Wound care education: how to ignite passion in the workforce

Georgina Rostron, Jane Valle, Emma Morris, Lucy Johnson

Georgina Rostron, tissue viability service nurse, Wrightington, Wigan and Leigh Teaching Hospitals NHS Foundation Trust; Jane Valle, matron tissue viability acute services, Manchester University NHS Foundation Trust; Emma Morris, infection prevention and control/tissue viability specialist, Manchester University NHS Foundation Trust; Lucy Johnson, tissue viability team lead, Stockport NHS Trust

This project, developed through the Leadership Education and Progress Scheme (LEAP, Advancis Medical), explored how to ignite passion for wound care education across generalist and specialist healthcare workforces. Six clinicians from podiatry and tissue viability across five NHS trusts designed and disseminated two tailored questionnaires, receiving 178 responses. Results showed that 72% of generalists received less than four hours of wound care education annually, resulting in a lack of confidence in practice. Specialists unanimously agreed on the need for foundational wound care training. They reported being under-resourced in specialist services and constrained by high staff turnover in generalist teams. Both groups preferred face-to-face training. Despite expressing a desire for further education, few clinicians used online tools to supplement knowledge. Only half of generalists expressed concern about the implications of their clinical decisions. Findings highlight a gap between education received and required competence. To foster passion and improve care, future strategies should address cultural, organisational, and behavioural barriers, while embracing innovative, competency-based learning models.

The Leadership Education and Progress Scheme (LEAP, developed by the clinical education department at Advancis Medical) involved six specialist clinicians in podiatry and tissue viability from five National Health Service trusts across the Northwest of England. The one-year scheme comprised soft skill modules, including leadership and management.

‘Managing wounds costs an estimated £5.3 billion a year in the UK. Poor wound care knowledge and a lack of access to specialist practitioners contribute to this expense.’
(Renwick, 2020)

Improvement in wound care was the key focus, as ‘the fundamentals of wound care are essential for promoting healing, preventing infection and improving patient outcomes’ (Benbow, 2017). The group talked about their difficulties regarding the challenges and variations in practice which they experience.

The group of six specialist clinicians in podiatry and tissue viability together decided upon a project relevant to their clinical areas, aiming to drive quality improvement. The group initially intended to devise an educational programme. Through further discussion they realised that they needed to explore the wider educational challenges influenced by behavioural, social and organisational issues. It was important to provide the workforce with a platform for their voices to be heard, in line with the NHS ‘People Plan 2020/2021’ (NHS England, 2020). The project focused on capturing opinions from generalist and specialist staff to support future delivery of education and thus support patient care.

To ensure that someone with a wound receives the care they
need, it is necessary for all health and care practitioners
to have wound care-related knowledge and skill.
(National Wound Care Strategy
Programme [NWCSP], 2023)

The difficulties voiced by the specialist staff in providing education included:

• Constraints in delivering training
• Organisational practicalities, such as suitable room availability
• Time taken to plan educational events, for example administration to book rooms
• Availability for staff to attend.

METHOD

Two questionnaires were devised by the six specialist clinicians to enable the group to gather underlying data from a plethora of workforces to determine if the assumptions around education were accurate.

The group collected information including staff location, grade, experience, incentives to attend education currently provided by their trust, learning approach, need for training, inclusion of competencies in training and educational platforms utilised. Care was taken to ensure neutral and non-leading questions to reduce the risk of unintentional bias (Erculj and Šulc, 2025). Different question types were used to gather both quantitative and qualitative data (Jones et al, 2013). When the questionnaire was sent out, a response was requested within four weeks via a user-friendly platform (Microsoft Forms). The team ensured that it would not be too time-consuming to complete, thus reducing the risk of compromising or increasing staff workload.

One questionnaire was designed for registered staff who were considered generalist, as wound care is one aspect of their role. This included acute, nursing home and community staff. The other questionnaire was completed by specialist podiatry and tissue viability staff. The specialist role involves having enhanced skills, with increased level of autonomy and the ability to manage complex wounds (Royal College of Nursing [RCN], 2014).

The questionnaires were designed to investigate both the barriers and opportunities related to wound care education and training. The goal was to gain a comprehensive understanding of clinicians’ experiences and gather their perspectives on how wound care education is currently delivered.

The questionnaire was piloted among a small cohort of generalist and specialist staff; it was revised taking account of the feedback received, to reduce ambiguity and increase the accuracy of responses.

To maximise the response, a standardised initial and follow-up email was developed by the group. This included an assurance that the responses would be anonymised to encourage candour. The responses were submitted digitally, collated and analysed by the six specialist clinicians.

Table 1: ‘Why do you refer to a wound care specialist?’

Theme	Feedback examples
Complex, non-healing  or deteriorating wounds	‘Complex wound. Deteriorating wound. Advice on dressing or managing wound.’ ‘If there is a wound that we are struggling to heal, or if there is a significant change in the wound that might need specialised treatments.’ ‘Wound appears infected, wound is large, needs specialist care…’
Dressing not effective or needs reassessment	‘For appropriate intervention and right dressing to be prescribed in timely manner.’ ‘To ensure using the right dressings.’ ‘If healing is delayed in current wound. If further support with treatment is needed.’
Outside clinician’s experience/need for second opinion	‘To get a second opinion to give a patient the best care possible.’ ‘I refer when wounds require specialist attention and dressings that I am not familiar with.’ 'If I feel the wounds are too complex for me to deal with.'
For specialist input (TVN, vascular, plastics, etc)	‘TVN, if complex wound, dressing regimes not working…’ ‘Referring to vascular for arterial damage… podiatry for diabetic foot wounds.’ ‘Plastics, would not necessarily refer unless patient has already been under them and needed further intervention.'
Following trust policies/guidelines	‘As per policy guideline or to seek assistance where I do not feel confident to manage a particular difficult wound.’ ‘After a period of time of using a treatment without improvement or if deterioration has occurred.’ ‘For specialist advice on complex wound care.’
To improve patient outcome/quality of care	'To gain further advice and knowledge for a specific patient in order to provide the best care possible.' 'To ensure patients get good, up-to-date treatment.' 'So that the best treatment for the individual patient can be agreed and the best possible wound healing and practice achieved.'
For specific wound types (e.g. foot, arterial)	'Podiatry if wound is below ankle.' 'Diabetic foot ulcer, arterial disease, pressure ulcers.' 'Refer to vascular for input regarding arterial damage that may be occurring due to pressure ulcer.'
When previous treatments have failed	‘If wounds are not healing with district nursing input and have tried numerous dressings for more specialised advice.’ ‘Used treatment from formulary but wound is not improving.’

RESULTS

178 questionnaires were completed and submitted for analysis.

Findings from the generalist questionnaire (n=150), completed by staff working in acute, nursing home and community settings indicated that:

• 75% of people are working in a culture that is perceived to value non-mandatory training
• 72% of generalists had received less than four hours wound care education in the last 12 months
• 32% of people had cancelled training or not attended training after booking on
• 50% use search engines to help practice
• 50% are not concerned about the implications of their clinical decisions related to wound care
• 56% did not feel confident to step down from a silver dressing
• 67% thought you should attend bandage training every one to two years to maintain skills. 28% attended training one to two years. This question related to staff who undertake compression bandaging as part of their role.

Table 2: ‘Do you feel confident to make the decision to discontinue the use of a silver dressing?’ (narrative responses)

Theme	Description	Representative quotes
Standard duration of use (typically two weeks)	Most respondents stated that silver dressings should only be used for a short period (maximum of two weeks). After this, a review or discontinuation is required	‘Silver should be discontinued after two weeks and then a re-evaluation of the wound.’ ‘Silver dressings should be reviewed after two weeks and if no improvement seen then they should be discontinued.’ ‘Silver is to be used for two weeks and then a review of this.'
Discontinue when infection resolves or no longer indicated	Silver dressings should be stopped when no signs of infection remain, or the wound is healing (e.g. epithelialising, no slough, malodour gone). Also mentioned: ineffectiveness or skin reactions	‘If the wound has healed and no signs of infection.’ ‘When no longer showing signs of clinical infection. After two weeks’ application.’ ‘Wound improvement, no clinical sign of infection, or dressing not suitable for wound type.’
Require specialist/TVN advice or prescriber input	Many do not feel responsible for discontinuing silver dressings and rely on TVNs or prescribers. Some noted clear protocols or instructions from specialists	‘Would only use or discontinue this under advice from TVN.’ ‘Special instructions always received from specialist nurses.’ ‘I would follow tissue viability plan of care.’ ‘Prescriber always gives date of review'
Lack of knowledge, experience or confidence	A large number reported limited experience, no training, or not being involved in wound care, including office-based roles, students or newly qualified staff	‘Do not have enough knowledge around silver dressings.’ ‘Never been taught this.’ ‘I need training.’
Cautions: overuse, allergies, resistance, magnetic resonance imaging (MRI) interference	Some staff raised safety concerns such as delayed healing, resistance, allergic reactions, and MRI contraindications due to silver	'Overuse can result in resistance.’ ‘If person has allergy or going for MRI.’ ‘Can potentially delay wound healing if overused.’ ‘You have to be aware of the risks/benefits of using silver dressings.’
Silver dressing function: antimicrobial for infected wounds	Several responses identified the intended purpose of silver dressings – as antimicrobial treatment for infected wounds, sometimes alongside antibiotics	‘Silver dressing benefits infected wounds for few days or weeks.’ ‘It can reduce microorganisms in infected wounds... helps to reduce pain, exudate and malodour.’ ‘To be used topically for antimicrobial properties to treat a local infection.’
Training needs and role boundaries	Many said that they need formal training or it is outside their role	‘I have never had training on silver dressings.’ ‘Currently a matron – I don’t do much wound care.’ ‘Not had training on this.’
Documentation and review practices	Some mentioned documenting the start date and setting clear review points for silver dressing use, ensuring continuity across visits	‘We do not always have continuity... so I write on the care plan the date that the silver was started and a note to review each visit for two weeks.’ ‘For doctors to review effectiveness.’

The group asked the question ‘Why do you refer to a wound care specialist? (e.g podiatry, TVN, plastics, vascular, etc)’. Table 1 synthesises the themes identified in the responses. It should be noted that some of the responses received were not applicable or left blank.

There was a further question asked: ‘Do you feel confident to make the decision to  discontinue the use of a silver dressing?’ Fifty-six percent of respondents did not feel confident. Table 2 synthesises the themes identified from the narrative responses provided alongside the yes/no answers. It should be noted that some of the responses received were either not applicable or left blank.

There was a further question asked: ‘Do you feel confident to make the decision to discontinue the use of a silver dressing?’ Fifty-six percent of respondents did not feel confident. Table 2 synthesises the themes identified from the narrative responses provided alongside the yes/no answers. It should be noted that some of the responses received were either not applicable or left blank.

The responses from the 28 questionnaires completed by specialists (tissue viability and podiatry staff working in acute and/or community settings) indicated that:

• 100% believed that there is a need for fundamental wound care training for generalist staff
• 86% enjoy delivering training
• 100% of people preferred to delivery training face to face
• 86% feel under-resourced to deliver training
• 39% of specialists said that they do not use search engines to help practice
• 89% of specialists believe the turnover of staff they give advice to is medium to high
• 4% of specialist staff are confident that non-specialist staff would appropriately discontinue an antimicrobial dressing.

The themes identified in response to the question ‘Why do people refer to your service?’ are shown in Table 3.

DISCUSSION

The authors found that there was a lack of robust evidence around wound care training and its delivery to generalist staff. A literature review concluded that:

Shortfalls were found in the
evidence base underpinning
wound care and in links between
evidence and practice, prevalence
of ritualistic practice and in
structured education at pre- and
post-registration levels

(Welsh, 2018).

Although a significant number of responses were received, there was some disappointment that the number of returns was not higher. They were distributed across the five trusts and the responses did not reflect the wide distribution. A study by Saleh and Bista (2017) on online surveys in educational research found that a number of factors influenced response rates, including communication methods (e.g. personalised emails) and reminders and incentives (e.g. older participants responded more when offered a reward). In the authors’ clinical opinion, these factors are likely to have influenced the number of responses received in this case.

The generalists’ responses received showed an appetite for wound care education but the results have shown that the amount of education received annually is minimal, despite organisational cultures valuing mandatory training. All the trusts involved have extensive programmes of wound care training and education available. The reported level of those who did not attend or short notice cancellations was 30% – broadly correlated with the training data recorded by the trusts.

There was a consensus among the group that face-to-face training is the preferred and most effective method of delivering education. Encouragingly, 100% of respondents expressed a preference for in-person sessions over digital formats. However, despite this preference, significant barriers remain. Specialists reported feeling under-resourced and highlighted challenges such as high staff turnover, which make it difficult to consistently deliver in-person training. As a result, although face-to-face education is ideal, services are often compelled to rely on the current hybrid model of digital and in-person delivery.

Surprisingly, only half of the generalist respondents were concerned about implications of their clinical decisions around wound care. This potentially relates to the reason why the majority of generalist clinicians do not feel confident to step down from antimicrobials. Interestingly, 96% of specialists agreed that there is a lack of confidence in stepping down an antimicrobial.

‘Both generalists and
specialists strongly favoured
face-to-face learning,
recognising its value in
fostering engagement,
confidence, and practical
skill development.’

Participants reported a need for additional training. Therefore, it was surprising that the number of participants using search engines was so low. The accuracy of this figure is uncertain, as despite assuring staff of anonymity, they may perceive that reporting search engine use is an admission of knowledge deficit. The use of search engines was expected to be higher and further exploration is needed to understand why this practice is not widely accepted in both generalist and specialist settings.

Table 3: ‘Why do people refer to your service?’

Theme	Feedback examples
Complex/ non-healing wounds	‘Specialist advice due to non-healing wounds.’ ‘Advice with hard-to-heal wounds, or other concerns.’ ‘For complex wounds or hard-to-heal wounds.’ ‘Chronic wounds, pressure ulcers, leg ulcers.’ ‘When they have tried multiple dressings, and the wound is still deteriorating.’
Pressure ulcers and high-risk wounds	‘Mandatory to refer to TVN for unstageable, deep tissue injury (DTI), category 3 and 4 pressure ulcers.’ ‘Pressure ulcers, deteriorating moisture-associated skin damage (MASD), fungating wound management.’ ‘Longstanding wounds, surgical wound dehiscence.’ ‘If the wound is more complex and would benefit from specialist input.'
Lack of confidence or knowledge	‘Staff do not have adequate knowledge regarding wound dressing material selection.’ ‘Staff find it difficult to categorise pressure ulcers.’ ‘Don’t feel confident to make decisions about care plans.’ ‘Refer because they don’t know how to do a dressing or choose dressings.’
Specialist interventions required	‘Topical negative pressure wound therapy, maggot therapy, debridement, osteomyelitis.’ ‘Specialist assessments which cannot easily be undertaken by the district nursing team.’ ‘Need for vascular assessment, offloading devices.’
Lack of pathway adherence/system overuse	‘Referral needs to be improved.’ ‘All wounds referred – some could be managed at ward level.’ ‘Staff don’t follow pathways already in place.’ ‘People refer for everything as there is not enough knowledge or incentive on wards.’
Referral as default/ cultural habit	‘Often referred to as a “tick box exercise”.’ ‘Because the doctor said so.’ ‘Because the dressing needs changing.’ ‘Staff expect TVN to perform assessments/dressings rather than doing it themselves.’
Support with care planning/reassurance	‘For support and advice on care planning.’ ‘When they want the “back up” of a TVN.’ ‘When a consultant needs support or the wound hasn’t healed as expected.’
Dressing selection/ product advice	‘For dressing advice and wound assessments.’ ‘Dressing selection when products on formulary are not working.’
Unknown aetiology/ diagnostic uncertainty	‘For wounds with unknown aetiology.’ ‘Significant deterioration with unclear cause.’ ‘Wound assessment advice when diagnosis is unclear.’

CONCLUSION

This project highlighted a significant gap between the education generalist clinicians receive in wound care and the level of competence required to deliver safe and effective treatment. While there is a clear desire for increased knowledge and support, current models of training and education delivery are not meeting workforce needs. Both generalists and specialists strongly favoured face-to-face learning, recognising its value in fostering engagement, confidence, and practical skill development. Organisational barriers, such as workforce turnover, time constraints, and under-resourced specialist services often make digital or hybrid training the default.

The findings reinforce the need to rethink how wound care education is delivered. Simply offering training is not enough. A shift towards competency-based, flexible and innovative learning strategies is essential. At the same time, organisational and cultural barriers must be addressed to create an environment where staff feel confident, supported, and motivated to build their wound care skills. Ultimately, empowering clinicians through accessible, effective education will lead to improved outcomes for patients and help reduce the significant economic burden of wound care on the NHS.

Further work in this area should explore how to embed wound care training into core competencies at all levels, particularly at pre-registration and induction stages. In addition, future work should focus on the impact of different educational models, such as adapting traditional teaching styles to include competency-based approaches, theories, and concepts with increased visibility and mentoring from specialist clinicians, as well as clinical confidence and patient outcomes.

In the authors’ clinical opinion, co-designing future strategies with staff from both generalist and specialist backgrounds is key to developing sustainable, scalable approaches that foster a culture of curiosity, accountability, and best practice in wound care. 

There is a commitment to both delivering and receiving wound care education. There are organisations that value nonmandatory training, specialists who want to deliver wound care education, and workforces which are eager to increase confidence and maintain skills.

The authors believe that by developing strategies that enable clinicians to access innovative, high quality education, and by destigmatising the use of technology and embracing digital evolution – while voicing opinions of staff and sharing a vision for wound care across organisations – an improvement in patient outcomes and a future workforce who are passionate about wound care can be achieved.