We are in fast-moving times in tissue viability. National work is bringing cohesiveness and consistency for wound care as an entity rather than discrete parts. I am thinking about the future and how we bring on a new community of nurses and nursing associates to implement initiatives and grow this work and area of practice. There are three important issues here: requirements of the professional body, education developments and the community culture of working groups.
In 2018 the Nursing and Midwifery Council (NMC) issued Future Nurse: Standards of Proficiency for Registered Nurses. The standards (NMC, 2018a) include a list of proficiencies (Annexe B) expected of a nurse at the point of registration. From a tissue viability perspective, the proficiencies include assessment of skin status, positioning and pressure-relieving techniques, appropriate action to reduce or minimise pain or discomfort, assessment of skin integrity and using appropriate products to prevent or manage skin breakdown, aseptic techniques when undertaking wound care and observing, assessing and responding to potential infection risks. The list helps focus education and support needed in practice from practice assessors and practice supervisors, and the proficiencies are also a means of establishing capability and a baseline for the newly qualified to build on.
The NMC recently allowed universities to offer a modest number of hours as simulation to complement teaching of skills. In February 2021 the NMC introduced further recovery standards, due to limits imposed by the pandemic on the range and number of practice placements available (NMC, 2021). These allowed simulation education already underway to help meet the proficiencies to be expanded to replace some practice hours to help students develop necessary skills. Universities such as my own rose to this challenge with students allowed up to 300 hours of simulation. As most nursing cohorts are large this was a demanding operation, especially in PPE with social distancing and smaller groups than normal.
Nothing exceeds real experience in practice settings but, done well, simulation is a worthwhile plan B. It gives a safe environment for students to test themselves and make mistakes that they learn from. It also gives a concentrated environment to pick up trends, misconceptions and stars of the future. These may be more difficult to detect when students are dispersed across multiple organisations. Simulation is an effective means of gaining wound management experience that transfers well to real patient care. For instance, assessing a wound and periwound skin or mastering the manual dexterity of preparing a dressing pack can be practised in simulation enabling a smoother transfer of the skill to a patient when the time comes. As we encourage more self-care the student develops empathy with patients and carers through their own experience. Increasingly hospitals are using their own simulation labs to enhance workforce skills.
Simulation is a specialism in its own right and goes beyond just a demonstration and observation of a skill. Planning, running and debriefing are essential to making this an authentic and meaningful activity. The Association for Simulated Practice in Healthcare and Health Education England (2016) published national standards for simulation-based education and promote the need for skilled and knowledgeable people to guide this education. In tissue viability the range of issues that affect skin integrity is vast and few students would experience everything in this journal, for instance. Rather than relying on being in the right placement at the right time, simulation can build foundations and offer nuances that develop and test knowledge and skill to help make future nurses adaptable and help keep tissue viability practice current and challenging, while reminding us this is about people and things that affect their lives.
So how does all of this influence the future? Once the enthusiasm, confidence and skill translates to a qualified nurse or nursing associate wishing to pursue a career in this area there needs to be somewhere for them to go as their expertise develops. As their portfolio builds, they have a lot to offer the community of practitioners involved in setting standards. A key starting point is often a local tissue viability/wound care group and it is good to see more of these building up their activities again as restrictions ease. Regional, national or international groups may be the next steps. In these groups there is a higher concentration of highly experienced people who are knowledgeable, articulate and have a network around them. Joining such groups can be daunting but it is vital that we bring in new talent and enthusiasm. In order to do this the community itself needs to be welcoming and inclusive. The Code requires nurses and nursing associates to ‘support colleagues learning … to help them develop professional competence and confidence’, ‘share your skills, knowledge and experience for the benefit of people receiving care and your colleagues’ and ‘act as a role model of professional behaviour’ (NMC, 2018b). There are many people in local networks who have so much to offer patient care if only given the chance.
If we are to address the major challenges in nurse education and give the current learners in nursing (student nurses and student nursing associates) the best opportunity to become highly effective practitioners with a wealth of experience then we must embrace the requirements of the standards, modern education techniques that are authentic to practice, and create a diverse and welcoming community for them to grow and influence future patient care in tissue viability.