Editorial Opinion: Qualifying the Use of “Only” in Your Job Description

Whether your practice or research is focused on wound or ostomy or skin or continence (or any combination of the aforementioned) care, chances are you find it difficult to describe the many aspects of your work. More often than not, listeners hearing you describe your specialty think your responsibilities mostly consist of applying dressings, pouches, ointments, or containment devices. Even if product application was the “only” aspect of your job, it involves a great deal more than acquiring a physical skills set. Regardless of your professional background, our codes of ethics require us to provide competent, evidence-based care.^1-3 This, in turn, involves staying up-to-date on the literature and scientific developments, which requires a fundamental understanding of research, research designs, the principles of evidence-based practice, evidence and available guideline appraisal, and how to decide whether a change in practice is needed. Such knowledge and skill applies not only to whatever product you are using, but also to the assessment and decision-making process that informs your choices. 

And this is not your “only” job. Prevention and other aspects of care such as patient and caregiver education are key components of wound, ostomy, skin, and continence management. These also need to be evidence-based, and the study designs used to evaluate the effectiveness of care components can be drastically different from those needed to evaluate the effectiveness of a treatment. 

The original research in this issue of OWM illustrates the breadth of practice issues and types of evidence we must consider. Ae and colleagues discuss a common complication of long-term gastrostomy tube placement: the development of hypergranulation tissue. Because traditional chemical cautery of these tissues can be painful and cause other complications, the authors tried a topical corticosteroid for 4 days.  This case study effectively raises the question: Why is chemical cautery the most commonly used treatment for hypergranulation tissue? What is the evidence for this and is there another, more effective, less painful, option?  

In another case study, Dettmers and colleagues describe the development of a protocol for using negative pressure wound therapy with instillation to avoid the surgical removal of orthopedic implants after the wounds became infected. Although rare, the seriousness of these complications warrants research to help clinicians improve the evidence base of managing these wounds. This case study illustrates how clinicians faced with real-world problems may have to improvise and hope for the best.  

On the other side of the research spectrum, Chen and colleagues conducted a meta-analysis of available literature to evaluate the predictive validity of the Braden Scale for pressure ulcer risk in long-term care. They conclude that, even though the scale has been widely tested and is valid and reliable, it may not be optimal for use in long-term care. 

Risk assessment is only one, albeit very important, step in the process of pressure ulcer prevention. We know nursing staff education has a positive impact on overall pressure ulcer knowledge and incidence rates. What has not been previously studied/determined is whether educating certified nursing assistants may improve skin assessment and documentation and reduce the rate of facility-acquired pressure ulcers. These findings, the result of Wogamon’s quality improvement project, also described in this issue of OWM, suggest we still have a great deal to learn about how to maximize the effect of the evidence available for use. 

This issue of OWM can help explain what you do without having to dance around the “only.” Next time someone asks, try this response: I interpret available research to prevent and manage wound, ostomy, skin, or continence problems based on the best evidence available while figuring out ways to manage common conditions better or uncommon problems as best I can. Then again, in our scope of practice, “only” can be used as a positive perception. Webster’s defines only as “alone in kind, not like another.” There certainly is no other field of health care with as many unique day-to-day challenges… or opportunities. 

References

1. American Nurses Association (2015). Code of ethics for nurses with interpretive statements. Available at: 

www.nursingworld.org/codeofethics. Accessed August 23, 2016.

2. American Medical Association. AMA Principles of Medical Ethics. Available at: https://download.ama-assn.org/resources/doc/code-medical-ethics/principles-of-medical-ethics-20160627.pdf. Accessed August 13, 2016.

3. American Physical Therapy Association. Code of Ethics for Physical Therapists. Available at: www.apta.org/uploadedFiles/APTAorg/About_Us/Policies/HOD/Ethics/CodeofEthics.pdf. Accessed August 13, 2016.

This article was not subject to the Ostomy Wound Management peer-review process.