Utilizing a systems approach to implement pressure ulcer prediction and prevention.

Efficient, effective patient care is an objective shared by all healthcare settings and systems. It is generally accepted that using national clinical guidelines facilitates pursuit of this objective. However, implementation of a guideline, or any process improvement activity, requires a systematic, collaborative approach from which new processes can be purposefully designed. This article reviews systems theory, presents the steps for process improvement using the Plan/Do/Check/Act cycle, and references a recent statewide quality improvement study conducted by the authors in collaboration with Stratis Health, a Minnesota Medical Peer Review Organization.

Examining threats to skin integrity.

Intact skin serves a vital role in maintaining homeostasis of the body and is regarded as the body's first line of defense against invading micro-organisms. The skin's barrier function can be jeopardized or threatened by several events: aging, dryness, bathing technique, activities of daily living, and soaps. In this paper, the authors review the structures of the skin that facilitate moisture retention and examine bathing practices that threaten the integrity of the skin. Finally, wound and skin care nurses, as well as generalist nurses, are encouraged to critically review the type of soap and the techniques used for bathing.

Principles and techniques in the use of convexity.

Expected outcomes for a correctly fitted ostomy prosthetic device include sustained, predictable wearing time, protection of the stoma from injury, and maintenance of peristomal skin integrity. To accomplish this, the pouching system must be properly sized and maintain continuous contact with the peristomal skin. Continuous contact is achieved when the faceplate provides a mirror image of the topography of the peristomal plane. Varying degrees of support and convexity of the faceplate are used to fit the unique characteristics of the patient's peristomal plane and stoma. Support can be absent, soft or firm. Convexity is some degree of outward curving of the faceplate. Characteristics of the stoma (i.e., flush, retracted, loop), peristomal plane (i.e., creases, hernia, scarring) and abdomen (i.e., flaccid, soft, or firm) may indicate the need for convexity. Potential problems include mucocutaneous separation, ischemia, laceration, erythema, ecchymosis, and pain if convexity is used inappropriately. Alternatives to convexity include the use of an ostomy belt or surgery. Ongoing, intermittent assessment of the prosthetic is essential to evaluate that the convexity and support have achieved the expected outcomes.

Hypergranulation tissue: a nontraumatic method of management.

Granulation tissue above the periwound area is usually considered an impediment to wound healing. Although there is very little in the literature regarding hypergranulation tissue, the fact that there are numerous treatments by various wound clinicians demonstrates the recognition of its presence as a clinical problem. The paucity of published information prompted the authors to design a study to collect objective data on a treatment method they had found useful in their practices. This article explores the issue of hypergranulation and offers a nontraumatic method of management. A prospective non-controlled correlational study was undertaken with ten patients and twelve wounds using a polyurethane foam dressing to reduce hypergranulation tissue. The results demonstrated a significant decrease in height of 2 mm of granulation tissue from initial measurements to measurements taken two weeks later (p < 0.01).

A comparison of an alcohol-based and a siloxane-based peri-wound skin protectant.

A report of a study which evaluated two products designed to protect the skin surrounding wounds.

Treatment objectives in chronic wound care.

Decision making in topical management of chronic wounds is complex and requires ongoing evaluation of the wound. Here are some useful approaches to managing simple and complex situations.

Innovative surgical procedures and stoma care in the future.

Innovative surgical procedures require particular attention to the technical, educational, and emotional issues. Patients need thorough education to understand surgical options, complications, and expected outcomes. Because of the new aspect of these procedures, patients and significant others may feel quite isolated from others. Recognizing behaviors which may indicate this problem and seeking opportunities to provide emotional support and role modeling from other patients are most therapeutic. The quest for continence provides the patient with alternatives to be cured of disease and avoid the need for an external appliance and an abdominal stoma.

Ileoanal reservoir: functional results and management.

Restorative proctocolectomy with ileoanal reservoir is an alternative to Brooke ileostomy. This study of 56 patients emphasizes functional results and management of the loop ileostomy, transient incontinence, frequency of bowel function, constipation, perianal skin, and psychosocial issues.