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Our new SCI Nurse Specialist

Meet Damian Smith, who joins us from The Duke of Cornwall Spinal Treatment Centre in Salisbury, where he was the tissue viability lead and focused on a holistic approach to skin care for spinal cord injured patients.

SIA: We’re thrilled to have you on board, Damian! Tell us a bit about your background.

DS: I’m based in the south west and have worked for 25 years in various parts of the spinal centre in Salisbury. For the last 17 or so I was based in outpatients, doing a community liaison role as the centre’s tissue viability lead. I’m first and foremost an SCI nurse specialist; the skin care focus came about out of necessity really – because the majority of SCI patients I was supporting in the community had pressure ulcers. I would coordinate all elements of the care pathway, liaising with the GP, DNs, tissue viability specialists, the plastics team if necessary – as well as working directly with the injured person on skin care and prevention.

SIA: What advice would you give an injured person regarding skin care?

DS: Firstly, that prevention is always better than treatment. Please don’t under-estimate the impact a pressure ulcer can have on your life. Check your skin twice a day: before you get up and when you go to bed. It takes seconds but this routine can have a massive impact on preventing pressure ulcers. If you see a red mark on your skin, do take it seriously. A couple of days’ bed rest now could save you weeks, months or even years of enforced bed rest in the future. By relieving pressure on the mark, you can stop a grade 1 pressure ulcer becoming more serious. Because don’t forget that what you see on the skin is often only the tip of the iceberg.

Think about your daily routine and how you can relieve pressure – there are so many more options now than when I started out in my career! Contact the SIA Support Line for more details on this – and speak to your wheelchair services team about annual pressure mapping updates for your chair, because your posture will change over time.

Part of rehab is about building up your skin’s tolerance to pressure – but this is affected by so many factors: age, posture, illness, diet. For example, any underlying infection with a raised temperature can affect the skin’s tolerance to pressure and can increase the risk of skin damage. Or if you hurt your shoulder and have to adjust your transferring technique, this could have a knock-on effect on your skin.

In terms of treatment, surgery is really a last resort, so it’s important to think about your protein intake to maintain your skin’s integrity and help it to heal. I recommend a multivitamin supplement too – as well as a blood test to rule out any deficiencies that may slow down or prevent healing.

SIA: One of your first challenges at SIA will be developing the new SIA Academy Pressure Ulcer Study Day for healthcare professionals. Based on your experience, how important is this sort of training?

DS: When I first took on the tissue viability lead at Salisbury, I was surprised by how many requests for support from tissue viability nurses I was getting. But I soon realised that, although they were experts in wound care, they didn’t necessarily have the knowledge about SCI that would help them support injured people to prevent pressure ulcers deteriorating or recurring. It’s the holistic approach that is so important: considering lifestyle factors such as diet, posture, seating, transferring, ageing, bowel and bladder management, etc. If you don’t understand the cause, you can’t remove it. I never thought I’d be teaching tissue viability nurses about pressure ulcer prevention – but I know they were always very grateful to have the support so we could work together to improve people’s quality of life. I think that’s what this study day will be about: sharing best practice so that we can reach more people and prevent more pressure ulcers.

Damian is our SCI Nurse Specialist covering the south west and can also give advice on skin management. To contact him and other members of our SCI Nurse Specialist Team ring our Support Line on 0800 980 0501 or email [email protected].

Download our factsheet for more information: https://www.spinal.co.uk/pressure_ulcers