My Scope of Practice: Kindness in Wound Care

Kindness, I’ve discovered, is everything in life. — Isaac Bashevis Singer, 20th century Jewish-American author

Christine Berke, MSN, APRN-NP, CWOCN-AP, AGPCNP-BC, (photo) can attest to the fact kindness can go a long way. “Always offer a smile even when you really don’t feel like it,” she says. “People respond to kindness (even when they are not kind back)!”

After graduating from the University of Nebraska College of Nursing (Lincoln, NE) with her ADN in 1983 and BSN in 1985, Christine initially focused on MedSurg and then moved on to Acute Rehabilitation with a focus on Gerontology. While raising her children, she worked for the State of Nebraska as a nurse specialist, providing and later authorizing services for persons with developmental and chronic disabilities. While working with this population, she was introduced to the specialty of wound ostomy continence (WOC) nursing. “I was hooked,” she says. “I was usually the nurse that volunteered to take care of the patients with ostomies or difficult wounds. I didn’t know there was a specialty just for this type of nursing care.”

Her first job opportunity as a wound ostomy nurse came in 2001 when a friend told her about a WOC job opening in a rehabilitation facility. “It was my dream job,” she says. “Eventually I realized I wanted more control over my practice as a WOC nurse, so I went back to school and became a nurse practitioner, graduating in 2008. I have been board-certified as a WOC nurse since 2003 and became AP WOC-certified in 2012.” In 2008, Christine earned her MSN from the University of Nebraska Graduate Nursing Department.

Christine currently works as a NP WOC expert in a university/research setting. “I am the primary, full-time provider in the clinic,” she says. “My practice is 60% wound care and 40% ostomy-focused.” In this role, Christine’s responsibility is to help patients adjust and rehabilitate to their fullest potential — she is a counselor and educator for the persons she serves in her clinic. “I don’t heal wounds,” she says. “The patients’ bodies do. It’s my role to figure out why they aren’t healing and coach them back to health/healing.”

The autonomy of being a NP WOC is one of the most gratifying and challenging aspects of Christine’s job. She finds the lack of knowledge and inconsistencies among health care providers is the largest barrier when it comes to wound care. “Most physicians and nurses have had little to no formal education on the management/care of chronic wounds and ostomies,” she says. “Often the information they have received is incorrect or no longer valid. This leads many patients to fend for themselves. I spend a lot of time correcting misinformation. Patients often feel frustrated to find out what they have or have not been doing doesn’t really help them progress toward their desired outcome.”

To achieve her patients’ desired outcomes, Christine refers patients as needed for Physical or Occupational Therapy, social and/or counseling services, vascular surgery, bariatric care/management, diabetes management, and so on. “My practice is collaborative,” she says.

As Christine coaches her patients back to health, her personal time is spent reading medical journals and her Bible and lately several biographies to prepare for a planned pilgrimage to Poland in 2016 with her 4 youngest children. Christine’s first individual/primary manuscript was published in January 2015 in the Journal of Wound Ostomy Continence Nursing. “I am in the process of writing for publication on a newly described phenomenon of friction injuries of the buttocks,” she says. When asked if this is a common occurrence in her practice, Christine replied, “Yes and no. I think these wounds often are misdiagnosed as pressure ulcers and sometimes moisture-associated dermatitis. They have a distinctly different presentation and are typically located over nonbony prominences of the buttocks and thighs. I have to convince the wound world they exist and are different than pressure ulcers and MASD, especially now that the Centers for Medicare and Medicaid Services no longer reimburses for hospital-acquired pressure ulcers.”

“People are usually very resilient in the face of awful suffering and diseases,” Christine says. “We may not be able to remove that suffering, but we can help them cope/adjust. You must have a true passion for this work; it’s not for everyone.” At the end of the day, Christine finds WOC nursing to be one of the most rewarding niches in nursing. She wholeheartedly believes patience, a love of learning and educating, and kindness are pivotal in her scope of practice. 

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