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NATVNS Notebook
Journal of Tissue Viability 1997 Vol? No 2
67
NATVNS NOTEBOOK Welcome to the notebook page of the National Association of Tissue Viability Nurse Specialist (NATVNS). This publication has come about due to the affiliation of the NATVNS with the Tissue Viability Society and the Society's generous provision of administrative support. Affiliation of our Association with a larger organisation was necessary in order to achieve a higher profile and to improve the communication links between the Regional Groups. Initially, three relevant organisations were approached: The Royal College of Nursing, The Tissue Viability Society and SNAP. Presentations were made by each of these groups to theNATVNS and a national ballot of membership went with the Tissue Viability Society. The Society agreed to affiliation and this was passed at it's AGM in October 1996. I hope that the collaboration between the NATVNS and the Tissue Viability Society will prove beneficial to us all. There is currently a network of Tissue Viability groups around the country which have developed to provide support and exchange of information between nurses involved in Tissue Viability. Many of these posts had developed with no clear guidance from the employer regarding the role and function of the nurse. The Regional Network is filling a need in providing a forum for nurses to meet, share information and to 'network'. The first group was started up by Maureen Benbow and her colleagues in theNorth West. This was followed by development of a North Eastern Group and a Southern Group. At this stage, discussion among these groups revealed commonalities which it was perceived would be better served through a National Association rather than individual groups working alone. Hence development of the NATVNS. There are currently seven Regional Groups. The Regional Groups provide a valuable resource for their membership. Each group has developed its format to meet the specific needs of its membership. As a rule of thumb each group meets quarterly or biannually to discuss issues such as the practicalities of incidence and/or prevalence monitoring, mattress and equipment audit and research protocols for example. The Regional Groups may have members who are not identified as Tissue Viability Nurses by their job description but who have some responsibility, influence or interest in Tissue Viability within their environment. The NATVNS has developed from recognition by the Regional Groups that issues such as job description, educational grounding and experience varied widely among the nurses in post. Neither was there an association addressing the specific need of nurses in Tissue Viability roles. The NATVNS aims to fill that gap. The aim of the group is 'to promote and enhance the speciality of Tissue Viability' through recognition and development of the role of the Tissue Viability Nurse Specialist. The group will liaise and collaborate with all relevant professionals, agencies and organisations in order to advance best practice. The NATVNS' valued role in providing a support and information network for its members is now enhanced by its affiliation with the Tissue Viability Society who are supporting the group by
recognising it as an entity in its own right and providing much needed administrative support. The NATVNS has now developed and ratified its constitution and a suggested job description for Tissue Viability Nurse Specialist posts developed in future. The job description was originally drafted by Madeleine Flanagan, Michele Kirkbride and Marie Batey to whom we extend our thanks, (in Michele's case this will be sent 'Down Under') and was published in the last issue of the Joumal of Tissue Viability. Further copies of the job description can be obtained from John Gisby or from the regional groups. Some confusion has arisen within the Regional Groups now that the NATVNS constitution has been ratified. Membership oftheNATVNSisopentothoseidentifiedintheirjobdescription as having an organisational responsibility for Tissue Viability (as defined in the NATVNS job description). This may mean that some Regional Members are not eligible for membership of the NATVNS, it does not mean however, that they cannot continue as valued members of the Regional Groups. I hope that the information contained within this notebook page will be of value not only to Tissue Viability Nurses but to all members of the Tissue Viability Society by providing an insight into the activities of the NATVNS and the Regional Groups. Karen Stevens Chairman REGIONAL ROUNDUP Midland (North) There are 17 members of the network covering the area of Nottingham, Lincolnshire, Derbyshire, Sheffield and Rotherham. We are currently reviewing our aims and philosophy or the forthcoming year and a number of issues are on the forthcoming agenda. These include: *Evaluation of pressure relieving equipment* Policy/guidance development* Audit* Seamless health care across community/ hospital interface* Incidence/Prevalence monitoring* Communication with DHA' s re quality monitoring* Increasing knowledge of dermatology. The group will also be exploring development of a clinical supervision model as a tool to assist members working in isolation. South The group is currently being chaired by Jo Bonomini while Karen Stevens is on maternity leave. Our meetings run quarterly and are organised round a theme. At our last meeting on December 13th presentations were made by Melanie Delve (Oxford) and Bill Cox-Martin (Salisbury) on running their equipment loan services. Many Tissue Viability Nurses are looking at the feasibility of equipment stores in their workplaces so we extend our thanks to Melanie and Bill for providinS insight into the practicaiities of such services in hospital an9 community settings. Our group has developed a membership pack for it's members with support from ConvaTec and each
68 Journal of Tissue Viability 1997 Vol 7 No 2 member who attends the meetings will receive a copy. This can be updated as information changes. The group are trying to standardise the way we monitor equipment and Karen Stevens is currently collating information on the groups mattress audit results. This is information on durability in a practice setting where use can not be controlled ie real life rather than ideal conditions. Our aim is to collect this information through NATVNS members in order to give us a realistic picture regarding the actual lifespan of various foam mattresses. This should help us with development of realistic and cost effective mattress replacement programmes. We are currently updating our list of members special interests and expertise. This will provide a resource directory for colleagues needing help and advice on topics such as audit, equipment selection, incidence and prevalence monitoring, developing equipment contracts, leg ulcer management etc .. The next Southern Group meeting is on Friday March 7th. For further information contact Jo Bonomini. Senior Nurse, Tissue Viability Service, c/o Post Room, The Royal London Hospital, Whitechapel Road, LONDON El lBB.
West Country The Royal Cornwall Hospital Trust are considering a research project into the effects of epidural anaesthesia and pressure sore incidence. They would be very interested to hear from anyone else undertaking similar work. Contact, Heather Newton, telephone no 01872 74242.
North and East Devon Interface Audit Group Pressure Damage. A major audit has recently been undertaken to:1. Identify in a prevalence survey all patients with Grade 3/4 (Stirling) pressure sores receiving care in North and East Devon. 2. Review the case records of those identified in the prevalence survey to determine appropriateness of nursing pressure sore prevention and treatment strategies. 3. To report back to the North and East Devon Health authority on findings, accompanied by recommendations. It is believed that this is the first attempt of its kind to study pressure damage amongst all healthcare providers (including the private sector) in a single purchasing locality. The data collected has been analysed, the report is in final draft and will be available later in the year. Information from the pressure damage audit group chairman, Andrew Kingsley, telephone no 01271 31160 1. South West Anti-Embolic Stockings/Pressure Damage All tissue viability specialists in the South West area are involved in drawing up nursing guidelines for 'good practice' for patients wearing anti-embolic stockings. Most of the specialists have encountered patients who have experienced pressure damage to their heels whilst wearing anti-embolic stockings.
Letters to the Editor Dear Sir Reading a letter by Peter Maleczek in Hospital Equipment and Supplies 1 on the need for hospital equipment with which to manage very heavy patients (those in excess of 28 stone) has prompted me to write this missive. Although Mr Maleczek does not mention pressure relieving devices specifically, providing adequate pressure relief for very heavy patients is a regular and increasingly common problem for our department. While the Nimbus II mattress (HE Huntleigh, Luton) is claimed to be able to support patients of up to 38 stone, I am not aware of any pressure relieving device that can support patients heavier than that. Yet, it is generally believed that when they become susceptible to pressure sores, these very patients are at particular risk because their weight creates very high pressures and fatty tissue is both more subject to shearing and has a poor circulation. Furthermore, regular re-positioning is virtually impossible as special hoisting equipment has to be obtained and installed which often takes a few days and the sheer size of the patients, limits available positions on the somewhat narrow Kings Fund Bed. This leads us onto the problem of beds. By and large, these patients require a widened electric profiling bed with a knee gatch. I do not know of any hospital which has such equipment. Renting it takes some time and rental companies do not always have the equipment in stock. This results in delays of many
hours or days. Thus, while they are at their most vulnerable, in the acute stages of their illness, very heavy patients cannot be given effective pressure relief. Clinical considerations apart, very heavy patients are frequently treated with less than the tact and care they need because of the danger of nursing staff incurring serious injury to themselves and their patient. The patient is made to feel guilty about their size, which cannot but effect their recovery through a lowering of self-esteem and feelings of being a burden to their carers. Our own observation corresponds with that of Mr Maleczek, that is that people in the 1990's are not as slim as the fashion magazines would have us believe and that very heavy patients are rapidly increasing in number. I would be very interested to hear from other members if they have similar problems and, perhaps more importantly, of what solutions they have found. I would also be keen to hear from equipment manufacturers whether they can help us now or will be able to in the future. Yours faithfully Jean Hookway, Equipment and Audit Assistant, StGeorge's Healthcare NHS Trust, London Reference: 1. Maleczek P. Equipment needed for the bigger patient. Hospital Equipment & Supplies 1997; Jan: 9.
67
NATVNS NOTEBOOK Welcome to the notebook page of the National Association of Tissue Viability Nurse Specialist (NATVNS). This publication has come about due to the affiliation of the NATVNS with the Tissue Viability Society and the Society's generous provision of administrative support. Affiliation of our Association with a larger organisation was necessary in order to achieve a higher profile and to improve the communication links between the Regional Groups. Initially, three relevant organisations were approached: The Royal College of Nursing, The Tissue Viability Society and SNAP. Presentations were made by each of these groups to theNATVNS and a national ballot of membership went with the Tissue Viability Society. The Society agreed to affiliation and this was passed at it's AGM in October 1996. I hope that the collaboration between the NATVNS and the Tissue Viability Society will prove beneficial to us all. There is currently a network of Tissue Viability groups around the country which have developed to provide support and exchange of information between nurses involved in Tissue Viability. Many of these posts had developed with no clear guidance from the employer regarding the role and function of the nurse. The Regional Network is filling a need in providing a forum for nurses to meet, share information and to 'network'. The first group was started up by Maureen Benbow and her colleagues in theNorth West. This was followed by development of a North Eastern Group and a Southern Group. At this stage, discussion among these groups revealed commonalities which it was perceived would be better served through a National Association rather than individual groups working alone. Hence development of the NATVNS. There are currently seven Regional Groups. The Regional Groups provide a valuable resource for their membership. Each group has developed its format to meet the specific needs of its membership. As a rule of thumb each group meets quarterly or biannually to discuss issues such as the practicalities of incidence and/or prevalence monitoring, mattress and equipment audit and research protocols for example. The Regional Groups may have members who are not identified as Tissue Viability Nurses by their job description but who have some responsibility, influence or interest in Tissue Viability within their environment. The NATVNS has developed from recognition by the Regional Groups that issues such as job description, educational grounding and experience varied widely among the nurses in post. Neither was there an association addressing the specific need of nurses in Tissue Viability roles. The NATVNS aims to fill that gap. The aim of the group is 'to promote and enhance the speciality of Tissue Viability' through recognition and development of the role of the Tissue Viability Nurse Specialist. The group will liaise and collaborate with all relevant professionals, agencies and organisations in order to advance best practice. The NATVNS' valued role in providing a support and information network for its members is now enhanced by its affiliation with the Tissue Viability Society who are supporting the group by
recognising it as an entity in its own right and providing much needed administrative support. The NATVNS has now developed and ratified its constitution and a suggested job description for Tissue Viability Nurse Specialist posts developed in future. The job description was originally drafted by Madeleine Flanagan, Michele Kirkbride and Marie Batey to whom we extend our thanks, (in Michele's case this will be sent 'Down Under') and was published in the last issue of the Joumal of Tissue Viability. Further copies of the job description can be obtained from John Gisby or from the regional groups. Some confusion has arisen within the Regional Groups now that the NATVNS constitution has been ratified. Membership oftheNATVNSisopentothoseidentifiedintheirjobdescription as having an organisational responsibility for Tissue Viability (as defined in the NATVNS job description). This may mean that some Regional Members are not eligible for membership of the NATVNS, it does not mean however, that they cannot continue as valued members of the Regional Groups. I hope that the information contained within this notebook page will be of value not only to Tissue Viability Nurses but to all members of the Tissue Viability Society by providing an insight into the activities of the NATVNS and the Regional Groups. Karen Stevens Chairman REGIONAL ROUNDUP Midland (North) There are 17 members of the network covering the area of Nottingham, Lincolnshire, Derbyshire, Sheffield and Rotherham. We are currently reviewing our aims and philosophy or the forthcoming year and a number of issues are on the forthcoming agenda. These include: *Evaluation of pressure relieving equipment* Policy/guidance development* Audit* Seamless health care across community/ hospital interface* Incidence/Prevalence monitoring* Communication with DHA' s re quality monitoring* Increasing knowledge of dermatology. The group will also be exploring development of a clinical supervision model as a tool to assist members working in isolation. South The group is currently being chaired by Jo Bonomini while Karen Stevens is on maternity leave. Our meetings run quarterly and are organised round a theme. At our last meeting on December 13th presentations were made by Melanie Delve (Oxford) and Bill Cox-Martin (Salisbury) on running their equipment loan services. Many Tissue Viability Nurses are looking at the feasibility of equipment stores in their workplaces so we extend our thanks to Melanie and Bill for providinS insight into the practicaiities of such services in hospital an9 community settings. Our group has developed a membership pack for it's members with support from ConvaTec and each
68 Journal of Tissue Viability 1997 Vol 7 No 2 member who attends the meetings will receive a copy. This can be updated as information changes. The group are trying to standardise the way we monitor equipment and Karen Stevens is currently collating information on the groups mattress audit results. This is information on durability in a practice setting where use can not be controlled ie real life rather than ideal conditions. Our aim is to collect this information through NATVNS members in order to give us a realistic picture regarding the actual lifespan of various foam mattresses. This should help us with development of realistic and cost effective mattress replacement programmes. We are currently updating our list of members special interests and expertise. This will provide a resource directory for colleagues needing help and advice on topics such as audit, equipment selection, incidence and prevalence monitoring, developing equipment contracts, leg ulcer management etc .. The next Southern Group meeting is on Friday March 7th. For further information contact Jo Bonomini. Senior Nurse, Tissue Viability Service, c/o Post Room, The Royal London Hospital, Whitechapel Road, LONDON El lBB.
West Country The Royal Cornwall Hospital Trust are considering a research project into the effects of epidural anaesthesia and pressure sore incidence. They would be very interested to hear from anyone else undertaking similar work. Contact, Heather Newton, telephone no 01872 74242.
North and East Devon Interface Audit Group Pressure Damage. A major audit has recently been undertaken to:1. Identify in a prevalence survey all patients with Grade 3/4 (Stirling) pressure sores receiving care in North and East Devon. 2. Review the case records of those identified in the prevalence survey to determine appropriateness of nursing pressure sore prevention and treatment strategies. 3. To report back to the North and East Devon Health authority on findings, accompanied by recommendations. It is believed that this is the first attempt of its kind to study pressure damage amongst all healthcare providers (including the private sector) in a single purchasing locality. The data collected has been analysed, the report is in final draft and will be available later in the year. Information from the pressure damage audit group chairman, Andrew Kingsley, telephone no 01271 31160 1. South West Anti-Embolic Stockings/Pressure Damage All tissue viability specialists in the South West area are involved in drawing up nursing guidelines for 'good practice' for patients wearing anti-embolic stockings. Most of the specialists have encountered patients who have experienced pressure damage to their heels whilst wearing anti-embolic stockings.
Letters to the Editor Dear Sir Reading a letter by Peter Maleczek in Hospital Equipment and Supplies 1 on the need for hospital equipment with which to manage very heavy patients (those in excess of 28 stone) has prompted me to write this missive. Although Mr Maleczek does not mention pressure relieving devices specifically, providing adequate pressure relief for very heavy patients is a regular and increasingly common problem for our department. While the Nimbus II mattress (HE Huntleigh, Luton) is claimed to be able to support patients of up to 38 stone, I am not aware of any pressure relieving device that can support patients heavier than that. Yet, it is generally believed that when they become susceptible to pressure sores, these very patients are at particular risk because their weight creates very high pressures and fatty tissue is both more subject to shearing and has a poor circulation. Furthermore, regular re-positioning is virtually impossible as special hoisting equipment has to be obtained and installed which often takes a few days and the sheer size of the patients, limits available positions on the somewhat narrow Kings Fund Bed. This leads us onto the problem of beds. By and large, these patients require a widened electric profiling bed with a knee gatch. I do not know of any hospital which has such equipment. Renting it takes some time and rental companies do not always have the equipment in stock. This results in delays of many
hours or days. Thus, while they are at their most vulnerable, in the acute stages of their illness, very heavy patients cannot be given effective pressure relief. Clinical considerations apart, very heavy patients are frequently treated with less than the tact and care they need because of the danger of nursing staff incurring serious injury to themselves and their patient. The patient is made to feel guilty about their size, which cannot but effect their recovery through a lowering of self-esteem and feelings of being a burden to their carers. Our own observation corresponds with that of Mr Maleczek, that is that people in the 1990's are not as slim as the fashion magazines would have us believe and that very heavy patients are rapidly increasing in number. I would be very interested to hear from other members if they have similar problems and, perhaps more importantly, of what solutions they have found. I would also be keen to hear from equipment manufacturers whether they can help us now or will be able to in the future. Yours faithfully Jean Hookway, Equipment and Audit Assistant, StGeorge's Healthcare NHS Trust, London Reference: 1. Maleczek P. Equipment needed for the bigger patient. Hospital Equipment & Supplies 1997; Jan: 9.