From the Editor: Passion in Practice

    In a perfect world, the passion that directs our choices — in careers, in life partners — would maintain its intensity throughout our lives. The reality is that passion is tested. With not enough time in a day to complete our work-related tasks, let alone indulge in personal responsibilities and pleasures, the objective often seems to be, “Just get the job done” — passion trampled and forsaken by overfull schedules and distractions and uncertainties too numerous to mention.

    Guidelines and protocols play a dual role in our ability to nurture passion. They add to the complexity of to-do lists but they also ensure facility and government-imposed standards are met when passion/perfection falters. To maintain their effectiveness, guidelines undergo assessment and revision, reflecting reconsideration and new evidence of what constitutes best practice in the provision of care, the introduction of products, and the scrutiny of the legal/regulatory community in our continuously evolving sphere of medicine.

    One example is the National Pressure Ulcer Advisory Panel, which is examining the staging system currently utilized to assess pressure ulcers. Their recent meeting was a testament not only to the expertise helping to shape wound care but especially to the passion critical to providing that care. In the course of that meeting, guidelines and passion merged when George T. Rodeheaver, PhD, was presented the Kosiak Award for his dedicated efforts in the pressure ulcer arena. In his acceptance speech, Dr. Rodeheaver passionately addressed the audience regarding guideline implementation. It’s not that we don’t have guidelines in place, he said. They are enacted and continuously scrutinized and updated and facilities ratchet up protocols in response. The question is, however, whether the guidelines are followed at the bedside, especially where lesser skilled employees (those subject to the highest turnover) are administering care. It isn’t enough to say you have guidelines — there must be incentives and rewards for following them and for providing good care. Dr. Rodeheaver beseeched his listeners to find, one facility at a time if necessary, ways to instill the importance of putting guidelines into practice. Don’t become complacent and just say, “We have a 2-hour turning protocol.” Go into each room and ensure that, indeed, patients are being turned every 2 hours.

    This issue of Ostomy/Wound Management underscores this blending of guidelines with passion. In her article, “Computer-based Testing of the Braden Scale for Predicting Pressure Sore Risk,” Maklebust addresses the need for training and education regarding appropriate use of assessment tools. Simply following guidelines and obtaining a risk score does not ensure the risk score is accurate. Clinicians must be well trained — in this scenario, via a computer-based program on using the Braden Scale — to help ensure reliable results. McIsaac makes a similar point in “Managing Wound Outcomes.” When protocols are in place and carried out, outcomes improve substantially, which affects cost as well as quality of care. And an important sidebar: if clinicians see positive outcomes from their efforts, they most likely will feel good — yes, passionate — about their work.

    Some approaches do not lend themselves as easily as others to guidelines. As Duimel-Peeters notes in her article on massage, sometimes care is quite literally in the hands of the provider because research does not readily provide the information required to shape evidence-based care. One particular type of massage may prove effective in preventing pressure ulcers; the clinician must utilize knowledge and skill when implementing this therapy. However, as Russell’s article poignantly notes, one of the most important (and hardest to document) aspects of care is compassion. The clinician may need to be reminded because the patient (as exemplified in this month’s “Notes on Practice”) already knows: “It’s not just a wound.”

    The April issue of OWM traditionally is referred to as the “SAWC issue” because it publishes close to the Symposium on Advanced Wound Care. Conference attendees know about rekindling passion — the many educational sessions, the product presentations, the networking with colleagues and presenters renowned in the field of wound care, and the chance to enjoy the local sites provide the opportunity to re-energize and reaffirm the passion that makes them effective wound care clinicians. The premier wound care conference, the Symposium attracts wound care clinicians from all over the world. The give-and-take of ideas also enhances on-going international information sharing, such as OWM’s partnership with The Journal of Wound Care (UK). But as Dr. Rodeheaver noted, it isn’t enough to attend the conference or avail oneself of our educational programs and publications. The challenge is to go back to your facilities and put what you learned and what excited you into practice, despite demands on your time and the resistance to change you will encounter.

    Don’t simply see the Symposium as a way to earn your mandatory CEUs. Let the conference (and OWM, of course) keep you passionate about your work. This, in turn, will sustain our passion as reviewers and editors.