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Waikato wound care expert Julie Betts retires

Fuseworks Media
Fuseworks Media

Julie Betts achieved Nurse Practitioner status in 2003, one of the first 10 NPs in NZ and one of only three who specialise in wound care.

In early April she retires from Waikato DHB, having made a contribution to wound care clinical practice and service development that is second to none. Her involvement in the development of manuka honey wound dressings with the late Prof Peter Molan of the University of Waikato brought Waikato into the spotlight internationally.

Julie’s interest in wound care developed as a district nurse when she saw a lot of people with wounds that were not healing, which led her to do reading and research to see what could be done better.

"In those days patients in the community required daily wound dressing by district nurses and so their lives were impacted and often on hold for extended periods of time. Their quality of life was as poor as someone with chronic disease such as cancer."

For Julie, it was a situation that needed to change.

"I did some overseas research and built up a case of what we could do to get different outcomes. At this point I became a clinical nurse specialist in wound care. Then one thing led to another, and people started to see the potential of having an expert resource."

As hospital demands grew another person was employed in wound care and a Community Leg Ulcer Service (working closely with the Vascular service) was established. This service provided education and training for district nurses so they could better assess, diagnose and treat people in the community.

Julie identified a treatment gap - the use of antibiotics to treat bacterial burden in chronic wounds often led to short-term relief but then re- infection frequently occurred resulting in a see-sawing of healing. What was missing was a topical antiseptic treatment, something put directly on the wound that would provide a more sustainable solution than intermittent antibiotics.

That solution appeared when Julie heard the Prof Peter Molan speaking at a conference about the potential antiseptic properties of manuka honey in 1998.

Working with Prof Molan and others, she was involved in the first clinical studies to test manuka honey’s antibacterial effect on wound’s in the late 1990s. These and later multi-centre trials using different products provided the evidence they needed.

Although the early research and product development was very much based in New Zealand, commercial interests with larger research, product development and marketing resources progressively became involved. Manuka honey and other local antiseptic topical dressings are now a significant factor in the wound care treatment worldwide.

Julie says there was and sometimes still is a difference in the attitude people have to using manuka honey. Lay people tend to trust honey, a natural product, whereas some healthcare professionals are still sceptical - if it is something you can eat, how can it be a proper medical treatment? In spite of the evidence of honey’s efficacy, some healthcare professionals will always favour non-natural antiseptic dressings over honey-based options.

She explains that manuka honey is not a "fix all" thing, but it is a forgiving product - because you can’t really over-use it or under-use it, it is very safe. However to get the optimal results you need to know as much about how it works and how to use it as you do with any other wound care product.

Another key contribution Julie has made in wound care is the development of the Waikato Wound Care service, building it from her own initial role as clinical nurse specialist to a team of five - two nurse practitioners and three clinical nurse specialists - Julie, her nurse practitioner colleague Maria Schollum, and clinical nurse specialists Jane Widdowson, Lishele Holloway and Ruth White, as well as project manager for pressure injuries Vanessa Vanderwolf.

In fact, it is the first and only Wound Care team in New Zealand. Many other DHBs have only one wound care specialist nurse, if that.

"Service development has been my focus for the past 10 years, particularly how best to deliver services to our rural and most vulnerable populations," she says. This has included wound care clinics in rural hospitals, and dedicated expert time in residential aged care facilities.

"We’ve made a very conscious effort to provide education to those people who work in these areas." The on-line modules developed by Julie and her colleagues have become a national resource for wound care education.

"We have also developed our expertise as a team, by ensuring all of us work across both hospital and community settings. The model used elsewhere (and at Waikato DHB originally) was to have one person focused on community wound care and another on inpatients. However we have found that a team-based approach increases the range of skills each one of us develops, as well as providing overlap to share the workload and better succession planning."

Julie takes with her an incredible knowledge of wound care and the appreciation and affection of many, but she leaves the legacy of a strong and committed expert nurse team to carry on this important work in the Waikato.

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