Paulo Alves: "It's only when we think about nursing in a preventive way that we can get a sense of its real impact"

What do a nurse and a diver have in common?

They have two very important things in common. Firstly, there is a very high risk factor. In diving, you can literally pay with your life. In nursing, we look after the lives of others. So this risk factor of paying with your life also exists in nursing. In both diving and nursing, we need to think ahead, plan ahead and be on the lookout for signs that could put us at risk. Especially when we look at nursing not only from a curative point of view, but also, and above all, from a preventative point of view. Only when we think of nursing in this way can we truly realise its importance and impact. The second point they have in common is that divers need to check their equipment before diving. Nursing also requires us to anticipate and check that everything is ready for the procedure ahead. We need to be able to anticipate so that we can provide the right response. Whether it's in the ocean or in a hospital with patients, you have to take care of all the risks, you have to anticipate and define a plan. When diving, I can't go into the water if I see that the tides are strong or if I haven't checked my oxygen and time. The same goes for wounds and the treatment I do: I always consider what the prognosis will be and what complications might arise.

What does it feel like to have your head in the water?

I've been diving for many years and it's amazing because every time I dive I forget everything around me. When I put my head in the water, I'm in another ecosystem. Literally. A whole new world of possibilities opens up for me to discover.  

Is it a team sport?

Absolutely. When we dive, we're always going to discover something new and it's impossible to do it without a team. In diving, you can never be alone, because the risks associated with this practice are so great.  Diving requires enormous trust in the team that goes with you. If one goes up, the other goes up. No-one is ever left behind.

Don't like being alone?

I don't like it at all. I need to be with people, with family and friends. Even in sport: I don't think I like running because it's a very solitary activity. I live to be with people, to collaborate and develop together. It's a characteristic that defines me well.

And nursing doesn't work alone either...

Nurses always work as a team. We make decisions autonomously, and others are interdisciplinary decisions, but at the end of the day it's teamwork that makes all the difference. What's more, we always involve the patient and their family in decisions, because we believe that collaboration with everyone involved is fundamental to achieving the best result. Anyone who dares to say they can do it in isolation won't be able to do it in the best way. It's just not possible.

You're the director of the Católica Porto School of Nursing and (post at FCSE). What are the main priorities of your mandate?

Our priority is to be innovative in the way we teach and research. Above all, we have to look at the needs of healthcare. They are very different from what we had before, so we have to be able to adapt the curricula of the programmes, we have to adapt the new capacities - of teaching and of our teachers - and optimise them for the new realities. It's our priority to bring innovation and technology to teaching, but also to healthcare provision. We prepare future nurses for the needs of the world.

‘The humanist and Christian matrix differentiates us a lot.’

What has been most challenging about your leadership role?

It's inevitable to bring up the question of the team and the fact that nobody can do anything alone. As a director, I have no other way of achieving objectives than by involving everyone. Management has processes that are very solitary, but what has fascinated me is the quest to mobilise people. How do you involve a team so that they all have a common focus? This is what I've been trying to do. My efforts are centred on this. It's a great challenge.

What values guide nursing education at the Universidade Católica?

The humanist and Christian matrix sets us apart. The values that guide the way we teach our students have a big impact. We focus a lot on supporting the most vulnerable. In addition, nurses are the ones who accompany people throughout their life cycle. From birth to death. We can't be afraid to accompany people in death too, this is very important. That's why we care so much about humanisation and it's a factor that really sets us apart.

You specialise in wound care. How did you come across this area?

In my first year working as a nurse, I was providing nursing care in Porto's Custóias prison. I began to have close contact with situations of physical and psychological violence within the prison and realised that injuries appeared with some frequency. I'm referring to both simple and surgical injuries. Later, when I was also working at the Hospital de S. João and the Hospital de Gaia, I realised again that the area of injuries and wounds was too dispersed and that there was a lack of knowledge. Within nursing we have several specialities, but at that time the area of chronic wounds didn't have this space and attention. There was very little scientific evidence on this subject and I became very interested. It wasn't just acute wounds caused by trauma or accidents, but also the chronic wounds that many people have, such as diabetic foot, or the wounds that many elderly people have because they are bedridden.

‘The Universidade Católica was a pioneer in valorising the field of wound care.’

Is wound care a comprehensive area?

It's a huge field, no doubt. But I began to focus in particular not on fast-healing wounds - a simple burn or a surgical wound - but on wounds that are twenty or thirty years old and don't heal. I realised that these chronic wounds are in the community. The figures say that around 70 per cent of these wounds are in the community and in families. A real hidden epidemic. There were no figures at all. We didn't know where these people were.

And so began his field of research...

Yes, as well as keeping up my clinical practice, I started specialising in this area and doing specific training. When I arrived at the Universidade Católica in 2009, it was precisely because of this area. I immediately began to implement the area of wound prevention and treatment and to teach a course dedicated exclusively to this area. In fact, my first study in this area sought to understand how much time nursing, pharmacy and medical schools devoted to wound care. I realised that there were often six hours dedicated to this subject in a four-year course, for example. The Universidade Católica was a pioneer in valuing this area and bringing it into teaching and research. We currently have around 20 years of research and evidence on this topic. Today we have new medical instruments and devices for use in wound treatment. We also have a shared research programme in this area with other faculties at Católica, for example with the School of Biotechnology. We are the first at national level to work on wounds, ostomies and incontinence, offering a postgraduate course on this. It's important to note that nowadays, the Order of Nurses already recognises the area of wounds as an added competence, something that didn't happen a few years ago, precisely because there was a lack of scientific evidence in this area. It's an area that has evolved rapidly. As well as being present in our bachelor's and master's programmes, we already have PhD students exploring this topic. We also have postgraduate programmes and are now developing new technologies, both in diagnosis and treatment. It was the Universidade Católica that made this possible.

‘Research has a very important place, because it was research that brought me this constant doubt, this permanent dissatisfaction.’

What drives you?

The family! It's the most important thing. It's the family that puts up with my bad behaviour, but above all, the family is my motivation to be happy. Research also has a very important place, because it was research that brought me this constant doubt, this permanent dissatisfaction. This is extremely challenging and motivating. I'm lucky enough to be able to vary my professional life between the clinical part, which I value very much because it allows me to be in contact with the community, teaching, which fulfils me enormously, and research, which is always a great challenge.

Good places to dive in Portugal?

I really enjoy diving in the Berlengas, without a doubt. I also like the Algarve and Madeira. The Azores are also exceptional, but I haven't had the opportunity to dive there yet. There's also a fabulous site in Vila Chã in the north. This is the site of a German submarine that has been sunk since the Second World War at a depth of around 33 metres. It's a risky dive because the area has complex tides and currents.

An unforgettable dive?

In the Red Sea. It was absolutely extraordinary. There is an immense wealth of animal life and the visibility you have in the water is much greater. There are huge animals! And the risk is greater, which gives us a great adrenaline rush.