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Chronic wounds

Chronic wounds programme - the German experience

There is a need for education in the treatment of chronic wounds for medical personnel - nurses and doctors – according to a recent paper published in the journal Military Medical Research. The article reviews a training programme that was introduced for nurses in 2005 by the German wound healing society ICW (Initiative Chronische Wunden) and the experience of how when the programme was adopted in three Chinese in led to further developments and improvements.

There is a need for education in the treatment of chronic wounds for medical personnel - nurses and doctors – according to a recent paper published in the journal Military Medical Research. The article reviews a training programme that was introduced for nurses in 2005 by the German wound healing society ICW (Initiative Chronische Wunden) and the experience of how when the programme was adopted in three Chinese in led to further developments and improvements. The courses, which have been certified by TÜV Rheinland, are regularly audited to ensure quality, have been attended by than 30,000 nurses in Germany. The courses are offered in more than 120 institutions throughout the country.

The paper, ‘Promoting the treatment of chronic wounds: experience from Initiative Chronische Wunden of Germany’, notes that in in China 15% of the population was above the age of 60 in China. In 2030, it is estimated that this percentage will have reached 30%. Moreover, as standards of living improves non-infectious chronic diseases, such as hypertension, diabetes mellitus, and hyperlipidemia, are increasing. In the course of these diseases, chronic wounds may develop, i.e., wounds lasting more than 8 weeks, and with an underlying cause.

Despite the rise in chronic wounds, the principles for the treatment of chronic wounds are not included in the curricula of doctors and nurses worldwide, which leaves health care professionals largely to their own educational development, and patients experience disparate treatment quality, depending on the individual quality of the centres to which they are admitted.

Figure 1: Chronic wounds. a Ulcer in chronic venous disease; b Hidradinitis suppurativa (acne inversa); c Peripheral arterial disease

In 2005, the first courses called ‘Wundexperte’ or ‘wound expert’, were offered and the curricula of these courses were developed by a group of experts, some of which included teachers of nursing who were ICW members. The courses included coverage of anatomy, pathophysiology and therapy of chronic wounds and a special effort was made to include the perspectives of the patient, the role of the families and other caretakers, and the importance of wound–related topics, such as nutrition and footwear.

In Germany, the courses are offered to all health care professionals who offer wound healing in any aspect of their daily practice. As well as nurses and doctors, podiatrists and other related professionals (i.e. pharmacists) have participated throughout the years. The course comprises a one-week school term and a two-day visitation in a wound healing institution. Upon completion of the visitation portion of the course, a written examination follows, and a case report must be delivered.

As the purpose of the course is to ensure a constant qualified workforce in wound healing, participants must be recertified every five years. During these years, they have to participate regularly in ICW-certified education, such as weekend courses, or in congresses where wound healing is discussed.

One course is focused on those who want to learn more about the medical background of wound healing and who wish to acquire advanced techniques, such as local debridement. The aim is to qualify participants for a leading position in a wound ambulance or wound healing unit in a hospital. The other course is more directed towards those who want to pursue a career in hospital administration. Organization of wound care in a cost-effective manner is becoming paramount, and advanced management skills are therefore needed.

The basic course, “Wundexperte”, is open to all health care professionals, including nurses, practitioners of any kind, and doctors. However, the paper states that compared to other groups, very few doctors have taken part in these courses thus far.

It is thought that there has been a certain reluctance among doctors in the past to treat chronic wounds, leaving the actual wound care in the hands of the nurses, without acknowledging that doctors play a crucial role in the therapeutic team. However, the paper does acknowledge that this is only slowly changing.

To promote further engagement of doctors, the ICW is now offering a course exclusively for this group. Pathologic and anatomic background as well as advanced techniques of diagnosis and therapies are the contents of this course. Participants must be graduates who have also finished specialization of any type. During the initial offerings of the course, interest has been raised by general practitioners, geriatricians, internists, and dermatologists, as well as general, plastic and vascular surgeons.

China

‘Wundexperte’ has been held several times, and approximately 300 Chinese nurses passed the exam to date. As the course concludes with the official ICW certification, no compromises are made concerning the contents. Additionally, the usual audits by ICW-approved auditors take place (as travel arrangements have to be made, the audits are planned, and the dates are known in advance).

However, there are already adaptations to the specific situation in China. For example, most of the course participants come from hospitals far away from the centre where the actual course takes place. They normally stay there in dormitories for two months. Two weeks are devoted to studies and six weeks are used to combine the newly adopted knowledge with practical work in a wound caring ward in their host hospital. Therefore, practical work is much more of a focus in China than it is in Germany. The ongoing dialogue between the Chinese and German partners will lead to further improvement of the quality of the courses in both countries.

“Possible adaptations to specific Chinese necessities are required and can be discussed in the friendly and productive atmosphere, which we have experienced in the last few years,” the authors conclude. “Such a discussion may lead to improvements in the courses in unforeseen aspects…Expanding our perspective to a truly worldwide cooperation is an exciting adventure and a perfect possibility to pave the way to mutual understanding.”

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