Understanding the development of advanced wound care in the UK: Interdisciplinary perspectives on care, cure and innovation

Abstract

Contemporary wound care in the UK has developed into two distinct complex wound care management spheres. The acute wound characterised by the contemporary, aggressive management of major trauma, and chronic wound care where there is widespread use of the term 'advanced' although, arguably its methods remain largely traditional [1]. Chronic wound care in the UK has now few connections with the more specialised systems that have developed for less prevalent burns and also for dermatological conditions [2,3]. Most management of people with complex wounds in the UK occurs in the community rather than in hospital with referral to a disparate range of health professionals including tissue viability nurses, vascular surgeons, podiatrists, physiotherapists, dermatologists, and occupational therapists. The bulk of the work is subsumed in community nursing.The historical literature on wound care has tended to concentrate on hospital-based, acute clinical activity, even though wound care decision-making, prevention and treatment are often the preserve of nursing and of patients themselves in the domestic rather than, or in addition to, the clinical sphere. While there has been much research examining the historical context of acute surgical wounds and injuries sustained on the battlefield [4], or 'wounding' as a predominantly socio-cultural process before the modern period [5], the case of chronic wounds has yet to be investigated.In 1962 George Winter published his observation that wounds in young pigs healed more quickly if covered rather than being left open to the air [6]. This has been widely seen as the starting point for 'advanced wound care' because it established the idea that a wound dressing could influence outcomes. It was followed by the introduction of occlusive and semi-occlusive dressings and various branded products such as Opsite from the 1980s. Wound care is now a multi-billion pound industry, yet there is a lack of recognition that products themselves are only a part of the story. As in other areas of healthcare, such as minimally-invasive surgery [7] and joint replacement [8], the development of innovation in this field can be seen as a multifaceted, uneven and contested process, not the simple invention and introduction of 'advanced' products and services.Drawing on historical, sociological and health sciences research and recordings of a series of Arts and Humanities Research Council (AHRC) funded cross disciplinary workshops connecting academics from a wide range of disciplines with service users, professionals and carers [9], this paper explores advanced wound care in the UK as a specific exemplar with wider resonance for understanding the particular climates in which clinical judgement and innovation adoption take place. It argues that with the historical shift from dry to moist wound healing came a narrow product focus in wound care which is intimately connected with the history of the professional development of AbstractGeorge Winter's 1962 paper in Nature reported his observation that wounds in ...

Constructing a problem and marketing solutions: A critical content analysis of the nature and function of industry‐authored oral health educational materials

“…These findings are consistent with what Madden (2012) documented within contemporary wound care, which is dominated by product-focused innovation and education despite historical evidence demonstrating that the organisation of care is at least as important to patient outcomes (Madden & Stark, 2019). Rather, industry-authored education finds synergy with a biomedical model that neglects the social and organisational determinants of poor health outcomes (Madden & Stark, 2019). Similarly, population oral health is heavily determined by socioeconomic and commercial influences, yet, health systems and research are oriented towards high-technology, treatment-focused approaches (Peres et al, 2019).…”

“…For example, when hospitals seek to purchase equipment, devices or medical products, the provision of educational support is often perceived as a “value add” and point of competition among companies (Miller et al, 2019). Industry representatives routinely provide product‐ and practice‐related education accompanying the introduction of new drugs, products and equipment into hospitals as well as ongoing product education and support in the form of “lunch n’ learns,” targeted in‐services and sponsorship of continuing education (Grundy, 2018; Jutel & Menkes, 2009; Madden & Stark, 2019). Industry sustains its presence in clinical settings through the provision of educational materials including research syntheses, product information sheets, brochures, posters and teaching materials, which nurses rely on to support clinical and purchasing decisions and for their own practice supports (Grundy, 2016, 2018; Jutel & Menkes, 2009).…”

“…Industry sustains its presence in clinical settings through the provision of educational materials including research syntheses, product information sheets, brochures, posters and teaching materials, which nurses rely on to support clinical and purchasing decisions and for their own practice supports (Grundy, 2016, 2018; Jutel & Menkes, 2009). Outside of hospital settings, nurses rely on industry as a source of continuing education at conferences and sponsored events, such as drug dinners (Grundy, 2018; Grundy et al, 2013, 2016; Madden, 2012; Madden & Stark, 2019).…”

“…In the field of wound care, advanced practice nurses work closely with industry representatives, developing relationships through sponsored conferences and continuing education (Madden, 2012). Industry, in this sector, is the principal source of information on product efficacy and novelty; the result is a “marketing feedback loop” where clinicians, persuaded by perceived expertise located within industry, consequently, adopt products into practice (Madden, 2012; Madden & Stark, 2019).…”

Wounds Research Network (WReN) - a community of practice for improving wound care-related trials

“…The relationships between these different groups have at times been fraught with tension due to differing perspectives and commercial interests, specifically with regard to the use of evidence to inform practice, which affects the quality of wound care that patients receive. 8,10,16 From an intellectual perspective, each group of people interested in improving the quality of wound trials can be considered a community of practice. [17][18][19][20] This conceptualisation is appropriate because people who belong to the research community decide what may be considered a good trial.…”