In This Issue of JWOCN

In addition to the traditional 3 sections included in every issue of the Journal of Wound, Ostomy and Continence Nursing, this issue opens with an article that cuts across all 3 areas to focus on a professional practice issue, predictors of success when students take their certification examination. Authored by Dr Janice M. Beitz, one of our WOCNEP program directors, this must-read article reports on the findings from a study of factors associated with success when completing a first WOCNCB certification examination.

This issue's Wound Care section opens with an article by Elizabeth Taggart, Linda McKenna, Joyce Stoelting, Geri Kirkbride, and Rosalie Mottar. They describe the development and implementation of a facility-wide unit champion program that increased the focus on multiple aspects of WOC nursing, including pressure ulcer prevention. You will want to read this article describing an innovative program for engaging nurses from every unit in essential aspects of WOC nursing care.

Liping Jiang, En Zhang, Yequin Yang, and Chunyu Zhang report on the expression of apoptic factors in stage III pressure ulcers. Apoptosis, simply defined, is the programmed death and removal of cells from the body. Billions of cells undergo apoptosis on a daily basis and the influence of apoptic factors has enormous relevance to our understanding of pressure ulcer healing. Ulla-Mari Kinnunen, Kaija Saranto, Anneli Ensio, Ansa Ivananinen, and Patricia Dykes next report the results of a Delphi study on a standardized wound care documentation model. You will want to read this article to gain insight into how these wound care nurses adapted the skin components of the Finnish Care Classification of Nursing Diagnoses and Interventions to develop a standardized model for documenting wound assessment and care.

Gursel Oztunc and Durdu Inan report the results of a study of pressure ulcer prevalence in a university-based hospital in Adana, Turkey. You will want to read this article to gain insights into the prevalence and locations of pressure ulcers in this hospital in Turkey and compare their findings with your experiences in your facility.

This issue's Ostomy Care section opens with a major research report from Paula Erwin-Toth, Sally J. Thompson, and Janet Stoia Davis. You will want to read this article to improve your knowledge of skin conditions and quality of life in a large population sample, using a double-layered pouching system. This issue's WOC Nurse Consult column also focuses on peristomal skin. Connie Kelly described the critical thinking processes used to manage a patient with an ileostomy and a painful peristomal skin condition. You will want to read this article to determine what the etiology of this painful peristomal skin condition truly is and evaluate the clinical decisions that drove this patient's care.

Your Continence Care section opens with a report of prevalence and risk factors for urinary incontinence in women attending a urology department's outpatient clinic in Ankara, Turkey. You will want to read this article to gain knowledge of typical and not so typical factors associated with urinary incontinence, and to compare the characteristics of these women with those of women seen in your practice or facility.

This issue's Clinical Challenges column describes the experiences of a certified WOC nurse in a Veteran's Administration health system with multiple acute care and long-term care beds, as well as approximately 50 ambulatory care clinics. You will want to read this article to gain insights into how a single WOC nurse applied a corporate culture framework to change practice associated with pressure ulcer prevention and care in her facility so nurses practicing in a variety of care settings would embrace and accept responsibility for maintaining skin integrity and treating selected wounds based on evidence-based order sets.

Is it a Quality Improvement Project or a formal research study, and how do I use their results in my practice? This issue's Spotlight in Research column qualifies as must-read because it answers this increasingly essential question that every WOC nurse must deal with when applying evidence-based practice procedures to their clinical decision making.

Evidence From Other Publications

Wound Care

In 2009, Bates-Jensen and colleagues1 reported on the association between subepidermal moisture measurement and early pressure damage in nursing home residents with darker skin tones. In a 2012 issue of the Journal of Spinal Cord Medicine, Guihan and colleagues2 report of experiences measuring subepidermal moisture in a group of 34 patients with spinal cord injuries receiving care at 2 Veterans Affairs Hospitals in the western United States. The dermal phase unit (unit of measure generated by this technology) was lowest for patients with intact and healthy skin and highest for patients diagnosed with stage I pressure ulcers based on visual skin assessment. The researchers also observed that dermal phase unit was measured over the heels in patients with healthy skin and stage I pressure ulcers. Findings from this study provide limited evidence that measurement of subepidermal moisture may provide a valid and reliable technique for detecting pressure-related skin damage prior to development of full-thickness pressure ulcers. However, as the authors note in this article, as well as the 2009 article published in the Journal of Wound, Ostomy and Continence Nursing,1 a more definitive trial is urgently needed to determine whether this technology will, at long last, provide the sorely needed technological aid to visual inspection for evaluating the presence and cause of skin damage prior to development of a visible pressure ulcer.

Ostomy Care

As we move deeper into the era of preventing the growing "never list," WOC nurses are becoming increasingly aware of preventing hospital readmission. In a recent issue of Diseases of the Colon and Rectum, Messaris and colleagues3 retrospectively reviewed 603 patients who underwent colon or rectal resection with creation of an ileostomy owing to colorectal cancer, inflammatory bowel diseases, or other causes. The 60-day readmission in this cohort was clinically relevant at 16.9%. The most common cause of readmission was dehydration (43.1%), followed by infection (25.5%) and bowel obstruction (20.6%). Regression analysis revealed multiple factors associated with a higher likelihood of readmission including laparoscopic approach, absence of epidural anesthesia, preoperative steroid use, and postoperative diuretic use. Additional multivariate analysis limited to readmission for dehydration identified postoperative diuretic use as the sole associated factor. While a number of these factors are outside WOC nursing practice, careful consideration of the use of postoperative diuretic medications is a potentially modifiable factor that may prevent morbidity and readmission in patients undergoing colon or rectal resection with creation of an ileostomy.

Continence Care

While prostatic enlargement in the aging male predicts continence,4 it is also associated with an increased risk for acute urinary retention. Despite the prevalence of this condition, surprisingly little research had been completed examining the efficacy of various treatment options for acute urinary retention. Fitzpatrick and coworkers5 reported findings of a prospective cross-sectional survey of urologic practices in France, Latin America, Algeria, and the Middle East. They reported on outcomes of 6704 men with acute urinary retention. The majority (71%) experienced spontaneous retention and 29% experienced retention following a surgical procedure or episode of heavy alcohol consumption. An indwelling catheter was inserted in the vast majority of patients (89.8%), followed by a voiding trial after a median time period of 5 days. Sixty-one percent of men were able to void after this short period of catheterization, and administration of an a-blocking drug almost doubled the likelihood of success on the voiding trial (odds ratio, 1.92; 95% confidence interval: 1.52-2.42). Predictors of failure include age > 70 years, history of bothersome lower urinary tract symptoms, and residual volume >= 1000 mL. Men who failed their voiding trials were managed by recatheterization and almost half ultimately required prostatectomy to reestablish spontaneous voiding.

Several aspects of this trial are clinically significant for WOC nursing practice. This study demonstrates reasonable success with a pragmatic and minimally invasive approach to managing an episode of acute urinary retention: a brief period of indwelling catheterization, institution of an a-adrenergic blocking drug, and voiding trial. It also demonstrates that the duration of indwelling catheterization can be comparatively short. Finally, this study is important because it represents a reasonably designed and well-executed real-world trial, describing clinical outcomes based on current best practices that are individualized to patient needs. I strongly believe that this is precisely the type of trial that many WOC nurses should consider as a first step toward establishing an evidence base for multiple WOC interventions used to manage patients with ostomies, chronic wounds, or incontinence.

References