It goes without saying that the landscape of WOC nursing clinical practice was radically altered in 2020 as a result of COVID-19. Both the Journal of Wound, Ostomy and Continence Nursing (JWOCN) and the WOCN Society responded to this in multiple ways. For example, the Society responded to the need to cancel our annual live event and offered WOCNext 2020 Reimagined as an online educational and networking event, which appears to have attracted the largest enrollment in the Society's history. In an era where most societies simply cancelled their meetings, followed by a smattering of individual online opportunities rolled out weeks to months after their scheduled live event, the response by the WOCN Society is a powerful testament of our community's willingness to respond rapidly when faced with a crisis.
The Editorial Board of JWOCN and numerous Society members responded with the addition of special sections related to COVID-19 in our July/August and September/October issues. The July/August issue included 2 Clinical Practice articles focusing on skin protection when using personal protective equipment and photodocumentation of wounds when caring for patients in isolation, and 3 "Views From Here" (guest commentaries) that described early experiences with the profound changes in our practice prompted by the COVID-19 pandemic. In the September/October issue, the Professional Practice Section included 4 articles that focused on one of the biggest issues facing our specialty practice as we began to recover from shutdowns in nonemergent care, the delivery of care using telehealth and related technologies. In addition, the Clinical Challenges section in that issue provided 2 cases studies: one described medical device-related pressure injuries related to prolonged positioning in the prone position, and the other case study described a deep-tissue injury and mucosal damage in a patient with COVID-19. Also, a View From Here discussed the role of WOC nurses in addressing the economic impact of COVID-19. The rapid response of the Society and Journal to address some of the challenges faced early in the pandemic demonstrates our strong commitment to engage our members in this continuing important dialogue.
SELF-CARE DURING A PANDEMIC: MOVING FORWARD VERSUS LOOKING BACK
This View From Here focuses on the essential elements we believe WOC nurses need in our toolbox as we move into 2021, and possibly beyond. Though the issue of self-care is often relegated to the bottom of the list of personal and professional priorities, we purposely moved it to the top! As with all health care providers, the demands placed on WOC nurses during this pandemic varied greatly. Some colleagues provided frontline care, which included preparing for a sudden expansion of critical care services for those with COVID-19, delivering care to multiple patients in isolation, and unexpectedly caring for clinician colleagues with skin damage caused by prolonged wearing of personal protective equipment. In contrast, other WOC nurses had their practice drastically reduced or temporarily stopped all together as nonurgent care services were curtailed during the initial surge of infected patients.
Self-care challenges for both groups rapidly emerged, owing to these disruptions in work habits. While some WOC nurses faced a sudden increase in work hours accompanied by fatigue and anxiety over contact with family and significant others, others experienced a sudden decrease in hours, leading to less physical activity and anxiety related to a return to work. Self-care was further challenged by the economic downturn caused by pandemic-related shutdowns, leading to fewer work hours, involuntary furloughs, pay cuts, and losses in personal and family income. Health and quality of life have been compromised for many people. We hear stories of WOC nurses becoming infected with COVID-19 and trying to deal with their own personal care. These individuals then jumped back in after recovery to respond to the illnesses and deaths affecting patients, family, and friends. There is no doubt that the many disruptions in daily life and personal relationships, activity restrictions, homeschooling, and elder care have resulted in short- and long-term consequences; many of these long-term consequences remain undefined.
We believe multiple skills are needed to meet the challenges of adequate self-care. Among the most important are identifying what we can reasonably control, what we can reasonably influence, and grappling with the greater challenge of recognizing circumstances we cannot control. This may be particularly difficult for WOC nurses and all frontline health care providers who attempt to care for patients, other staff, and families/significant others all at the same time. Several simple strategies to cope with this challenge include setting realistic boundaries and gently but firmly reminding others of personal and professional boundaries. A simple first step may be learning to turn off e-mail, texts, and pages when away from clinical practice and when taking time off. Several online apps are available to reduce stress and anxiety that focus on mindfulness, breathing, and movement (yoga, meditation, visualization); there are a plethora of free downloads, books, music, and other useful resources that can be used on the run, when time is short.
Additional challenges include listening to our bodies, acknowledging our "gut instincts," and proactively setting aside time to engage in activities that restore mental and physical well-being. Finding and creating time for such activities is particularly challenging: Television, the Internet, and social media are attractive, but such activities often provide a distraction or temporary diversion that occupy time but fail to provide any true restoration of physical and mental well-being. While we do not presume to know which activities or habits each individual will find as personally restorative, we nevertheless assert that this journey is a necessity and not a luxury!
Above all, adopting a proactive and creative approach to our professional and personal lives is imperative, rather than responding reactively as external circumstances often encourage. This may be the most pervasive and difficult component of self-care to master. Our specialty practice community entered 2020 in a pre-COVID-19 world, and we leave this year in a society that has been impacted at every level: personally, interpersonally, socially, and economically. In addition, in this tumultuous and uncertain time, the health care industry is experiencing a significant economic downturn and still reeling from the initial pandemic-related shutdown.
The reactionary perspective is to focus on the trauma we have faced. Instead, we choose to send a call for action to let our "best selves" shine through as we enter 2021! Many WOC nurses are currently engaged in several growth endeavors, both personally and professionally. However, changing or reshaping our practice to meet the needs of the future may include rethinking what is possible and adding new skills or refining novel ways of utilizing current skills. WOC nurses are resilient and innovative and are dedicated to making a difference in the lives of others. Ingenuity is the key!
EXPANDING THE REACH AND DEMONSTRATING THE VALUE OF WOC NURSING SPECIALTY PRACTICE
* Acquire additional education to augment our practice-hot areas include artificial intelligence, nursing bioengineering, legal nurse consulting, and advanced practice nursing.
* Develop skills in the multiple aspects of telehealth (refer to our special section in the September/October JWOCN issue) and the use of formal telemedicine technologies such as augmented virtual reality devices and remote monitoring tools.
* Consult with industry partners that deliver telehealth-based products and services.
* Collaborate with research partners to extend the use of new monitoring devices in the home care setting.
* Create and nurture virtual group activities (journal club, professional sharing among multifacility health systems, WOC listservs, chatbots).
* Expand or create care teams including unit-based care champions and specialty practice care extenders such as wound and ostomy treatment associates (WTAs and OTAs). In addition, encourage WTAs or OTAs to consider pursuing full-scope WOC nursing practice.
* Develop a business model for marketing, demonstrating the value, and expanding the reach of WOC nursing practice.
* Use available resources for COVID-19 and clinical practice.
* Access the Collections Section on the JWOCN Web page, which lists articles that provide evidence documenting the value of the WOC nurse in multiple care settings.
* Use WOCN Society resources: explore the COVID-19 resources listed on the WOCN Society's home page; engage with other WOC nurses to share experiences and practice ideas on the Society's COVID-19 forum; and use other Society guidelines and best practice documents to guide marketing and delivery of care that are available in the Document Library and Bookstore.
* Register with ECRI (http://guidelines.ecri.org) to obtain free access to 109 COVID-19 Guidelines and other evidence-based clinical practice guidelines that are available in their online repository.
* Develop creative strategies for patient and clinician education:
* Explore opportunities to provide consultation and educational services to organizations without WOC nurses using online and virtual technology.
* Provide lectures and/or precept WOC or other students using online platforms inside and outside of the work environment.
* Accept or seek out adjunct appointments to local nursing, medical, or physical therapy schools that offer online teaching opportunities.
* Use YouTube or other social media and online platforms to deliver standard patient education.
Finally, we sincerely want to hear from you! Share your challenges and successes and your creative and innovative insights. What have you found to be helpful, enlightening, and ultimately beneficial? How is your world changing, both professionally and personally, as a result of the pandemic? There are multiple platforms for sharing this information, ranging from member forums to Letters to the Editor of JWOCN to writing your own "View From Here" guest commentary. We stand proud as a united force of WOC nurses whose armamentarium must be nimble, pragmatic, and forward-thinking. Together we lead the way toward a preferred future, beyond the current crisis.