My Scope of Practice: Learning and Sharing Skin Safety Knowledge
“It’s a beautiful thing when a career and a passion come together.” — Unknown
When she was a nursing student on clinical rotation on a medical-surgical unit at a local hospital, DeSales Foster, DNP, MSN, CWOCN, CRNP, GNP-BC (photo) cared for a patient who had just had an ileostomy. “She was scared, in pain, and expected to learn how to care for her new ileostomy and an abdominal wound and go home the next day,” Dr. Foster remembers. “I felt the patient needed more than I had to offer her. Education in this area consisted of a look at the product and a description of the surgery. The patient’s lived experience was not a part of the education, and I wanted to offer more.”
Dr. Foster was motivated to explore the possibilities; she eventually focused her practice on wound, ostomy, and continence (WOC) nursing. In 2002, she became a Certified Wound and Ostomy Care Nurse and 4 years later earned her Masters of Science in Nursing as an Adult Nurse Practitioner, both programs of LaSalle University (Philadelphia, PA).
In 2007, Dr. Foster began working at Riddle Hospital (Media, PA), part of the Main Line Health System. She accepted the position with the caveat she would be hired as a certified registered nurse practitioner (CRNP). “I was the first CRNP in the system in this specialized practice,” Dr. Foster says. “I had to create the position of CRNP by finding a collaborating physician and applying for credentialing and privileges at the hospital. My job requires me to have a close association with all staff, collaborate on patient care with all physicians, and teach new nurses and patient care technicians dermal defense for all of our patients. I work with the physical and respiratory therapy departments, case managers, nutritionists, and nurse managers. Even the transport team is involved — we all are committed to keeping our patients safe and taking responsibility for avoiding pressure ulcers. Wounds take minutes to prevent and months to heal. Our goal is to restore patients to an equal or higher than previous level of functioning during their stay.”
Dr. Foster also utilizes the team-centric approach with a system-wide dermal defense team and the hospital dermal defense team for monthly pressure ulcer prevalence studies. Staff from every unit is involved. “It is our duty to keep pressure ulcers from occurring in the hospital,” Dr. Foster says. “Our staff is well aware of this responsibility and document all pressure ulcers assessed on admission.” This effort has contributed to a record below the national average and benchmark. The hospital’s ICU received the Gold Beacon Award for Excellence in 2014, which Dr. Foster feels her ICU dermal team helped achieve through consistent prevention of ICU-acquired pressure ulcers. She also facilitates an ostomy support group that she has been running since 2007.
Dr. Foster feels fortunate — she has no barriers in providing superior care and every opportunity as a lifelong learner to grow and enhance her knowledge. Already a CWOCN, a CRNP in adult health (2006), and a CRNP in gerontology (2010), she completed her Doctor of Nursing Practice at Thomas Jefferson University (Philadelphia, PA) in 2013 and is currently studying at the University of Pennsylvania (Philadelphia, PA) to complete her studies as an Acute Adult Gerontology Nurse Practitioner.
Throughout her career, Dr. Foster has taken a special interest in aging and the geriatric population. She is a member of a system-wide work group for senior services with the mission to enhance and expand existing services for the senior population. One key part of her elder-focused interest is providing advice to improve the care of seniors through continuous product assessment. “Finding products and revising our formulary are key to this job,” Dr. Foster says. “All related products are reviewed by the dermal defense team before being sent to the value analysis committee for final review. No product is passed without CWOCN inspection.” Dr. Foster also takes the time to explain the product options to the patients and their rights in getting what they need. Dr. Foster believes it is very important for the patient to know as much as possible to be secure in the outcome. For example, using the correct continence care aid in the hospital leads to a more satisfied patient and is important to avoiding moisture-associated skin damage. “Some patients need to wear briefs to maintain dignity while in the hospital,” Dr. Foster says. “I make an effort to explain this to staff and to our senior population. Wound, ostomy, and continence care is very frightening — teaching nurses how to provide gentle care reduces anxiety and pain for patients and family.” Dr. Foster’s work has taught her humility, patience, and understanding, but she recognizes there is still much more to learn. She tells the young nurses she mentors to “Keep learning” — advice she herself follows as she navigates her scope of practice.
This article was not subject to the Ostomy Wound Management peer-review process.
