IN THIS ISSUE OF JWOCN
The concept of prevention as a cornerstone of WOC nursing is neither novel nor news to any in active clinical practice. WOC nurses remain at the cutting edge of preventive practice for a variety of issues such as pressure injury, lower extremity wounds, diabetic foot ulcers, peristomal skin complications, and moisture-associated skin damage. While it is easy to point to individual examples of research, systematic reviews, and quality improvement projects, I submit that the WOCN Society and its official journal have gone beyond simply advocating for these practices. Instead, I assert that the Society and its collective publication venues have built the increasingly complex armamentarium of resources necessary to build and sustain a culture of care essential for supporting skin health. These essential resources include multiple clinical guidelines published by the Society, coupled with Executive Summary articles appearing in its official Journal. The Journal has also published 2 algorithms that aid nurses in decision making for patients at risk for pressure injury and venous leg ulcers. These publications, in turn, are paired with interactive electronic algorithms produced by the WOCN Society that render them immediately available for use in various healthcare settings. In addition to these essential resources, Journal of Wound, Ostomy and Continence Nursing (JWOCN) continues to regularly publish articles describing authors' original research and clinical experiences in creating a culture of care needed to create centers of excellence in skin health. Read each of the articles in this issue to find out more about the cutting-edge innovations and identify how they can add to the environment of aggressive and effective prevention that characterizes your practice.
Charleen Singh, Cheryl Anderson, Earla White, and Noordeen Shoqiart evaluate the impact of a pediatric pressure injury prevention bundle in 99 children's hospitals in the United States. This article qualifies as must read because it focuses on a seldom studied population taken in the context of pressure injury prevention (infants and children), and it raises a timely and clinically relevant point about direct linkage between documentation of preventive interventions and pressure injury occurrences versus overall participation in a preventive initiative.
W. Ben Mortenson, Sarah Thompson, Alison Wright, Jeanette Boily, Kevin Waldorf, and Sandy Leznoff describe findings from their cross-sectional survey that queries practice patterns of occupational therapists throughout Canada. They specifically queried weight-shifting practices for prevention of pressure injuries among patients in wheelchairs. You will want to read this timely and clinically relevant article to determine what these important colleagues recommend to their patients and how their recommendations compare and contrast to your practice.
Mary Arnold-Long, Kevin Emmons, and John Chovan report findings from their study that sought to achieve consensus about the status of incontinence-associated dermatitis and intertriginous dermatitis as nurse-sensitive quality indicators and whether they should be included in routine data collection for the NDNQI (National Database of Nurse Quality Indicators) database. You will want to read this research report to determine the consensus achieved by these clinical experts and to compare their opinions with your insights concerning the current status of efforts to prevent these prevalent forms of moisture-associated skin damage.
Ma'en Aljezawi and Ahmad Tubaishat reported findings from their study of pressure injury prevalence and use of preventive interventions in adults hospitalized for cancer care. This article qualifies as must read because it examines pressure injury occurrences in another understudied group (oncology patients) and the need to reexamine pressure injury preventive practices in this vulnerable group. Michelle Barakat-Johnson, Catherine Barnett, Timothy Wand, and Kathryn White examine one of the central threats to excellence in prevention-the need to ensure sustained preventive efforts essential to long-term reduction of preventable healthcare-associated conditions. Their study was completed in response to an unexplained rise in pressure injury occurrences, a frequent challenge to any ongoing preventive program. You will want to read their study to increase your insights into the relationships among knowledge, attitudes, and actual implementation of preventive interventions for pressure injury.
This issue's Ostomy Care section addresses a critical issue in ostomy management, creation of a palliative ostomy in persons with high-stage and unresectable colorectal tumors. C. Pickard, R. Thomas, I. Robertson, and A. Macdonald describe their experience with 86 patients who underwent palliative ostomy surgery to manage bowel obstruction and its impact on survival. This article qualifies as must read for any WOC or ostomy nurse tasked with managing a new ostomy in a person receiving end-of-life care. It also comprises our first Brief Research Report. Introduction of the Brief Research Report is in direct response to several conversations with experienced researchers seeking to publish brief highlights of focused studies that do not fit the longer format of a typical research reports. I am pleased to accommodate this reasonable request and call upon our most prominent clinical and basic science researchers to use this exciting new feature of JWOCN!
This issue's Continence Care section reintroduces an effective but sometimes maligned component of continence care: use of absorbent products to contain urinary or fecal incontinence. Selection, use, and evaluation of absorbent products are a traditional role of WOC and continence care nurses; unfortunately, it fell out of favor in the 1990s due to a well-intentioned but unrealistic expectation that newer options in pharmacologic, surgical, and neuromodulatory management of incontinence were destined to eclipse traditional care including the use of absorbent products. History has proved that while a minority of patients can be effectively managed by these ongoing techniques, the use of absorbent products remains the most common management strategy for incontinence, and persons with incontinence seek out and are benefitted by education, counseling, and support from WOC and continence nurses. This article, written by Dea Kent, JoAnn Ermer-Seltun, Laurie McNichol, and myself combines results of a scoping literature review, consensus conference of clinical experts, and content validation of a set of consensus-based and evidence-based statements that will be used to construct the latest of the WOCN Society's algorithms for care. I also believe it marks an important stepping stone in our evaluation of continence care as it applies to WOC nursing practice-as I have state before and am pleased to say again, "You are a Continence Nurse!"
This issue's Clinical Challenges feature article focuses on support surface selection. Judy VanWhye and Susan Willer describe 5 cases of patients placed on a low air loss immersion mattress following myocutaneous flap surgery. They cogently describe the rationale for switching from an air fluidized to an immersion surface with low air loss feature, along with graft survival and related clinical outcomes, in these high-risk patients. Is this a strategy you should consider adopting in your facility? Read this article and judge for yourself.
The Getting Ready for Certification feature article focuses on advanced practice ostomy management. Advanced practice certifications in wound, ostomy, continence, and trispecialty (WOC) care are important additions to the traditional certifications offered by the WOCNCB. Read more about advanced practice certification and answer the questions in this issue's feature article from the WOCNCB to learn more. Want even more practice items? Visit our web page at https://journals.lww.com/jwocnonline/pages/default.aspx and click on the Collections tab to see more options for practice questions when getting for certification or recertification by examination.
Finally, I am enormously excited to share a teaser from our Canadian colleagues. The CAET has a new name; read on to find out about the cogent and rational process that led up to this momentous decisions and join me in congratulating our neighboring association's new name!