In This Issue of JWOCN
Those of you that have been accessing JWOCN online may have noticed that a few of the articles in the May/June issue were already made available in an electronic format before appearing in the printed journal. You will be seeing more and more of these PAP (Publish Ahead of Print) articles published in this format throughout 2010 and beyond. There are several reasons for this trend. Perhaps the most compelling argument is to provide you with the latest, best evidence at the earliest possible moment. A second persuasive argument is to encourage you to discover, and to regularly visit, http://www.jwocnonline.com, the latest benefit for you as a WOCN member and/or subscriber to the Journal of Wound, Ostomy and Continence Nursing. This vastly enhanced Web page contains far more than the traditional table of contents, links to abstracts or article reprints, and archived issues. Instead, JWOCN online is being transformed to a dynamic site that contains not only the must-read information available in the printed edition of the Journal but also a variety of complementary and novel information essential to your growing sophistication as a consumer (and producer) of current best evidence. For example, when you go to JWOCN online, you will find JWOCN Latest Edition. You will want to regularly check this feature to find the latest PAP articles. You will also find collections from the Editorial Board. This feature will provide an easily accessible collection of Journal articles from multiple issues on a single topic such as Pressure Ulcer Prevention, Stomal and Peristomal Complications, or Incontinence Associated Dermatitis. In order to ensure that this Web page remains a dynamic and invaluable resource for you, the Journal's Editorial Board and the WOCN Board of Directors have worked together with our publisher (Lippincott) to establish a Web Page Editor. After an intensive search of a stellar group of candidates, I am pleased to announce that Lee Ann Krapfl will serve as our first Web Page Editor. In addition to the features I have outlined in this Context (and multiple features you will find out about only if you visit the site), you will be hearing from her directly as she deals with the latest issues facing WOC nursing practice.
This issue opens with a View From Here focusing on the Kennedy terminal ulcer (KTU). Diane J. Yastrub draws on her experiences as a WOC nurse and expert witness to raise issues about the etiology, pathophysiology, assessment, and management of this wound. You will want to read this feature to gain insights into her views about the unique features of the KTU and how it may differ from the typical pressure ulcer seen in patients not nearing the end of life.
Your Wound Care section opens with an article by Connie Harris, Barbara Bates-Jensen, Nancy Parslow, Rose Raizman, Mina Singh, and Robert Ketchen, who report on a pictorial guide to the Bates-Jensen Wound Assessment Tool (BWAT). This article contains must-read information for any WOC nurse who has faced the challenge of teaching novice or generalist nurse colleagues using the BWAT to evaluate and document wound responses to ongoing treatment. Cynthia Sylvia and Vanessa Jones report a qualitative study of the lived experiences of WOC nurses practicing in wound care. You will want to read this article to validate similarities between your experiences and those reported by study respondents, to gain insights into our wound care practice from the researchers' analyses, and to identify how their synthesis of these observations informs your lived experiences as a WOC nurse.
Most will agree that no-rinse skin cleansers provide an attractive alternative to soap and water, but are these formulations truly as effective for removing irritants and harmful microorganisms from the skin? Anna-Clara Ronner, Carolyn Berland, Bo Runeman, and Bertil Kaijser summarize findings from a study comparing soap and water to a no-rinse skin cleanser in a group of healthy volunteers. Efficacy of each product was based on its ability to remove a common gram-positive organism (Staphylococcus aureus) and that all too familiar gram-negative adversary (Escherichia coli) from the skin. You will want to read this valuable article to determine whether no-rinse skin cleansers perform as well as the historical gold standard, soap and water.
Diba Maria Sebba Tosta de Souza and Vera Lucia de Conceicao Gouveia Santos report results of a study that examined the incidence of pressure ulcers in a group of elder patients residing in a long-term care facility. This study is a must-read article not only because it evaluates incidence of every pressure ulcer stage (including stage I) but also because it analyzes several understudied associated factors, including pharmacologic agents and body mass index.
This issue's CE article by MariJo Letizia, Jonathan Uebelhor, and Elizabeth Paddack reviews the literature and contrasts wound care management in a palliative care setting with traditional treatment. This comprehensive article is an excellent companion piece to our View From Here, which focuses on the KTU. You will want to read this article and complete the attached CE questions, to sharpen your skills and understanding of the goals for wound care at the end of life.
Your Ostomy Care section opens with a report of the influence of adhesive forces of various hydrocolloid barriers by Yuko Omura, Motoko Yamabe, and Sadao Anazawa. This study is another must-read feature of the Journal because it provides meticulous and interesting observations on peristomal skin changes associated with a variety of hydrocolloid wafer skin barriers. You will want to read this article to enhance your understanding of various wafers, as well as evidence for varying forms of peristomal skin changes associated with mechanical forces caused by removing a pouching system versus those associated with exposure to effluent.
Although rightly considered a final resort, many patients cared for by WOC nurses require long-term indwelling catheterization for bladder management. Mary Wilde, Judith Brasch, Kathryn Getliffe, Kathleen Brown, James McMahon, Joyce Smith, Elizabeth Anson, Wan Tang, and Xin Tu report a study that examined the appropriateness of long-term catheterization in community-dwelling individuals and the relationship between catheter care practices and complications. You will want to read this research report to gain additional knowledge about the challenges associated with long-term catheter use.
Your Challenges in Practice section focuses on the management of an enterocutaneous fistula. Linda Woodward describes a case of a male patient who developed a fistula following radical surgery to remove a large abdominal malignancy. This article provides a fascinating and invaluable read because it describes management of a high-volume enterocutaneous fistula in the context of a rare connective tissue tumor of the gastrointestinal tract. After reading the case description, you will be immediately drawn to the insightful commentary from Kathy Froiland, who describes these rare gastrointestinal stromal tumors, and the latest targeted therapies giving new hope to patients affected by this rare and often-deadly tumor, as well as novel challenges for the WOC nurses who help manage these aggressive tumors.
In this issue's Spotlight on Research from the Center for Clinical Investigation, Susan Steele summarizes techniques for identifying the type and level of evidence you can gain when reading a research report. This easily qualifies as a must-read article because it provides basic techniques for the first step in identifying evidence for practice, extracting information from a research report.
Evidence From Other Publications
In a recent issue of Wound Repair and Regeneration, Fogerty and coinvestigators1 analyzed the Nationwide Inpatient Sample database to determine whether race influenced the likelihood for developing a pressure ulcer. Based on data from slightly fewer than 95,000 individuals, they found that African Americans tended to experience more pressure ulcers than Caucasians and that they tended to develop pressure ulcers at a younger age. This risk occurred in both genders and across all age groups. Additional analysis sought to determine whether access or socioeconomic status influenced the likelihood of developing a pressure ulcer, but no relationships were found implicating either of these factors. These data provide several important insights: African Americans are at higher risk for pressure ulceration than Caucasians, and this risk appears to be associated with as yet undefined differences in skin tolerance rather than socioeconomic factors. Further research into this clinically relevant finding is urgently needed, and WOC nurses should incorporate these findings into individual patient decisions when implementing a pressure ulcer prevention program.
The immediate direct costs associated with intestinal surgery for treatment of inflammatory bowel disease are widely known, but our knowledge of the long-term costs remains incomplete. Holubar and colleagues2 studied 60 patients who underwent this extensive surgical procedure because of ulcerative colitis. Despite initial average costs of approximately $89,839, analysis of long-term medical costs revealed that patients who underwent reconstructive surgery saved an average of approximately $9,000 to more than $12,000 over a 2-year period following recovery depending on whether they underwent ileal-pouch anal anastomosis or Brooke ileostomy. Although the decision to undergo a surgical procedure is based on far more factors than economic cost alone, these data provide another element to be considered when counseling a patient considering elective surgery for the management of ulcerative colitis or any inflammatory bowel disease.
Arising at night to void (nocturia) is one of the most common lower urinary tract symptoms and one of the least well understood. Tikkinen and colleagues3 recently reported results of a population-based case-control study examining common factors associated with this symptom and its population-level impact. Based on responses from 3,744 participants, they found that for men, urinary urgency (ie, overactive bladder dysfunction), benign prostatic hyperplasia, and snoring had the greatest overall impact on nocturia as compared to urgency, obesity, and snoring in women. These findings support our current understanding that nocturia is probably caused by 2 factors, a reduced functional bladder capacity associated with overactive bladder and increased nocturnal urine production associated with multiple factors including obstructive sleep apnea. Given the level of bother associated with nocturia, the results of this case-control study provide additional evidence that assessment of nocturia, and its successful treatment, must address 2 major factors: nocturnal urine production and overactive bladder dysfunction.
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