In This Issue of JWOCN
Your March-April issue is packed with articles that provide the latest knowledge about pressure ulcer prevention, quality of life in persons with ostomies, preoperative stoma site marking, indwelling catheter securement, continence and intermittent catheterization, incontinence-associated dermatitis (IAD), and certification.
Think you have "heard it all" when it comes to pressure prevention? Read on and reconsider! This issue's Wound Care section opens with a second report from the VCU Pressure Ulcer Summit. Sue Creehan, Janet Cuddigan, Dana Gonzales, Denise Nix, William Padula, Joyce Pittman, Vicky Pontieri-Lewis, Christine Walden, Belinda Wells, and Robinetta Wheeler provide recommendations for development of centers for excellence in pressure ulcer prevention. While I suspect most will agree that we have identified the essential bundle of interventions needed to prevent facility-acquired pressure ulcers, there is little doubt that integrating these changes into daily practice and ensuring they are sustained remain a significant challenge. You will want to read this article that I believe represents a landmark publication for a national approach to achieving these lofty goals, and formally recognizing facilities that reach this level of excellence. Debbie Hanna-Bull reports results of a quality improvement initiative for prevention of heel pressure ulcers in an acute are facility. I strongly encourage you to read this article that addresses many of the points raised by Creehan and colleagues concerning achieving sustained reduction in pressure ulcer occurrences.
The role of nutrition in pressure ulcer prevention and healing is well established, but techniques for assessing nutritional status remain rudimentary. Serum markers for assessing nutritional status are only modestly reflective of wound-healing potential, and risk assessment using current instruments is challenging as well. Natasha Miller, David Frankenfield, Erik Lehman, Melissa Maguire, and Victoria Schirm report results of a retrospective study of use of the Braden Scale Nutrition subscale for nutritional assessment. This article is must read for every WOC nurse involved with pressure ulcer prevention, regardless of your care setting.
The issue's Wound Care section closes with Christine Berke's description of the development of a visual guide for identifying anatomic locations on the buttocks. The insights provided in this View From Here are essential to every nurse interested in accurately documenting skin damage in this vulnerable region of the human body.
The emotional challenges associated with creation of an ostomy are well known to every WOC nurse. This issue's Ostomy Care section opens with an analysis of suicide occurrences in patients with bladder cancer managed by radical cystectomy and urinary diversions. This article by Zachary Klaassen, John DiBianco, Rita Jen, Benjamin Harper, Grace Yaguchi, Lael Reinstatler, Cynthia Woodard, Kelvin Moses, Martha Terris, and Rabii Madi (along with the accompanying View From Here) are essential reading for every WOC nurse. In addition to these must-read articles, Vera Santos, a member of the Journal's Editorial Advisory Board, Fabiana Augusto, and Gustavo Gomboski report a secondary analysis of a parent study (also published in the Journal) about quality of life in patients with ostomies cared for in an outpatient setting. You will want to read this important study of survival and challenges following ostomy creation, and factors known to ameliorate the psychosocial challenges created by urinary or fecal diversion.
The Ostomy Care section closes with a joint statement from the Italian Association of Stoma Care Nurses and the Italian Society of Surgery concerning preoperative stoma site marking by Gabriele Roveron, Giorgio De Toma, and Maria Barbierato. The authors of this landmark statement for health care providers throughout Italy not only collaborated in the creation of this document but also desired to publish it in a journal that provides a global voice representing WOC nursing. I believe they chose wisely, and I strongly encourage you to read their statement and compare their approach to preoperative stoma site marking to your practice in this essential area of our specialty.
Incontinence-associated dermatitis has evolved from an underrecognized and often ignored problem to a central concept in nursing and WOC specialty practice. Mikel Gray, Laurie McNichol, and Denise Nix summarize a decade of promises, progress, and challenges since the first IAD expert panel met in 2005. I invite you to read this View From Here that exemplifies one of the many human conditions WOC nurses have elevated from "low-level hygienic matters" to clinically relevant, manageable, and (most importantly) preventable conditions.
Securement of the indwelling catheter has not been found to prevent catheter-associated urinary tract infections (CAUTIs), but it has been shown to prevent inadvertent urothelial damage associated with traction placed against the unsecured catheter and unintentional traumatic removal of the catheter in some cases. Yvonne Appah, Kathleen Hunter, and Katherine Moore (previous Editor-in-Chief of the Journal) report findings from a study that examined catheter securement practice in an acute care facility in North America. Read this clinically relevant study to determine current practice concerning this important element of indwelling catheter care.
WOC nurses not only play a central role in indwelling catheter care but are also intimately involved, along with urologic specialty practice nurses, in intermittent catheterization. F. Faleiros, N. Favoretto, J. Da Costa, C. Kappler, F. Pontes, and E. Atila report a study of the influence of intermittent catheterization in continence in patients with spina bifida. You will want to read this study that adds valuable evidence to an often-overlooked benefit to self-catheterization, its influence on social continence.
As the list of "never events" associated with admission to an inpatient facility grows, so must our sophistication in providing effective preventive care. Kamishia Thomas reports results of a quality improvement project that incorporated an evidence-based, nursing-focused algorithm and once-a-shift nursing rounds in an effort to achieve sustained reduction in facility-acquired CAUTIs. Read this article to find out whether her approach was effective.
Certification is at the heart of WOC specialty practice, and it is an essential component of the well-deserved respect and recognition we have earned over the past half century. Phillip Botham, Jeannine Thompson, and Cathy Reimanis authored this issue's must-read Getting Ready for Certification. It analyzes how the WOCNCB constructs questions for certification for WOC advanced practice registered nurses, WOC specialty practice nurses, and wound treatment associates.
Similar to my comments on IAD, I proudly argue that WOC nurses have played a central and critical role in elevating topical therapy for acute and chronic wounds from application of "saline and gauze" to the complex and effective collection of interventions employed in 2016. Dr Chang Chang from the Department of Plastic Surgery in Taiwan describes application of topical therapy to the case of an 85-year-old woman with an infected diabetic foot ulcer in an ischemic limb. In addition to reading about his management of this challenging patient using a topical approach, I urge you to appreciate this Challenges in Practice as a powerful testament to our efforts to elevate evidence-based topical wound therapy as an effective approach to limb salvage in cases traditionally defined as doomed to failure without amputation.