2012 Research Grant Recipients
Monday, August 13, 2012
Posted by: Becky Dryden
Sage Products, Inc. - WOCN Society CCI Research Grant for Incontinence Associated DermatitisGrant Recipient: Megan Anderson, BSN
Universal Pressure Ulcer Prevention Bundle with WOC Nurse Support
The development of pressure ulcers for critical care patients is significant, with rates ranging from 14% to 42%. Despite clinical guidelines, pressure ulcers continue to occur. A major issue is that adherence to guidelines is inconsistent. Factors affecting use of guidelines include length and complexity. Many hospital specific guidelines recommend referring patients to Wound Ostomy Continence (WOC) nurses for advanced intervention. The referral process is often dependent on the patient's risk and delays in referrals to WOC nurses are common. Nurses' lack of knowledge for prevention may indicate that different methods for supporting adherence to guidelines are important. This study will examine two distinct guidelines using a quasi-experimental, pre-post design with 200 subjects in each phase comparing nurse adherence to five pressure ulcer prevention interventions, the prevalence of pressure ulcers, and the degree of injury. The pre intervention phase focuses on a comprehensive guideline currently in place on three critical care units. This guideline is lengthy and includes 31 interventions, along with criteria for WOC nurse referral. The post-intervention phase examines a universal, pressure ulcer prevention bundle with proactive WOC nurse support. A bundle is a brief guideline consisting of five evidence-based interventions implemented regardless of patient risk supported by semi-weekly WOC nurse rounding, which is a change from the current WOC nurse referral based process. The purpose of the rounds is to prevent care delays, improve staff knowledge, and proactively identify patient needs. Analysis includes t-test for differences regarding guideline adherence and logistic and ordinal regression for examining the effects of the intervention on occurrence of pressure ulcers and degree of injury.Principal Investigator:
Megan Anderson has been employed as a CWOCN at North Memorial Medical Center in Robbinsdale, Minnesota for four years. North Memorial Medical Center is a Level I trauma Center. She is a graduate of Bethel University's Nursing Program, and Metropolitan State University WebWOC Program, both in St. Paul, Minnesota. Megan received her certification in foot and nail care in 2010. Her nursing background prior to WOC nursing is eight years in critical care where she continues to work in a casual part-time position.
Hollister, Inc. - WOCN Society CCI Research Grant on Positive Outcomes for the Ostomate
Grant Recipient: Janice M. Beitz, PhD, RN, CS, CNOR, CWOCN, CRNP, MAPWCA
Grant Title: Stomal and Peristomal Complications: Prioritizing Management Approaches in Adult Patients
Abstract: Stomal and peristomal complications are well described in the literature and recent research has addressed validation of definitions of these complications and suggested interventions. Previous research has explored incidence and prevalence of these complications in various kinds of ostomies but not explored outcomes of selected interventions. The proposed study is an exploratory mixed methods quantitative study with qualitative components based on previous research that seeks to answer these questions: How do expert WOC (Wound, Ostomy, Continence) nurse clinicians rate the appropriateness of proposed interventions for selected stomal and peristomal complications in adult patients? Based on expert clinical judgment, what intervention(s) work most effectively to manage selected stomal and peristomal complications in adult patients? Are there other approaches that have not been identified? A cross sectional quantitative descriptive design with qualitative components will be used. Following a small pilot testing of the researcher-designed instrumentation, a mailed survey will be sent to WOC nurse experts who self-identify as having ostomy certification and/or ostomy care expertise. A minimal sample size of 250 respondents will be sought. Summary statistics will be calculated, ratings of interventions' appropriateness will be analyzed, and prioritized rankings for interventions derived. Insights into the approaches plus the possible addition of new methods will be thematically analyzed using qualitative data reduction techniques. Results will be disseminated in the literature and at a prestigious national conference. The research outcomes have the potential to substantially improve the care of adults with fecal and urinary diversions and to generate the science base for future WOC nursing.
Principal Investigator: Dr. Janice M. Beitz is Professor of Nursing and Co-Director of the Wound, Ostomy, Continence Nursing Education Program (WOCNEP) at La Salle University School of Nursing and Health Sciences in Philadelphia, Pennsylvania. Dr. Beitz has over 40 years of nursing experience in acute and sub-acute, and outpatient care settings. She is a graduate of the Germantown Hospital School of Nursing and La Salle, Villanova, and Temple Universities. She is board certified as a CNS in medical-surgical nursing, as a CNOR, as a WOC nurse, and as an adult CRNP. Dr. Beitz has won several professional awards including the Nurse of Distinction and President’s Award of the Northeast Region of the WOCN Society and, in April 2012, was awarded the Master of Wound Care Award of the American Professional Wound Care Association. She has conducted multiple funded research studies
Molnlycke Health Care - WOCN
Society CCI Research Grant on Critically Colonized/Infected Chronic Wounds
Grant Recipient:Ying-Ling Jao, MSN, BSN
The Measurement of Weight-bearing Activity and Activity-associated Pain in Persons with Prior Diabetic Foot Ulcers Abstract:
Weight-bearing activity is a major modifiable factor and may play an important role on foot ulceration in diabetes. However, studies have shown conflicting results and the underpinning mechanism of weight-bearing activity is poorly understood because it has not been evaluated using appropriate measures. Pain is prevalent in diabetic patients but often overlooked. Aims of the study are to: 1) examine the validity and feasibility of using a three-dimensional activity monitor to measure weight-bearing activity in people with prior diabetic foot ulcer (DFU), and 2) compare the difference in activity-associated pain levels between individuals with and without prior infected DFU. A prospective, descriptive design will be employed. Subjects will be recruited from a large study of DFUs. Target sample size is 30 subjects: 15 subjects with prior DFU infection and 15 subjects without. Subjects will be asked to wear an activity monitor (ActiGraph) and attend a 30-minute activity session to perform six different activities. Data on total steps, total standing hours, and total walking hours of each activity will be collected from directed observation and the ActiGraph. Then subjects will be asked to wear an ActiGraph for 14 days and receive three telephone interviews. Through the interviews, data will be collected on: 1) complications associated ActiGraph use, and 2) foot pain levels. The Coefficient of Variance (CV) between data collected from the ActiGraph and directed observation will be calculated to indicate the validity. Descriptive statistics on patterns of activity and monitor use will be summarized to indicate the feasibility of using ActiGraph for weight-bearing activity measure. Finally, repeated measure ANOVAs will be used to determine whether foot pain levels in different weight-bearing situations are different between infection and non-infection groups. Principal Investigator:
Ying-Ling Jao is a PhD candidate at the University of Iowa, College of Nursing, Iowa City. She received her BSN from Taiwan, and MSN in the adult and greontological nurse practitioner program from the University of Iowa. Dr. Sue Gardner, an associate professor at the University of Iowa, is Ying-Ling's mentor and also the co-investigator in this project. Ying-Ling has been actively working with Dr. Gardner’s diabetic foot ulcer research team for more than four years.
Sage Products, Inc. - WOCN
Society CCI Research Grant for Heel Pressure Grant Recipient:Natasha Miller, BSN, RN
Incidence of Hospital Acquired Pressure Ulcer Development and the Association with Nutritional StatusAbstract:
Nutrient intake is predictive of pressure ulcer development. However, accurate patient screening and assessment is difficult in the clinical setting, with nutritional status evaluation especially problematic. The twofold purpose of this research project is to: a) determine the extent to which the Braden nutrition subscore and other nutrition screening parameters collected in a clinical environment are predictive of pressure ulcer development; and b) determine the extent to which these same parameters predict the development of heel and sacral ulcers. The proposed study will use matched case-control design to evaluate the Braden nutrition subscale and the selected nutrition factors not included in the Braden (body mass index, weight loss, and nutrient intake) on pressure ulcer development. Records of patients admitted to the facility in 2011 that developed pressure ulcers and a comparable control group admitted in the same year that did not develop a pressure ulcer will be used to gather data. Patient unit and characteristics (gender and age) of the control group will be proportional and comparable to the pressure ulcer group. Comparison of clinical data retrieved from pressure ulcer and electronic medical record databases will enable reliable and valid evaluation of data. These available records provide a unique opportunity to evaluate accuracy of clinical data to predict pressure ulcer development. Logistic regression will determine variables predictive of pressure ulcer development. Separate logistic regression analysis will be conducted for development of heel and sacral ulcers.Principal Investigator:
Natasha Miller is a CWOCN practicing in the acute care setting at Penn State Milton S. Hershey Medical Center in Hershey, Pennsylvania. Natasha received her BSN from Messiah College in Grantham, Pennsylvania, and is currently enrolled in the Adult Gerontology Clinical Nurse Specialist program at Penn State University. She has been certified as a CWOCN by WOCNCB since January 2011. She has particular interest in the reduction of hospital-acquired pressure ulcers.
Society's Member Research Grant Grant Recipient: Lynn D. Mohr, MS
Adolescent Perspectives Following Ostomy Surgery: A Grounded Theory StudyAbstract:
Adolescence is a time of rapid growth and these changes can often make the adolescent very self-conscious, sensitive, and worried about their own body changes. For adolescents with an ostomy, the self-consciousness and sensitivity concerning their body is heightened. Much of the available literature centers on adult experiences with ostomies, while very little information is available regarding adolescents experiences. The purpose of this study is to describe adolescent (13-18 years of age) experiences in the early post-operative period following ostomy surgery from the adolescent perspective. Using qualitative grounded theory methodology, study participants will be adolescents between the ages of 13-18 years of age will be sought. A semi structured interview guide will be used to guide an interview lasting 45-60 minutes. Interviews will be coded to identify core categories or main concerns for this population. The resultant core categories will provide the beginnings of a theoretical framework about the adolescent’s experiences and assists in answering how adolescents resolve or work thru the experience of ostomy surgery. Further this study information is significant because understanding the adolescent perspective will assist the WOCN nurse in providing care in the preoperative and post-operative period and in the development of educational materials, and ostomy appliances specific to adolescents.Principal Investigator:
Lynn D. Mohr received her diploma from St. Luke's' School of Nursing in Cedar Rapids, Iowa; a BS from South Dakota State University in Brookings; and a MS degree in nursing from the University of Kansas in Kansas City, Kansas. She currently is a PhD student at Rush University College of Nursing in Chicago, Illinois. Lynn is a certified pediatric clinical nurse specialist and pediatric nurse with over 30 years experience working with children and their families. She is the past national president for the Society of Pediatric Nursing. Lynn has just completed her WOCN educational program, and her practice focuses on wound, ostomy, and continence issues in pediatrics.
Regenesis Biomedical - WOCN Society CCI Research Grant for Unsatisfactorily Healing WoundsGrant Recipient: Cheryl S. Postlewaite, MSN, RN
Comparison of Patient Experience With Wound Healing and Functional Outcomes After Cesarean SectionAbstract:
Patient centered care is an expanding area of research. No studies to date compare the wound healing experience and outcomes of obese women to non-obese women after cesarean section. Obesity is an independent risk factor for cesarean delivery and development of wound complications in post-cesarean women. Other obese populations report tearing sensations, pain and difficulty with activities of daily living after abdominal surgery. The incidence of wound complications after cesarean delivery reported in the literature varies widely; possibly because most wound issues arise after discharge and are managed in outpatient settings. The combination of wound outcomes with patient report on functional status and pain after delivery is a new way to look at the care of this surgical population. It is posited that the obese women will experience more wound drainage, more wound complications, more pain with movement, lower body image, and greater difficulty with activities of daily living and child care than women who are not obese. This new knowledge could lay a foundation for the development of new ways to prevent complications and manage the care of the new mother with obesity. This topic is important because the incidence of obesity is rising and obesity related complications represent significant burdens both to the patient, the new family and to the economy at large. If the aims of the project are successful, there will be a better understanding of the impact of obesity on wound healing, functional status and pain after surgical delivery. Without this foundation, it is difficult to develop strategies to prevent wound complications in obese women following C-section. The ultimate goal is to contribute to reduced healthcare costs and improved patient outcomes in this sizeable but under-studied population.Principal Investigator:
Cheryl S. Postlewaite received her MSN from the University of North Carolina at Greensboro, and has over 25 years of nursing experience in a variety of roles. Cheryl is a certified WOC nurse practicing at Mission Hospital in Asheville, North Carolina. She is currently balancing clinical practice, research, and pursuit of her PhD at East Tennessee University in Johnson City, Tennessee.
Research Grant: Bard, Inc. - WOCN Society CCI Research Grant Fecal Incontinence
Grant Recipient:Angela L. Stokes, MSN, RN, CWOCN, CFCN
Grant Title: Identifying the Prevalence and Associated Factors of Fecal Incontinence in the Acute and Critical Care Settings
Abstract: Fecal incontinence (FI) is an ongoing concern in the acute care setting. The purpose of this study is to examine the prevalence and associated factors of fecal incontinence in the acute care setting across multiple hospitals in a local community. The actual prevalence of FI is unidentified in this setting. An expanded knowledge gained from this study will help lead health care workers to recognize the under reported symptom of FI and its associated factors so that individualized treatment plans can be implemented. There is limited evidence that studies the prevalence and associated factors of fecal incontinence in the acute care setting. There is a need to study the prevalence of FI in order to identify the patients who suffer with this symptom. This research will be a descriptive cross-sectional study. There will be two prevalence studies completed three months apart at seven local hospitals. The sample size will include all patients in medical-surgical, telemetry, acute inpatient rehabilitation and critical care units. Descriptive statistical analysis will be performed. This study will be performed during the third and fourth quarters in 2012. By identifying the actual prevalence of fecal incontinence in the acute care setting, nurses will become aware of how great an impact this symptom has on patients. Identifying the presence of associated factors of fecal incontinence will allow the staff nurses to implement interventions earlier in the plan of care. The Wound Ostomy Continence (WOC) nurse is in a position to provide education and counseling to address reversal or elimination of the associated factors of fecal incontinence.
Principal Investigator: Angela L. Stokes has been employed at the Truman Medical Center in Kansas City, Missouri, for 18 years, the last six years as the wound care nurse. She obtained a tri-certification (CWOCN) in September 2009, and obtained Foot and Nail certification (CFCN) in March 2012. Angela is currently the Secretary/Treasurer for the local Kansas City Wound, Ostomy, Continence Society (WOCN) Midwest regional affiliate, and is on the planning committee for the Continence Track for WOCN Society's National Conference.