In This Issue of JWOCN
After serving as Editor-in-Chief of the Journal of Wound, Ostomy and Continence Nursing, Dr Katherine Moore went on to be our Continence Care Section Editor for the past 5 years. No one could have been more qualified to serve in either role. As Editor-in-Chief, Dr Moore worked closely with our publisher to ensure that our Journal joined the small and elite cohort of scholarly publications tracked with a Thomson Reuter Impact Factor, the most widely recognized measure of a journal's impact within the global community. She has authored a host of articles and conducted numerous clinically relevant studies in the areas of clean intermittent catheterization, pelvic floor muscle training for postprostatectomy incontinence, and washouts for indwelling catheters. A Professor with the University of Alberta's Faculty of Nursing, Dr Moore has also served as Vice Dean, while continuing a clinically meaningful practice as a continence nurse specialist. Dr Moore is retiring from her role as Continence Care Section Editor. She will be missed!!
Dr Sandie Engberg has agreed to act as Continence Care Section Editor for the Journal. Dr Engberg is an Associate Professor of Nursing at the University of Pittsburgh School of Nursing and Chair of the School's Department of Health Promotion & Development. In addition to her dual role as faculty and Chair at the University of Pittsburgh, Dr Engberg is a Visiting Professor at the University of Basil in Switzerland, where she mentors doctoral students and junior faculty developing their own research careers. Her qualifications for this role are prodigious. Dr Engberg is currently the Principal Investigator of a study funded by the National Institute of Health investigating the efficacy of acupuncture for overactive bladder dysfunction with urgency urinary incontinence, and her research on the role of behavioral management of homebound elders with urinary incontinence has had a historic and significant impact on the practice of every WOC nurse and continence nurse specialist working with frail elders. As you will notice from the distinctively clinical focus of her research, Dr Engberg also maintains an active clinical practice as Co-Director of the Continence at her university's health system. As a reader (and current or soon to be author), you deserve a publication that delivers both the latest research and cutting-edge clinical information in all 3 areas of our practice. Dr Moore has delivered this level of excellence over the past 5 years and Dr Engberg will continue to deliver the kind of must-read articles you need and expect from your Journal.
This issue opens with an integrative review of an increasingly prevalent condition that every WOC nurse faces: caring for persons with bariatric health issues. Anne Blackett, Susan Gallagher Camden, Susan Dugan, Judy L. Gates, Therese Henn, Karen Lou Kennedy Evans, and Janet H. Lutze discuss a variety of issues associated with ensuring your facility provides both safe and dignified care for obese persons. This article qualifies as must-read because it addresses issues of patient and staff safety when managing persons who are obese, skin care, and continence issues of special interest to WOC practice, and issues of advocacy and dignity for this special needs group.
Your Wound Care section opens with a research report based on a focus group session involving 9 certified wound care nurses practicing in the home health care setting. While the issues of prevention they discuss will be familiar to WOC nurses in all settings, the results of this group discussion are must read because the respondents reported strategies used to adapt preventive interventions to the home health setting. Regardless of your practice setting, you will want to read this fascinating research report to understand the unique challenges and innovative solutions your colleagues apply when adapting prevention in the home.
Monitoring for pressure ulcer incidence in the acute or long-term care facility has become mainstream practice, but identifying and implementing the optimal response to an occurrence or cluster of occurrences are less standardized. Vicki Haugen, Judy Pechacek, Travis Maher, Joy Wilde, Larry Kula, and Julie Powell describe a Rapid Process Improvement Workshop in response to unmet needs when patients at risk for pressure ulcers were transferred from an inpatient unit to various special services in their facility, such as the operating suite or diagnostic services suite. You will want to read this thorough description to determine whether this 2-day process may be just the answer your facility seeks when implementing an ongoing facility-wide pressure ulcer prevention program.
Multiple authors have noted the severe paucity of wound, ostomy and continence education in the undergraduate nursing curriculum. Janice M. Huff reports a comparison cohort study that examined the effect of a single 3-hour educational intervention on 2 groups of nursing students. You will want to read her article to evaluate the potential effectiveness of this comparatively brief intervention on the knowledge, and hopefully the practice patterns, of nursing students when exposed to education provided by a WOC nurse.
Dorothy B. Doughty provides this issue's WOC Nurse Consult focusing on a nonhealing lower extremity wound in a 66-year-old patient. You will want to read this increasingly popular feature of the Journal to both expand your knowledge of this clinical scenario and put your critical thinking skills to the test under the guidance of a legend in WOC nursing education and practice.
Your Continence Care section opens with an original research report from Yildiz Denat and Leyla Khorshid comparing the effect of 2 fecal containment devices for prevention of incontinence-associated dermatitis. You will want to read this original research report comparing the effect of an adult containment brief versus an anal pouch on the skin of a group of acutely ill patients with fecal incontinence.
Alvisa Palese and Giorgio Carniel report data from a study that examined the effect of a multi-intervention program designed to treat incontinence-associated dermatitis and prevent recurrence among frail, elderly nursing home residents. Similar to Denat and Khorshid, this article qualifies as must-read because it evaluates the effectiveness of a nursing management program for continence that combines a defined skin care program with absorbent products and advice from continence nurse specialists to determine its effect on the incidence of incontinence-associated dermatitis, the comparative costs of the management program versus traditional care, and the environmental impact of the intervention.
Haobin Yuan, Beverly A. Williams, and Ming Liu report a study that examined attitudes toward urinary incontinence among community nurses and community-dwelling older persons living in Shanghai China. You will want to read this study to learn more about how Chinese elders and community nurses approach urinary incontinence and the similarities between their attitudes compared to those encountered in your practice.
Elizabeth Geiger Jones provides this issue's Challenges in Practice and presents 4 cases of patients who experienced skin breakdown in the sacral/perigenital area following cardiac surgery. Sound like pressure ulcer or possibly incontinence-associated dermatitis? Read this article to find the surprising answer and to determine how Elizabeth's insights will impact your practice when assessing sacral or perigenital skin breakdown in the critically ill, postoperative patient.
Preparing for initial certification or considering examination for recertification? In either case you will want to read the Getting Ready for Certification from Heidi H. Cross, Carolyn Sorenson, and June Smith of the WOCNCB, who focus on ostomy. In addition, I urge you to visit http://journals.lww.com/jwocnonline/pages/default.aspx to find Web Page Editor Lee Ann Krapfl's collections. One of these collections, titled "WOC Certification," provides quick access to the Journal's entire collection of WOCNCB Getting Ready for Certification Feature, a must-read experience for any WOC nurse seeking initial certification or recertification.
Finally, this issue's Research Spotlight contains part 2 of Lynn Eberly and Susan Talke's 6-part series on Statistical Hypothesis Testing. This article focuses on comparing mean values across multiple patient groups using Analysis of Variance. As with their first feature, the authors use an example published in the Journal of Wound, Ostomy and Continence Nursing, which greatly enhances its applicability and access to practicing WOC nurses.
Evidence From Other Publications
Given the challenges associated with managing many nonhealing wounds, it is not surprising that achieving wound closure is often the primary goal of care. However, wound closure is often associated with significant scar formation, which may result in a more fragile area of closure, an increased risk of wound recurrence, and cosmetic disfiguration in some cases. The results of a recent study published in the American Journal of Pathology add to a modest but growing body of evidence that scarring may occur, in part, due to a paucity of chemokine receptors that functionally turn off healing, resulting in reemergence of inflammation and increased scar formation (as opposed to the more desirable epithelialization).1,2 Our knowledge of the various chemical and physical factors that lead to this process remains incomplete, but associated factors include mechanical stress on the wound acting under the influence of various integrins and adhesion molecules, endostatin, angiostatin, angiopoietin-2, extracellular proteinases, and oxygen. Yates and coinvestigators1 evaluated the effects of chemokine receptor 3 (CXC3) and found that absence of signaling was associated with hypertrophic and hypercellular scarring in an experimental model. Unfortunately, development of a CXC3 agonist or antagonist to prevent premature deposition of scar tissue and allow greater time for epithelialization remains in the future. Nevertheless, this line of research is significant for wound care because it may lead to the development of therapeutic agents allowing clinicians to prevent premature wound closure and associated hypertrophic scarring in favor of more functionally stable and cosmetically pleasing closure via epithelialization.
Crohn's disease is typically considered a relative contraindication for ileoanal pouch anastomosis (IPAA) because of the perceived risk for developing the disease in the pouch. While the rationale for this risk is sound, little evidence exists exploring the actual incidence of Crohn's disease in patients with IPAA. Shen and colleagues3 identified 11 patients from a 3500 case patient registry who had a confirmed diagnosis of Crohn's disease prior to IPAA. They were compared with an age-matched group of patients with a preoperative diagnosis of ulcerative colitis. All subjects were followed for at median of 7 years (interquartile range, 4-11 years). Crohn's disease developed in the pouches of 7 patients (64%). The onset of signs and symptoms varied from 0.2 to 15 years postoperatively. The results of this study strongly suggest that hesitancy to create an IPAA in a patient with Crohn's disease is well founded.
Is cranberry juice effective for prevention of urinary tract infection? This question is traditionally met with mixed evidence, and the results of a recently published, double-blind, randomized, placebo-controlled trial suggest that women who consumed 240 ml (8 ounces) of cranberry juice twice daily had no fewer urinary tract infection recurrences than women randomly allocated to drinking a colored and artificially flavored placebo beverage.4 Subjects were 319 otherwise healthy college-aged women who were enrolled after experiencing a single episode of cystitis. While these results provide evidence supporting a lack of efficacy for cranberry juice consumption in otherwise healthy college-aged women, I urge you to await the results of a second large clinical trial currently underway in British Columbia, before drawing firm conclusions about the ongoing and interesting debate over the role of regular cranberry juice consumption for prevention of urinary tract infection.
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