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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.
Thursday, January 7, 2016
Wound care clinicinas would agree that support surfaces generally play a vital role in a comprehensive pressure ulcer prevention and treatment program.  And there is also agreement that clinicinas should have a method to monitor the effectiveness of the support surface.  A former recommendation for routine bedside monioting of support surfaces was to implement a 'hand check' to determine that the patient was not bottoming out.
 
The NPUAP recently drafted a group of clinicians to conduct a literature search to validate the hand-check as a method of performance evaluation.  Their result is a position statement published this year.  The actual statement is available following this link.
 
Support surfaces continue to improve.  Clinicians now have the availability of a wide variety of foam, air and gel surfaces in powered and non-powered versions to include overlay devices, mattress replacement systems and integrated bed systems.  Hand-checks, while being quick and easy, are not supported by the evidence as they are a subjectuve measurement, they create the potential for infection risks, they can cause shearing injury to fragile or moisture compromised skin, they can be affeceted by the patient's bed positioning and they have never been validated as a reliable test.
 
Certainly bedside methods to validate support surface effectiveness have not kept pace with advances in support surface technology.

Wednesday, November 4, 2015
This year marks the golden anniversary of the nurse practitioner.  50 yrs ago, a public health nurse and pediatrician established the first NP certificate program at the University of Colorado School of Nursing.  The program was designed to prepare pediatric nurses the skills and knowledge necessary to provide preventative services in an outpatient or office setting in collaboration with a physician.
 
During the 1960s, health care began its movement toward specialization.  Physicians were increasingly moving out of general practice and into the more profitable specialties.  This created huge gaps in primary care, preventive care and management of chronic disease states.  Nurse practitioners were considered to be the perfect 'gap-fillers'.  Today, the American Association of Nurse Practitioners reports 205,000 licensed NPs in the U.S. with 86% prepared to provide primary care services. 
 
By 1980, most states began requiring advanced graduate degrees for NPs.  Within the next 10 years, the US Congressional Office of Technology found that NP's provided care equivalent to that of physicians and were a common provider available in most health care facilities.
 
Nurses were able to demonstrate that they could quickly adapt to meeting the needs of their communities by functioning very effectively in their expanded roles.  Numerous studies support very high patient satisfaction with care delivered by NPs, and the quality of that care is consistently rated to be better than or equal to the care delivered by physicians.
 
In our specialty, many wound care nurses are beginning to recognize the autonomy and prescriptive authority provided to the advanced practice nurse to be a huge asset in the management of chronic wounds as well as management of the underlying chronic disease conditions.  Increasing numbers in our ranks are pursuing NP education and licensure.  I believe the day will come when NP education will be a minimum requirement to sit for the WOCN certification exam.
 
 

Wednesday, October 14, 2015
Americans say nurses have the highest honesty and ethical standards, according to the most recent Gallop poll.  For us, this is not news.  Nurses have topped this list each year since we were first included with the exception of 2011 when firefighters were included in response to their heroic effort during the 9/11 attacks.  But this is not information that we should take for granted.  The public is fickle and a few isolated incidents by a few bad apples spread by social media can ruin the public perception of an entire profession quite easily.
 
Physicians have not ranked as high as nurses, but their rankings have been higher than other non-healthcare professionals in business, law and politics.  The high rating for physicians last year is significant after the Ebola outbreak which infected a number of physicians both in the U.S. and in West Africa.
 
But this year, there have been a few very public situations that may impact the upcoming survey.  For example, a Virginia man under sedation for a colonoscopy, recorded an unflattering and insulting conversation between his anesthesiologist and his gastroenterologist.  Even though his medical care was deemed to be fine, he sued and won a sizable judgment for defamation, medical malpractice and punitive damages.  Currently in the news, there have been secretly recorded video tapes released that show physicians for Planned Parenthood discussing in very calloused and uncaring terms the retrieval of fetal tissue and organs for research, certainly an emotionally charged topic.  And then, the Annals of Internal Medicine published an essay written by doctors that detail some very lustful, even possibly criminal behavior by gynecologists in an effort to shine sunlight on the issue.  We can privately scorn these individuals as being unrepresentative of their professional colleagues.  Or we can look at the similarities and try to deem a message for ourselves.
 
Let's start by acknowledging that lighthearted joking and prankster behavior can be a vehicle to ease the tension of a stressful day or an emotionally charged clinical situation.  Let's also acknowledge that the public might not understand or appreciate the type of language or behavior that often takes place at the nurse' station or in the locker room, especially when taken out of context.  Yes, let's admit that if asked, we might also have unflattering and unprofessional stories we could anonymously tell an editor or journalist about the behavior of nursing colleagues.  But let us also accept that a high ranking for honesty and ethical standards comes with responsibility.  We cannot take this honor for granted.  Everyone today has a cell phone with a camera and a recording device.  Digital media makes it easy for a small, seemingly minor human error or lapse in judgment to go viral.  Remember that the whole world is watching.
 
 
 
 

Tuesday, September 1, 2015
THE UNITED OSTOMY ASSOCIATIONS OF AMERICA (UOAA) is declaring that October 3, 2015 be recognized as Ostomy Awareness Day 2015-Many Stories, One Voice. The aim of World Ostomy Day is to improve the rehabilitation of ostomates worldwide by bringing to the attention of the general public and the global community the needs and aspirations of ostomates.
 
I am certified in the full scope of WOC nursing practice.  Even so, the lion's share of my practice involves management of complex wounds.  That being said, my ostomy patients hold a very special place in my heart.  And I would be a very sad nurse if I couldn't care for ostomy patients.  They often face so many physicial, emotional and social hurdles.  And I feel the tremendous satisfaction of knowing that I made an impact in helping them to cope and fully rehabilitate.
 
So it is with gladness that I plan to celebrate with the UUOA and WOCN Society in recognizing Ostomy Awareness Day on October 3, 2015.  On this day, we commemorate individuals who have had this life saving surgery, and recognize the families and caregivers who function, often in silence, to offer their love, support, and physicial care.  We also need to think about all of health professionals who went before us in creating the various life enhancing surgical interventions, and the forerunners of enterostomal therapy, a specialty group focused on patient advocacy and improved quality of life for this patient population.  And lastly, we cannot forget to acknowledge our industry partners, who invest research and devlopment efforts to constantly improve the appliances and supplies that foster independence and security.
 
On this day, we are charged to spread the word about ostomy surgery and how this surgery can make a positive difference in the lives of our patients. With ONE VOICE, we can share our MANY STORIES of successful rehabilitation.

Wednesday, August 5, 2015
Recent legislation in many states mandates the use of Safe Patient Handling and Mobility devices which allow a patient to be moved while minimizing the strain and injury risk to the healthcare worker.  The success of these devices in reducing injuries greatly depends on the ease and availability of the equipment, specifically leaving the lift slings under the patient while in bed in order to be ready for immediate use.  This seems to fly in the face of what wound care clinicians constantly harp on, which is to minimize the number of layers between the patient and the therapeutic support surface in order to maximize pressure redistribution, manage tissue loads and micro-climate.  Keeping the lift sling in place may negatively impact tissue load and micro-climate, but may inversely facilitate easier and more consistent turning/repositioning while reducing friction and shear to the skin.
 
The National Pressure Ulcer Advisory Panel has recently issued a White Paper to increase critical thinking when lift slings are used in combination with therapeutic support surfaces.  This White Paper is available at this link.
 
 
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.