EDITORIAL

Context for WOC PracticeMikel Gray

Copyright © 2006 by the Wound, Ostomy and Continence Nurses Society J WOCN ■ September/October 2006 459

■ In This Issue of JWOCN

This issue of the Journal includes multiple arti-cles with a special focus on ostomy care and re-search. Susan Steele reviews existing researchand clinical knowledge of ostomies created asthe result of traumatic injury. She reviews themost common types of traumatic injuries thatresult in ostomy surgery and the Wound, Os-tomy, and Continence (WOC) nurse manage-ment of this specialized population. In additionto updating and refreshing your knowledgeabout traumatic injury and ostomies, you shouldread this article for insights into how theWOC nurse can most effectively interact withthe trauma team.

Vicky Haugen, Donna Bliss, and Kay Savik re-port on perioperative factors that influence long-term adjustment to an incontinent ostomy. Thisresearch report represents the first published re-port from a project funded by the WOCN Centerfor Clinical Investigation’s Small Grant Program.Haugen’s research team includes a statistician(Kay Savik) and a research mentor (Dr DonnaBliss), who now serves as the director of theCenter. Many of their findings are of particularinterest, including observations on the creationof ostomies by specialist surgeons, and how help-ful WOC nurse education was perceived to be bystudy participants following ostomy surgery.

Vera Lúcia Conceição de Gouveia Santos,Eliane Corrêa Chaves, and Miako Kimura also re-port on quality of life and coping strategies asso-ciated with temporary and permanent ostomies.Although both temporary and permanent os-tomy groups had similar quality of life scores,there were important differences in the copingskills used to manage life with an ostomy be-tween these patient groups. These differencesprovide valuable insights into the educationaland support needs of persons with temporaryversus permanent ostomies, a research need thatwas commented on by Steele in her review oftrauma and ostomy surgery.

Yuko Omura, Seki Kazuhara, and Oishi Kenjireport on a novel method to test the adhesiveproperties of skin barriers. This research reportrepresents a departure from the traditional re-search articles found in this journal. This is abasic science study, rather than a clinical researchproject, focusing on physical models constructedto test and compare skin barriers integrated intopouching systems. Commentary by Ostomy Sec-tion Editor, Barbara Hocevar, provides a cogentand persuasive argument as to why you shouldbecome familiar with this level of research. Thisarticle is an informative and thought-provokingaddition to this ostomy-focus issue.

Merilyn Annells examines a single aspect oflong-term adjustment to gastrointestinal ostomy,gas or flatus. She uses qualitative methods (her-meneutic phenomenology) to explore the livedexperiences of persons with fecal ostomies.However, in contrast to many phenomenologyresearch reports, she constructs a narrative illus-trating common lived experiences associatedwith involuntary passage of flatus, rather than direct quotes from study participants.

The two Clinical Challenges also focus onostomy issues. Molly Pierce uses a case study toillustrate management issues associated withdiversion of urine and stool into a sigmoidcolostomy, commonly called a wet colostomy.Michelle Rice and Jane Fellows then examine theuse of soft silicone foam for the treatment ofperistomal skin breakdown. In a commentarycovering both of these unique and novel cases,Ginger Salvadalena provides commentary sum-marizing existing, if incomplete, evidence sur-rounding both of these clinical scenarios.

■ WOUND CARE

Two articles in the Journal focus on wound care.Dr. Laura Bolton provides an Evidence-BasedReport Card that examines the safety and effi-cacy of silver products used to manage pressureulcers, venous ulcers, and diabetic foot ulcers.

J Wound Ostomy Continence Nurs. 2006;33(5):459-461.Published by Lippincott Williams & Wilkins

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PISH scores at 8 weeks in nursing home residents withstage II, III, and IV pressure ulcers who were randomizedto standard care, or standard care plus supplementationwith a concentrated, fortified collagen protein hydrolysatesupplement. Not surprisingly, subjects randomized to re-ceive the nutritional supplement showed approximatelytwice the rate of wound healing as did those randomizedto receive treatment without nutritional supplementation.

■ OSTOMY CARE

Is a 1-stage procedure feasible for selected patients undergo-ing restorative proctocolectomy, or is a temporary divertingileostomy needed to prevent septic complications? Remziand coworkers2 reviewed medical records of 277 selected pa-tients undergoing a 1-stage approach by comparing it withthose of 1725 patients who underwent an ileo-anal pouchanastomosis using a 2-stage procedure. Subjects undergoingthe 2-stage procedure tended to be older, heavier, and tak-ing higher doses of steroids than those selected for a 1-stageapproach. Nevertheless, when outcomes were compared, nodifferences emerged in the incidence of septic postoperativecomplications, or long-term quality or functional outcomes.Although this retrospective trial does not provide definitiveevidence that a 1-stage procedure is superior to a staged ap-proach, it does demonstrate the feasibility of this approachin carefully selected patients.

■ CONTINENCE CARE

Radiation therapy is associated with an increased risk forpostoperative fecal incontinence in patients who undergosurgery for colorectal cancer. To determine the impact of ra-diotherapy on pelvic floor muscle rehabilitation, Allgayerand associates3 compared results in a group of 41 patientswho underwent surgery for colorectal cancer with radiationtherapy with those of 54 subjects managed by surgeryalone. As expected, patients managed by surgery and radia-tion experienced more severe fecal incontinence and moresevere rectosigmoidal inflammation than those managedby surgery alone. Nevertheless, following a 3-week periodof intense, clinician directed pelvic floor muscle training,patients managed with radiotherapy achieved equivalentshort-and long-term treatment effects when compared withthose managed by surgery alone. The findings of this quasi-experimental trial are encouraging because they demon-strate that even patients with comparatively severe post-operative fecal incontinence and rectal urgency associatedwith rectosigmoidal inflammation can achieve significantimprovements in continence with pelvic floor muscletraining, a noninvasive intervention that forms the corner-stone of behavioral interventions.

■ References1. Lee SK, Posthauer ME, Dorner B, Redovian V, Maloney MJ.

Pressure ulcer healing with a concentrated, fortified, collagenprotein hydrolysate supplement: a randomized controlledtrial. Adv Skin Wound Care. 2006;19(2):92-96.

Her report provides essential insights into the existing evi-dence related to the ever-growing group of products seek-ing to incorporate silver ions in order to reduce woundbioburden in a variety of chronic wounds and the criticalissue of safety. It also serves as an ideal follow-up to theclassic integrative literature on silver products and woundbioburden authored by Nancy Tomaselli in the last issue ofthe Journal.

Dorothy Weir and Kathleen Farley report on an inves-tigation of ointment versus spray for delivering a prepara-tion of papain, urea, and chlorophyllin copper complexsodium to the wound bed. Data for their research, col-lected at the 2005 WOCN National Conference, have beenused to investigate both a physical model of a wound bedand results of a survey to determine WOC nurses’ impres-sions of the impact of delivery vehicle on the convenienceof product application by professional and lay care providersand the potential for product contamination with repeateduse. They also provide a pharmaco-economic evaluation ofprojected costs of a spray versus an ointment formulation.From overactive bladder drugs to wound care products, clini-cians and pharmacologists are becoming more and moreaware of the importance of the delivery vehicle in terms ofproduct efficacy and safety. Read this article to gain insightsinto the potential clinical implications of a spray versus anointment to deliver papain, urea, and chlorophyllin coppercomplex sodium to the wound bed.

■ CONTINENCE

Does privacy affect toileting in the acute, long-term care orhomecare settings? This question might seem irrelevant tomany physician colleagues, and even to some nurses in cer-tain specialty practices, but its importance is driven homeevery time a continence nurse must coax a patient to uri-nate in the urodynamic laboratory or a WOC nurse is calledon to manage constipation or fecal impaction in a patientwho is unable to defecate in an acute care setting. In a studyof 120 adults with fecal incontinence, Asangaedem Akpan,Margot Gosney, and James Barrett explore the impact ofcare setting and the level of dependence on privacy associ-ated with fecal elimination. In this era of increasing concernabout the privacy of medical information, this study con-fronts a seldom considered but critically important issuefacing patients (and particularly those with fecal inconti-nence) on a daily basis: How do we maximize privacy dur-ing defecation while maintaining safety for patients withimpaired mobility and dexterity?

■ Evidence from Other Publications

■ WOUND CARE

WOC nurses have long advocated the significance of nu-tritional assessment and intervention in order to facilitatechronic wound healing, but clinical evidence examiningthe influence of nutritional supplements on pressureulcer healing remains sparse. In the 2006 issue of Advancesin Skin and Wound Care, Lee and associates1 compared

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2. Remzi FH, Fazio VW, Gorgun E, Ooi BS, et al. The outcomeafter restorative proctocolectomy with or without defunction-ing ileostomy. Dis Colon Rectum. 2006;49(4):470-477.

3. Allgayer H, Dietrich CF, Rohde W, Koch GF, Tuschhoff T.Prospective comparison of short- and long-term effects of pelvic

floor exercise/biofeedback training in patients with fecal incon-tinence after surgery plus irradiation versus surgery alone forcolorectal cancer: clinical, functional and endoscopic/endosonographic findings. Scand J Gastroenterol. 2005;40(10):1168-1175.

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