Sage, Inc. - WOCN Society CCI Research Grant for Incontinence Associated DermatitisGrant Recipients:
Donna Z. Bliss, PhD, RN, FAAN, FGSA (Co-PI) (top image)
Jennifer Hurlow, MSN, GNP, CWOCN (Co-PI) (bottom image)Grant Title:
Refining the Incontinence Associated Dermatitis and Its Severity Instrument to Include Dark-Toned Skin (IADS-D) and Testing Among WOC Nurses
Dermatitis is the most common physical complication of incontinence. Timely recognition and management of IAD can prevent worsening of its severity. The Incontinence Associated Dermatitis and its Severity (IADS) Instrument is the only instrument that has undergone psychometric testing by nursing staff, but its development focused on light-toned skin. There is a need for an instrument that can assess IAD on dark-toned skin. The aims of this study are to refine the Refine the Incontinence Associated Dermatitis and its Severity (IADS) Instrument to include assessment of IAD and its severity on darker-toned skin (IADS-D) and test its validity and reliability among wound, ostomy, and continence nurses. Photographs of IAD on light and dark skin will be evaluated for incorporation into the IADS. Case scenarios will be developed for testing the IADS-D. Clinical experts will determine the face and content validity of the revised instrument and review the case scenarios. Attendees at the 2012 WOCN Society national conference will test the IADS-D using the case scenarios. Their responses will be used in determining criterion validity and reliability of the instrument. Co-Principal Investigator (Top Image):
Dr. Donna Bliss is a Professor at the University of Minnesota, School of Nursing, in Minneapolis, MN, and holds the School of Nursing Foundation Professorship. Dr. Bliss is the current Director of the Center for Clinical Investigation of the WOCN Society. She has 20 years of research experience and funding and 75+ publications about incontinence and associated skin damage. She is currently funded by NINR, NIH, for 2 studies: (1) assessing ethnic and racial disparities in incontinence and skin damage in nursing home residents and (2) identifying the literacy and care needs of caregivers of individuals with dementia related to incontinence and skin damage. Co-Principal Investigator (Bottom Image):
Jennifer Hurlow is a Nurse Practitioner with Plastic Surgery Group of Memphis in Tennessee. She is a geriatric nurse practitioner who has worked in both primary care and in her specialty of wound ostomy and continence nursing. Jennifer Hurlow is an advanced practice nurse with more than 22 years of nursing experience, providing care in hospitals, nursing homes, home health, and in outpatient.
WOCN Society's Member Research Grant Grant Recipient:
Martha Davis Cobb, MS, RN, MEd, ACNS-BC, CWOCN
Colostomy Irrigation: Current Knowledge and Practice of WOC NursesAbstract:
In a recent study of colorectal cancer survivors with intestinal stomas, a question was included about irrigation practices. Findings from 101 respondents revealed 30% used irrigation. Most were patients who had surgery many years ago, and were older. Among those who did not irrigate, some reported they did not know what irrigation was and were interested in learning the technique. Based on these data, this study will explore what current WOC nurses practice in relation to colostomy irrigation.
Colostomy irrigation (CI) is a method to control ostomy output by emptying the bowels through instilling liquid into the large intestine through the stoma. Studies have illustrated that eligible patients who practice irrigation find it useful in achieving fecal continence, which may enhance quality of life. Additional literature includes descriptive studies on the positive impact of colostomy irrigation on quality of life, exploring what solutions to use for irrigation and methods to evaluate colonic emptying following irrigation. Positive and negative aspects have also been reported by patients, including improved bowel control, improved self-esteem, & diminished anxiety; they also reported time required, loss of flexibility, and technical demands.
As a follow up to these studies, there is a need to learn more about the current practices of WOC nurses in relation to teaching patients about CI. A one-time, online survey will be utilized to query WOC nurses regarding current knowledge and practice of WOC nurses in relation to colostomy irrigation.Principal Investigator:
Martha Davis Cobb received her BSN from the University of Arizona, and a MS degree in nursing from UCSF. She received a MEd from the UofA. Martha is a certified WOC nurse and has balanced her nursing practice of WOC care in acute care, along with ongoing education and clinical instruction for undergraduate students. She has served in leadership positions at the national and affiliate levels with WOCN Society. Martha's current nursing practice is focused on clinical research.
Hollister, Inc. – WOCN Society CCI Research Grant for Continuity of CareGrant Recipien
Linda M. Herrick, PhD, RNGrant Title:
WOC Nurse Perceptions of Problems Experienced by Ostomates with Shortened Length of Stay
This descriptive study will collect data from Wound, Ostomy, Continence (WOC) nurses regarding their perceptions of changes in practice and patient outcomes of patients who have undergone laparoscopic-assisted surgery resulting in a bowel ostomy. Laparoscopic techniques and evidence-based practices have reduced the length of stay from 7 to 10 days to approximately two days. Postoperative patient education related to ostomy care and life adjustments focuses primarily on the patient being able to empty the appliance. Preoperative teaching is often limited in referral centers due to an emphasis on next day surgery. The outcomes of reduced time on patient education and WOC nurse practice are unknown. While efforts are made to make referrals for home care and nursing homes, many patients are getting basic information and obtaining skills such as emptying and applying the appliance. Referrals are often completed for those patients with other health or ability issues than just a new ostomy. Needs for continuity of care are being identified for other patients. This study will focus on gathering information from WOC nurses using semi-structured interviews with WOC nurses at three sites of a major medical center to obtain their perceptions of patient complications, questions, and issues and changes in their practices. A review of WOC nurse medical record notes will be completed at one site with the largest number of WOC nurses. Notes related to post-discharge outpatient visits and phones will be abstracted for 6 months during the current year and for the corresponding 6 months 3 years prior. Data will be collected related the numbers of calls/visits, the number of different patients, and types of issues/questions, and resolution. The electronic medical record allows for review of records by provider. Analysis will include content analysis of interviews and descriptive data of record abstraction.Principal Investigator:
Dr. Linda M. Herrick, a Clinical Associate Professor at the University of Minnesota, School of Nursing, has served as nurse manager, administrator, and researcher at Mayo Clinic, Rochester, MN specializing in Gastroenterology and Hepatology and Colorectal Surgery. Her interest is effects of system changes on patient outcomes.
Dr. Herrick's research focuses on outcomes of changes in surgery and postoperative care resulting in shortened hospitalization. The Katharine J. Densford International Center for Nursing Leadership Clinical Scholar Program provided initial time to partner with clinical colleagues to pursue several studies in this area.
Molnlycke Health Care – WOCN Society CCI Research Grant for Critically Colonized/Infected Chronic Wounds Grant Recipient:
Teresa Kelechi, PhD, GCNS-BC, CWCNGrant Title:
A Physical Activity Intervention, MECALF, to Reduce Pain in Patients with Critically Colonized/Infected Chronic Leg UlcersAbstract:
Pain is prevalent in patients with chronic leg ulcers, and can be severe when ulcers are critically colonized/infected (CCI). These patients disproportionately suffer from functional impairments, specifically reduced ankle range of motion (AROM) and strength that limit physical activity (PA). Without physical activity (PA), function remains poor, pain persists, and wound healing or infection resolution is hindered. While PA can confer many benefits, patients with CCI ulcers and pain are unlikely to adhere. Motivation and self-efficacy play key roles.
To evaluate a Wound Ostomy and Continence (WOC) nurse directed, patient-centered intervention called MECALF: motivational enhancement (ME) and conditioning activity for leg function (CALF), in a sample of patients with CCI ulcers and pain who are receiving care in an outpatient wound clinic.
Does MECALF, delivered by WOC nurses during wound care visits in ~4 to 6 sessions, over 8 weeks, in addition to usual care (UC), reduce pain
- increasing motivation and self-efficacy about exercise and PA;
- performing "small-steps” exercises;
- improving function (ankle range of motion, strength; and,
- increasing physical activity (walking, day-to-day activities)
The aims of the study are: (1) train nurses to perform MECALF intervention; (2) design a pilot cluster randomized trial and test MECALF and UC at one wound clinic in 12 patients with CCI leg ulcers and pain and compare outcomes to a matched wound center where UC is provided to 12 patients; (3) track patient adherence and nurse fidelity to treatment; and, (4) measure study impact and expected outcomes (research questions 1–4) pre- and post intervention.
Means of the scores at baseline and follow-up and mean change from baseline to follow-up will be compared between groups using pooled t-tests (or Wilcoxon rank sum tests) and paired tests (or Wilcoxon Signed Rank tests). Principal Investigator:
Dr. Teresa Kelechi is an associate professor and department chair, College of Nursing, Medical University of South Carolina, Charleston, SC where she is a funded researcher on wound care prevention strategies. Specifically, she studies skin temperature and the use of cryotherapy (cooling wrap) to prevent venous leg ulcers. Most recently, Dr. Kelechi is studying the use of motivational enhancement techniques by WOC nurses to assist wound patients with increasing physical activity.
Regenesis Biomedical, Inc. – WOCN Society CCI Research Grant for Slow Healing Wounds Grant Recipient:
Joyce Pittman, PhD, RN, FNP-BC, CWOCN Grant Title:
Unavoidable Pressure Ulcers: Development and Testing of CriteriaAbstract:
Pressure ulcers cause pain, loss of function, infection, extended hospital stay and increased costs. Mortality rates are reported to be higher for pressure ulcer-related hospitalizations. In spite of advanced wound products, advanced support surfaces and prevention methods, pressure ulcer prevalence and incidence has continued to climb. This raises the question, are all pressure ulcers preventable or avoidable?
The purpose of this study is to: (1) develop a definition for hospital-acquired avoidable and unavoidable pressure ulcers; (2) develop an instrument to describe hospital-acquired avoidable and unavoidable pressure ulcers (Pressure Ulcer Inventory); and (3) examine the validity and reliability of the newly-developed instrument. Instrument development will follow the step-wise approach described by DeVellis.
Analyses will include: descriptive analyses presenting means, standard deviations, frequencies and percentages; ANOVA; Chi-square; and psychometric testing of the newly developed instrument. Braden's conceptual model for the etiology of pressure ulcers is the theoretical model used in this study.
This study's findings will provide a standard and consistent definition for identifying avoidable and unavoidable pressure ulcers. Important new knowledge regarding hospital-acquired pressure ulcers will be provided through this work. Principal Investigator:
Dr. Joyce Pittman is the Wound/Ostomy Team Leader and Nurse Practitioner at Indiana University Health in Indianapolis, Indiana. She has been in nursing for over 32 years and certified as a WOC nurse for more than 12 years. Dr. Pittman is active as an advanced practice nurse specializing in wound, ostomy, continence conditions and complex wound management, nurse sensitive outcomes, and pressure ulcer prevention. She completed her BSN at University of South Florida and MSN and PhD at Indiana University. Dr. Pittman’s areas of research have included chronic wounds, ostomy risk factors/complications, bowel management methods, and implementation of bowel management program in critical care.
Hollister, Inc. – WOCN Society CCI Research Grant for Patient Outcomes Grant Recipient:
Catherine Ratliff, PhD, APRN-BC, CWOCN, CFCNGrant Title:
What is the Frequency and Timing of Ostomy Leakage in the Community Setting?Abstract:
Few clinical research studies actually describe ostomy leakage by ostomates in the community. Additional research in this area could provide a better understanding of leakage problems to define gaps in the current educational process of the ostomate to proactively minimize leakage complications and improve the quality of life of the ostomates.
A predictable pouch wear time without leaking is important to maintain quality of life of the ostomate. Leakage and skin irritation have been shown to be a major cause of social isolation with the fear of leakage keeping ostomates from leaving their homes. The purpose of this study is to describe the frequency and timing of ostomy leakage for those discharged from a major medical center over a 2-year period with a discharge diagnosis of an ostomy using an investigator developed questionnaire. A convenience sample will be obtained using the ICD-9 codes for colostomy, ileostomy, and ileal conduit of patients that have been discharged from that facility within the past 2 years. Patients may be readmitted multiple times for other reasons than their ostomy but their ostomy could still be one of the top ICD-9 codes so demographic data regarding the date of their initial ostomy surgery will be obtained. The list is generated from the central data repository and is not a list generated by the WOC department, which will minimize bias. Some of the patients may or may not have seen an ostomy nurse on the recent admission. Descriptive statistics (frequencies, percentages, and means) will be used to describe the sample. Chi-square will be used to see if the groups, those that leak versus those that do not leak, differ on demographic and other variables.Principal Investigator:
Dr. Ratliff is an associate professor at the University of Virginia, School of Nursing where she is the program director for a Wound, Ostomy, Continence Program which, has been in existence over 10 years. She also is a nurse practitioner and runs a wound clinic at the University of Virginia Health System where she has done so for over 15 years. Dr. Ratliff is widely published in the field of wound, ostomy and continence care and has spoke on these topics at many national and international meetings.
Sage, Inc. – WOCN Society CCI Research Grant for Heel PressureGrant Recipient:
Shawneen Schmitt, MSN, MS, RN, CWOCN, CFCNGrant Title:
Effect of a Topical Antiseptic in Reducing Levels of Colonized Bacterial on Eschar and Healing Progress: A Pilot StudyAbstract:
Unrelieved pressure over a bony prominence such as the heel may develop overtime a protective black non-viable leather-like tissue called eschar. Research indicates not to debride dry stable eschar on heels but keep it intact especially if the individual’s foot has poor circulation and/or decreased sensation. Often the treatment is "painting" a topical antiseptic to reduce the colonized bacterial level and keep the eschar dry such as 10% Povidone-iodine (Betadine). Recently, a new practice has emerged using 0.5% Chlorhexidine Gluconate (CHG) in 70% isopropyl alcohol (IPA) (Chloroprep) to the eschar as being safer and more effective antiseptic than 10% Povidone-iodine. The study’s significance is that there is no clear scientific principle for an evidence base practice in treating heel pressure ulcers with eschar. The purposes of this pilot random control trial (RCT) study are to determine the efficacy in reducing colonized bacterial levels on heels with eschar by using 10% Povidone-iodine or 0.5% Chlorhexidine Gluconate (CHG) in 70% isopropyl alcohol (IPA) or simply wrapping the heel in dry gauze. This study will also evaluate the appropriateness in using the "Pressure Ulcer Scale for Healing" (PUSH) on wounds covered with dry eschar. For three consecutive days, the eschar in all three groups will be cleansed with 9% saline and sterile gauze, photographed, PUSH tool completed, wound culture done and one of the randomized interventions applied. Data analysis will be based on multivariate statistical tests including repeated analysis of variance and non-parametric testing on the PUSH tool data. One of the expected outcomes is that there will be no difference between the study groups, thereby, developing a wound care evidence-based practice that would be safe, simple and cost-effective. The other outcome is that the PUSH tool will not be an effective instrument to measure healing of wounds with eschar. Principal Investigator: Shawneen received her Bachelors Degree in Nursing from the University of Wisconsin-Milwaukee, as well as her Masters Degree in Administrative Leadership/Adult Education in 1977. She also completed her Masters Degree in Nursing from the University of Phoenix. Shawneen has maintained her certification by the WOCNCB in wound, ostomy and continence care since 2000, and her certification in foot and nail care since 2005. She is an active member of the Wound Ostomy Continence Nurses Society serving as chair of the Education Committee and elected to the Nomination Committee. Shawneen currently holds the position of CWOCN and CFCN Nurse Specialist at Froedtert Health-Community Memorial Hospital, Menomonee Falls, Wisconsin, and is the co-chair of their Research EBP Council.