'Articulate your practice or risk irrelevance: building bridges was the theme of last month's wound cure society conference. Many nurses discovered, perhaps for the first time, the relevance of research to improved patient outcomes.

The world has changed and the good old days are never coming back." So said keynote speaker and internationally renowned paediatric nursing specialist Philip Darbyshire in his opening address to the New Zealand Wound Care Society (NZWCS) Conference in Wellington last month. Darbyshire, who is chair of nursing in the Department of Nursing and Midwifery Research and Practice Development at Adelaide's Women's and Children's Hospital, challenged the largely nursing audience of over 200 to get started on some practice-focused clinical research. "If you do not articulate your practice, people will assume you have none," he warned. He cited aged care, where most hands-on care is now clone by unqualified staff, as an example of an area where nurses failed to articulate what they did and the reasons for it. Using a combination of humour, power point graphics and practice anecdotes, Darbyshire conceded that many clinicians were uninterested in and even hostile to research, with a negative attitude to academia. "The clinical and the academic worlds must learn to talk to each other. We must get this relationship right," he said. "The world is changing and clinicians who dismiss research as just 'academic garbage' or claim that 'using common sense' is all that is needed, may find themselves irrelevant and out of a job.

"A lot of clinicians say they haven't the time, the money or the expertise to do research. But at some point, the financiers will come and ask them what they do all day, why they do what they do in that particular way, how they could do it better and whether they know what they do makes any positive difference.

"The quality assurance or evidence-based practice bandwagon is never going to stop and clinicians will have to be able to provide a rationale for what they do if they are to survive. Doing nothing is not an option, nor is waiting for more staff, more money, more time, fewer patients or more resources. None of these things is going to happen."

What nurses needed to do was to get a project started, and to work respectfully and collaboratively with colleagues on a project that was 'do-able', had a distinct endpoint and promised benefits for all involved. Suitable research collaborators might include medical colleagues, physiotherapists or university researchers. The secret, he said, was to do one project and to do it well, then do another after that. "You just have to make a start."

Writing a grant proposal was the first step and one that forced clinicians to think, write and to be clear about their aims. Research shouldn't be a miserable activity and could even be built around a social activity. "We already find time for useless meetings, so finding a little chunk of time regularly for something useful, shouldn't be impossible. No good team leader would ever oppose nurses getting involved in clinical practice research. The research revolution will happen in your area when you start to think and practise as if it had already taken place," Darbyshire concluded.

Conference convenor and NZWCS chair Jenny Phillips said Darbyshire's address provided many delegates with a real awakening to the relevance of research to practice. "Through his direct and humorous approach, he was able to gently break down much of the resistance some clinicians feel towards this topic. Overall, the conference presentations really showed how essential the links between research, education and different practice areas are to providing evidence-based, patient-centred wound management."

'Bottom-up' approach for diabetes ulcer clinic

The following keynote speaker, Hawke's Bay nurse practitioner Pip Rutherford described the interdisciplinary diabetes ulcer clinic she helped set up at Hawke's Bay District Health Board four years ago, with the aim of reducing the amputation rate for people with diabetes (see March issue, p12-14). "We have used a 'bottom-up' approach in setting up this clinic by enlisting key players like the podiatrist, the diabetes nurse specialist, myself and the clinical photographer, and then getting buy-in from management. The clinic is held in the orthotics department, as so many foot ulcers can be prevented by wearing suitable shoes."

Ulcers were the most common complication with diabetes, Rutherford said. A 59 percent increase in diabetes was predicted in Australasia in the next ten years, with 49 percent of all lower limb amputations in Hawke's Bay resulting from diabetes. Half of all Maori people with diabetes were as yet undiagnosed.

"Interdisciplinary collaboration has been a real success factor in our clinic. We have high levels of clinical support and good data collection. The rote of the clinic is not to manage people's care but to assess their vascular, neurological, biomechanical, nutritional, social and general health needs. We then refer patients to the right sources for treatment and see them once or twice more over the next few months to review their progress. So far, over 60 percent of ulcers have healed and around 25 percent have improved.

"Our model is attainable in any setting and is not limited to large organisations. The idea is to get everyone involved and to build bridges with a range of health professionals."

Winning poster presentation

Poster presentations were a major feature of the conference and "were a higher standard than many I have seen at international conferences", said Phillips. Judging the 13 posters were keynote speakers Darbyshire, associate professor of domiciliary nursing at the Silver Chain Nursing Association and Curtin University of Technology in Western Australia, Keryln Carville, and Wellington Cancer Centre clinical nurse specialist Wayne Naylor. The winner was a poster on a pilot study into vacuum assisted closure as an adjunct to compression bandaging for healing of venous stasis ulcers, presented by David Keiser of the University of Otago's Christchurch School of Medicine, Catherine Hammond from Christchurch's Nurse Maude Association, and Justin Roake and David Lewis from the Christchurch School of Medicine's Department of Surgery.

Delegates appreciated the exhibition stands by 15 different health care supply companies. Much of the important networking, an essential part of the two days, took place around these stands.

Philips was encouraged to see a proposal to establish two more local NZWCS areas. "This development can only help to build ongoing education and support networks for health professionals involved in wound care," she said. There are currently seven NZWCS branches throughout New Zealand.