Volume 43 Number 3
Ingenuity: out of necessity
Jenny Prentice
For referencing Prentice J. Ingenuity: out of necessity. WCET® Journal 2023;43(3):7.
DOI https://doi.org/10.33235/wcet.43.3.7
Historically, the universe is awash with examples of ingenuity; whether it be the capacity of animals to evolve and develop techniques to survive as their environment has changed or those that have emanated from human effort when faced with a dilemma. Helmstetter in terms of modern culture describes ingenuity as “...the creation of a solution to a dilemma or problem …and demonstrating novel or unusual approaches to achieve a solution”1. Resourcefulness, cleverness, inventiveness and originality are also other characteristics associated with ingenuity.
Ingenuity borne out of necessity is a common construct of articles within this issue of the WCET® Journal. Singh et al describe how during the COVID-19 pandemic they used video teleconferencing technology to overcome the barriers of distance, time zones and limited clinical sites to collaborate with the Wound Ostomy and Continence Nurses (WOCN) Society USA to develop and provide the first accredited international advanced wound, ostomy and continence education program to nurses in Vietnam and other Asian countries. The program, which was hosted via the Ho Chi Minh University School of Nursing and the University Medical Center, had 23 nurses who graduated in the specialty of wound, ostomy and continence nursing.
The difficulty in identifying skin changes that may lead to the development of a pressure injury in people with a darker pigment to their skin has long been acknowledged. In discussing the salient issues pertaining to skin assessment and identification of changes within the skin of patients with dark skin tones, Black et al refer to the emerging use of clinical visual detection technologies such as subepidermal moisture (SEM) assessment technology and long wave infrared technology (LWIT) as promising clinical technologies for early identification of skin changes before they are visible to the naked eye. Earlier detection and confirmation of subepidermal skin changes, it is proposed, will assist with avoidance of pressure injury development through earlier implementation of pressure injury preventative strategies and /or reduce the incidence of latent presentations with associated more extensive tissue damage in people with darker pigmented skin.
Karadağx et al, within their poignant case study, tell of the ingenuity of a 54-year-old Turkish shepherd, who because of cost constraints, washed and re-used his colostomy irrigation equipment for over 13 years. The circumstances leading to this unusual situation are explained, as are the secondary unintended cost savings achieved. Fundamentally, however, the authors explain the need to review health insurance and reimbursement process for ostomy equipment in Turkey so that people with ostomies are not disadvantaged and can safely use ostomy appliances as per manufacturers’ instructions.
In many low-income resource poor countries, local and readily available low-cost remedies for treating and healing wounds are out of necessity often the first choice of dressing. Coffee powder is one such resource. Coffee powder, which reportedly has antioxidant, antimicrobial and anti-inflammatory effects, has been used as a traditional method for treating wounds, particularly in Indonesia, for many years. Haesler reviews the current evidence on the use of topical coffee powder for facilitating wound healing in a variety of wound types. Which species of coffee bean, the process of applying coffee powder as a topical dressing and how coffee powder interacts with the wound bed are identified.
Ingenuity and adaptability are synonymous with wound, ostomy and continence nursing as we strive to provide best practice clinical care to achieve the best possible clinical outcomes with the resources available to us in the context of the person, their personal preferences, their medical conditions or clinical circumstances and their living environment.
Thank you all for continuing to use your passion, expertise and empathy to rise to these challenges with your ingenuity.
Best wishes to you all, Jenny.
独创性：因需而生
Jenny Prentice
DOI: https://doi.org/10.33235/wcet.43.3.7
回望历史进程，独创性无处不在；它是动物随环境变化而进化和发展出的生存技巧，也是人类面临困境时展现出的创造力。在现代文化方面，Helmstetter将独创性描述为“提出困境或问题的解决方案并展示实现解决方案的新方法或非常规方法”1。足智多谋、聪明机智、富于创造性和原创性也是与独创性相关的其他特征。
因需而生的独创性是本期WCET®期刊所发布文章的共同主题。Singh等人描述了在COVID-19大流行期间他们如何使用视频会议技术克服距离、时区和临床研究中心受限带来的障碍，与美国伤口、造口、失禁专科护士（WOCN）学会合作，为越南和其他亚洲国家的护士开发和提供首个获得国际认可的高级伤口、造口、失禁教育项目。该项目由胡志明市大学护理学院和大学医学中心主办，有23名毕业于伤口、造口、失禁护理专业的护士参与其中。
在深肤色患者中，难以识别可能导致压力性损伤的皮肤变化是长期以来的公认问题。在讨论与皮肤评估和深肤色患者的皮肤内变化识别相关的重要问题时，Black等人认为，要想在皮肤变化变得肉眼可见之前对其进行早期识别，新兴的临床可视化检测技术（如表皮下水分[SEM]评估技术和长波红外技术[LWIT]）是颇具前景的临床技术。有学者提出，早期检测和确认表皮下皮肤变化将有助于压力性损伤预防策略的早期实施，进而避免压力性损伤的发生，和/或降低深肤色人群中与更广泛的组织损伤相关的潜伏表现的发生率。
Karadağx等人进行的一项病例研究讲述了一名54 岁土耳其牧羊人的独创性，同时也令人感到酸楚，因为成本限制，他不断清洗并重复使用自己的结肠造口灌洗设备，持续时间超过13年。该研究解释了导致这种异常情况的原因，以及额外实现的非预期成本节约。然而，究其根本，作者解释了对土耳其造口设备的医疗保险和报销过程进行审查的需要，帮助造口患者脱离不利处境，并且可以根据制造商的说明安全使用造口器械。
在许多资源匮乏的低收入国家，出于需要，用于伤口治疗和愈合且现成可用的当地首选低成本疗法通常是敷料。咖啡粉就是此类资源之一。据报告，咖啡粉具有抗氧化、抗菌和抗炎作用，多年来一直用作治疗伤口的传统方法，特别是在印度尼西亚。Haesler回顾了当前与使用外用咖啡粉促进各类伤口愈合相关的证据。此外，还确定了咖啡豆的种类、使用咖啡粉作为外用敷料的过程以及咖啡粉与伤口床相互作用的方式。
独创性和适应性与伤口、造口、失禁护理密不可分，我们致力于提供最佳实践临床护理，以在考虑到患者状况、个人偏好、医学疾病或临床情况及其生活环境的情况下利用可用资源获得可能的最佳临床结局。
感谢您持续投入您的热情、专业知识和同理心，以独创性迎接这些挑战。
谨致问候，Jenny。
Author(s)
Jenny Prentice
PhD BN RN STN FAWMA
References
- Helmstetter M. A Story Of Human Ingenuity Crossing Decades. Michael Helmstetter https://www.forbes.com/sites/michaelhelmstetter/2021/07/06/a-story-of-human-ingenuity-crossing-decades/?sh=129f92403596
