In This Issue of JWOCN

This issue of the Journal includes a focus on Ostomy Research. Given the paucity of the evidence base supporting ostomy care, we are particularly pleased to publish 3 articles containing original data, and our Evidence-Based Report Card on preoperative teaching and stoma site marking. In addition, this issue contains a CE article about surgical wounds in the critical care unit, and a detailed case study about a traumatic soft tissue wound in a sailor. The continence section contains a report of the prevalence and character of urinary incontinence and lower urinary tract symptoms among community-dwelling elders in South Korea.

In addition to these platform articles, this issue contains multiple feature articles covering cutting edge clinical and professional issues. The Challenges in Practice feature focuses on the management of wet desquamation associated with radiation therapy. This issue's Spotlight on Research is part 5 of the ongoing Qualitative Research Proposal series by Dr Ayres focusing on rigor in data analysis. Finally, in a Point/Counter-Point View from Here, WOCNEP Directors Dorothy Doughty and Janice Beitz debate the WOCNCB proposal concerning a new certification credential for LPNs/LVNs and RNs without baccalaureate preparation.

I. M. Wilson, D. P. Kerr and S. Lennon examined possible relationships between low back pain and ostomy surgery in an ostomy support group in Northern Ireland. They also used focus group interviews to evaluate whether persons living with ostomies experience low back pain, and whether they perceive that their pain is associated with the stoma surgery. Read this novel research report to better appreciate why ostomy surgery may increase the risk of low back pain, and patients' experiences with this common affliction.

Joyce Aycock, Alessandro Fichera, Janice C. Colwell, and David H. Song review experiences with surgical repair of parastomal hernia using an acellular dermal matrix. Readers of the Journal will be familiar with my frequent pleas for case series (multiple case reports) summarizing your clinical experiences with novel technologies and interventions for the common conditions that form the daily challenges of WOC nursing practice. Read this article to learn about the potential role of acellular dermal matrix in the ongoing search to reduce the recurrence rate of patients undergoing surgical repair of parastomal hernias, an excellent example of a concise and valuable case series reporting on a novel surgical approach to a common and difficult stomal complication.

Kimberly A. Mitchell, Susan M. Rawl, C. Max Schmidt, Marcia Grant, Clifford Y. Ko, Carol M. Baldwin, Christopher Wendel, and Robert S. Krouse evaluated the demographic, clinical, and quality of life variables in veterans living with an ostomy. Read this article to explore the sources of embarrassment among veterans with an intestinal ostomy and its relationship to physical, spiritual, and psychological domains of quality of life. In addition to learning more about the negative impact of embarrassment on ostomy patients, and sound strategies for alleviating or reversing its adverse influence, you should read ahead in this editorial to explore the richness of knowledge that can be obtained from a comparatively simple research project such as a cross-sectional survey of persons living with an ostomy. Do you have a large population of patients with a particular type of wound, ostomy, or incontinence problem? If so, please consider what information you might wish to learn from your patients that may not only inform your existing practice, but also the practice of your colleagues around the world.

In this issue's Wound Care Section, Sevim Celik reviews surgical wound infections in the critical care setting. Read this article and complete the attached CE activity to review basic principles of postoperative surgical wounds, their epidemiology, prevention, management, and impact on hospital course. You will also find this article interesting because it reviews multiple foreign language articles and research reports not frequently accessed or quoted when authors who speak English as a first language review these concepts.

David R. Crumbley and John A. Perciballi review the case of a contaminated wound with significant tissue loss caused by the type of high-energy weapon commonly used in military operations in Iraq and Afghanistan. Read this lavishly detailed case study for an in-depth discussion of the role of negative pressure wound therapy, as well as complementary and alternative treatments for this life-altering wound.

This month's Continence Section focuses on an understudied but rapidly growing age group, the "older old" (persons aged 85 years and older). Hyo-Jeong Song and Jong-Myon Bae evaluated the prevalence of urinary incontinence and lower urinary tract symptoms in community-dwelling elders in 9 villages in Jeju Island, South Korea. Read their article for insights on the frequency and severity of lower urinary tract symptoms in the very old, its relationship to common co-morbid conditions including depression and cognitive impairment, and how these elders and their families coped with these challenges in the home care setting.

Evidence from Other Publications

Wound Care

Do mood, anxiety, and emotional state influence wound healing? This question has long been considered relevant by WOC and wound care nurses. Clinical experience strongly suggests that depression and anxiety negatively influence wound healing and predispose the patient to additional morbidity or even mortality. A small but growing body of evidence is being published that supports this clinical impression. In 2001, Cole-King and Harding1 evaluated wound healing in 53 subjects with leg ulcers. Patients found to have anxiety and depression as evaluated by the Hospital Anxiety and Depression Scale (HADS) were more likely to have delayed wound healing than patients who did not have these conditions. More recently, Ismail and coworkers2 prospectively followed 253 persons with their first diabetic foot ulcer. They measured the presence and severity of depression using the Schedules for Clinical Assessment in Neuropsychiatry 2.1. They found that 8% had a minor depressive disorder, but 24% suffered from major depression. Patients with minor and major depression had an approximate 3-fold risk of death when compared to patients without depression. Nurses have long argued that caring requires a holistic view of the person that includes psychosocial factors such as mood and emotional state. Emerging evidence demonstrates that anxiety and depression not only create psychosocial distress, they impair the body's ability to heal wounds, and increase the risk of additional morbidity or even death.

Ostomy Care

Given the profound impact of an ostomy on body image, it is not surprising that much of the available clinical research about persons people with ostomies, and especially nursing research in this area, focuses on quality of life (QOL). In a recent issue of the Journal of Surgical Research, Krouse and colleagues3 evaluated QOL in 1457 persons using a disease-specific questionnaire, the QOL-ostomy. Specifically, they compared QOL among patients with an ostomy created to treat cancer to those whose ostomy was created for nonmalignant diagnoses such as inflammatory bowel disease. Common challenges for all persons living with a colostomy included uncontrolled passage of gas, sexual problems, travel difficulties, and dissatisfaction with appearance. Of note, persons whose ostomy was created because of malignancy reported higher QOL than persons whose ostomies were created for benign diseases or disorders. This research provides additional support for the idea that creation of an ostomy negatively impacts QOL regardless of underlying etiology.

Continence Care

More than a decade ago, the WOCN Society defined continence nursing as incorporating urinary and fecal incontinence and incontinence-related skin disorders. A large and growing body of research evidence clearly demonstrates the intimate relationships between urinary and fecal elimination and the adjacent skin. For example, Houwing and associates4 compared histopathologic samples from patients with moisture-associated skin damage from "superficial" pressure ulcers. They found distinctive histologic characteristics. Moisture-associated skin damage was characterized by inflammation while pressure-associated lesions were characterized by ischemic damage. The authors go on to question whether clinicians should attempt to differentiate these wounds, and whether attempting to differentiate these wounds might be dangerous if clinicians failed to take proper preventive measures for pressure ulcer prevention when moisture-associated skin damage is diagnosed. While the results of this research provide additional evidence that the etiology and pathophysiology of moisture-associated skin damage differs from pressure ulceration, it does not logically follow that recognition of incontinence or moisture-associated skin damage detracts from appropriate evaluation of pressure ulcer risk. Instead, the ability to recognize both pressure and moisture provides nurses with additional insight into the complex and multifactorial causes of skin damage, and a greater understanding of how to prevent both problems before skin integrity is compromised.

Another example of the close relationship between bladder and bowel function in children is provided by Loening-Baucke,5 who studied the epidemiology of urinary incontinence, fecal incontinence, and constipation in children attending primary care clinics in the United States. Based on a moderate-sized sample of 482 children, she reported a fecal incontinence prevalence of 4.4%, a urinary incontinence prevalence of 10.5%, and a constipation prevalence of 22.6%. Not surprisingly, she also found that children with constipation were significantly more likely to experience both urinary and fecal incontinence. Loening-Baucke6 and other researchers7 have also reported on an increased risk of urinary tract infections among children with urinary incontinence and constipation. This article adds further evidence demonstrating the inseparable relationship between urinary and fecal elimination functions and the pelvic floor muscles and support mechanisms shared by the lower urinary tract, distal colon, and rectum.

References