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Getting the SKINny
Current events and issues of relevance to WOC Nurse practice, updates on new website features and links to external sources of interest to WOC nurses.
Tuesday, July 01, 2014
The 46th Annual Wound, Ostomy and Continence Nurses Society Conference in Nashville is now a memory.  For all of you who were fortunate to attend, you are no doubt still sorting through your workshop materials.  And your head is likely still swirling with ideas you can incorporate into your daily practice. 
As a member of the JWOCN Editorial Board, one of my favorite experiences is watching the annual award recipients.  The Journal is proud to recognize outstanding manuscripts.  There are two manuscript awards, one for outstanding clinical innovation and the second is for the outstanding research study.
I hope you will take the time to revisit the 'Best of the Best' manuscripts for 2013.
Kudos to authors Virginia Sun, Marcia Grant, Carmit McMullen, Andrea Altschuler, Jane Mohler, Mark Hornbrooke, Lisa Herrinton, Carol Baldwin and Robert Krouse as recipients of the Clinical Manuscript Award for their study examining ostomy-specific concerns in persons with colorectal cancer who have lived with an ostomy for more than 5 years.  This article is recognized because it documents the need for ongoing contact with an ostomy nurse.
Another kudos to authors Elizabeth Jesada, Joan Warren, Dorothy Goodman, Ruth Lliuta, Gail Thurkauf, Maureen McLaughlin, Joyce Johnson, and Larry Strassner as recipients of the Research Award for their multisite study comparing digital photography to bedside assessment for pressure ulcer staging and wound characteristics included in the Bates-Jensen Wound Assessment Tool.  This cutting edge study reports the limitations and strengths associated with digital photography as a tool for chronic wound assessment.
Congrats to these authors!

Monday, June 02, 2014
Nearly 25 years ago, I was sitting in a classroom, a student at the Abbott Northwestern Enterostomal Nursing Education class. (A shout-out to all Abbott alumni!)  We had a guest lecturer that left a lasting impression on me.  A vascular surgeon was invited to our class to speak on revascularization interventions.  And he did meet the defined objectives.  Unfortunately, his lectured was peppered with a number of inflammatory comments about WOC nurses.  He defined the WOC nurse as someone who waltzes in to the rescue with a backpack full of bandage samples, when in fact, the issue was not one that a bandage could fix.  He chided us for being too focused on the topical treatment and not looking at the big picture, for inadvertently giving patients false hope and information by implying that all that was needed to heal the wound was a fancy bandage.
While his comments were not the most politically savvy considering the audience of soon-to-be WOC nurses, everyone in the room agreed with his points.  We had just spent weeks being lectured by the faculty on the importance of managing the wound systemically.  Chronic wounds are skin manifestations of chronic disease.  The role of adequate perfusion in supporting wound healing had already been drilled into us.  Our shock was the fact that he didn't recognize this. 
For me, his points brought a different clarity.  We all function in settings where 'clinical tasks' are often valued more than 'critical thinking'.  A dressing change is something that can be quantified.  And after you do 20 dressing changes a day, it is a skill that is easily mastered.  Not a day goes by when I am asked to recommend a topical treatment, when it is clear that the bandage won't fix the problem. 
While we are all experts at doing dressing changes, our clear value as WOC nurse clinicians comes from seeing the big picture, from seeing the topical treatment as a part of a larger plan of care.  Since the settings where we work value the 'dressing change' skill, it is easy to get pigeon-holed into that role. 
That is not to diminish the ability to accurately assess a wound and select a topical treatment that maintains wound bed moisture, contains the exudate, protects the wound from trauma and environmental contamination and supports autolytic debridement are not critical thinking and decision making skills worth touting.   But our value to the healthcare system comes from our ability to see the wound as part of a patient, and to critically analyze the wound history and characteristics as they fit into the patient's history and presentation.  I believe that it is this ability that distinguishes WOC nurse clinicians from others with less vigorous wound training focused exclusively on topical therapies.  Yes, many can be taught how to select and apply topical therapies.  But the future of healthcare reform will demand more. 
25 years ago, this guest lecturer obviously didn't have a clue to the critical thinking and problem solving skills the WOC nurse should bring to the team.  If he is still in practice, let's hope his opinion has changed and it is savvy WOC nurses who have changed his mind.

Thursday, May 01, 2014
National Nurses' Week begins each year on May 6th and ends on May 12th, Florence Nightingale's birthday.  It has been celebrated during this designated week since 1991.  The 2014 theme is Nurses: Leading the Way.
Nurses represent the largest single profession in the health care system, with more than 3 million registered nurses in the United States.  National Nurses Week is a time of year to reflect on the important contributions that nurses make to provide safe, high-quality health care.  Nurses are known to be patient advocates, acting fearlessly to protect the lives of those under their care. Most nurses didn't choose their careers because of the great hours, pay or working conditions.  National Nurses Week is an opportunity for all of us to reflect on why we entered the profession and why we choose to stay in the profession.
The theme is an appropriate one as nurses are leading the way in the delivery of quality care in a health care system undergoing huge transformation.  Health care delivery is evolving.  And today, more than ever, nurses are stepping out of their comfort zone, and are becoming innovators in this changing enviornment.  The Institute of Medicine's Future of Nursing report has called for the nursing profession to meet the call for leadership.  Nurses are the cornerstone of the public health infrastructure, promoting healthy lifestyles and educating communities on disease prevention and health promotion.
When nurse staffing levels increase, the risk of patient complications and length of hospital stays decrease, resulting in huge cost savings to the health care system. Nurses provide culturally and ethnically competent care and are educated to be sensistive to regional and community customs.  Nursing is a powerful profession because we each have the ability as individuals and as a group to make a difference in people's lives.  Let us celebrate our compassion, our creativity, and our competence and focus on all of the things that are great about this chosen profession.

Wednesday, April 02, 2014
April 13-19, 2014 has been designated as National WOC Nurse Week.  It is the one week of the year when we highlight the work of our speciaty practice.
This year's theme is Compassionate Care and Results.  The theme is fitting as our specialty practice combines kind, compassionate care that garners praise from patients, with clinical expertise, and this combination delivers improved clinical outcomes, lower costs and changed lives.
A recent study published in this Journal investigated how WOC nurses affect patient outcomes in the home health care setting.  Home care agencies with a WOC nurse, compared to agencies without a WOC nurse were:
       * Nearly twice as likely to have improvement in pressure ulcers
       * 20% more likely to have improvement in lower extremity ulcers
       * 40% more likely to have improvement in surgical wounds
       * 40% more likely to have improvement in urinary incontinence.
       * 14% more likely to have improvement in bowel incontinence.
Another study published in the Journal of Nursing Care Quality showed that nurse certification in wound care improved the reliability of pressure ulcer identification and staging, and the reliability of the National Database of Nursing Quality Indicators (NDNQI) Pressure Ulcer Indicator.
WOC nurses meet patient needs not usually provided by physician services or other health care providers.  Our specialization is based on intensive education, precepted clinical experiences and a rigorous independent certification process.  WOC nursing is one of the few specialties recognized by the American Nurses' Association, signifying that the scope and standards of practice adhere to the very high standards cultivated by the national society.
The goal of WOC Nurse Week is to spread the word and educate others about the work WOC nurses do every day for patients with wounds, ostomies and incontinence.  On this occasion, it is my pleasure to tell my colleagues that they are valued for their committment to WOC nursing excellence. Less than 20% of American nurses are board certified.  It takes persoanl dedication and persistence to achieve and maintain certification in our WOC nursing specialty.  Cheers to my hard-working colleagues!

Monday, March 03, 2014
In my current capacity, I do a lot of consulting in long term care facilities.  So as a result, I have not only brought my wound/ostomy expertise to the table, but also a knowledge of the federal regualtions that these facilities function under.  I have found myself meeting with state surveyors on a regular basis.  And through these encounters, I have been increasingly troubled with the way facilities are 'graded'.
I am sure that you are aware of the CMS Nursing Home Compare website, that gives consumers information on the caliber of a given nursing home.  These ratings are based on the annual state survey as well as data generated by the MDS.  While nursing homes have a general idea when their state survey will happen, surveyors show up unannounced and spend several days observing the care in the given facility.  Based on the observations of care and review of policies and documentation, certain scores or grades are given.
If you have ever been in a facility during a state survey, you will witness a very stressful enviornment.  Surveyors can be quite intimidating.  Staff are trying to be on their best behavior.  Despite that, there does seem to be a 'gotcha' mentality, and this is unfortunate.  We should all be trying to improve systems and processes of care.  We should all have the same goal.  The survey process should be one of education and support, not punishment and bullying.
I think about myself, imagining that I was looking to find a top-quality nursing home facility for an aging parent.  What would I want to know?  What factors would I use to judge the quality of a facility? And could I get the answers by looking at the website?  Right now, the answer is questionable.
For example, I cetainly would want to know that my parent would be safe and protected from abuse.  So is it useful to know that a facility could be sited for elder abuse simply because one of the staff is obserevd calling one of the residents by an endearing name such as "honey" or "dear?"  Yes, staff needs to be respectful of resisdents, and the use of endearing terms should be discouraged.  But does this really rise to the level of abuse?
And a recent survey cited a local facility for not providing a home-like environment simply because they had removed tablecloths from the dining room because of a safety concern.  Really?  When nursing homes are cited for what seems to be rather minor and insignificant issues, it makes the whole survey process a bit of a sham.  If no body can be perfect, and everyone gets cited for something, then how does one distinguish the good homes from the really bad ones?
I think state surveyors are well aware of the 'bad' nursing homes and the 'good' nursing homes, well before they ever walk in the door.  They know which facilities get regular complaints from residents and families.  They know which facilities have a steady turnover of staff and administration, a big red flag to quality issues.  They know which facilities smell of urine, stool and body odor.  They know facilities where residents look unkempt.  They know the facilities where the staff are in good spirits, working together as a team, and obviously enjoying the work they do.  None of these factors are ever reflected on the website.
So in this economic climate, where we are all working to do more with less, maybe we should step back and look at this whole regulatory process. As a taxpayer as well as a future purchaser of nursing home care,  I think there has to be a better way.
About the Author

Lee Ann Krapfl
Wound, Ostomy and Continence Nurse (1991 – present) at Mercy Medical Center in Dubuque, IA. Practices the full scope of wound, ostomy and continence care for adult and pediatric patients. Provides WOC nursing services in acute care, long term care, home care and outpatient settings. Has been an active member of the WOCN Society, most recently serving on the Council as the Chair of the Public Policy Committee.