Nurse helps lead significant change in pressure ulcer assessments across Wales

A Swansea Bay nurse is helping change the way pressure ulcers in specific patients are dealt with throughout Wales to avoid unnecessary pain and harm.

Pressure ulcers are areas of damage to the skin and tissue underneath caused by prolonged pressure or medical devices such as plaster casts, tubes and oxygen masks. They usually form on bony parts of the body, such as the heels, elbows, hips and tailbone, but can develop on any part of the body.

Cerina Howells has been reassessing the current processes around diagnosing and treating pressure damage in Swansea Bay and across Wales so that dark skin toned patients of all ethnicities are also included, and not just light-toned ones.

Cerina’s suggestions are now being discussed at an all-Wales level to make pressure ulcer care and wound care more inclusive across the nation.
In recognition, she has now been named as one of the health board’s first Florence Nightingale Foundation (FNF) Academy Fellows, to help develop her leadership and skills further via a mentorship programme.

Cerina, who works in Neath Port Talbot Hospital’s endoscopy unit, said: “I noticed some of the assessments on wards weren’t tailored to people with dark skin tones, like myself.

“In assessments, dark skin toned people like me are not represented anywhere. This is most apparent during pressure ulcer assessments. When you are assessing someone’s skin, you are told the skin will turn red and blanch (it takes on a whitish appearance as blood flow to the region is prevented) – I’ve never been red in my life, so how would anyone recognise pressure damage happening to me?

“When you go on a ward, you’ll see pressure ulcer posters which only use examples of pale skin toned patients. There is an obvious lack of diversity. If dark skin toned people aren’t being represented in the risk assessments, then the chances of identifying potential pressure damage will be missed and it cause them a lot of unnecessary pain and harm.

PICTURED: Cerina works in Neath Port Talbot Hospital’s endoscopy unit.

“Accurate representation of the increasingly diverse and multicultural population of patients within Swansea Bay is really important. As we are also recruiting a large number of overseas nurses who primarily originate from countries where people have dark skin tones, it is important that they too feel represented as well as the patients they look after. 

“Within the health board, thanks to the support of Hazel Powell, Sharron Price and Rachel Govier-Williams, there is an active push to raise awareness about this and for changes to happen.

“Diversity in pressure ulcer care is now being discussed at an all-Wales level to enable it to become more inclusive."

Cerina was diagnosed with myasthenia gravis - a rare long-term condition that causes muscle weakness – in 2014, and it was this which gave her the desire to make a difference.

She said: “Most of my extended family are in nursing, and after my diagnosis I knew I wanted to go into nursing too.

“Originally, I wanted to be a movement disorder nurse as it was linked to my condition, but I was passionate about gastroenterology - my grandfather had bowel cancer – so I trained as a nurse and qualified in before starting my Masters Degree in gastroenterology.

“I started in Swansea Bay in 2018 as a bank healthcare support worker while I was studying at university and progressed to my current role as a nurse in the endoscopy team.

“I am someone who likes to keep learning and progressing, so to be named as one of the health board’s first three Florence Nightingale Foundation Academy Fellows is a big thing for me.

“It involves a lot or mentoring and learning from leaders within the health board. I’ll meet my mentor a few times over the next 12 month, attend virtual FNF leadership sessions and shadow other leading figures.”

Cerina, who left her home country of Zimbabwe in 2000, has spent the last five years working for the health board, and been inspired by a colleague who has also influenced change within Swansea Bay.

Omobola Akinade is well-respected within the health board for the tireless work she has done to help black, Asian and minority ethnic (BAME) colleagues.

Omobola has spoken up against racism in the workplace, helped higher-level positions become more diverse and been an instrumental figure for overseas nurses who work in Swansea Bay.

PICTURED: Florence Nightingale Foundation Alumni Champion Omobola Akinade.

She has been recognised both internally and externally, having been nominated for the Compassionate and Inclusive Leader category in the National BAME Health and Care Awards. She was also included in the Excellence in Equality & Inclusion category in the health board’s recent Living Our Values Awards.

To add to that, Omobola has since been named as a Florence Nightingale Foundation Alumni Champion.

The role involves championing the work of the foundation, which focusses on improving health, clinical outcomes and patient experience by allowing nurses and midwives access to sophisticated and bespoke leadership development opportunities.

Omobola, a practice development nurse who helps train international nurses in the health board’s Baglan headquarters, said: “I’m very honoured to be named as an alumni champion. I am very passionate about the work the foundation does and the opportunity it gives nurses and midwives to develop.”