In This Issue of JWOCN
I recently participated in a seminar where a colleague presented her opinion about a specific case that challenged current best practice concerning identification of a lesion as a pressure ulcer versus moisture-associated skin damage. Though she clearly identified her assessment of the case as "based on my clinical experience," she was promptly challenged by an audience member who stated something along the lines of "I want you [clinical experts] to meet and decide this issue, and tell us the rules so we can follow them consistently." I have sympathy for both the querying clinician and my presenter colleague. The desire to be "told the rules" and to follow them is rational and attractive. Unfortunately, as we all know, this assumes that a sound evidence base exists or one can be dictated by taking a vote, as the wound care clinician requested. This is unfortunately not always the case. Multiple clinically relevant areas exist in our practice; they include the controversy whether some pressure ulcers are unavoidable, the etiology of gluteal cleft wounds, and the efficacy of certain interventions for prevention of lower extremity or pressure ulcers.
This issue of the Journal contains 2 articles that summarize consensus among expert panels that address areas of our practice supported by minimal evidence; one focuses on medical adhesive safety in clinical practice and a second focuses on peristomal moisture-associated skin damage. Both provide comprehensive consensus-based statements about best practice, and both summarize the sparse research and clinical evidence available supporting the statements advocated by panel members. However, similar to multiple areas in our practice where evidence is lacking, neither document provides hard-and-fast rules for practice. Individual clinical decision making remains just that, a clinician's best judgment given a single patient in a unique local facility.
The first consensus article focuses on medical adhesives; it includes assessment, prevention, and treatment of skin injuries associated with the use of products or devices that incorporate various medical adhesives. The consensus panel for this article is an impressive mixture of nurses from multiple specialties including wound care, critical care, neonatology, and gerontology, along with physicians interested in this clinically relevant topic. Authored by Laurie McNichol, Carolyn Lund, Ted Rosen, and others, this article qualifies as a must read for every WOC nurse and wound care specialist whose practice includes prevention and management of skin tears and other damage associated with products that incorporate medical adhesives.
The second consensus report focuses on peristomal moisture-associated dermatitis in patients with fecal ostomies. This article, authored by Mikel Gray, Janice Colwell, Dorothy Doughty, Margaret Goldberg, Jo Hoeflok, Andrea Manson, Laurie McNichol, and Samara Rao, reports the proceedings of a panel that reviewed the etiology, pathophysiology, epidemiology, assessment, prevention, and treatment of what is thought to be the most prevalent peristomal skin complication. You will want to read this article to gain further insights into current best practice in this area or ostomy nursing care.
The home health care setting remains an essential component of a modern health care system. The value of the WOC nurse in home health is well known and has recently been well documented by Westra, Bliss, and colleagues in a 2-article series published in the first 2 issues of the Journal's 40th anniversary volume.1,2 This issue of the Journal includes 2 features that further explore WOC nursing practice in the home health care setting. In a "View From Here" feature, Katie James discusses various practice opportunities for the WOC nurse in home health care, including direct consultation and indirect care via education of others. In a second article focusing on the home health care setting, Mary Vrtis focuses on means to control costs when managing complex wounds in the home health care setting. Both of these articles qualify as must-read discussions for any WOC nurses contemplating or currently practicing in this rapidly evolving health care setting.
Three articles appear in this issue's Wound Care section. Ann van Hecke, Dimitri Beeckman, Maria Grypdonck, Frans Meulineire, Lynn Hermie, and Sofie Verhaeghe report findings of an exploratory, descriptive study of knowledge deficits and information seeking among patients with leg ulcers. You will want to read this article to gain insights into the significant knowledge gaps in these patients, and to plan how to provide the effective education and counseling needed to improve the likelihood of adherence to preventive and treatment recommendations.
In addition to the review and consensus report from Gray and colleagues, this issue's Ostomy Care section includes 2 original research reports. Ginger Salvadalena summarizes findings from a study that evaluated the incidence of stoma and peristomal complications during the first 3 months following ostomy surgery. You will want to read this well-designed and well-written article to improve your knowledge of the most prevalent complications during the early postoperative period, as well as factors associated with the development of these early-stage complications.
Anne Kjaergaard Danielsen, Erik Elgaard Soerensen, Kristen Burcharth, and Jacob Rosenberg report findings from a study that evaluated the lived experiences of 15 persons with fecal ostomies due to colorectal cancer or nonmalignant conditions such as inflammatory bowel disease. You will want to read this article to improve your insights into the self-imposed isolation and concerns about disclosure associated with creation of a permanent ostomy.
Claire Taylor reported results of a study that focused on anterior bowel resection syndrome in a group of patients who underwent surgical reversal of a fecal ostomy. You will want to read this important phenomenological study because of its insights into the lived experiences of patients who anticipated restoration of presurgical bowel function following ostomy closure but experienced quite different outcomes.
This issue's Challenges in Practice feature discusses a novel technique for construction and use of a simple cardboard tube to protect the peristomal skin and guide placement of a solid skin barrier in patients with a fecal ostomy and enhanced vulnerability to peristomal moisture-associated skin damage. You will want to read this article by Margaret Heale to determine whether this simple and cost-effective method for enhancing independence in patients with high output ostomies or functional impairment that impairs their ability to quickly and efficiently change a pouching system might be applicable to your patient population.
Leann Richbourg and Marta Krissovich, both certified Advanced Practice Nurses, provide this issue's Getting Ready for Certification feature that includes 3 items that require the critical thinking skills essential to the WOCNCB APN certification examinations. In addition to reading this popular feature, visit jwocnonline (http://journals.lww.com/jwocnonline/pages/default.aspx) for further discussion of the essential elements of critical thinking as you prepare for these newer and increasingly essential certification credentials.
Kevin Emmons and Joanne Robinson provide this issue's Research Spotlight that reviews urinary incontinence severity and quality-of-life instruments. This article is part of an ongoing series of features that summarize the most important instruments used in a variety of areas of our practice. This article qualifies as a must read for any WOC nurse or continence specialist who manages ambulatory patients suffering from urinary incontinence and associated lower urinary tract symptoms.
We stand on the shoulders of giants; this often-quoted phrase perfectly suits the commentary from Janice Colwell (Ostomy Section Editor) and Nancy Schuller reviewing classic articles in the area of ostomy care. This commentary reminds us as WOC nurses of the classic articles that established many components of ostomy specialty practice, and many issues that remain hotly debated as we enter the 21st century.
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