For Cheryl Frank, a wound management nurse who has practised in her area of speciality for more than 30 years of a 40-plus year career, the appeal of her practice area comes from the level of personal responsibility she gets to take on.
It is all about using documented data to evaluate practice, she says.
“I am highly interested in the resilience of the body and being able to impart a level of improved quality of life to patients with a wound,” Cheryl explains, adding that “unravelling the mystery of delayed healing in wound management” is a compelling challenge.
Cheryl’s career began in Macksville Community Health in the 1980’s, after which she worked as a CNC Wound Management within the Gold Coast Health District in 1996.
Career opportunities included collaborating with the Queensland Patient Safety Centre to write the State Pressure Injury Policy, Developing a Wound Management online learning tool with APNA and working with APNA to educate GP nurses and GPs in chronic wound management through national speaking engagements.
In 1999, she introduced the use of Ultrasonic Debridement in clinical practice to Australia to manage acute and chronic wounds, and after 25 years working in the Gold Coast’s public and private health sectors, Cheryl returned in 2019 to NSW’s Mid North Coast Local Health District as a generalist nurse.
She says a typical day in wound care usually begins with a clinical hand over, reviewing each patient via the TIME acronym (Tissue, infection/inflammation, moisture balance and edge of wound), and assessing their outcomes.
“[We] focus on planning for referral patterns for patients not meeting anticipated healing outcomes and prepare the necessary products for each patient,” Cheryl explains, outlining the treatment steps that follow.
“We clean the surrounding tissue and moisturise whilst we are soaking the open wound and try to promote a level of comfort in order to glean clinical and social information from the patient about their wound for example, pain, patient concerns, the social history, and try to engender less stress.
“We document the wound appearance, assess the symptoms evaluate and report any variance to the local GP or Wound CNC.”
The community health team debriefs at the end of each day, with Cheryl noting that like the majority of modern healthcare settings, the focus is on patient-centred care.
“We create an environment that is as comfortable as possible in order to calm the patient as best we can in a clinical environment. If we are visiting in the home we are mindful that we promote patient-centred evidence based care as best we are able,” she says.
The enjoyment Cheryl gets from such a day to day process is palpable.
“I enjoy the challenge, the team work and wound healing outcomes. I love the collection and collation of data to show we are making a difference in people’s lives and the utilisation of these data to develop quality improvement projects,” she says.
“The work of a wound clinician is generally self-reliant. We are responsible for our learning, how we implement quality improvement and how we engage with the patients to deliver patient centred care.”
Working at Macksville, which is classified as a remote area, Cheryl also takes on a variety of responsibilities as part of her work, and admits there are some challenges that the current work environment creates.
“In a remote area, we are all generalist nurses and rely on the skills of a visiting Clinical Nurse Manager for debridement once per fortnight. We are hoping that skills development opportunities and career pathways will be afforded [to] all remote community nurses.”
Nevertheless, she is also excited that she has come full circle with her work, and enjoys the gratitude of local residents.
“This community is a low-socioeconomic, high-retiree population impacted greatly by the bushfires, floods and COVID-19 restrictions but the patients are such salt of the earth folk and are so grateful for our role in their lives,” she says.
“We, like most areas of NSW have been impacted by reduced nursing numbers and consequently we have had to learn to work innovatively to overcome this throughout the COVID pandemic.”
Moving forward, Cheryl hopes to bring her skills (she previously co-led the Wound Busters model of care with some success on the Gold Coast) in chronic wound management care to the Mid North Coast Local Health District, pointing to NSW Health’s Leading Better Value Care projects as a precedent.
“[It] fills me with hope that remote areas will continue to be able to access educational and clinical support via telehealth in the early detection and management of complex wounds and that we will be able to more effectively manage chronic wounds in the community,” Cheryl says.
“I hope to see career pathways in advanced clinical nursing practice in the Remote areas.”
While one eye is undoubtedly on the future, Cheryl admits that looking back on the journey of her career, she is filled with thankfulness for the positions and roles she has had the opportunity to take on.
“I have had so many wonderful opportunities both nationally and internationally in my wound management career for which I am very grateful,” she says, adding that the direct engagement of her current work mirrors the work she undertook in her early career.
“Wound Bed preparation has been a passion since the mid 80’s and I hope I can impact innovation in the management of chronic wounds in the remote setting.
“I love being at the coalface once again; I have come full circle.”