I am pleased to observe that evidence-based practice (EBP) and knowledge translation are recognized and accepted as vital to wound, ostomy, and continence (WOC) specialty nursing practice. I am also pleased that WOC nursing has been recognized as a specialty area of nursing practice by the American Nurses Association (ANA).1 Two of the ANA acknowledged standards of practice for WOC specialty nurses address competencies for development, dissemination, translation, implementation, and integration/use of research and evidence-based interventions and strategies to achieve goals and outcomes for individuals with WOC needs.

To support, advance, and guide the delivery of expert health care by WOC nurses, the WOCN Society has been at the forefront of developing best practice documents and evidence-based guidelines for management of patients with WOC needs for many years; these efforts include our evidence- and consensus-based clinical practice guidelines (CPGs), consensus-based best practice documents, JWOCN Evidence-Based Report Cards, and clinical decision algorithms.

The Society's Wound Guidelines Task Force has developed CPGs for management of wounds due to arterial, venous, and neuropathic diseases and pressure injuries. Development of CPGs is a rigorous, demanding, and time-consuming process that requires skills, financial resources, and a strong dedication and commitment by the volunteer members of the task force. As a reflection of the rigor committed to these guidelines, they were accepted by the National Guideline Clearinghouse (NGC) for inclusion on their Web site, until the NGC was discontinued. The WOCN Society is now a participating guideline developer with the ECRI Guidelines Trust, and the new guideline for management of lower-extremity venous disease (LEVD)2 has been accepted by ECRI for inclusion in ECRI's online guideline repository.

According to Ratliff,3 the purpose of CPGs is to set standards for clinical practice by facilitating consistent research-based clinical decisions. Evidence-based guidelines can stimulate practice changes, reinforce or validate current clinical practice, and/or raise awareness of the limited research underlying traditional practices in wound care.3 They can also influence quality care by encouraging health care providers to use interventions that have been proven to be beneficial and effective while discouraging the use of harmful or ineffective interventions.4 Obtaining research to guide clinical practice can be challenging to health care providers due to workload, time constraints, and/or limited access to databases to retrieve research literature. All of the Society's CPG Task Forces create evidence-based recommendations from systematic reviews, quality assessment of studies, and a synthesis of findings from multiple relevant studies.

The recommendations in the new LEVD guideline were developed for WOC nurses or other health care providers in various care settings at the point of care. However, experience has demonstrated that adoption and integration of evidence-based recommendations into clinical practice require more than dissemination. This lack of implementation of CPG recommendations was demonstrated in a retrospective study conducted by Lorimer and colleagues4 to determine if the care of patients with venous leg ulcers (N = 66) receiving home care was evidence-based and congruent with recommendations compiled from 3 published and widely disseminated CPGs. Findings indicated gaps between the recommendations for care and the documented care. For example, slightly more than half (53%; 35/66) of records included an identified etiology of the leg ulcer; 66.66% (44/66) of patients were treated with compression; and less than half of those who received compression (47.72%; 21/44) had an ankle-brachial index documented prior to starting compression. In addition, Lorimer and colleagues4 found that regular measurements were performed for only 11% (7/64) of ulcers; only 15% (10/66) of patients were assessed for pain; and specific patient education about the leg ulcer was present in only 3% (2/66) of records. I acknowledge that this study was published 15 years prior; nevertheless, my experience suggests that gaps between CPGs and clinical practice continue to occur. Challenges to implementation of CPGs are primarily related to the content and the environment where the guidelines will be used, and some content might have to be adapted to meet the context of the practice environment.5

Therefore, the Society's Task Force and I recognized the need to develop strategies to identify and address barriers to implementation and integration of recommendations from our CPGs in the clinical practice setting. As a result, we have incorporated the Brief Guide for Applying Evidence-Based Knowledge to Clinical Practice (Brief Guide) into the updated LEVD guideline.2 The intent of the Brief Guide, based on the phases of the Knowledge to Action Framework developed by Graham and colleagues,6 is to provide a quick resource with a list of key strategies/activities for implementing/applying evidence-based knowledge from CPGs to clinical practice for WOC nurses and other health care providers.

As Wallin's5 group noted, there is no magic bullet or recipe for effective implementation of evidence-based CPGs. Recommendations from CPGs should not be used as a recipe that fits every clinical situation; instead, they should be integrated into practice based on individualized patient assessment, clinical expertise, critical thinking, and judgment to achieve the most effective outcomes in accordance with the patient's preference, values, and goals. In my clinical practice, I found that starting with evidence-based care achieved the most effective, timely, and cost-effective patient outcomes. However, there are situations and challenging cases where evidence is lacking or not achieving the desired results, and we as WOC nurses must employ our skills in the art of nursing to problem-solve using creativity and innovation to achieve optimal patient outcomes. I also acknowledge the need for continued research to determine if CPG recommendations are being implemented in our care settings and urge you to identify what strategies have proved most effective to facilitate the application of evidence into clinical practice in a Research or Quality Improvement Report published in JWOCN.

I personally wish to thank the WOC nurses who are serving and have served as members and chairs of the Wound Guidelines Task Force since 2000 for their diligence and dedication in developing the Society's CPGs. I encourage WOC nurses and other health care providers to embrace EBP and integrate recommendations from the 2019 LEVD CPG and other evidence-based CPGs from the WOCN Society and other groups into your practice.

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