My Scope of Practice: Seeking the Evidence Base for Care

Research is to see what everybody else has seen, and to think what nobody else has thought. Albert Szent-Gyorgyi, Nobel Prize in Physiology winner

  Maintaining the patient’s dignity is especially important when working in the wound, ostomy, and continence (WOC) field. Ivy Razmus, MSN, RN, an experienced WOC nurse, urges her colleagues to never forget they are dealing with people at a very vulnerable time and most private part of their lives.   Treating them with respect and maintaining their privacy continues to be of the utmost importance to this caring practitioner. Her determination to provide considerate care is underscored by her ongoing interest in education and research to increase the evidence base.

  Ivy attended Grand Valley State University (Allendale Charter Township, MI) where she received her BSN and later her MSN. After graduating, she worked as a nurse in a primarily pediatric setting. During the time she was a clinical manager of the Pediatric Intensive Care Unit at Saint Francis Hospital (Tulsa, OK), Ivy was involved in a research study with Martha Curley, PhD, RN, FAAN, on pressure ulcers in critically ill children at Boston Children’s Hospital, Children’s Hospital of Philadelphia (PA), and Saint Francis Hospital (Tulsa, OK). This study inspired Ivy to further her education, and ultimately helped direct her toward WOC education and practice. In 2009, she received her postgraduate certification from LaSalle University (Philadelphia, PA) in WOC nursing. Ivy was a seasoned nurse before she became a certified WOC nurse and found many of the skills she had learned throughout her career particularly applicable within the specialty. “The WOC field offers the right combination of patient interaction, critical thinking, leadership opportunities, patient advocacy, and collaboration among multiple disciplines,” she says. She adds, “And it is never too late to become a WOC nurse.”

  Ivy is now working toward a PhD at the University of Kansas (Kansas City, KS) in the School of Nursing and doing her dissertation on pressure ulcers in children in acute care. Ivy is confident her research and work toward her PhD will translate into better care for patients. “I hope to be involved in improving care at the bedside by utilizing best practice and by being involved in clinical research,” she says. “I would like to be a resource for gaining information through data collection and analysis or through literature review that would impact patient care positively. I am in the data analysis phase of my study and hope to be able to share this knowledge with other healthcare professionals in the future. Life outside of work involves working on my dissertation.”

  Although Ivy’s research isn’t complete, the influx of good, evidence-based studies in the arena continues to improve the specialty. “I think the amount of research that has been accomplished has transformed our practice,” she says. “Wound healing knowledge continues to grow, technologies for ostomy appliances continue to evolve. Knowledge about the etiology of a wound such as distinguishing between incontinence-associated dermatitis and pressure ulcers has changed the way we provide care and has improved care. There is still much more to learn, especially in younger populations and in home care.”

  Ivy continues, “Our practice as WOC nurses has an important leadership component. We drive the initiatives for pressure ulcer prevention, optimal skin management, and patient education. We are fortunate there is a foundation of research and evidence to help support decisions in product selection, patient education, staff education, and patient advocacy. Without evidence, it would be difficult to provide rationale for improvement in our health practice.”

  Ivy is most involved with pressure ulcer and continence-related skin breakdown and prevention at her current job and tries to incorporate the latest research into her care. “If there is a product that would benefit our patient population, I advocate for obtaining that product using evidence-based practice as my rationale. Recently, we used a cause map to determine why our length of stay was prolonged for some patients with wounds,” Ivy says. “Mapping out processes such as wound care can illuminate areas for improvement.”

  As a WOC nurse, Ivy is able to interact with many kinds of patients. She does pre-op site marking, sees the patients after surgery, and does discharge teaching. She performs pressure ulcer verifications and is involved in planning care for patients at risk for pressure ulcers. In addition, she is involved with patients with acute and chronic wounds in the hospital and helps plan care and processes with other wound care team members. In all of her responsibilities, Ivy employs the evidence-based research she and her colleagues work so hard to conduct. Continuing to be a resource for gaining information through data collection and analysis that positively impacts patient care has broadened Ivy’s scope of practice.

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