IN THIS ISSUE OF JWOCN

This issue is packed with landmark articles, novel investigations into clinically relevant topics, and clinical studies that speak to your daily practice. I open this Context for Practice with a topic that continues to dominate conversations across the United States and beyond, "What is the impact of our specialty on patient outcomes, patient satisfaction, and costs?" The relevance of this question is apparent to any WOC nurse who has ever been asked to justify her or his position or proposed adding another WOC nurse to a facility of a health system in response to overwhelming patient need. Diane Boyle, Sandra Bergquist-Beringer, and Emily Cramer present findings from a study that evaluated the influence of certified WOC nurses on 2 facility-acquired conditions prevalent in the acute care setting, pressure injury, and catheter-associated urinary tract infection. This article qualifies as must read not only because it strengthens our steadily growing evidence base demonstrating WOC nurse impact in various care settings1,2 but also because it extends this line of investigation into the acute care setting, where most WOC nurses practice.

This issue's Continence Care section opens with a pair of articles examining an understudied and often undervalued aspect of continence management, the science of containment. As a clinician practicing in continence care and restoration for more than 35 years, I participate in the delivery of cutting-edge surgical, pharmacologic, and behavioral treatments for individuals with urinary or double urinary and fecal incontinence. However, even in the rarefied environment of a referral-based practice, I continue to recognize the essential (and often undervalued) role that containment plays in continence care. For some, it is a temporary means to contain urinary or fecal incontinence until more definitive procedures alleviate or eliminate incontinence. For others, containment is a primary means of continence management, and delivering education, care, and counseling to these individuals is no less important than preventing pressure injuries, teaching a person with a new ostomy to change a pouching system, or applying negative pressure therapy to a nonhealing wound. I strongly encourage you to read the 2 articles by Susanne Alenljung and her colleagues, Gunnar Hall, Ulla Forsgren-Brusk, and Helene Widen, that explore the characteristics of odors associated with used absorptive incontinence products. While the science in these articles can be accurately described as "preclinical," the implications are clearly relevant to clinical practice; specifically, how do we improve containment technology, protecting not only our patients' skin but also their dignity as human beings?

This issue's "Ostomy Care" section opens with what may be largest and most geographically diverse study of health-related quality of life among Chinese persons living with an ostomy ever published. Zhaohui Geng, Doris Howell, Honglian Xu, and Changrong Yuan report findings from a multiprovincial study of quality of life in Chinese individuals with ostomies. You will want to read their article to expand your knowledge of the effects of ostomy surgery on quality of life in different cultures and identify both the unique and shared factors their patients and others across the world face as they learn to assert the new normal following creation of an ostomy.

Janice Colwell, Laurie McNichol, and Joy Boarini report outcomes of a structured discussion among expert clinicians that spanned the breadth of 2 countries, the United States and Canada. Their study describes findings of clinicians' perceptions of the frequency of peristomal skin problems among their patients and its prevention and management. This descriptive study, which involved almost 800 ostomy nurses, may represent the largest cross-sectional sample ever to address current best practices for patients with peristomal skin issues. It qualifies as must read for any WOC or ET nurse who wants to understand current best practice in this area and the ongoing challenges related to establishing evidence-based interventions for prevention and management of peristomal skin damage.

This issue's Wound Care section opens with an algorithm for preventing and managing patients with central venous access diver-related skin impairment. This algorithm was developed by an international group of clinical experts. It is evidence based wherever possible, and based on consensus among expert clinicians when evidence is lacking. This approach will be familiar to JWOCN readers and WOCN Society members familiar with the 2 clinical algorithms developed and distributed by the WOCN Society, our Selecting the Right Support Surface for the Right Patient, and the Compression for Venous Leg Ulcer Algorithm.3,4 This must-read article, authored by Daphne Broadhurst, Nancy Moureau, and Amanda Ullman, describes development and initial validation of our practice in the area of medical adhesive-related skin damage associated with the use of central venous access devices.

While the current focus on facility-acquired pressure injury prevention is entirely understandable, given ongoing efforts to reduced never events to just that. Nevertheless, research on pressure injuries present on admission is comparatively sparse, and this is the topic that Lisa Corbett, Marjorie Funk, Gilbert Fortunato, and David O'Sullivan tackle in their study of more than 1000 patients admitted to hospital with pressure injuries. You will want to read their article to learn more about the epidemiology, clinical characteristics, and risk factors associated with these wounds. Stephanie Slayton, Paula Morris, and Jason Brinkley report a study of tissue interface pressures when healthy subjects sat on a hospital recliner and various pressure redistributing cushions. You will want to read this important article to improve your knowledge about this important aspect of pressure injury prevention.

Every WOC nurse knows that turning and repositioning is an essential component of an effective pressure injury program. However, we are also aware of the challenges associated with effective turning, especially in heavier or entirely immobile patients such as those who are critically ill. Melinda Edger reports findings form a before-after study of a safe handling device in a 17-bed intensive care unit. You will want to read more about findings from her study, and the outcomes of the associated quality improvement project, to determine whether this type of device might play a role in your facility's pressure injury prevention program.

The WOCN Society's Clinical Guidelines for pressure injuries, diabetic foot ulcers, and lower extremity ulcers are essential resources for every WOC nurse. Becky Carroll, Catherine Ratliff, and Linda Droste provide an Executive Summary of the Society's latest update of guidelines for pressure injury prevention and management. I suggest you need to look no further for cutting guidelines to this essential component of your practice and the evidence that supports the interventions you recommend.

In this issue's Challenges in Practice feature article. Kersten Reider describes management of a woman with an open abdominal wound and an enteroatmospheric fistula using an isolation technique. You will want to read about her management of this incredibly complex and vulnerable patient to see how she applies an isolation technique (previously described in JWOCN by Brindle and Blankenship5) to promote wound healing while effectively containing effluent from the fistula.

Finally, in this issue's CAET Feature, Valerie Chaplain describes a practice and effective technique for delivering focused education to first-line nurse colleagues. You will want to read her lucid description of an educational kiosk and determine whether this approach might be just the solution you are seeking when attempting to deliver education to busy clinicians in an environment where time away for education is increasingly sparse.

REFERENCES