In This Issue of JWOCN
This issue of the Journal contains the variety of article formats, as well as the range of topics, essential to maintain your cutting-edge knowledge of WOC practice. Article types include original research reports, case studies, review articles, and editorial opinions. In addition, this issue provides several articles that explore areas of care that lack sufficient evidence to be described as evidence based. There are a variety of techniques to deal with these aspects of our practice, such as case studies demonstrating feasibility of an assessment or intervention to integrative reviews synthesizing the existing research that supports current best practices. Articles and editorials describing expert opinion are an historical approach to this challenge, but its popularity has declined because of growing demands that statements about practice, and especially statements about effectiveness, safety, or comparative effectiveness must be based on current best evidence. While this ultimate goal remains optimal, we are all familiar with multiple areas of WOC specialty practice where research is so limited that it is not possible to declare the vast majority of our practice as evidence based. In this case, we rely on collective clinical experience and expert opinion. Given the limitations of individual expert opinion, clinicians are increasingly turning to achieving consensus among clinical experts in order to provide more balanced statements about practice in areas where evidence is lacking. I have participated in several such consensus panels, and this issue of the Journal includes 3 articles that report proceedings of groups charged with reaching consensus about areas of care with limited or sparse supporting evidence. Elise Rodd-Nielsen, Jean Brown, Jillian Brook, Helen Fatum, Mary Hill, Josee Morin, and Liette St-Cyr authored an executive summary of the Canadian Association for Enterostomal Therapy's Recommendations for Conservative Sharp Wound Debridement. This article is an example of an area of care where limited supporting evidence has been augmented by consensus-based statements about how this skill fits into generic and specialty nursing practice, skill training, indications and contraindications, safety and management of adverse side effects, and documentation of care outcomes. In addition to reading the executive summary, you will want to refer to the Supplemental Digital Content for the article that provides the full document.
Mary Mahoney, Barbara Rozenboom, and Dorothy Doughty summarize proceedings from 2 consensus sessions held at the 2011 and 2012 WOCN National Conferences focusing on assessment of gluteal cleft and trunk wounds. This article provides an excellent example of a clinically relevant assessment (accurately identifying the primary etiologic factors associated with skin damage affecting the trunk or gluteal cleft) that is supported by only the sparsest of evidence. In this case, consensus statements synthesize emerging research concerning the influence of pressure, shear, friction, and moisture on gluteal cleft and trunk wounds. You will not only want to read this article to review the current consensus; you will want to follow up by attending the upcoming session at the 2013 WOCN National Conference in Seattle, Washington.
C. Tod Brindle, Rajiv Malhotra, Shelby O'Rourke, Linda Currie, Debbie Chadwik, Pam Falls, Christi Adams, Jacob Swenson, Dhol Tuason, Stephanie Watson, and Sue Creehan summarize a consensus process that focused on defining essential characteristics of hemodynamic instability in critically ill patients, physiologic responses to turning and repositioning, and the impact on pressure and shear forces affecting the skin. You will want to read this article that not only challenges inconsistencies in how we define hemodynamic instability, but also critically examines the physiologic impact of turning and repositioning and its influence on prevention of pressure ulcers.
Mary M. Shannon, Joyce Hawk, LaTroy Navaroli, and Thomas Serena report findings from a study examining patient adherence to measures recommended for prevention of recurrent venous ulcers. You will want to read this study, funded by the WOCN Center for Clinical Investigation's grant program, to learn more about the proportion of patients with venous leg ulcers who adhere to preventive interventions, as well as the significant minority who do not.
Members of the WOCN Society's Clinical Practice Ostomy Committee, Mary Mahoney, Kathryn Baxter, Joanna Burgess, Carol Bauer, Cathy Downey, Janet Mantel, Jacqueline Perkins, Michelle Rice Ginger Salvadalena, Vickie Schafer, and Shirley Sheppard, summarize the procedure for obtaining a urine specimen from a urostomy. This article qualifies as must read, not only for WOC nurses with experience in ostomy care, but also as a resource for other clinicians, including both nurses and physicians, who are unfamiliar with these procedures.
Jeanette Fingren, Elisabet Lindholm, and Eva Carlsson report a study of phantom rectal syndrome after abdominal perineal resection with ostomy creation. You will want to read this clinically relevant research report that focuses on an understudied sequela of resection of the rectum and its influence on health-related quality of life.
Hiromi Nakagawa and Hanako Misao report results of a study that examined the effect of distance between ostomy location and abdominal incision site of the incidence of surgical site infection in patients undergoing surgery for colorectal cancer. This article qualifies as must read for any nurse who cares for patients with fecal ostomies and wishes to determine factors potentially influencing a never event, surgical site infection.
Mary H. Wilde, Mandy Fader, Joan Ostaszkiewicz, Jacqui Prieto, and Katherine Moore present a systematic review of procedures used to decontaminate urinary drainage bags in persons with long-term indwelling catheters. This review is valuable because it illustrates the paucity of evidence underlying this practice and provides recommendations for additional research needed to underpin nursing advice to patients with long-term indwelling catheters.
Maria Lombrana, Laura Izquierdo, Antonio Alcaraz, and Ascension Gomez summarize a prospective, descriptive study that examined clinical outcomes in urinary incontinence following radical prostatectomy. You will want to read this article to gain insights into the impact of a nurse-run clinic on urinary incontinence in the first year following prostatectomy, including adherence to pelvic floor muscle exercises, and accuracy in identifying, isolating, contracting, and relaxing these muscles.
This issue's "Challenges in Practice" column describes the case of a school-aged child injured in the devastating earthquake in Haiti. His injuries led to a temporary ostomy that was subsequently reversed. You will want to read this cutting-edge report that describes application of a lightweight, mechanically powered negative pressure wound therapy device for this patient who lives in an area without reliable sources of electricity.
In this issue's "Spotlight on Research" column, Teresa J. Kelechi and Jane V. Arndt review pressure ulcer risk assessment instruments. You will want to read this overview of available instruments, research evaluating their validity and reliability, and their readiness for use in routine clinical practice.
Finally, this issue's certification review provides 3 questions related to wound care. You will want to read this valuable and popular feature of the Journal to learn more about different levels of questions constructed for WOCNCB certification examinations, and to gain additional appreciation of the importance of content outlines when taking a certification examination.