{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,2]],"date-time":"2026-09-02T18:16:31Z","timestamp":1788372991524,"version":"build-2803163510"},"reference-count":34,"publisher":"Mark Allen Group","issue":"Sup9","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Br J Community Nurs"],"published-print":{"date-parts":[[2026,9,1]]},"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Effective leg ulcer care includes the removal of hyperkeratosis, a thick, adherent layer of dead skin. In the UK, available methods to remove hyperkeratosis include debridement pads, pre-impregnated cloths and tenotomes. However, evidence supporting their efficacy remains limited.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Aims<\/jats:title>\n                    <jats:p>This study aimed to explore how expert clinical intuition can inform a protocol to guide less-experienced nurses in selecting appropriate methods for hyperkeratosis debridement.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>Drawing on Benner's \u2018novice to expert\u2019 model, three highly experienced nurses observed each other's practice while debriding hyperkeratosis in leg ulcer patients. Standard of care was maintained throughout.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Findings<\/jats:title>\n                    <jats:p>Tenotomes were consistently the most effective, removing adherent scales efficiently. Debridement pads removed only loose debris, while pre-impregnated cloths were ineffective for stubborn scales but useful for rehydration post-tenotome use.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions:<\/jats:title>\n                    <jats:p>A simple protocol recommending tenotomes for hyperkeratosis removal was developed. Further research is needed to evaluate its implementation in clinical practice.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Implications for practice:<\/jats:title>\n                    <jats:p>The protocol offers practical guidance for selecting hyperkeratosis debridement methods and may support more consistent leg ulcer care.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.12968\/bjcn.2025.0212","type":"journal-article","created":{"date-parts":[[2026,9,2]],"date-time":"2026-09-02T17:43:53Z","timestamp":1788371033000},"source":"Crossref","is-referenced-by-count":0,"title":["The value of intuition in selecting debridement aids for the removal of hyperkeratosis: an introspective study"],"prefix":"10.12968","volume":"31","author":[{"given":"Fania","family":"Pagnamenta","sequence":"first","affiliation":[{"name":"Nurse Consultant\/Associate Professor (Tissue Viability), Newcastle upon Tyne Hospitals NHS Foundation Trust, Northumbria University, Newcastle upon Tyne, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sophie","family":"Robson","sequence":"additional","affiliation":[{"name":"Senior Sister (Regional Burn Unit), Newcastle upon Tyne Hospitals NHS Foundation Trust and Northumbria University, Newcastle upon Tyne, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Linda","family":"Mason","sequence":"additional","affiliation":[{"name":"Staff Nurse (Dermatology), Newcastle upon Tyne Hospitals NHS Foundation Trust and Northumbria University, Newcastle upon Tyne, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"5130","reference":[{"key":"e_1_3_3_1_1","doi-asserted-by":"publisher","DOI":"10.1177\/13684302221088506"},{"key":"e_1_3_3_2_1","doi-asserted-by":"publisher","DOI":"10.1177\/0270467604265061"},{"key":"e_1_3_3_3_1","doi-asserted-by":"crossref","unstructured":"Benner P Tanner C Chesla C. 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