The Wound, Ostomy and Continence Nurses Society

Research And Funding / 2008 Grant Recipients

2008 Research Grant Recipients

Research Grant: Attention to Detail. Attention to Life. TM Continence Care Leadership Program Research Grant supported by Hollister Incorporated and the WOCN Society

Grant Recipient: Joyce Pittman, BSN, MSB

Grant Title: An interventional study of bowel management systems on incontinence associated dermatitis

Abstract:
Brief Introduction/Significance: Fecal incontinence is a major cause of incontinence associated dermatitis (IAD) and is associated with pressure ulcer development. Gray (2007) reported that the prevalence of incontinence in the hospital setting has been estimated to be as high as 27%. Incontinence is also considered to be a factor in pressure ulcer development due to the compromise in skin integrity. Patients who have fecal incontinence are at an increased risk of developing IAD and secondary fungal infections.
Purpose/Aim: We propose to offer two methods of bowel management to control fecal incontinence and incontinence associated dermatitis (IAD) in the patient in the intensive care unit; 1) Bowel management system catheter (BMS); and 2) nasopharyngeal trumpet (NT) utilized as a fecal incontinence device. We propose to compare these interventions to the usual care (UC) given to patients with fecal incontinence in the intensive care unit.
Aim 1: We will compare the BMS group, the NT group, the UC group on the development of new or worsening incontinence associated dermatitis (IAD) and pressure ulcers.
Aim 2: We will compare the BMS group, NT group, and UC group on clinician satisfaction and ease of use.
Aim 3: We will describe the relationships between demographic, clinical characteristics, and IAD.
Aim 4: We will describe relationships between IAD and pressure ulcers.
Method Summary: The three interventions will be compared on the development and/or worsening of incontinence associate dermatitis (IAD) and pressure ulcers in a prospectively randomized intervention study with three groups; 1) BMS (Hollister Zassi Bowel Management System) group; 2) Rectal nasopharyngeal trumpet (NT); and 3) Usual care (UC) group.
Planned Statistics/Outcome: Descriptive statistics will be computed for all variables using central tendency indices, variability indices, and frequency distributions. We will compare demographic information at baseline between the groups using the t-test for continuous variables (describing with means and standard deviations) and using the Pearson chi-square test for categorical variables (describing with cross-classification tables). Multiple and linear regression will be done to describe associations and relationships between variables.
Implications: The need to find additional options for persistent fecal incontinence is crucial as the acuity of the patient increases and regulatory concerns reinforce the need for establishing best practice guidelines in the critical care areas. This study will add to the growing body of knowledge regarding best practice for those with persistent fecal incontinence in the intensive care unit.

Principal Investigator Bio: Joyce Pittman is an Advanced Practice Nurse (Family Nurse Practitioner) and a certified Wound, Ostomy, Continence (WOC) Nurse at Clarian Health and has over 28 years experience in clinical practice as a registered nurse and over 10 years experience in Wound, Ostomy, Continence nursing. Joyce has experience in the development of wound management programs in the acute, outpatient, and home health settings. She has also developed a continence outpatient program in collaboration with Physical Therapy focusing on bio feedback and nonsurgical management of incontinence. Most recently, Joyce has been practicing as a Nurse Practitioner/Wound, Ostomy Team in large Level I Trauma systems. In this role, she has been active as an advanced practice nurse practitioner specializing in wound, ostomy, continence conditions, focusing on complex wound management, prevention, health systems, staff training and collaboration with medical staff. Joyce has been involved in the development of policies and procedures, competencies, in-service programs, nurse sensitive indicator initiatives, contract development with skilled nursing facilities, product evaluation, and marketing strategies.

Joyce has received several awards such as the Aging Fellowship, Dr. Sherri Smith Grant, and WOCN Research Poster Merit award. Joyce is continuing her pursuit of excellence as she completes the PhD in Nursing program at Indiana University.

Joyce has been involved in research activities that include a retrospective study of post operative surgical dressings, a qualitative study of living with a chronic wound, a secondary analysis of veterans with an ostomy, and a on-going study that is exploring the demographic and clinical factors related to new stoma formation and the testing of a new instrument to identify risk factors of ostomy complications. Joyce and colleagues at Clarian Health have recently been awarded a grant that will enable them to compare bowel management methods to decrease incontinence associated dermatitis. Her practice and research is focused on the ultimate goal of improving the quality of life of those individuals with wound, ostomy, and continence issues and improving the quality of care provided in our healthcare systems.

Research Grant: 3M-WOCN Research Grant: Studies of Venous Leg Ulcers

Grant Recipient: Mary Shannon, MSN, CRNP, CWOCN

Grant Title: Risk factors for venous leg ulcer recurrence.

Abstract:
Brief Introduction/Significance: Recurring venous stasis ulcerations account for a large proportion of return visits to wound centers. This trend is identified in other settings as well, including home care and long term care, and can result in hospitalizations as well.
Purpose/Aim: The purpose of the study is to evaluate the reasons that patients develop recurrent venous ulcers after they have had appropriate treatments to heal previous ulcers and have been discharged with compression stockings with instructions on leg elevation as well as other lifestyle changes.
Method Summary: the patient will be identified when he/she schedules a return visit to the wound clinic. At that first visit, the patient will be given a questionnaire to fill out asking about a multitude of issues, including compression, leg elevation, and other changes in their medical condition.
Subjects and Settings: The participants will be patients who have been to one of our wound clinics located in the Western Pa region, and are returning with a recurrent venous ulcer.
Planned Statistics/Outcome: The data analysis will use logistical regression (or logit analysis); this will implement likelihood estimation for analyzing the relationship between the multiple independent variables and the dependent variable (leg ulcer recurrence). Results will be evaluated to see if there are any trends and commonality in behaviors in a significant way that suggests major reasons for recurrence.

Principal Investigator Bio: Mary Shannon is a Family Nurse Practitioner and CWOCN from the Western PA. She has been working in home health for 20 years, and while doing that, obtained her BSN from Slippery Rock University in 1990, then a masters degree from Carlow University in 2003. She obtained her CWOCN from Wicks Educational Associates in 2000, and worked in home care, then began working in long term care and outpatient clinics as a wound consultant. Currently she works for Penn North Wound Centers for Advanced Wound Care. She has participated in the regional WOCN chapter and helped on planning committees for the conference when it was held in Pittsburgh. She has mentored/precepted many other WOCNs from several schools. She has two grown children, and enjoys rural living with her husband of 35 years.

Advice to other WOCNs considering applying for grant money? Go for it! Get to your regional conference and allow yourself to be inspired! We are in such a unique position in that we have hands-on contact and interaction with so many of these patients that need our help, and we need to use that to gather data and find out what else we can do to improve the quality of life of our patients. There is nobody out there in wound care who can do what we do; we need to take advantage of it!

Research Grant: Sage Products – WOCN Grant for Perineal Skin Care

Grant Recipient: Mary Arnold Long, MSN, RN, CRRN, CWOCN

Grant Title: Incontinence-Associated Dermatitis in a Long Term Acute Care Facility.

Abstract:
Introduction/Significance: Many wounds classified as Stage I and Stage II pressure ulcers may actually be attributable to incontinence-associated dermatitis (IAD) and not to pressure. There are reports of IAD prevalence in both acute care and in nursing homes. However, there are no published reports regarding IAD in long term acute care (LTAC). In 2007, the Drake Center Advanced Wound Team performed a cross sectional pilot study among LTAC facility patients. The results from this pilot study suggested the need for additional investigation.
Purpose/Aim: This study has three specific aims: 1) Describe the prevalence of IAD and PUs. 2) Describe the nosocomial incidence of IAD and PUs. 3) Describe factors associated with development of IAD and PUs.
Method Summary: The study utilizes an observational repeated measured design. Data will be collected prospectively for twelve consecutive weeks on the LTAC units at Drake Center utilizing a modified Sage data collection form that incorporates components of Brown’s perineal dermatitis grading scale.
Planned Statistics: In Aim 1, the prevalence of IAD or PUs will be summarized by descriptive statistics of frequency. In Aim 2, the development of IAD or PUs will be assessed using a Kaplan-Meier survival curve. In Aim 3, two or more survival curves recognized by a risk factor will be assessed and compared using log-rank tests. Multiple Cox proportional hazard models will be used to assess the association of development of IAD or PUs to multiple risk factors and their interactions. Statistical analyses will be performed using a SAS version 9.1 software (SAS, Cary, NC) package. P-values <0.05 will be considered statistically significant.

Principal Investigator Bio: Mary Arnold-Long, MSN, RN, CRRN, CWOCN, ACNS-BC is certified by ANCC as an adult health clinical nurse specialist with additional certifications in rehabilitation nursing (by ARN) and in wound, ostomy & continence nursing (by WOCNCB).  Her MSN is from University of Cincinnati in Adult Health with a focus in Rehabilitation.  She has been a member of WOCN fourteen years and has practiced that long as a wound, ostomy, continence CNS.  She has practiced at Drake Center for seven years.  Mary has presented posters at national conferences and has presented on care of patients with wound, ostomy or continence needs across the United States.  She is currently a member of the WOCN National Conference Planning Committee and President of the Mideast Region WOCN.  Mary lives in Mason, OH with her husband, Richard.

  Mary encourages WOCN members to consider applying for CCI small grant funding.  She has received excellent advice & support from Donna Bliss to rewrite the initial study proposal.

Research Grant: WOCN Members’ Research Grant

Grant Recipient: Beth Helvig, MS, RN, CWOCN

Grant Title: The Use of High-frequency Ultrasound to Detect Heel Pressure Injury in Elders

Abstract: Pressure ulcers originate near the bone and progress in an outward direction (Quintavalle). Zulkowski found that 90% of a population of newly admitted long-term care patients had heel ultrasound changes consistent with injury, most in the absence of skin changes. Early identification of pressure ulcers is imperative to spare patients the consequences of injury; CMS regulations lend a financial incentive. This is a comparative descriptive study to evaluate high-frequency ultrasound and clinical findings over time to determine what relationships may exist between the two methods’ ability to identify the occurrence of heel pressure ulcers. Subjects are medical patients ≥65 years, with Braden ≤18, admitted to the hospital within the previous 72 hours and having at least 1 heel free of pressure ulcer per NPUAP staging. Consenting patients will have demographic and medical information collected, their lower extremities examined for sensory and circulatory changes, and heels assessed by ultrasound and visually. Every other day for up to 4 assessments the Braden score will be reevaluated and the heels will again be assessed via ultrasound and by clinical examination for NPUAP stageable injury. The research will continue until 100 patients have undergone a minimum of two research assessments, 2 days apart. Continuous data will be examined using histograms and tests for normalcy. Survival analysis, Analysis of Covariance with repeated measures, and other appropriate statistical measures will be used to assess the differences between the two detection methods and to predict the appearance of clinically detectable pressure ulcers over time.

Principal Investigator Bio: In 1972, while a student at Capital University in Columbus Ohio, I was introduced to the world of Burn Care and was hooked on the complexity of patients with wounds. I got my MSN from Texas Woman’s University, pursuing the Clinical Nurse Specialist role with a focus on burn care. As a Burn Care CNS I’ve worked at the Baltimore Regional Burn Center, UTMB and The Shriners Burns Hospital in Galveston, and the U of Washington Burn Center at Harborview in Seattle. 13 years ago, I attended Emory’s WOCN program, which enabled me to work with a wider range of trauma patients at HMC. In 2005 we moved to NY, where I am the Skin Care Clinical Nurse Specialist at Rochester General Hospital. As a Magnet Hospital, RGH has an active Nursing Research program, and it is as a Nursing Research Fellow that I have been given the opportunity to pursue this research question. A common challenge for a novice researcher is how to narrow a question to something manageable, and I’ve greatly appreciated the feedback from the CIC committee to help me focus my question. Thank you to the membership for supporting me in this quest.

I have grown as a person, caring for excellent clients and making life long friendships through being a part of WOCN.