In This Issue of JWOCN

This issue's Context is remarkably broad in its scope, reflecting the increasing number and quality of manuscripts submitted for publication to the Journal. The Wound Care section opens with an article about skin tears. Toni McTigue, Stephanie D'Andrea, Janet Doyle-Munoz, and D. Anthony Forrester evaluate the knowledge of acute care registered nurses about skin tears. You will want to read their article to refresh your knowledge of the epidemiology, classification and assessment, preventive care, treatment, and documentation of skin tears. In addition, you will want to read the article to evaluate the effectiveness of this Web-based educational program and to determine how you might adapt a similar approach in your facility.

Barbara Pieper, April Vallerand, Cheryl Nordstrom, and Ellen DiNardo report on a study of bodily pain, depression, and perceptions of control and coping in a group of patients with venous ulcers. WOC nurses have long been aware of the realities of pain and emotional distress among patients with all types of chronic wounds, including venous ulcers. More recently, researchers have begun to examine the deleterious effects of these events on wound healing itself.1 The article from Pieper's group qualifies as a must read for every WOC nurse who manages patients with venous leg ulcers and the associated physical and emotional toll caused by these chronic and difficult-to-heal wounds.

Although the validity of several pressure ulcer risk assessment scales has been solidly established, multiple factors unique to critical care units are thought to influence pressure ulcer risk. Leman Senturan, Ukke Karabacak, Sebahat Ozdilek, Sule Ecevit Alpar, Songul Bayrak, Songul Yuceer, and Nebahat Y[latin dotless i]ld[latin dotless i]z report on a study of relationship factors commonly encountered in critical care units and pressure ulcer risk, including indicators of oxygenation and ventilation status in patients managed by mechanical ventilators. You will want to read this article to determine the relationship of these factors to pressure ulcer risk in the intensive care unit.

In a brief report for the Journal, Jill Evans summarizes the epidemiology, etiology, pathophysiology, assessment, and management of patients with toxic epidermal necrolysis and Stevens-Johnson syndrome. You will want to read this succinct and cogent review of these rare but devastating syndromes and how the wound care nurse plays a vital role in the multidisciplinary team required when managing patients with severe exfoliative disorders.

This issue's Ostomy Care section contains 2 state-of-the-science reviews. In the CE article, Doris Butler reviews early postoperative complications following ostomy surgery. This article qualifies as a must read for many WOC nurses desiring a brief and cogent review of diagnosis and nursing management of early postoperative complications following both temporary and permanent ostomies. Kathryn Sloots and Lynne Bartlett review the nursing management of postsurgery bowel dysfunction. This article, based on a combination of clinical experience and literature review, provides an excellent guide for managing patients with bowel dysfunction following ileoanal anastomosis, restorative proctocolectomy, or low anterior anastomosis, and provides must-read clinical pearls with the latest available research in this challenging area of care.

This issue's Continence Care section opens with a WOCN Society position statement on the role of the WOC nurse in continence care. You will want to read this position statement to gain insight into the ongoing national conversation about the optimal role for WOC nurses when managing incontinence issues in acute care, long-term care, home care, and ambulatory care settings.

Ozden Dedel[latin dotless i], Cicek Fad[latin dotless i]loglu, and Serhat Bor report on a study to establish the reliability and validity of a Turkish language version of the Fecal Incontinence Quality of Life Scale (FIQOL). You will want to read this article to gain insights into how the authors validate this well-known instrument and to determine whether the FIQOL may be a useful tool for use in your patient population. Susi Saxer, Rob de Bie, Theo Dassen, and Ruud Halfens explore relationships among attitudes, beliefs, and knowledge of urinary incontinence. You will want to read this article to gain an updated perspective on the complex relationship among attitudes toward urinary leakage, knowledge about the condition, beliefs about persons experiencing incontinence, and its potential impact on practice among nurses and nursing assistants.

Despite its long pedigree, teaching intermittent catheterization and related skills needed to manage neurogenic bladder dysfunction in children remains a considerable challenge. Gisele Martins, Zaida Soler, Fernando Batigalia, and Katherine Moore describe a systematic teaching and learning strategy for Brazilian caregivers of children with neurogenic bladder based on clinician interaction and a specially designed booklet. You will want to read this research report to gain insight about techniques for both teaching families with limited educational backgrounds, as well as the significance of supplementing verbal instruction with well-designed instructional materials.

In addition to our platform articles, this issue of the Journal contains 3 recurring features that are especially useful for readers. Eileen Harwood and Elizabeth Hutchinson continue their ongoing series of articles about methods for data collection with a must-read article focusing on training and managing staff involved in data collection. Similar to its predecessors, this article provides a highly pragmatic and incredibly useful guide for collecting accurate and useful data.

In this issue's Getting Ready for Certification, Amy Schaffner provides advice about preparing for certification, including questions about lower extremity ulcers. Whether you are a recent graduate of a WOCN Professional Education Program or an experienced nurse who has elected to recertify via examination, this series provides must-read information about how to approach a systematic program of review and study and individual questions that test your ability to recall, apply, and analyze essential knowledge when delivering wound, ostomy, or continence care.

Evidence From Other Publications

This Context will continue to explore a single evidence-based document or clinical practice guideline rather than reviewing selected articles in each of the areas of WOC practice. In this first segment of this series, I examined the Cochrane Library of Systematic Reviews, focusing on a review and meta-analysis of pressure redistributing devices for the prevention of pressure ulcers. This Context examines Best Practice Recommendations for Enterocutaneous Fistulae. Released in 2009 by the Canadian Association of Enterostomal Therapists, these Best Practice Recommendations summarize current clinical knowledge and the extremely sparse clinical evidence associated with the assessment and management of enterocutaneous fistulae.2 The committee that wrote the practice guidelines used a process similar to that employed by the Registered Nurses' Association of Ontario (RNAO), a group that has produced dozens of such documents, including several focusing on wound, ostomy, and continence care.3 The RNAO uses a systematic approach to generating best practice guidelines that includes selection of a topic, identification of an expert committee, a systematic literature review, formulation of best practice recommendations based on the best available clinical evidence, and peer review by stakeholders sharing interest in and clinical expertise about the topic of the guideline.

Guideline Panel Members wrote 10 clinical recommendations, focusing on the assessment of enterocutaneous fistulae, identification and modification of etiologic and associated factors, patient-centered concerns related to the management of enterocutaneous fistulae, and organizational support for WOC nursing practice. Evidence supporting these recommendations were ranked using a system advocated by the RNAO, where level I evidence is based on randomized clinical trials or a meta-analysis of multiple randomized clinical trials, level II evidence arises from nonrandomized comparison cohort studies, level III evidence is based on nonexperimental (descriptive or observational studies), and level IV evidence is derived from expert opinion informed by clinical experience. Not surprisingly, no recommendation arose about level III evidence, and most were level IV. Assessment recommendations focused on the performance of a comprehensive nursing assessment and the identification of goals of care within a multidisciplinary context. Nutrition was identified as a key component of the recommendations aimed at identifying and modifying etiologic and associated factors, as well as selective use of pharmacologic agents such as antisecretory or antimotility drugs, pancreatic enzymes, sucralfate, and agents to manage bile salt loss such as cholestyramine. Recommendations focusing on patient-centered concerns included providing emotional support and maintenance of maximal patient dignity, education for both patient and family, containment of fistular effluent, protection or the perifistular skin, and maximization of mobility. Organizational support recommendations outlined policies, procedures, and staff education needed to manage these complex patients, identification and utilization of a multidisciplinary care team, and creation or enhancement of programs that allow patients with fistulae to return to the community. These recommendations and supporting research are enhanced by multiple appendices that provide immediately useful clinical knowledge. While a careful review of the Panel's recommendations reveals a shocking paucity of evidence related to the assessment and management of enterocutaneous fistulae, the document remains an invaluable resource because it both illustrates gaps in our knowledge and evidence base while skillfully reviewing best practices and revealing the multiple questions that must be answered if we are to move beyond expert opinion to evidence-based care in this complex and challenging patient population.

SOBEST 2009

The VIII Brazilian Congress on Wound Ostomy and Continence Care and III Latin American Congress on Wound Ostomy and Continence Care will be held at the Rio Quente Resort, Goiania, Brazil, on October 25th to 29th, 2009. International speakers include Dr Barbara Braden (USA), Dr Marco Romanelli (Italy), Dr Jose Ruiz Contreras (Mexico), Dr Christine Norton (UK), Dr Sandra Gamboa (Colombia), Mrs Amanda Wells (UK), Mrs Louise Forest-Lalande (Canada) and Mrs Heidi Hevia Campos (Chile). There will be simultaneous translation (English-Portuguese and Portuguese-English) for English speaking lectures. If we have enough Spanish speaking delegates, there will also be translation for Spanish. For more information please visit the following website: http://www.cbe09.com.br

International Continence Society 39th Annual Meeting

San Francisco 29th September-3rd October 2009

Reduced registration fees and free workshop for WOCN members-register now!!

WOCN is proud to announce a new collaboration with the International Continence Society (http://www.icsoffice.org) the leading, international multidisciplinary society concerned with furthering education, scientific research, clinical practice and removing the stigma of urinary and fecal incontinence.

The 39th Annual Meeting of the International Continence Society (ICS) is set to attract over 2,000 participants. Leading continence experts from across the globe will present a rich scientific programme covering breakthroughs in science, research and medicine. http://www2.kenes.com/ics/Pages/home.aspx

This year, WOCN have negotiated a fantastic deal for WOCN members. Register before the 30th of June 2009 and you will be able to attend for the reduced rate of $275 (normal rate for nurses $325) and attend a co-sponsored WOCN skin health-workshop free of charge (normally $90)!! http://www2.kenes.com/ics/registration/Pages/Registration.aspx

Free workshop to WOCN members

Skin Health and Incontinence: Evidence-Based Practice and Current Research

Faculty: Mandy Fader, Mikel Gray, Donna Bliss, Barbara Bates-Jensen

The aim of this workshop is to review and discuss the evidence-base for clinical practices designed to prevent and treat incontinence-associated skin damage. The workshop will focus on exploring the mechanisms by which skin is damaged by urine and faeces (including the effects of pressure, friction and shear); reviewing the prevalence of skin health problems in people with incontinence; discussing the reliability, validity and utility of clinical and research tools for assessing wet or damaged skin; examining the evidence to support current methods for preventing and treating skin health problems and identifying guidelines for management of skin health.

This is the first time that WOCN have collaborated with the International Continence Society-come and join us in what promises to be an exciting and rewarding conference.

References