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 Welcome to the September/October issue of JWOCN, a magnificent source of up-to-date information to guide your evidence-based clinical practice. Wound articles focus on pressure injuries (PIs). Koloms, Cox, VanGilder and Edsberg provide a synopsis from a large cohort of United States acute care patients (N=296,014) examining the role incontinence plays in skin damage. A significantly higher proportion of incontinent patients had deep tissue and unstageable HAPIs with incontinence revealed as a notable risk factor for HAPI development.
Pittman, Otts, Riley and Mulekar​ used mixed-methods, participatory action research with key stakeholders to look at PI prevention practices, do a gap analysis for missed care, and develop a validated gap analysis instrument. Conducted in a large academic acute care hospital, they found substantial gaps in PI prevention and management practices and, importantly, developed a valid/reliable instrument and model for future studies. Seton, Hovan, Bogie, Murray, Wasil, and colleagues conducted a quality improvement project on PI prevention education in a unique setting: a Veterans Administration (VA) hospice unit. The use of their innovative interactive program with nursing staff resulted in significantly improved PI knowledge and practice, and they discussed the challenges of sustainability for hospice settings.
Ostomy-related articles target various aspects of the ostomate experience. Kittscha, Fairbrother, Bliokas, and Wilson conducted an integrative literature review on ostomy adjustment. The review of 25 sources revealed adjustment was associated with some demographic and operative factors but that the role of support groups in promoting well-being was not well explored. Further interventional studies seeking to test approaches supporting ostomy adjustment were lacking. Aykuz, Erdemir, and Ugurlu​ studied Turkish ostomy patients experiences of privacy challenges. Using a survey approach with 80 participants, they found ostomy patients reported physical and psychosocial problems with privacy and were concerned that personal information was not kept private, and that physical conditions in hospitals did not support privacy. McNichol, Markiewicz, Goldstine, and Nichols evaluated the effect of a manufacturer-provided postoperative ostomy care program. Using a cross-sectional design, they identified that ostomates who used the support program more frequently were more likely to contact a program representative with a problem like peristomal skin care challenges and benefitted from active engagement with the program. Gleba, Miller, Peck, and colleagues examined the concept of best-in-practice care for ostomy and continent diversion patients via patient and clinician perspectives of the UOAA Patient Bill of Rights. The researchers asked if the PBOR was being used and if participants believed it improved care. Study findings were interesting in that they supported that both groups believed the PBOR could improve care but there were discrepancies between patients and clinicians' views of the actual implementation of the PBOR components.
Continence care was addressed by Al Hasan, Neal-Herman, Norman, Zhao, and Carlson​ in their study about clean intermittent catheterization (CIC) and the impact of a patient support program on ED visits and hospitalizations within the first 30 days of using CIC. Patients who received the patient-centered chronic care self-management program had significantly less complications and better adherence to good CIC self-care practices. Other great articles address diabetic foot care and pyoderma gangrenosum management. JWOCN is again providing critical guidance informing your daily clinical practice. Take the time to check it out!!

​Your Deputy Editor

Janice M. Beitz

Interactive Evidence-Based Pressure Injury Education Program for Hospice Nursing: A Quality Improvement Approach

Seton, Jacinta M.; Hovan, Holly M.; Bogie, Kath M.; More

Journal of Wound, Ostomy and Continence Nursing. 49(5):428-435, September/October 2022.