| Journals Watch
2001 This section features a constantly updated list of recently published articles relevant to nurse prescribing. Abstracts of the papers are included and incorporate an expert's opinion about the article. Users are encouraged to submit their views about published papers through the feedback section. Please note: In this section of the website we aim to cover articles on areas where nurses do prescribe. However, not all the treatments or appliances mentioned are prescribable by nurses. For that reason, nurses should check the up-to-date versions of the Nurse Prescribing Formulary and Drug tariff if they are in any doubt. Wound and
leg ulcer care
Charles H. Using compression bandages in the treatment of venous leg ulceration. Professional Nurse 2001; 17(2): 123-125 Summary: This article discussed the advantages of short-stretch bandages for venous leg ulcers. These bandages have an extensibility of 70-90% of their original length, are applied at full stretch and do not expand when the calf muscle is exercised; long-stretch bandages stretch to more than 100% and should not be fully stretched during application. The author discusses the advantages of short-stretch bandages, particularly the oedema reduction which leads to a reduction in leg circumference, providing the bandage is re-applied as necessary. There is some evidence of a relationship between oedema reduction and pain relief. Short-stretch bandages provide recommended levels of compression for the calf muscle during work or rest. The different methods of applying short-stretch bandages are then described. back
Nursing Times 2001; 97(28): 50-69; Nursing Times 2001; 97(35): 40-66 Summary: These two wound care supplements include articles on: cleaning and dressing traumatic wounds, bandaging, pain relief and the latest RCN and NICE guidance on pressure ulcers; managing extravasation injuries in preterm neonates; non-healing leg ulceration; vacuum-assisted closure; local wound management of traumatic wounds; adverse reactions to topical medicaments and wound care products; and how to manage coursework. back Website: www.nursingtimes.net Pudner R. Hydrocolloid dressings in wound management; Alginate and hydrofibre dressings in wound management. Journal of Community Nursing 2001; 15(4): 44-48; and 15(5): 38-42 Summary: In the first article in a series on wound dressings, the author looks at the role of hydrocolloid dressings and in the second, at alginate and hydrofibre dressings. Because of the number of dressings available, as well as all the other factors that need to be considered, choosing a dressing can be a complex decision. Wound product formularies have been produced by many community trusts to help nurse prescribers and other nurses. Although hydrocolloid dressings look similar, they differ in their composition and construction; these differences are discussed in relation to their functions. When hydrocolloids have absorbed wound exudate, their permeability to moisture vapour increases, allowing some to pass through the back of the dressing. They all have an outer waterproof layer. Their occlusive nature promotes angiogenesis and macrophage activity. Their insulating properties mean the wound surface remains near body temperature. As the dressings absorb fluid, a gel forms and provides a moist environment at the wound surface, which has several benefits. Hydrocolloids can be used on leg ulcers, pressure sores, superficial burn wounds, small donor site wounds and minor abrasions (and possibly, in certain circumstances, on diabetic patients with foot ulcers). They are seen as particularly suitable for children as they allow most normal activities. Hydrocolloid dressings can be used on sloughy and necrotic wounds as they promote debridement, although the patient should be alerted to the possibility of an initial increase in wound size. The gel formation property means they can be used on granulating and epithelialising wounds. On the whole, they are not suitable for heavily exuding wounds. Although they can be used on colonised wounds, they may not be suitable for infected wounds or where the presence of anaerobic organisms is suspected. The application and removal of different sorts of hydrocolloids are discussed and the research evidence for their efficacy and impact on patients discussed. The author concludes that they promote an optimum environment for wound healing, can reduce pain, protect wounds from the environment, allow patients to maintain a normal lifestyle, and can be easily removed. Alginate dressings also look similar to one another but differ in their composition and the way in which they are assembled. They are derived from salts of a seaweed polymer, alginic acid, which contains mannuronic and guluronic acid residues. Dressings with a high mannuronic content gel faster, forming a weak flexible gel that can be removed by irrigation (Sorbsan™, SeaSorb™, Melgisorb™, Tegagen™, and Algisite M™) . Those with a high guluronic acid content gel more slowly into a more structurally stable gel that needs to be removed in one piece (Kaltostat™ and Algosteril™). Whether they contain calcium alginate or calcium-sodium alginate also affects their properties. Another variation is that some are constructed to avoid fibres being left behind in the woundSodium ions in the exudate replace calcium ions in the alginate, forming a hydrophilic gel and creating a warm, moist environment for wound healing. The dressings absorb fluid and then form a gel around each fibre. They can be used on wounds producing moderate to large quantities of exudate, for example pressure sores, leg ulcers, donor site wounds, cavity wounds, wound sinuses, infected wounds and foot ulcers in diabetic patients. They should not be used on dry wounds or those covered with hard necrotic tissue. They are useful in wounds with a tendency to bleed and on sloughy and granulating tissue. They are often used on infected wounds. Only one hydrofibre dressing is available at present, Aquacel™, which is a soft non-woven that absorbs fluid directly into the fibres. It then becomes a coherent gel sheet that can be handled and absorbs further exudate. Little fluid is released back to the skin or wound, reducing the risk of skin maceration. It can be used in moderate to heavily exuding wounds, and may be more absorbent than alginates and so of particular benefit in heavily exuding ones. It has no haemostatic properties, however. The methods of application and removal for alginates and hydrofibre dressings are described and the available research discussed. These dressings are of value in the treatment of exuding wounds as they are flexible, conformable, absorb exudate and should be easy to apply and remove without pain or trauma. backWebsite: www.jcn.co.uk
Summary: The third article (see above for the first) in this series examines the use of amorphous hydrogel dressings in wound management. Hydrogels provide a moist environment, are non-adherent, safe, free from particulate contaminants, and are available in hospitals and the community. Flat sheets are mainly used for burns and scars whereas the amorphous hydrogels are used for pressure sores, fungating wounds, extravasation injuries and other wound types. Like the other dressings, their composition and functions can differ even though they look similar. Amorphous hydrogels have no fixed structure and viscosity decreases as fluid is absorbed. They seem able to donate or absorb fluid depending on wound hydration and have a high water content, making them useful in wound debridement. They consist mainly of water with a small amount of starch or carboxymethyl-cellulose polymer; many also contain 20% propylene glycol as a humectant and preservative. Examples include Intrasite Gel™, Aquaform™ and Sterigel™. Others, such as GranuGel™, Nu-Gel™ and Purilon Gel™ , also contain ingredients to increase their viscosity, which may help in their application and keep them in place.Amorphous hydrogels are well suited to necrotic and sloughy wounds and are often used with sharp debridement. They are sometimes used on granulating and epithelialising wounds but maceration may occur. An appropriate secondary dressing should be used, depending on the amount of exudate. It has been suggested that they should not be used on infected wounds because of the possibility of over-hydration allowing micro-organisms to spread but some authors have suggested suitable precautions for these cases including the use of systemic antibiotics. The application and removal of amorphous hydrogels are discussed, as is the evidence for their efficacy. If larval therapy is to be used, amorphous hydrogels are often used to soften hard, dry, necrotic tissue before the larvae are applied, although the results from one study suggest that all remaining hydrogel should be removed from the wound before larval application (except for Purilon Gel™, which did not seem to have a detrimental effect on the larvae). backWebsite: www.jcn.co.uk
Pudner R. Iodine impregnated dressings: Low/non-adherent dressings in wound management. Journal of Community Nursing 2001; 15(7): 35-36 and 15(8): 12-17 Summary: The fourth and fifth article in this series on dressings in wound management (see above) look at the use of iodine impregnated dressings and low/non-adherent dressings. Although the use of iodine in wound
management has been the subject of some debate recently, it has been suggested that it
should have a role. Both povidone-iodine and cadexomer iodine impregnated dressings are
discussed. Cadexomer iodine is a 3D starch lattice formed into spherical microspheres, trapping iodine in the lattice. As fluid is absorbed, the pore size of the lattice increases, releasing iodine. The cadexomer absorbs exudate from the wound bed. Iodosorb™ is available as powder or ointment and Iodoflex™ as a paste wafer. Again, a change in colour from orange to cream indicates that all the iodine has been released. These dressings are only suitable for exudating wounds and particularly for chronic, sloughy or infected wounds. They can be used on leg ulcers, pressure ulcers and diabetic ulcers but no single course of treatment should exceed three months. Their application and the research studies examining their use are discussed. In the fifth article, the author points out that although many dressings are called "non-adherent", they are often in fact of low adherence. Most are also of limited absorbency and will need a secondary dressing and all have perforations to allow exudate to pass into the absorbent layer or secondary dressing. Three of the dressings, N-A™, N-A Ultra™, and Tricotex™, look similar but N-A Ultra™ has a silicone coat which should make it non-adherent whereas the other two are sterile knitted viscose primary dressings. The open structure of the fibres means that exudate can pass through to the secondary dressing. Melolin™, Release™ and
Skintact™ can all be described as absorbent, perforated plastic film-faced dressings,
although again their compositions differ. None should need a secondary dressing as they
have pads to absorb minimal exudate but if the exudate dries in the holes of the apertured
film layer, there may be some adherence. Mepitel™ and Mepilex™ are soft silicone wound contact dressings. Mepitel™ is made from silicone gel bound to a polyamide net and will not adhere to the wound bed but will adhere to adjacent dry healthy skin. It is particularly useful for wounds that are painful at dressing changes. Mepilex™ consists of a soft silicone wound contact layer with a polyurethane foam film backing, making it highly absorbent and conformable. Tegapore™ is a very thin dressing classed as a membrane. It is made from a virtually non-adherent woven hypoallergenic polyamide net that allows exudate to pass through the pores into the secondary dressing. The dressing becomes transparent when wet, allowing monitoring of the wound without its removal. This dressing is particularly useful in those patients with severe pain at dressing changes as it can be left on the wound bed for prolonged periods with only the secondary dressing being changed. Most of these dressings can be used in any
granulating or epithelialising wound with minimal exudate, but some (Melolin™,
Release™, Skintact™, and Mepilex™) should be suitable for low to moderate
amounts as they contain an absorbent material. All can be used on leg ulcers, abrasions
and lacerations. Website: www.jcn.co.uk
Pudner R. Post-operative dressings in wound management. Journal of Community Nursing 2001; 15(9): 33-34 Summary: In
the sixth article in this series (see article summaries), the author
turns her attention to the use of post-operative dressings such as Mepore™,
Primapore™, Opsite Post-Op™, and Mepore Ultra™. The properties of the different dressings
are discussed. Although neither Mepore™ or Primapore™ is waterproof, dressings
such as Mepore Ultra™ and OpSite Plus™ (formerly OpSite Post-Op™)
incorporate vapour-permeable film layers that allow patients to bath and shower and also
provide protection against bacteria. Mepore UltraTM has a latex-free adhesive. Other
dressings include Duoderm Extra Thin™, Tielle Lite™, Opsite™, and
Tegaderm™. One study compared the use of a polyurethane film dressing with a dry gauze dressing and immediate exposure of the wound in 160 patients undergoing inguinal hernia repair or high saphenous vein ligation. After five days, the infection rate was five times higher in the wounds covered by a polyurethane film dressing than in those that had been exposed, but patient comfort and scar quality were similar. The authors pointed out that if 'clean' post-operative wounds can be exposed in this way without impairing healing, they can be assessed at any time and savings can be made in dressing materials. Other studies have also suggested that surgical wounds can be exposed after 24 hours without complications. back
Summary: In
the seventh article in this series, the author examines the use of deodorising dressings
in wound management. Most of the dressings contain activated charcoal which adsorbs the
small gas molecules responsible for the odour. The following products can
all be used in the management of malodorous exuding wounds that may be heavily colonised
or infected with micro-organisms: Actisorb Silver 220™, CarboFlex™,
Carbonet™, Clinisorb™, Denidor™ (rarely used nowadays), Lyofoam C™,
Anabact™ and Metrotop™. In Actisorb Silver 220™
(previously Actisorb Plus™), a pure activated charcoal cloth is impregnated with
silver which prevents bacterial growth within the wound and on the dressing.
CarboFlex™ and Carbonet™ are low or non-adhesive multi-layer dressings
containing activated charcoal cloths. ClinisorbTM is an activated charcoal cloth between
two layers of viscose rayon coated with polyamide. Lyofoam C™ contains LyofoamTM
polyurethane dressing as well as nonwoven fabric bonded to charcoal granules.
Anabact™ and MetrotopTM are prescription-only topical agents containing metronidazole
that kill anaerobic bacteria in the wound. The author goes on to discuss how the wound should be prepared, how the dressings should be applied and how they should be removed, stressing particularly that the entire wound surface should be covered when using an activated charcoal dressing. There is research evidence to support the efficacy and benefits of some of these dressings. back Website: www.jcn.co.uk Pudner R. Foam,
hydrocellular and hydropolymer dressings in wound management. Journal of Community Nursing
2001; 15(11): 26-34. The foam and hydrocellular dressings are
available either as flat sheets with or without an adhesive border or as cavity wound
dressings. They include: Lyofoam™, Allevyn™, Cavi-Care™, Biatain™,
Cutinova Foam™, and Spyrosorb™. In hydrocellular dressing Allevyn™,
there is a non-adherent polyurethane 3D wound contact layer, a middle hydrophilic
hydrocellular absorbent layer and an outer polyurethane film layer. The dressing can
absorb 10 times its own weight in exudate. The article goes on to describe the other
dressings in this range. Pudner R. Vapour-permeable film dressings in wound management.. Journal of Community Nursing 2001; 15(12): 20-25 In the ninth article in this series (see
above for others), the author examines the use of vapour-permeable film dressings in wound
management. They can be used as primary dressings, or as secondary dressings to regulate
water vapour loss, or to protect skin from damage caused by friction or excessive fluid. Godsell G. Wound care following dermatological surgery. Practice Nursing 2001; 12: 15-22 Summary: The type of dressing applied after dermatological surgery and the correct post-operative management of the wound is one of the essential ingredients for successful surgery. This article looks at the factors that affect14:15 06/02/01 wound healing, potential complications, and the different types of wound closure. The author then discusses the characteristics of the range of wound dressings available and points out that as most dermatological surgery is planned, there is usually an opportunity for a full pre-operative assessment. The patient needs to be given good written instructions and contact numbers in case of problems. Because patient compliance is so important, dressings should be easy to maintain, cosmetically acceptable and comfortable. back Website: www.practicenursing.com
Gray DG and Cooper PJ. Accountable wound management. Practice Nursing 2001; 12(3): 94-101 Summary: This article looks at the use of the most common wound dressings in the UK in the context of professional accountability. Practice nurses are professionally accountable for the treatments they prescribe and must therefore have a working knowledge of the commonly used wound care products. This, together with justifiable assessment plans and clear treatment goals, provides the key to safe clinical treatment. In most cases, several products are suitable for the circumstances. The author outlines three case studies and lists the indications, contraindications, and method of applications for the various types of dressing available in the UK. backWatson S. The pathophysiology of different types of leg ulcers; Harker J. The effect of bacteria on leg ulcer healing; and Bentley J. Preventing unnecessary suffering: an audit of a leg ulcer clinic. Br J Community Nursing 2001; 6(3):118-124, 126-134, and 136-144 Summaries: In the first of these three articles about leg ulcers, Steve Watson discusses the main conditions that can lead to leg ulcer formation. Understanding the causes of leg ulcers is important in correct diagnosis and treatment. Age of the patient is often a factor in their development as the majority are caused by degenerative changes to the circulatory system. The author discusses the pathology, signs and symptoms, history and diagnosis of arterial, venous, mixed, diabetic, and neoplastic leg ulcers, and their treatment options, before concluding that restoring normal haemodynamics will heal most ulcers. The second article looks at the conflicting evidence for the role of bacteria in delaying leg ulcer healing, stressing the limitations in the available evidence, before concluding that larger studies with more standardized methodologies are necessary to resolve this issue. What is clear is that leg ulcers can heal in the presence of bacteria and that their presence does not equate to infection. In the meantime, research on leg ulcers and bacteria should be interpreted with caution because of the methodological problems discussed here. In the third article, Jenny Bentley describes how the implementation of evidence-based practice in a leg ulcer clinic within existing resources reduced the percentage of recurrence. The author describes how a clinic for people with healed ulcers was set up alongside an active ulcer clinic and as part of the same service, to provide better follow-up and monitoring of healed patients. back
Miller M. Wound infection unravelled. Journal Community Nursing 2001; 15(3):31-36. Summary: Uncertainty persists over the point at which a chronic wound becomes infected: even the presence of large numbers of pathogenic bacteria does not mean the wound is infected. Some studies suggest that chronic wounds contain pathogenic bacteria that do not appear to affect healing. It seems that although invading bacteria need to be present in sufficient numbers and pathogenicity, the success of the bacterial invasion will depend on the individual host’s defence mechanism, although there is still controversy around this issue. If this is so, swabs are unlikely to provide a differential diagnosis of infection. Diagnosis should instead be based upon clinical signs. The author discusses these and the different treatment methods, including antibiotics, antiseptics and maggots. backWebsite: www.jcn.co.uk Kingsley A. A proactive approach to wound infection; Morrell C et al. The management of venous leg ulcers: a project to improve care. Nursing Standard 2001; 15(30); 50-58; 68-73. Summaries: In the first of these articles in a supplement on tissue viability, the author discusses the nature and causes of wound infection, the value of microbiology, and the use of an infection continuum and a treatment algorithm to promote effective care in wound infection. The infection continuum can be used as a framework for clinical practice, and goes from sterility, through contamination, colonisation, critical colonisation to infection, with the action to be taken at each stage described. The treatment algorithm sets out a framework for the treatment of infected and critically colonised wounds. The other article describes a project to develop resources to improve leg ulcer management. An audit tool and complementary resources were developed and pilot sites recruited. Audit criteria were based on clinical practice guidelines for the management of patients with venous leg ulcers. The article describes how the project was conducted and the results it generated. A comparison of two audit periods showed that more leg ulcers healed more quickly during the second period. backWebsite: www.nursing-standard.co.uk Howard A. Treating children’s wound pain in the community. Nursing Times 2001; 97(14); 57-58. Summary: The early discharge of a child from hospital with a wound that requires management at home presents some challenges to the children’s community nurse. As part of a wound care supplement, the author discusses how to ensure that dressing changes are free from pain and anxiety. Children have individual reactions to pain but even in very young children it is possible to make a reasonable estimate, using appropriate pain assessment tools and the parents’ perceptions. The child’s perception should always take precedence unless it is clear that fear of another intervention is influencing their reporting. One of the difficulties for community nurses is that timing visits in order to be able to provide appropriate pain relief before a dressing change is not always easy.. However, timing of analgesia is so important. Paracetamol or ibuprofen, for example, if administered half an hour to one hour before dressing changes are often sufficient. Parents are often confident enough to administer these as directed by the nurse, who should use a mobile phone to ensure that the child receives analgesia at the optimum time. GPs can prescribe stronger analgesia, although very severe pain should prompt the question of whether care in the community is appropriate. The wound contact material can affect the degree of pain, particularly at dressing changes, and costs should be considered in the context of the benefits offered by some. The author discusses the different materials available and their characteristics, pointing out that the most appropriate material for use in the community may be different from that which would be used in hospital. The nurse should gain the trust and co-operation of the child before the dressing is changed and also needs to spend the time necessary to gain the co-operation of the family. Older children and parents may wish to be involved in changing the dressing. Family-centred care will help reduce anxiety and pain. backYoung T. Leg ulcer assessment. Practice Nurse 2001; 6 April: 50-52 Summary: Treatment regimens for leg ulcers vary significantly depending on the cause of the ulcer. Incorrect treatment can exacerbate the damage and, in severe cases, cause loss of the limb. Accurate diagnosis is therefore imperative and after a thorough assessment a nurse can often introduce an effective treatment plan. The author discusses the comprehensive assessment necessary: it should encompass the patient’s health status, leg ulcer history, the impact of the ulcer on the individual, limb examination, a biochemical and pharmaceutical review and an assessment of the venous and arterial system. One clue can be found in the speed of ulcer presentation: arterial ulcers occur in weeks whereas venous ulcers may have been present for years. backBenbow M. Assessing wounds. Practice Nurse 2001; 23 March: 44-50 Summary: Accurate and comprehensive wound assessment is a prerequisite for uncomplicated healing and nurses need to keep up-to-date with new evidence and development. As well as assessing the wound, other considerations include the level of mobility, degree of dependence, nutritional status, presence of any concurrent illness, mental state and patient’s attitude. The author discusses the different ways in which wounds heal and the essential conditions for wound healing before looking at the assessment itself and the different classification methods used. A combination of approaches is needed to assess wounds and how they are healing. Infected wounds make up a large part of the primary care workload and the presence of infection influences the choice of treatment. back
Almond R. Starting up a leg ulcer assessment clinic. Journal of Community Nursing 2001; 15(4): 33-36. Summary: This article describes how a leg ulcer assessment clinic was set up by two nurses in January 1999. They have so far seen 25 patients, giving them 90-minute appointments to allow comprehensive assessment. The author describes the outcomes for these patients and concludes that with the necessary training nurses are more than able to run leg ulcer clinics. backWebsite: www.jcn.co.uk Edwards L. Colonisation versus infection of indolent venous leg ulcers. Journal of Community Nursing 2001; 15(6): 36-41. Summary: Silver and iodine dressings seem to have a role in alleviating the problems of bacteria, exudate and odour that are often found in indolent venous leg ulcers, although there is a need for further evidence, according to the conclusion of this article. The author discusses how infection can be distinguished from other clinical manifestations. Even with effective compression bandaging, it seems that some venous leg ulcers are slow to heal. It may be that many indolent ulcers are colonised with a variety of bacteria which could impede healing and it has been suggested that the use of antiseptics can reduce bacterial count and odours. Further research is needed on the specific efficacy of silver and iodine in venous leg ulcers, to allow clinicians to make informed decisions. back Website: www.jcn.co.uk Summary: This supplement, published in association with the Wound Care Society, contains articles on traumatic wounds, ultrasound therapy, leg ulceration in rheumatoid arthritis, developing a protocol for the care of skeletal pin sites, and the implementation of best practice in pressure ulcer prevention. back
Eagle M. Compression bandaging. Nursing Standard 2001; 15(38):47-52. Summary: The application of external graduated compression therapy is now recognized as the most important factor in treating venous leg ulcers and nurses are increasingly able to prescribe some of the products used and must be accountable for their practice. This article discusses the assessment of patients, the application of compression therapy, the science and principles of the therapy, and the classification and choice of bandages. back Website: www.nursing-standard.co.uk Baxter H and McGregor F. Understanding and managing cellulitis; Watret W and White R. Surgical wound management: the role of dressings; Davies C. Use of Doppler ultrasound in leg ulcer assessment; Nursing Standard 2001; 15(44): 50-56; 59-69; and 72-74. Summary: The first article in this supplement on tissue viability looks at the relatively common emergency of cellulitis and its management. Appropriate antibiotic therapy, often intravenous at first, is the mainstay of treatment and pain relief is also important. The second article looks at the management of surgical wounds and the value of wound healing products in the context of clinical governance and value for money. It concludes that recent advances in dressing manufacture should mean that patients no longer experience pain in post-operative wound care. Nurses working with surgical patients should be aware of current research and incorporate it into wound care protocols. The third article stresses the importance of Doppler ultrasound in the holistic assessment of leg ulcers. It discusses the measurement of ankle or brachial pressure indices using Doppler ultrasound and then discusses the diagnostic tests that involve Doppler ultrasound. backStephens F and Stillard K. Using PACT data to monitor usage of sterile dressing packs. Nurse Prescriber/Community Nurse 2001; 7(1):37-38. Summary: A reduction in the prescribing of sterile dressing packs by district nurses of 23% followed an examination of PACT data in East Kent. This article describes how this change was implemented. A clinical and financial governance group for nurse prescribing operates in the East Kent Community NHS Trust to identify areas where reductions in cost and improvements in quality can be made. The tagging facility on PACT was used to produce quarterly budgets for each prescribing district nurse, and showed that the average spend from June to August 1999 was £249. Discussions with nurses and the Wound Interest Group within the trust led to the suggestion that the decision on whether a procedure needs to be clean or sterile should be made before a sterile dressing pack is opened and that the majority of wounds managed in the community (mainly chronic) would only need a clean procedure. This information was disseminated in a variety of ways to try to make sure that a decision to use a sterile dressing pack was based on evidence rather than routine. The apparent success of the strategy has provided an impetus to develop further prescribing indicators. back
Boyer M. The role of
nurse prescribing in leg ulcer management. Nurse Prescriber/Community Nurse 2001; 7(5):
29-33. Watret L and Armitage M.
Barriers to healing. Journal of Community Nursing 2001; 15(11):38-45. Wound Care Society. Nursing Times 2001; 97(48):47-66. As well as an article on the care of partial thickness burns, this supplement explains how intermittent sequential compression therapy can help in the care of people with dependent oedema of the lower limbs. It also contains articles on the psychological aspects of wound healing, on how nurses can make critical appraisals of systematic reviews before they put them to practical use, and on a survey of wound care in nursing homes. back Website: www.nursingtimes.net Taylor K. The management of minor burns and scalds in children. Nursing Standard 2001; 16(11): 45-51. About 47 000 children sustained a burn or
scald in the UK in 1999, with children under 3 being most vulnerable. This article
explains the processes involved in skin healing in children and discusses how to build up
a relationship with injured children and their parents. |
