Can you believe it? An entire issue devoted to pediatric wound, ostomy, and continence care!! We suspect that your reactions are similar to those expressed by the students on attending their first pediatric WOC lecture [horizontal ellipsis] curiosity balanced with apprehensive silence. It seems to us that there are two kinds of nurses in the world-those who love pediatrics and our colleagues who are happy to have only adult patients and will say with relief, "I don't know how you do it." Few nurses are comfortable practicing in both arenas, and, to tell you the truth, we secretly feel a bit smug when we bring one of these nurses over to the pediatric world of WOC nursing.
We are so excited about an issue of JWOCN devoted to pediatrics and believe it validates our subspecialty. Collectively, we represent more than 30 years of nursing practice and are pleased to have this opportunity to share a few thoughts with you about why we think pediatric WOC nursing is so special.
We pediatric folk are relatively few and are employed throughout the country in various capacities. Because of our vast geographic separation, collaboration typically involves a telephone call to a colleague in another city or state or an e-mail posting on the forum. Fortunately, many of us have access to wonderful adult colleagues practicing at neighboring hospitals. They have graciously responded as we tapped into their expertise on some of our most complex cases. This teamwork often results in successfully adapting products and techniques to accommodate the needs of our small patients. We gratefully acknowledge the adult WOC nurses who have mentored us and laid the groundwork for our subspecialty.
We have often heard "children are not little adults." This cliche rings true to the pediatric WOC nurse trying to match product to pediatric patient, highlighting the second factor that contributes to the uniqueness of our practice. With the exception of smaller pouches, many of the basic ostomy care products are the same for children and adults. However, several of the accessory ostomy products contain ingredients that may be too harsh for an infant's skin, causing skin excoriation or resulting in skin tears owing to the stronger adhesive.1 To choose the most appropriate and effective products for both ostomy and wound care, the pediatric WOC nurse must be aware of how a child's skin differs from that of an adult.
Many of the wound care products and support surfaces are not the appropriate size or are not adequately researched to meet the needs of the child. It has happened more than once that we have applied a negative pressure wound therapy device to an infant and found that the suction pad and smallest size foam dressing were too large for the wound and surrounding anatomy. Because of the smaller consumer market of pediatrics, manufacturers of specialty wound care items (eg, low-air-loss beds and advanced wound care products) have little or no research to support the efficacy of these products in children.2,3 Many of the wound care dressings are supplied in 4 x 4" sizes, and we often use only a small portion of the dressing to fit the child's wound. The leftover portion of the dressing is often saved for the next dressing change, which could potentially affect the integrity of the product.
Finally, the third factor that makes pediatric WOC nursing exciting and challenging is the variety of consults we receive. Diversity is to be expected. The typical day for the pediatric WOC nurse may require problem solving for the mundane (eg, diaper dermatitis) to the complex (eg, micropreemie with a large abdominal wound and fistulae requiring multiple treatment modalities). Similarly, the pediatric WOC nurse's practice involves the complete age spectrum of childhood; therefore, knowledge of normal growth and development is essential.4 For instance, when called to assess the active toddler who continuously pulls off her ostomy pouch contaminating her central line, the pediatric WOC nurse must devise strategies to effectively manage this patient while promoting age-appropriate activities. Likewise, counseling a teenager coping with self-image issues related to a new ostomy includes tips on contemporary fashions (eg, low riders and swimsuits), as well as suggestions for handling peer and social relationships (eg, the prom).
We know you will enjoy this landmark issue. It contains the first pediatric prevalence survey completed since the adult-based prevalence surveys were initially begun a decade ago. Also in this issue you will find practical articles on topics that are close to our hearts, such as gastrostomy tubes, pressure ulcer risk factors, and negative pressure wound therapy device applications. The journal's editorial staff has done a stellar job in bringing together the best nurse researchers and clinicians whose manuscripts illustrate the uniqueness of pediatric wound, ostomy, and continence nursing.
We are privileged to have been asked to write this editorial and contribute to this issue. We thank Katherine Moore and JWOCN for this opportunity and look forward to future articles devoted to pediatric topics.
In parting, here are a few thoughts to ponder. You may be a pediatric WOC nurse if:
1. You place stoma paste in a syringe because squeezing from the tube wound cover the entire cutting surface.
2. Measuring tapes that are 6" (15 cm) are all that is needed to measure most wounds.
3. You choose an ostomy pouch by how small the wafer is so it does not cover up the umbilicus or by how long it is so it doesn't hang below a toddler's shorts.
4. You address every adult in the room as the mommy or daddy.
5. You make it a practice to apply the dressing or ostomy pouch to the Barbie doll or teddy bear before you apply it to the child.
6. Your goal is to volunteer at the UOA Youth Rally Camp.
7. You select a baby nipple to stabilize your G-tube.
8. Supply representatives start their conversations with you by saying, "There is no research in pediatrics with this product, but [horizontal ellipsis]"
9. You go to a national conference and there are only 1 or 2 topics that focus on pediatrics.
10. You find yourself going by the room, even if you don't plan to see that child today, because he or she is so cute and you want to see his or her smile.
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