From the Editor: Making Good Choices
Congratulations. If you are reading this journal, you have achieved some measure of success. You established a career path, earned a clinical degree and/or certification, and added initials after your name. You are making a difference in the lives you touch. Plus, at your core you are most likely a person of hope, of expectation — someone who sees the injured body human as healable, someone who makes quality of life-affirming decisions.
Your journey was not without pause. Professional pursuits and provision of care require option assessments. It is safe to assume, given your status, your career choice was grounded in inherent interest and god-given and/or acquired talent and skill, carefully conceived, and judiciously executed with an eye to your priorities (stress versus rewards. Work versus family). This being Life and all, priorities and the choices on which they are based can change in an instant (see marriage, birth, downsizing). Yet despite the dynamics of the day-to-day, you plow ahead, seeking and giving the fulfillment that comes of synchronized head and heart. You make informed decisions. You feel good about what you do.
Your practice decisions, too, are evidence-based, allowing you to administer care with confidence in the outcomes. There are rules and protocols to follow, very Aristotelian and if/then-oriented but never cookie-cutter — that is, until a patient flouts “typical” and prescribed management does not achieve desired outcomes, a not-uncommon occurrence in wound care. Then the science of your calling yields to the art — individual clinician ingenuity and determination trumping literature. Some (disparagingly, fearfully) call this off-label usage. I prefer to think it allows proactive clinicians to weave a product’s potential into proof of its greater capabilities.
Some decisions are outright gambles —last-ditch, prayer-filled, do-no-harm efforts born of gut feelings and intuition, only tentatively connected to knowledge and experience —also known as determinedly “trying anything.” Sculpted from concern for your patient, such choices reflect your conviction in the power of healing. When outcomes are good, gratitude outweighs assuredness.
This issue of OWM is a testament to all manners of choice. It features several case studies in which clinicians of various levels of education and expertise facing challenging wound care dilemmas make decisions grounded in evidence, experience, resourcefulness, and compassion. For example, when a wound occurs within a wound — ie, the wound fistula described in the article by Reed et al — drainage management becomes a priority. What better than to suck away the problem? But science needed an assist from art; an approved approach to wound care was modified with good results. Meanwhile, larger clinical studies are needed to grow the evidence base for vacuuming wounds closed. Clinicians around the world will tell you vac-ing works but the jury still seems to be out as to exactly why, just as debate ebbs and flows — as exemplified in Letters to the Editor — over silver-containing products and product classification.
Pieper discusses the impact of chronic venous insufficiency and leg function on quality of life in HIV-positive injection drug users, providing additional clinical information regarding the long-term effects of patient lifestyle choice.
Leach notes that while venous ulceration is traditionally managed with compression, the addition of an herbal therapy — horsechestnut seed extract — can be a cost-effective way to enhance the effect of treatment. Is there a place for “natural” in technology-driven care?
Fleck’s examination of the ingredients contained in products that provide nutrition directly to the skin help justify choosing them to manage a difficult-to-treat disease.
Glenn examines treatment of a traumatic wound requiring debridement in an elderly patient. Concerns regarding at-risk skin in older patients limit treatment choices. Does that make it easier or harder to select appropriate products?
An interdisciplinary area of study — decision theory — examines how decisions are reached. Most information in this arena is concerned with identifying the best choice for the ideal decision-maker — ie, one who is fully informed, able to compute with perfect accuracy, and fully rational. Decision analysis, the practical application of the theory or how people should make decisions, searches for tools, methodologies, and software (decision support systems) to help people make better decisions. A related area of study attempts to describe what people will actually do. Such ivory tower thinking admittedly lends itself more to mathematics, statistics, economics, philosophy, management, and psychology and reminds the rest of us that some choices (and outcomes) are predictable — and some are not. When healing in a stalled wound is kick-started with a new management approach or a wound in an at-risk patient can be debrided safely, the going is easy. But what about decisions made in combat situations (“My Scope of Practice”), where knowing a certain product works doesn’t make it available? Or when providing the tiniest of patients “(Addressing the Pain”) necessary treatment further compromises their delicate skin?
That’s when Ostomy Wound Management and the Symposium on Advanced Wound Care (my annual good wishes for the Symposium to follow) can help, educating wound care clinicians so they can make educated choices. Whether decisions are firmly evidence-based or extensions thereof, OWM editors are humbled and proud to be the conduit for wound care information. Clinicians, no matter your status or setting, here are four professional choices for you: Keep reading, keep studying, keep publishing, and keep up the good work.
S an Antonio—historic
Y ‘all should come away euphoric
M ake the most of CEU-ing
P rograms, posters for the viewing
O ral abstracts, great exhibits
S cheduled time to network, kibbitz
I nformation from all sources
U niformly helpful courses
M ore ways to learn: sawc.net
For wound care facts they’re your best bet!
