Skin and Wound Care: Challenges and Opportunities

This special joint issue of Advances in Skin & Wound Care and Nursing Management was designed as a practical resource for both healthcare leaders and clinicians. Using an evidence-based approach, the authors discuss complex topics of great concern to the global healthcare community.

In “Building a Business Case for Hiring Wound, Ostomy, and Continence Nurses” and “Who Should Assess and Stage Pressure Injuries in Hospitalized Patients?” the authors address the cost of wound care, prudent use of resources, and a business case for investment in wound care nurse specialists’ expertise. They raise important questions about long-debated and controversial topics, including who should stage pressure injuries and whether staging is even necessary.

Other “how-to” articles discuss starting and growing essential programs. “A Patient Navigation Model to Improve Complex Wound Care Outcomes” demonstrates that minimal changes in home care improved or healed previously unhealable wounds through community-based, interprofessional teamwork; continuity; and patient-centered care coordination. In “Capturing Essentials in Wound Photography Past, Present, and Future: A Proposed Algorithm for Standardization,” Chiu and colleagues present the technologic, scientific, artistic, and legal concerns of using photography in wound care. “Seven Strategies for Optimizing End-of-Life Skin and Wound Care” is an important read for all who care for patients and loved ones at end of life. It provides guidelines on individualizing goals of care and staff education. “Creating a Comprehensive Hospital-Based Skin and Wound Care Program to Improve Outcomes and Decrease Pressure Injuries” details my journey in designing, implementing, and leading an interprofessional program resulting in significant improvements in care and fewer pressure injuries.

This issue highlights the imperative for interprofessional clinical and administrative collaboration to provide cost-effective care and optimize outcomes. Resources are key: time, money, and people. Evidence-based strategic planning requires flexibility and inclusion, involving all stakeholders (including frontline staff) in decision-making and resource allocation.

Experts, providers, and leaders must create an environment that not only establishes policies and standards but also gives those in direct care the evidence-based tools to effectively do their jobs. In a 2020 study on shared governance, Olender et al¹ found that the most important factor to improve caring and outcomes was staff empowerment. In wound care, staff empowerment comprises a formal structure to give interprofessional staff a voice in shared decision-making, including selection and use of evidence-based products and equipment; nurse, physician, and allied health wound specialists to consult, assess, classify, and guide care; the needed products, supplies, and equipment available across the continuum of care; and patient-centered, practical home care models.

Healthcare systems and policymakers must break the bureaucratic paralysis and culture of blame that often create the biggest barriers to change and improvements. Today, many healthcare systems are large, billion-dollar, multifacility enterprises. Decisions must be informed by and made in concert with those on the frontlines of care. As clinicians and administrative leaders, we need to commit to using research and evidence, empowering staff, fostering interprofessional collaboration, evaluating the outcomes, and sharing the findings.

This joint issue is a first for both journals. Special thanks to the publishers and editors for their vision in creating this collaborative issue; to the authors for their knowledge translation; and to the readers, both clinical and administrative, whose partnership can empower staff, streamline systems, and create cost-effective, quality skin and wound care.

As the Guest Editor for this special issue, I built on my unique experiences as a seasoned chief nurse executive, hospital director, clinical nurse specialist, researcher, professor, graduate of the University of Toronto’s International Interprofessional Wound Care Course, and leader on nursing association and editorial boards, to bring together interprofessional topics, authors, and manuscripts. I hope readers find this special joint issue interesting and valuable in their practice and policymaking.

Kathleen Leask Capitulo, PhD, RN, FAAN, FNYAM, IIWCC, FACCE, C-CNS