In This Issue of JWOCN
This issue of the Journal truly covers a breadth of topics that are important to your daily practice. They include intertriginous dermatitis, incontinence-associated dermatitis, negative pressure wound therapy for recurrent pilonidal disease, calciphylaxis, diabetic foot ulcers, deep tissue injuries, pressure ulcers, cultural aspects of ostomy adjustment, and peristomal herniation.
Joyce M. Black, Mikel Gray, Donna Z. Bliss, Karen L. Kennedy-Evans, Susan Logan, Mona M. Baharestani, Janice C. Colwell, Margaret Goldberg, and Catherine R. Ratliff present a state-of-the-science review of 2 prevalent forms of moisture-associated skin damage, intertriginous dermatitis, and incontinence-associated dermatitis. You will want to read this article, the second in a series of 3 detailed discussions presented by a panel of experts with substantial knowledge of the assessment and management of this important aspect of skin care that is relevant to every WOC nurse's practice, whether your practice focuses mostly on wound care, ostomy care, continence care, or full-scope practice.
Dawn Farrell and Siobhan Murphy review the literature pertaining to the use of negative pressure wound therapy for management of recurrent pilonidal disease. Primarily affecting younger adults, severe cases of recurring pilonidal disease often require surgical management, leading to significant wounds that require WOC nursing expertise. This article qualifies as a must-read feature of the Journal because it provides a succinct synthesis of existing clinical experience and evidence about the emerging importance of negative pressure wound therapy for management of postoperative wounds in this challenging population.
Dianne L. Feeser reviews the literature and challenges prominent conceptions about the etiology, pathophysiology, diagnosis, and management of calciphylaxis. You will want to read her cogent article to determine whether calciphylaxis may be a more prevalent disorder than was once thought, whether the etiology is limited to end-stage renal disease, and how WOC nursing management of calciphylaxis-related wounds is evolving as our understanding of the underlying disorder continues to evolve.
Diabetic foot ulcers are an important aspect of WOC practice, and a central issue for the growing number of certified foot and nail care nurses. Sue E. Gardner, Stephen L. Hillis and Rita A. Frantz describe an original study that examined the predictive validity of the PUSH tool for monitoring healing of diabetic foot ulcers. You will want to read the results of this original study to determine whether the PUSH tool can be used to predict time to heal in persons with diabetic foot ulcers.
The diagnosis and management of deep tissue injury is an ongoing challenge for all WOC nurses. Jeremy Honaker and Michael Forston report a clinical case series of noncontact low-frequency ultrasound, combined with a traditional prevention program. Their program is designed to prevent suspected deep tissue injuries from progressing to higher-stage pressure ulcers. You will want to read their innovative approach to care and determine whether you might adopt their protocol to your facility.
Yuko Nanjo, Gojior Nakagami, Toshiko Kaitani, Ayumi Naito, Kimie Takehara, Jiao Lijuan, Naoki Yahagi, and Hiromi Sanada report a study that employed a qualitative exploratory research design to identify the relationships among etiologic factors, interventional nursing care, and morphologic characteristic of pressure ulcers in critically ill patients. You will want to read their article to determine the intensive care unit-related factors they found to be associated with an increased likelihood of pressure ulcers, and to determine whether you have had experiences with a previously undescribed pressure ulcer morphology they label, leaf type. You will also want to read their article to improve your understanding of the qualitative exploratory design they employed in this highly innovative study.
While more research concerning the magnitude and type of effect of turning and repositioning exerts on preventing tissue damage is urgently needed, its importance to a comprehensive pressure ulcer prevention program is widely recognized. Anita Voz, Carol Williams, and Marian Wilson describe results from face-to-face interviews with 101 RNs working at a community-based acute care facility about their knowledge of their patients' Norton Scores and its impact on turning schedules. You will want to read this valuable study because it provides valuable insights into staff nurses' knowledge of a pressure ulcer prevention score from a validated instrument and whether identification of a patient as high or low risk resulted in alterations in the frequency of turning.
This issue's Ostomy Care section compared culture and psychosocial function in a group of British and Japanese persons living with ostomies. You will want to read this innovative study because it provides a direct comparison of psychosocial adjustment to an ostomy in almost 500 Japanese versus more than 450 British respondents. This article qualifies as must read because it identifies statistically significant and clinically relevant differences in adjustment and provides original insights about the previously undescribed influence of culture on this essential process.
In this issue's WOC Consult, Section Editor Barbara J. Hocevar describes a case of a patient with a peristomal bulge interfering with pouching and general clothing fit. You will want to read the case, answer the questions, and review the rationale for assessment and management provided by Barbara in her discussion of this common stomal complication.
In this issue's Continence Care section, Donna Zimmaro Bliss, Kay Savik, Melissa A. L. Thorson, Susan J. Ehman, Kelly Lebak, and Gregory Beilman evaluated 45 patients in a surgical intensive care unit. You will want to read the results of this well-designed and well-executed study to gain insight into the time to development, severity, and risk factors associated with incontinence-associated dermatitis in this vulnerable population.
In this issue's Clinical Challenge column, Saman Mohammadi Pour describes wound management in the case of a middle-aged male with necrotizing fasciitis of the genital area (also known as Fournier's gangrene) managed by extensive surgical debridement with resulting tissue loss. You will want to read this valuable article to gain insights into how Pour used negative pressure wound therapy to both enable early definitive reconstructive surgery and reduce this patient's hospital length of stay.
In the last issue of the Journal, Etnyre and colleagues1 published an excellent review of the role of the Certified Foot and Nail Care Nurse in prevention of lower extremity amputation. The Certification Review from the WOCNCB focuses on preparing the CFCB credential.
Susan E. Telke and Lynn E. Eberly continue their 6-article series on statistical hypothesis testing. In this issue's Spotlight on Research feature, they discuss statistical measures used to determine agreement among individuals when interpreting results of a diagnostic test. You will want to read this informative feature to increase your knowledge of the term interrater reliability and how Cohen's kappa statistic is used to measure agreement among 2 or more individuals while controlling for the likelihood that agreement occurred due to chance alone.
Evidence From Other Publications
Wound Care
Negative pressure wound therapy has proved effective for a variety of wounds, and the rate of adverse side effects has proved to be low. However, in a recent issue of Archives of Orthopedic and Trauma Surgery, Citak and colleagues2 reported a case of necrotizing fasciitis in a patient managed with vacuum-assisted closure for a stage IV pressure ulcer on the right ischium. The patient was a 43-year-old male with a spinal cord injury; he had no history of diabetes mellitus or smoking. His necrotizing fasciitis was treated with wide surgical excision, systemic antimicrobial therapy, bedrest, and a myofascial tissue flap. He was discharged from hospital at 3 months and again able to use a wheelchair for mobility. The authors acknowledge that the precise factors resulting in this serious complication cannot be known with certainty. Nevertheless, they recommend applying negative pressure wound therapy in an infected high-stage pressure ulcer only after surgical debridement and dressing changes more often than every 5 days. While negative pressure wound therapy remains an important intervention for managing a variety of chronic wounds, this case serves as a reminder of the small but clinically relevant risk of serious adverse side effects associated with application of vacuum-assisted closure to an infected wound.
Ostomy Care
Clinical experience powerfully suggests that ostomy surgery exerts a profound impact of the individual and her or his partner, but surprisingly little research has been published in this area. Cakmak and colleagues3 evaluated 567 married couples that included one partner who underwent ostomy surgery for colorectal cancer. Ostomy surgery was found to influence social lives of both patient and partner, with more than half of male and one-third of female partners reporting spending more time at home. In addition, a statistically significant and clinically relevant portion of both male and female partners stated they had become sexually inactive because of their partners' ostomy. Although further research is needed, including studies set in North America and western Europe, the findings of this study are important because they reveal the profound influence of ostomy surgery on the patient and his or her family, including their partner.
Continence Care
Suburethral injection of glutaraldehyde crossed-linked collagen was shown to be effective for management of stress urinary incontinence in the late 20th century, and several agents continue to be used in current practice.4 In a recent issue of Lancet, Graf and coinvestigators5 report a randomized controlled trial comparing the submucosal agent dextranomer stabilized in hyaluronic acid for treatment of fecal incontinence. The main outcome measure of this trial was reduction in the number of fecal incontinence episodes; subjects who reported a 50% or higher reduction were deemed responders. Two hundred eight subjects were randomly allocated to the active treatment group and 70 were randomized to a sham group. Slightly more than half (52%) of patients who received the active treatment were deemed responders as compared to 31% of subjects who underwent the sham treatment. Beneficial results persisted for the 1 year of data collection. The authors report 2 serious adverse side effects associated with treatment, one rectal and one prostatic abscess. Transient proctalgia was reported by 14% of the active treatment group. The results of this study demonstrate the efficacy of the bulking agent dextranomer for treating fecal incontinence. Nevertheless, additional research and clinical experience is needed before its broader role in managing fecal incontinence can be defined.
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