.

Yeah.

So do you want to talk?

Yeah, yeah, absolutely.

We talked to them.

So we highlighted this article because it came up very timely for me because as I'd mentioned earlier, I'd had some increased feedback from my followers, you know, and airing their frustrations, which I totally understand about.

They felt a lack of preparedness for when they.

They hit the floor.

So the.

Which led me to the article which was timely for me.

Oh, sorry, did I say something else?

2016.

But it's now been superseded by the fourth edition last year in 23.

So that's an important point.

And late.

Well, yeah, lateish 23.

Lateish 23.

Yeah.

And I think the article was submitted in August of 23.

So, you know, potentially some of that body of work is a little bit out of date.

And that's.

And we'll talk to that about research and amplification of poor research in a subsequent podcast.

Yeah, absolutely.

I mean, and it's not such poor research.

Yeah.

Anyway, complex topic.

It's a complex topic.

Yeah, no, no, not, not a problem.

There's a lot, as we said at the outset, there's a lot of different ways we could go with this conversation and we just want to open it up.

Yep, just want to open it up.

I guess we're here to say that we don't necessarily have the answers.

Doesn't mean that we've got the answers just because we might be perceived as, you know, wound care.

Very experienced people.

Yeah.

So where was I headed with that?

I.

Look, I'm going to, from the outset, share a little bit of a different opinion to where the article was going.

The article had a lot of recommendations.

We only knew a little bit from the article about the perceived experts I mean, yeah, yeah, yeah.

We would have liked to have known a bit more.

We didn't feel as broad as what it perhaps could have been.

There wasn't a definition so much about what that expert was.

But anyway, it was unclear whether the 17 experts that were involved in the Delphi study were informal roles in wound management or informal roles.

And one category I think defined wound specialist, wound nurse, wound consultant, but there was an n of 2.

So there's a bit of ambiguity in the paper.

There was a mean average use of experience, I think.

Yeah.

Which I thought was on the lower side compared to some of the breadth of experience that's in this country.

Yeah, yeah.

I mean, hats off to anyone doing research.

Like it's very easy for us to critique it, but again, we're going to be prickly and so.

And we're just raising those issues.

We're just saying, hey, yeah.

Yep.

Because we don't want to take anything in isolation.

So it was broad eye.

My, honestly, my head hurt in reading some of the recommendations.

There was a whole heap of topics in first, second and third year.

But what I'm seeing out there and what I'm hearing from.

15,000 People on my TikTok account, where I know that's crowdsourcing data, but you know,.

They, it's still data though.

It's still, it's really important data.

They are the people that are going to be looking after us in a couple years when we've got these chronic wounds.

You know, they're telling me they want more wound education but at the same time I'm coming across a lot of people on there who don't have fundamental education, don't grasp the basics.

And I actually feel that they're not in a position to really understand so much of the things we would come along and like to educate them on, such as some of those topics in the standards for wound care, Australian standards, that the education would be lost on them.

They're not because they're not even grasping the basics.

They don't have as much of an understanding of disease process.

I think you had made a challenge me the other day.

You made a comment that if we can expect someone to set up an IV and administer medications, why is it so far fetched that we can't expect them to be doing a reasonable standard of wound, you know, management?

So there's a whole heap of issues there.

But I felt the recommendations were quite fragmented and ambiguous,.

Conceptually illogical.

That's the best way.

Like they separated the ant.

Separated ant into surgical from standard.

But then why should that be separated from the procedure itself?

Because wound.

I think we've tended in wound management in the last couple of years.

My opinion also to have taken aseptic technique and kind of owned it as wound care.

But it's a framework that informs wound care, doesn't it?

So why is it specific?

Yeah.

That actually needs to be completely removed.

Why are we owning.

Yeah, yeah.

So look, we had a lot of questions.

Yeah.

Now I'm on.

Yeah.

And, and let's.

Yeah, we, I think we both agree about our peak body developing a set of standards for ANT in wound management.

Yes, we do have an opinion.

Yeah.

It's sort of like having ANT in cathedralization and ANT for intravenous interventions, cannulation.

I know.

Do those exist?

I'm not even aware.

And for, I don't know, palliative care and for oncology.

I don't know why we decided to pocket that one up.

I don't know.

So, so, so going.

What's jumped out for you there?

Oh, there's so many.

I should have been writing it down.

I think we, we will touch base on a lot of these.

So these topics that we're picking out of those 74 that were listed, we'll unpack a lot of those and we'll have, we'll try to have some guest speakers as we move forward.

Definitely on infection.

Yeah.

But even like again another topic and this may sound boring to the readership and I think people out there know me that I'm really into the language of wound management and semantics.

I'm going to throw out this word called polysemy which some people may have heard me talk about and look up the word polysemy and look up polysemy in health.

But talking about.

So even in the NHMRC guidelines on wound infection and we talk about simple wound, there's no real evidence based definition for what a simple wound is.

Can I just even say what a wound is?

Oh yeah, yeah.

Quickly.

When is it a wound?

When is it an ulcer?

That's a whole nother.

We're going to talk about aetiologies but.

If you look up for medico legal journals the definition of a wound, that's really hard because the epidermis continues on into our mucosa, right down into our stomach.

Where's a wound edge?

Where does the wound edge begin and end?

Are we writing two of the pressure injury stages that have intact skin on our wound chart?

Yeah.

And how does that interface?

And so we can't even describe simple and wound, we can't even define those consistently to students.

And so how can you then develop an educational framework around concepts that may seem simple to us, but when you're trying to translate that into the clinical setting.

What is a simple wound?

I'll never forget a person that I had presented with a tiny wound.

Tiny wound that literally had two crisscross bandages on.

And I can't remember this woman was septic, but tiny wound.

And it was just on her lateral thigh.

And like all of us should be doing, I grabbed a. I tried to probe the wound and I put the probe into the wound and I felt her entire femur.

Yep, 100%.

And she'd had a soil borne organism.

She had an orcardial infection and that was a necrotizing infection.

Terrible.

And yet had two crisscross bandages on.

So what?

Fair enough.

We can assume that people do probe wounds and therefore that will be classified as a complex wound.

But we often don't.

And what's.

And I've often seen simple wounds being described in the time it takes to perform a dressing.

And that's what the NHMRC guidelines used to define as.

I'm pulling a face here for people who are listening.

Yeah.

So I still have people that I.

Is a stage one pressure injury is simple wound?

No, not at all.

That I'm picking up in a number of sectors.

They're talking, telling me about a sterile versus a clean technique.

I was like, really?

Yeah, really.

Is that the language that we're.

And these are younger people who I would have thought would have come through with an understanding of aseptic technique framework from NHMIC infection management.

Yeah.

And so that should have cut across all their professional practice, not just wound management.

And we will talk about sometimes how we covet wound management and try and protect and try and create new paradigms just in wound management.

I think that does us a great disservice.

And I think the wound or the standards or the ant standards for wound management are one of them.

Yeah, absolutely.

Which are controversial in themselves.

Absolutely.

I think we get in the habit and I'm not criticizing anyone here.

I've been guilty.

Okay.

Hand on heart.

I think in wound management we navel gaze a lot and we like to own it as a profession, as a clinical profession, but it's not ours.

And we get so surprised when other people aren't following perhaps the type of evidence or clinical practice guidelines that we think are the beast knees.

And they don't even know about them, you know, so we've got to Take a step back.

But yeah, that, that certainly frustrates me.

We've got to eat a bit of.

Eat a bit of humble pie.

I think sometimes.

Going back to that paper, I think it's sometimes really hard, always easy.

First of all, this study would have probably got ethics approval.

I'm not too sure whether they did to do research.

Anyone who's done research out there, just simply getting an ethics application in is a struggle.

And then finding the time to do it and dedicating that time to do it.

So I understand all the efforts that have gone into this research and then for me to just stand back and go, oh, yeah, well, I still think, and that's one thing, if you put yourself out there for publication or a podcast or whatever, you have to understand that there should be criticism and reflection.

And when I looked at the topics assigned to year one, year two, year three, when you and I went through it, we went, well, hang on, I think it was.

I don't know, we haven't got it.

But arterial assessment was in third year or vascular assessment was in third year.

Yes, yep.

And things didn't match up or.

No, vascular assessment was in second year, but doing an ABPI and a toe pressure was in third year.

How does that work?

And if we're teaching it so separately and conceptualise it so separately, all that's going to happen is it's going to be considered that way once they go into clinical practice.

And so for.

And we'll talk about what a vascular assessment is.

But if you're teaching vascular assessment, you teach vascular assessment, but don't call it vascular assessment in first year and then teach part of that in another year.

And yeah, look, I'm not an academic, I don't have to develop programs.

I mean, I've educated in the past, but again, it's all easy for me to be so hoity toity about it.

But I wonder.

Yes, they had all these clinical experts and academics in the room, but I'm concerned now that this evidence based on old guidelines.

And I was actually part of the feedback for the fourth edition.

And I'll be very clear, I'm a bit disappointed that there were certain things that weren't accepted, but, you know, some were accepted,.

But we're looking at a.

And so that myth is now going to.

Well, not the myth, but that evidence is going to be amplified out there.

I often think what do we do with that?

Yeah, yeah.

I don't know.

I don't have the answer.

I don't have the answer.

I, I look at a lot of those, more what I would term advanced topics and think, do all of those students need to hit the floor in the first or second year and know all of them, Some of them might be working in areas where they do very little wound care, dressing type, you know, assessment management.

So is it really, are we, you know, pushing some of that on?

Is it acceptable that they come out with a foundational understanding of basic topics to deliver safe care in line with the organisation's existing policies and procedures and guidelines that people like us have helped develop like skin tear protocols, pressure injury assessment and staging.

I would love it if they all just consistently staged and follow and those things exist in a lot of facilities and the places that these students will go and do grad years.

And I feel as though when students come to me and say we've missed out on all this stuff, but they, they haven't looked at the existing resources that are at their workplace and what's on the wall in their treatment room that could really guide them and give them some self directed learning, you know, and also that's an extreme, you know, that's a polarized opinion.

But I am probably a inherent realist sometimes to my detriment too.

Well, you're right.

I think you're so right though, talking about a foundational understanding.

And I believe that the intent of the people who are in the, on the Delphi panel, their intent was to base the first year subjects on foundational learning and on foundational topics.

But just before we walked in here to do the, this episode, you pointed out that there was one subject in year one that was about essentially holistic assessment of the person and their environment.

Whoa.

And that's sort of, that's my lane, like almost, you know, by the time the, you know, the proverbials hit the fan, the shit's hit the fan.

That's where we're assessing.

Yeah, we're doing that.

And that's like detective work.

Yeah, I think it was assessing the wound healing environment.

What even is that?

Yeah, wound healing environment.

But boy, oh boy, I mean, is that at a local level?

Is that at a, you know, the physical environment?

Is it the systemic environment?

I'm sure it isn't.

But even using that term, and that's advanced stuff, I'd rather if you'd asked me what would be the foundational topics would be the wound hygiene document, the anti biofilm strategy document.

That is fabulous.

That framework.

And we should put the link to that.

But I think if we will put.

The link to that.

The International Wound Infection Institute.

Oh.

As well.

For wound infection.

They are both.

And you know, and then, you know, hats off to Terry Swanson, nurse practitioner, who's been very instrumental in driving both those documents and leading a lot of available education.

Yeah.

For people like us and others to come along and experience that in community settings that it often is available free online.

Yeah.

And if you asked me what would be the.

What would be the foundational topics, that's what I'd do.

Just get them because.

Yeah, get them.

Working with those two documents and frame subjects around those two documents.

Absolutely.

I would add on to that pressure injury staging, skin test staging classification.

Yeah.

How to fill in a wound chart.

And I would add on basic understanding of the role of dressings and dressing categories.

Because I really get it when students come to me and say, tell me about the dressings.

And I'll say it's not about the dressing.

But you know, maybe for them it is.

That's what they understand.

They need to know.

Of course I need to know more.

But is it such a bad thing that they should know when to refer on.

And you know what, just again, giving that.

As you're talking, I'm thinking about the tablet analogy.

So you can teach them.

These are antihypertensives, these are anticholinergics, these are opioids.

Nice generic categories.

Yeah.

Just maybe don't look and look.

We're winging it here.

We don't have the solutions.

But I just felt that those categories just didn't make.

If I was trying to apply that, translate that research into the clinical setting.

It just does not work the way things happen in the real world.

And we need more.

You know, the listeners may be aware of real world research, you know, and Keith Harding, Professor Keith Harding from Wales is a strong proponent.

We really need more real world research into wound management.

And we'll touch on that when we talk about the iodosorb.

Yes.

The antimicrobial.

Antimicrobial.

So that's a little bit of a teaser.

A teaser, yeah.

We need more real world research.

And so again, getting a panel of experts into a.

Well, not into a room, but it's an easy study design much, you know, easier methodology to apply than real world research.

But geez, I'd love to have had an opportunity to be on that panel, but then again, I'm feeding the monster, you know, it really.

We need real World research and we're.

Acknowledging wide variety of challenges out there and a system that often doesn't support.

I feel as though nursing as a profession, I'm just, you know, talking about nursing, not saying that nurses are the only ones that do wound care.

We've said that before.

But there are a lot of stuff, systemic issues and lack of support of nurses.

I think as a profession we don't do well.

I'm incredibly encouraged by a lot of the nurse coaches now that are in these spaces doing an amazing amount of work to try and help and coach nurses how to navigate some of these issues and trying to address these broader systemic issues.

And some of these wound care things that we're talking about are wrapped up in those things and yet we do not have the answers for those.

I. I feel as though I'm going to make a broad statement here to kind of wrap up my last prickly comment and, you know, say that I think sometimes in wound care we would like everything to be done to a standard that may be set too high.

I think there's a foundational standard because, you know, wound care is not everyone's thing either.

I sometimes feel there's a bit of an underwritten current that comes through in standards.

And perhaps that article that be like, well, if I knew I was going to be a wound consultant 20 years ago or 30 years ago, whatever, when I was an undergraduate, those are the topics I might have wanted to learn, but not every.

They were great topics for people who are going to want to go on and advance and do all those things.

But at what point should wound education, should some of it be plan to be a postgraduate, not necessarily postgraduate studies, but what responsibility do we have for people in the workplace for good, solid education they don't have to necessarily pay for that should be part of their ongoing professional development.

I find that challenge whenever I'm asked to come in and educate.

I might have half an hour with people, I might have two hours with people, and they want every topic under the sun and it's just not possible.

We don't give it the time.

So these issues also exist not just in undergraduate, but in postgraduate, you know, just in the workplace.

I've just seen a situation where there was a regional seminar on the complexities of wound management in a regional setting and there was not one wound expert on the panel and there were three medical professionals and a nurse who didn't have any formal education in wound management.

And I'm not saying a nurse needed to be there, but definitely a wound management Expert and who worked in a formal role in wound management should have been there.

That's concerning.

Yeah.

And unfortunately, because predominantly wound management is still predominantly the domain of nursing, although, you know, we fully understand that some.

That's evolving definitely across the professions.

And I think you were talking about that.

There are a lot of people out there doing really good work.

I just wish sometimes I could be a PR agent for these people.

You know, we really.

I don't know.

And that's another topic about how we talk about what we do.

I mean, as I said in the previous episode, I tell people I'm not a nurse who puts groovy band aids on people.

And that's how I often say that.

And I actually talk about roughly what I do.

Yeah, but look, we've opened that.

We've opened that topic.

We would love anyone to reach out to us if you.

If they've got any thoughts on that.

Certainly if there's any.

Anyone who has influence in undergraduate education with, you know, who wants to weigh in on that.

You know, I think it needs to be discussed more.

Yeah.

All right, so look, thank you for the prickly.

The prickly topic.

We've.

We've probably assisted ourselves in, you know, hashing out some of that and it'll give us a lot more to think about moving forward.

So.

But I think definitely we've been critical, but I think to provide some constructive feedback.

Definitely.

Oh, you know, no matter what level exactly, clinician or what area you work in, what discipline you work in or sector.

And there's clinical pearls in there and there are beautiful, easy or a more in depth read for what your needs are.

And it's a document that will sit well on your shelf and will be well used.

Yeah.

Yeah, lovely.

Let's.

Let's cut that one there.

Okay, beautiful.

Thanks everyone, for listening and we'll catch.

Catch you in the next episode.

Thank you.

Okay, see you.

We are so grateful to have this opportunity to share our learnings and challenges with you today.

Hopefully it has inspired you to be more curious in your clinical practice and burrow down to issues that bug you.

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And in the meantime, go forth, be curious and burrow into some ant nests.

Through I give it all, give it all for you but what you do, what I do Take your rounds to cover you.