In today's complex world of healthcare, it's impossible for us to be content experts in all areas....we all have our own talents and skills. Some of us are experts in Outcome and Assessment Information Set (OASIS)-C, coding, and wound care. My topics of content expertise are in infection prevention and control and accreditation-related standards compliance. In this April issue of the Home Healthcare Nurse journal, other nurses, including Certified Wound Ostomy and Continence Nurses (CWOCNs), contribute their knowledge and expertise on how to improve our patient's care and ultimately our patient care outcomes.

In the CE article "Wound Assessment & Management: Wound Care Fundamentals and OASIS-C: One Home Health Agency's Educational Initiative," Mary Farren and Yanick Martelly-Kebreau, who are CWOCNs, share their expertise in an article about how they helped their staff more accurately answer OASIS-C wound-related questions. These WOCNs review the fundamentals of wound assessment, wound-healing mechanisms related to the OASIS-C M items, and wound terminology. Their tips will help you prepare your patient for the initial integumentary assessment and help you better communicate and document your nursing interventions...which is key because they serve as the basis for capturing the process measures that ultimately impact the quality outcomes for your home health agency.

Skin breakdown and the development of pressure ulcers in children is a topic often overlooked. In the article "Preventing Skin Breakdown in the Immobile Child in the Home Care Setting," Marjorie McCaskey, Lisa Kirk, and Cathy Gerdes share their expertise....in fact one of the authors, Cathy Gerdes, shares her expertise from personal experience in caring for her 29-year-old son who at the age of 6 suffered a C2-C3 injury. These authors discuss the use of the Braden Q Scale, which was adapted from the adult Braden Scale as a risk assessment tool, and how it can be used to assess for the specific risk factors for skin breakdown in the pediatric population, as well as offer strategies to prevent skin breakdown in pediatric patients.

For years now, home health agencies have been striving to maintain a low rate of hospital readmissions. To reinforce this focus of transitional care, the Community-Based Transitions Model (CBTM) was developed to improve patient transitions. Home care transitions are a part of the healthcare reform law, The Patient Protection and Affordable Care Act. The CBTM model of care was developed by home care providers to provide clinicians with additional skills to address gaps in all care transitions along the chronic condition continuum. Innovative evidence-based care transition care models have been replicated and serve as an excellent foundation for improvements in patient transitions. In the article titled, "Community-Based Transitions Model: One Agency's Experience," Beth Hennessey and Paula Suter discuss their experience when the CBTM was implemented by their nurses serving as health coaches.

Not only can we learn from each other in professional ways, but we can also learn from each other by the mistakes that we and other clinicians have made. Kelley Hall raises some interesting questions and issues in her article, "Professional Boundaries: Building a Trusting Relationship with Your Patient." She discusses some of the common things that home care and hospice nurses could do to cross professional boundaries....anyone that's been in home care long enough has been presented with situations in which patients or their families have limited resources or support. We in home care are "nice people" and want to do what we can to help our patients...even as I read this article...I realized that I may have crossed the line in giving out my cell phone number or taking other actions that were meant to be true acts of kindness. This article not only raises interesting questions, but also offers solutions to these issues by providing two policies on professional boundaries and gratuities. These policies offer specific concrete examples and guidelines for what is acceptable behavior....a good reminder of the need to set limits between the patient and the nurse...sometimes hard to do, but very important!!

Lastly, Heather McKenzie from the VNAA offers an excellent perspective in her editorial "Wound Care Is Not Holistic Patient Care." She offers a wake-up call to rethink how we approach our patient's care, and to not just treat a portion of our patient, but to look at the patient as a whole and work together as an interdisciplinary team.

We all have our areas of expertise, and in this issue we can learn from nurses who share their expertise in patient care, such as wound care and pressure ulcer prevention, establishing and implementing models of care, to raising our awareness of how our actions and behavior impacts patients, and to rethinking about our patients and looking at them in a holistic manner. As a member of the HHN Editorial Review Board since 1996, this wonderful journal has provided a forum for home care and hospice nurses to sharing their experiences so that we may all learn from each other. Thank-you for your ongoing contributions and sharing your knowledge and expertise....at the end of the day...it's all about the patient.