IN THIS ISSUE OF JWOCN
The Journal publishes multiple article formats, including research reports, review articles, and special features such as Challenges in Practice, WOC Consult, and Spotlight on Research in order to meet the varying needs of our readers. However, I believe this issue is unique in offering an autoethnography and executive summary of a clinical practice guideline from the WOCN Society. The autoethnography is authored by Denis Frolich, who describes his journey to self-disclosure of a temporary ostomy as part of a staged restorative proctocolectomy. You will want to read this article not only to determine what an autoethnography is, but also to gain valuable insights as to how the author used a Web-based video-log (vlog) as one means to identify and connect with other persons living with an ostomy. In addition to reading his account in the printed journal, you will also want to take this opportunity to visit our newest electronic format for providing you journal content, our I-Pad edition, and link to a vlog from Mr Frolich.
This issue's Wound Care Section also opens with an article format that is uncommon for the Journal, an executive summary. As every WOCN member knows, the Society has a tradition of producing evidence-based documents based on systematic literature review (clinical practice guidelines), and content-validated best practice documents when evidence does not rise to the level of a practice guideline. The Society's Wound Guideline Task Force summarized evidence-based recommendations for managing lower extremity venous disease and preventing venous leg ulcers in a Clinical Practice Guideline. Task force members, including Teresa Kelechi, Jan Johnson, Phyllis Bonham, Penny Crawford, Myra Fields-Varnado, Bonny Flemister, Catherine Ratliff, Nancy Tomaselli, and Chair Margaret Goldberg, have summarized evidence-based statements and recommendations for care in an executive summary article that easily qualifies as a must read and must reference anytime you care for a patient with chronic venous disease, with or without a lower extremity ulcer. Eileen Rae Jimenez and Lynne Whitney-Caglia also focus on issues related to the care of persons with lower extremity ulcers in their Challanges in Practice article. In addition to summarizing outcomes of 3 cases, they provide a protocol for application of topical nitroglycerin ointment to the affected leg. You will want to read this article to evaluate the surprisingly positive and durable effects they achieved on both chronic wound pain and sleep.
The remaining 2 articles in this issue's Wound Care Section focus on pressure ulcer care. This first is a comprehensive review article that evaluates the predictive power of the Braden Scale for Pressure Sore Risk; it is authored by Jill Cox. You will want to read this article to enhance your knowledge of this key element of WOC nursing practice and your appreciation of the dilemma posed by measuring predictive power of an instrument designed to quantify pressure ulcer risk, while simultaneously using results of the instrument as part of a prevention program. Bonnie Alvey, Nancy Hennen, and Haelie Heard examine a different, but no less clinically relevant, aspect of pressure ulcer care in their descriptive study evaluating a computer-based clinical decision support system designed to help nurses to accurately stage and document pressure ulcers. You will want to read this article to determine whether a similar system could provide a valuable tool for staging and documenting pressure ulcers among nurses in your facility or system who do not specialize in wound care.
This issue's Continence Care Section opens with a randomized controlled trial comparing 3 common strategies for managing fecal incontinence in the critically ill patients, an indwelling stool management system, nasal trumpet, and traditional management based on containment including the use of an anal pouch. This article represents a growing trend of randomized controlled trials examining WOC nursing practice, along with a growing number of research reports supported by grants from the WOCN Center for Clinical Investigation. You will want to read this article, authored by Joyce Pittman, Terrie Beeson, Colin Terry, William Kessler, and Lisa Kirk to determine which of these care approaches achieved the best outcomes in this sample of critically ill adults. Hyo Jeong Song closes the Continence Care Section with an observational study of constipation in community-dwelling elders in Korea. You will want to read this study to both improve your insights into the prevalence of constipation in this vulnerable population and enhance your knowledge of risk factors for constipation.
Getting Ready for Certification also focuses on continence. Donna Thompson and Marta Krissovich define the latest nomenclature used to describe various forms of urinary incontinence, followed by 3 practice questions that illustrate essential skills and knowledge in this challenging component of WOC nursing practice. Whether you are preparing to renew your certification by reexamination or preparing for your first certification test in WOC nursing, you will want to regularly read this invaluable feature of the Journal, and review past features on our Web page that can be accessed at http://www.jwocnonline.com or through the Society's Web page at http://www.wocn.org/.
Teresa Kelechi, Bonnie Dumas, Moby Madisetti, Bobbie Rinard, and Greg Loftis provide a highly pragmatic Research Spotlight feature that describes a step-by-step approach to beginning data collection for a clinical study. Whether you are pursuing an advanced degree that includes a dissertation or capstone project, or you have just been awarded a research grant from the WOCN Center for Clinical Investigation, this article qualifies as a must-read that will help you bridge the gap from proposal to successful implementation of your study in a busy clinical setting.
Evidence From Other Publications
In the May/June issue of the Journal of Wound, Ostomy and Continence Nursing, I described a best practice statement for preventing and managing skin tears from an Australian group.1 In addition to providing recommendations for this underappreciated area of care, the article highlighted multiple gaps in our knowledge, including lack of a standardized means of evaluating the potential for specific types of adhesives incorporated into topical wound dressings to damage the skin of our patients. In 2011, Klode and coinvestigators2 evaluated the energy required to remove 56 different dressings from both a physical model (steel surface) and skin of healthy volunteers. These adhesives divided into 4 broad categories, polyurethanes, hydrocolloids, silicones, and acrylates. They not only found differences in the energy required to remove the various adhesives from the skin but also reported a direct proportional relationship between the force needed to remove a given adhesive and the associated discomfort. While additional research is needed to confirm these results and determine their clinical relevance, the findings of this study are relevant to WOC nursing practice because it provides a foundation for more sophisticated evaluation of the relationship between application and removal of adhesives and maintaining skin integrity in already-vulnerable patients with chronic wounds.
Ostomy Care
Who cares for the ostomy once it is created? This question is central to WOC nursing, but the answer remains surprisingly elusive for both WOC nurses and the surgeons who create ostomies. In a recent issue of the Journal of Urology, Tal and coworkers3 reported results of a telephone questionnaire administered to 65 adults who had undergone urostomy surgery 6 to 74 months (M = 30 months) prior to study participation. Slightly more than half (52%) stated that they were independent when caring for their ostomy. Women were significantly more likely to report independence in self-care as compared to men (85% vs 44%); independence in self-care was associated with a higher quality of life and psychological impact scores. Not surprisingly, multivariate analysis of factors associated with achieving independence in ostomy care included early education by an ostomy nurse. While the association between postoperative management by an ostomy nurse is not surprising to the readers of this journal, the comparatively low proportion of males in this study who professed independence in self-management emphasizes the need for every patient to have access to early and ongoing care provided by a WOC nurse.
Continence Care
Data concerning the efficacy of cranberry product for prevention of urinary tract infections continues to be published and analysis of these data continues to show mixed results. Mutlu and Eckinci4 report results of a randomized controlled trial of 20 subjects with neurogenic bladder managed by intermittent catheterization. Subjects were randomly allocated to receive either a placebo capsule or cranberry capsule once daily; data collection persisted for 6 months. Children who received the cranberry tablets had significantly fewer infections when compared to those who received the placebo preparation (P = 0.012). While the results of this small trial cannot be viewed as definitive, they do suggest that the potential benefits of cranberry products for prevention of urinary tract infection deserve further investigation, especially as we seek to reduce the overuse of traditional antimicrobial agents.
References