Context for Practice: Impact of WOC Nurse in the Acute Care Setting

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This issue is packed with landmark articles, novel investigations into clinically relevant topics, and clinical studies that speak to your daily practice. I open this Context for Practice with a topic that continues to dominate conversations across the United States and beyond, “What is the impact of our specialty on patient outcomes, patient satisfaction, and costs?” The relevance of this question is apparent to any WOC nurse who has ever been asked to justify her or his position or proposed adding another WOC nurse to a facility of a health system in response to overwhelming patient need. Diane Boyle, Sandra Bergquist-Beringer, and Emily Cramer present findings from a study that evaluated the influence of certified WOC nurses on 2 facility-acquired conditions prevalent in the acute care setting, pressure injury, and catheter-associated urinary tract infection. This article qualifies as must read not only because it strengthens our steadily growing evidence base demonstrating WOC nurse impact in various care settings1,2 but also because it extends this line of investigation into the acute care setting, where most WOC nurses practice.
This issue's Continence Care section opens with a pair of articles examining an understudied and often undervalued aspect of continence management, the science of containment. As a clinician practicing in continence care and restoration for more than 35 years, I participate in the delivery of cutting-edge surgical, pharmacologic, and behavioral treatments for individuals with urinary or double urinary and fecal incontinence. However, even in the rarefied environment of a referral-based practice, I continue to recognize the essential (and often undervalued) role that containment plays in continence care. For some, it is a temporary means to contain urinary or fecal incontinence until more definitive procedures alleviate or eliminate incontinence. For others, containment is a primary means of continence management, and delivering education, care, and counseling to these individuals is no less important than preventing pressure injuries, teaching a person with a new ostomy to change a pouching system, or applying negative pressure therapy to a nonhealing wound. I strongly encourage you to read the 2 articles by Susanne Alenljung and her colleagues, Gunnar Hall, Ulla Forsgren-Brusk, and Heléne Widén, that explore the characteristics of odors associated with used absorptive incontinence products. While the science in these articles can be accurately described as “preclinical,” the implications are clearly relevant to clinical practice; specifically, how do we improve containment technology, protecting not only our patients' skin but also their dignity as human beings?
This issue's “Ostomy Care” section opens with what may be largest and most geographically diverse study of health-related quality of life among Chinese persons living with an ostomy ever published. Zhaohui Geng, Doris Howell, Honglian Xu, and Changrong Yuan report findings from a multiprovincial study of quality of life in Chinese individuals with ostomies. You will want to read their article to expand your knowledge of the effects of ostomy surgery on quality of life in different cultures and identify both the unique and shared factors their patients and others across the world face as they learn to assert the new normal following creation of an ostomy.
Janice Colwell, Laurie McNichol, and Joy Boarini report outcomes of a structured discussion among expert clinicians that spanned the breadth of 2 countries, the United States and Canada. Their study describes findings of clinicians' perceptions of the frequency of peristomal skin problems among their patients and its prevention and management. This descriptive study, which involved almost 800 ostomy nurses, may represent the largest cross-sectional sample ever to address current best practices for patients with peristomal skin issues.
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