Successfully managing incontinence-related irritant dermatitis across the lifespan.

The management of irritant dermatitis caused by incontinence is not always an easy patient care problem to solve. A brief review of the literature demonstrated that irritant dermatitis from body fluids is either not an issue in the healthcare arena or that only a few individuals have recognized it as a healthcare concern. Many products are used to treat this type of dermatitis, yet this can be a very challenging problem for the clinician and painful problem for the patient. It is imperative for healthcare providers to be aware of the effects of stool and urine on the skin, how products interact with body waste, and how to manage this problem properly.

A comparative study of an alternating air mattress for the prevention of pressure ulcers in surgical patients.

Research indicates that 8.5% of all patients undergoing surgical procedures for more than 3 hours develop pressure ulcers. In some types of surgery, incidence rates in excess of 25% have been reported. An 11-month study was conducted on the safety and efficacy of an experimental alternating air device in comparison with a tertiary care facility's conventional practice. A series of 217 patients undergoing surgical procedures scheduled for a minimum of 3 hours were enrolled. No ulcers developed in the experimental group and 11 ulcers developed in seven patients in the control group (8.75% incidence rate). Of the 11 ulcers, one was Stage I, four were Stage II, and six were unstageable secondary to eschar. The difference between the groups is significant at the P = 0.005 level. Individuals who developed ulcers had a length of stay approximately 7 days longer than the hospital average for comparable patients who did not develop ulcers.

Intraoperatively acquired pressure ulcer prevalence: a national study.

OBJECTIVE: This study was completed to determine the prevalence and identify comorbid conditions for intraoperatively acquired pressure ulcers. DESIGN: A multisite, descriptive study was conducted. SETTING AND SUBJECTS: A multisite sample population of patients from 33 of 50 states undergoing a surgical procedure of at least 3 hours' duration was studied. INSTRUMENTS: A Hospital Background Data Form and a Patient Data Form were constructed to collect demographic data and information pertinent to surgically acquired pressure ulcerations. The Weighted Index Comorbidity Scale was incorporated into the Patient Data Form. METHODS: Institutional and patient data forms were mailed to 1543 members of WOCN who practiced in an acute care facility. Each member was asked to collect data on those patients who had surgeries of 3 hours or longer during a period of 1 week. MAIN OUTCOME MEASURES: Patient and facility characteristics, visual observations of the patient's skin over a 72-hour period after surgery, and the Weighted Index Comorbidity Scale were used to determine the prevalence of surgically acquired pressure ulcers and the presence of relevant comorbid conditions. RESULTS: An analysis of 104 returned facility surveys including 1128 patients was completed. The prevalence of pressure ulceration among this group was 8.5%. Forty percent of those surveyed underwent a procedure lasting approximately 3 hours and 33% underwent surgery lasting more than 5 hours. As the length of surgery increased, so did the percentage of patients with pressure ulcers. Most patients had at least 1 comorbid condition (78%). CONCLUSIONS: The risk of intraoperative ulcerations increases as surgical time increases. Although patients with comorbid conditions known to affect the risk of ulceration under normal circumstances experienced pressure ulcers in this investigation, no significant relationship was found to link the presence of these conditions to an increased risk of intraoperatively acquired ulcers. Therefore all surgical patients undergoing prolonged procedures should be considered at risk for intraoperative ulceration.

Latex allergy and the WOC nurse: a review of the literature.

The WOC nurse is familiar with products used to manage skin care. Latex sensitivity and allergy is becoming epidemic in the United States and is being studied by the Centers for Disease Control and Prevention (CDC) because of its life-threatening consequences. Education and prevention from further exposure must be addressed by health care workers. With the wealth of information on manufactures and their products, and a basic understanding of cellular immunology, the WOC nurse can facilitate the move toward either a latex-free or latex-safe environment for patients and health care staff.

Oral care and its role in WOC nursing.

The impact of nutritional status and the ability of the patient to fight infection directly are related to the practice of the WOC nurse, who is well versed in the care of the body's integument with respect to patients with ostomies, wounds, tubes, and incontinence. The status of the patient's oral cavity and its relationship with nutrition and wound healing have not; however been adequately addressed by WOC nurses. Involvement of the WOC nurse in preventive and therapeutic oral care can ensure a healthier gastrointestinal tract, improved nutritional status, and improved outcomes in caring for the person with a wound ostomy, or incontinence. This article reviews the literature related to oral care and discusses its relevance to WOC nursing practice.

Comparison of programs for preventing drug-nutrient interactions in hospitalized patients.

Three programs with different levels of pharmacist intervention designed to prevent drug-nutrient interactions (DNIs) were studied. Six drugs were selected for the study on the basis of their potential for involvement in significant DNIs and the hospital's drug-use profile. During a two-week control phase, the existing pharmacy system, in which no patient-specific information on DNIs is provided, was assessed. During the next four weeks, patients were randomly assigned to intervention 1, placement of a brightly colored label in the medication drawer and on the cover of the nursing medication card flip-chart, or to intervention 2, placement of the labels plus a five-minute structured patient-counseling session. Occurrence of DNIs and nurses' and patients' knowledge of DNIs were assessed. A DNI was defined as potentially altered drug absorption due to inappropriate timing or administration of a drug in relation to food. The occurrence of DNIs decreased significantly under the label system (from 24% to 19%) and under the combined label-counseling system (to 16%). However, the frequency of DNIs did not differ significantly between the two intervention groups. Patients' and nurses' knowledge of DNIs improved as a result of the interventions. The frequency of DNIs decreased when labels were used to alert nurses to proper medication timing.

A descriptive study of the career mobility of ET nurses.

A qualitative study of the career mobility of ET nurses in the United States was conducted. Self-report questionnaires and demographic data sheets were mailed to a sample of 117 ET nurses, and the return response was 54.3%. Members of the study sample ranged in age from 29 to 58 years, and the range of duration of practice as an ET nurse was 1.5 to 18 years. The current positions of the respondents varied from staff nurse in a non-ET nurse role to director of marketing or education for manufacturers of wound, ostomy, and incontinence products. Practice sites were evenly distributed between industry and clinical. Analysis of self-report questionnaires and telephone interviews identified 30 themes, which were reassessed for similarities and condensed to eight themes. These include consequences of the experience of being an ET nurse, precipitating event that resulted in a career change, ET nursing as a demarcation in practice, perception as currently practicing as an ET nurse, career mobility, feelings regarding ET nursing experiences, self-directedness in professional growth, and trajectory from clinical nursing to the business world.

Dermatological management of Kaposi sarcoma.

Kaposi sarcoma (KS) is a chronic wound care problem for health care providers. Management of KS includes topical, intralesional, and systemic treatment modalities. The type of treatment used for KS depends on the classification of the disease which can be classical KS, African or endemic KS, iatrogenic immunosuppression KS, and epidemic or AIDS KS.

Investigation of the Knoll Assessment Scale in a tertiary care facility.

The purpose of this study was to assist in assessing the validity and reliability of adaptation of the Knoll Tool, Assessment of Pressure Ulcer Potential. Data were retrospectively collected from charts of a random sample of patients (n = 62) who were admitted to a tertiary care facility. Total risk scores ranged from 0 to 22 with a mean of 8.7 and a standard deviation of 6.37. The alpha for the total assessment tool was .6352 with a standardized item alpha of .5973. Discriminant analysis predicted group membership at 62.9%. Group membership was most accurately predicted in Group 1 (76.9%). Discriminant analysis using a score of 11 predicted only 46.8% of group membership, although Group 1 predicted 88.5% and Group 4 predicted 85.7%. Low predictions may be related to small sample size.

A retrospective study of the use of specialty beds in the medical and surgical intensive care units of a tertiary care facility.

A retrospective chart audit of 55 patients placed on specialty beds in the medical and surgical intensive care units of a tertiary care hospital during 1989 was performed to establish criteria for placement on specialty beds. A modified Knoll Assessment of Pressure Ulcer Potential tool was used to determine which risk factors were common among the patients. Mean total risk scores was 21.15 with a standard deviation of 4.74. Significant correlations were found between seven of the eight risk factors and the total risk score. A high total score on the modified Knoll tool indicates a need for placement on specialty beds.