The value of intuition in selecting debridement aids for the removal of hyperkeratosis: an introspective study.

BACKGROUND: 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. AIMS: 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. METHODS: Drawing on Benner's 'novice to expert' model, three highly experienced nurses observed each other's practice while debriding hyperkeratosis in leg ulcer patients. Standard of care was maintained throughout. FINDINGS: 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. CONCLUSIONS: A simple protocol recommending tenotomes for hyperkeratosis removal was developed. Further research is needed to evaluate its implementation in clinical practice. IMPLICATIONS FOR PRACTICE: The protocol offers practical guidance for selecting hyperkeratosis debridement methods and may support more consistent leg ulcer care.