A passion for wound care: District nurse Susan McAuley, named last month as NZNO's newest nurse clinician, spends 80 percent of her daily workload treating wounds. It's work she never tires of.

District nurse Susan McAuley is passionate about wound care. And she's delighted to have her innovative practice in district nursing at Counties Manukau District Health Board (CMDHB) recognised nationally.

NZNO's board of directors approved the recommendation of NZNO's certification committee * to certificate McAuley as a nurse clinician (district nursing, wound care specialty) at its meeting last month. The timing enabled McAuley to be recognised in conjunction with this month's International Nurses' Day celebrations.

McAuley has worked for CMDHB for the past 30 years, the last 15 of them full-time as a district nurse. She was drawn into district nursing when her children were young, as this was a way of working regular hours. She has worked as a team co-ordinator and team leader at the Papakura base, one of four bases operated by the DHB. However, when this leadership system was disestablished in the 1990s, McAuley went back on the road as a district nurse. "What I enjoy is the variety of the work and the different types of people and conditions you come across. A district nurse's work revolves a lot around wound care--around 80 percent of my daily workload--but it also covers issues like incontinence, home intravenous therapy, rheumatic fever prophylaxis, ostomy management and palliative care. There is always a new challenge to keep your interest alive and providing care to people from all walks of Life in their homes is a real privilege."

From 1997-1999, MCAuley worked as a research nurse on a leg ulcer study in the clinical trials research unit at Auckland University's School of Medicine. The study set out to examine the incidence and prevalence of leg ulcers in New Zealand and to undertake a case-control study on the causes of leg ulceration. "Working on this study opened up a whole new world for me. I learnt a great deal about research, about what makes a good study and about leg ulcers and their causes."

Following the study's completion, McAuley assisted with the development of a credentialing process for CMDHB staff involved in managing venous leg ulcers. She now supports her peers in reviewing their clinical practice to ensure consistent management of this condition across the DHB. "I realised that many nurses weren't using the correct treatment for managing leg ulcers, ie compression bandaging, consistently. I helped develop a clinical board policy and an education programme that ensure we provide the same service across all areas--outpatients, inpatients and in the community. Most large hospitals and many smaller ones now recognise compression bandaging as the gold standard and accepted practice in this area."

Last year, McAuley was recognised as an "expert" nurse on the CMDHB's senior nurse clinical career pathway. This title recognises her leadership qualities and ability to be a role model to others in her specialty.

Does honey help to heal leg ulcers?

As a result of her enthusiasm for evidence-based practice, McAuley is now a principal investigator in the "honey as adjuvant Leg ulcer therapy" (commonly known as HALT) research study trial for CMDHB. This multi-centre study began last year and involves four DHBs--Auckland, Counties Manukau, Waikato and Christchurch--in a randomised, controlled trial of a honey-impregnated dressing for venous leg ulcers. McAuley has assisted with the study design and provides support for the trial research nurse at Counties Manukau. "We are aiming to have 100 participants in each area and will compare people with leg ulcers using a honey-impregnated dressing along with compression bandaging, and those using the bandaging without the honey. The main aim is to find out whether using honey in addition to compression bandaging has any effect on venous Leg ulcer healing. The study also aims to find out about healing, infection, six-month recurrence, quality of life and costs of treatment."

McAuley takes an active role in the New Zealand Wound Care Society and is grateful for the networks she has developed as a result. She has co-ordinated the society's leg ulcer working party for the past two years. "Belonging to the society and serving on local and national committees have been invaluable for my practice. A few years ago, the society saw a need for an advanced wound care course that would be accessible and affordable for nurses. I helped instigate and co-ordinate four of these courses, which included presentations from international guest speakers. Wound courses are now being run through polytechnics, so it is gratifying to see this need now being filled elsewhere."

McAuley is proud of the new triaging and workload allocation system now being trialed in the district nursing service. This involves senior district nurses triaging new admissions and workload. By indentifying client risk against criteria, all clients are seen in a timely manner. The system has helped balance nurses' workloads.

Underpinning McAuley's nursing practice in south Auckland is a commitment to the principles of the Treaty of Waitangi--participation, protection and partnership. "Ensuring I work in a culturally safe way is very important to me," she said.

* For information on the work of NZNO's certification committee, see p29.