Volume 44 Number 3
Shared expertise informing practice
Jenny Prentice
For referencing Prentice J. Shared expertise informing practice. WCET® Journal 2024;44(3):7.
DOI 10.33235/wcet.44.3.7
The forthcoming 2024 WCET® and Association Stoma Care Nurses (ASCN) UK joint Congress in Glasgow is another example of how the WCET’s® mission, “ to lead the global advancement of specialised professional nursing care for people with ostomy, wound or continence needs”1, is being met. Common benefits attributed to attending scholastic conferences are shared interests with likeminded committed colleagues from different backgrounds, different perspectives and diverse areas of expertise; networking and developing individual or cross-institutional collaborations or opportunities for mentorship; the acquisition of new knowledge or skills and exposure to new ideas, products or cutting technology2,3. And, to simply enjoy the experience.
The President and President Elect within their message ‘This is finally it!’ give an indication of some of the highlights to be experienced by attending the Congress and recognition of those who have shared their expertise over time.
A snippet of wisdom to inform clinical practice and assist with developing therapeutic patient relationships is provided by Smart in her Guest Editorial where she shares the importance of allowing patients to tell their story without interruption. Smart postulates that just two minutes of clinician’s time can facilitate building clinical trust, openness, adherence and acceptance of their situation.
The complex topic of immunosuppressants and wound healing is examined by Appoo et al in their literature review entitled ‘Examining the association of immunosuppressants and wound healing: a narrative review’. Classes of immunosuppressants including corticosteroids,calcineurin and mTOR inhibitors, monoclonal and polyclonal antibodies and antiproliferative agents and indications for use and effects on wound healing are identified. It is concluded the majority of immunosuppressants’ effects on wound healing are varied. Immunosuppressive therapies most cited to have detrimental effects on wound healing were corticosteroids and mechanistic target of rapamycin inhibitors. The necessity for early referral to specialists with expertise in wound management to review people with wounds receiving immunosuppressant therapy is emphasised.
Carter, in her case study, describes the challenges of managing a large lower limb haematoma that became a complex chronic wound in an elderly lady with memory loss who resides in a nursing home. Additional factors to overcome were the consumer’s behaviours impacting on the provision of clinical care and the limitations imposed by COVID-19. Carter describes the use of evidenced-based assessment and clinical decision-making frameworks to guide principles of wound management and choices of a silicone contact layer and non-adhesive foam dressing.
Evidence for the use of potassium permanganate (Condy’s crystals) in treating wounds and potato peel dressings for healing superficial burns in low- and middle-income countries is synthesised by Haesler. Although Condy’s crystals has been used since the 1850s for its antimicrobial and astringent properties in reducing wound exudate in various wounds and skin conditions, there is insufficient evidence to recommend the use of Condy’s crystals to promote wound healing. Similarly, there was a lack of evidence on the use of potato peel dressings to promote healing in burns. With both modalities a high level of bias was reported within the small number of studies reviewed.
Sharing our expertise with others to inform clinical practice is imperative to wound healing, maintenance of wounds where healing is not achievable and improved quality of life. In addition, the importance of reviewing the nomenclature, research and evidence-based practices around convexity in ostomy appliances, and their use in the immediate post-operative period to prevent peristomal skin complications, is highlighted in the Journal Supplement supported by Hollister and Dansac.
I look forward to shared experiences in Glasgow.
With kind regards
Jenny
共享专业知识,助力造口护理实践
Jenny Prentice
DOI: 10.33235/wcet.44.3.7
即将于2024年在格拉斯哥召开的WCET®与英国造口护理护士协会(ASCN)联合大会,是WCET®“引领造口、伤口、失禁的专科化职业化护理的全球发展”1这一使命的又一鲜活例证。参加学术会议,益处多多。在这里,你可以与来自不同背景、不同视角和不同专业领域的志同道合的同事分享彼此的兴趣爱好;建立联系,发展个人或跨机构合作,或获得指导机会;还能掌握新知识或技能,接触新理念、新产品或尖端技术2,3。当然,参会过程本身也充满乐趣。
大会主席和候任主席在致辞“这一刻终于到来!”中,为我们介绍了此次大会的诸多亮点,并对长期以来无私分享专业知识的人士致以衷心的感谢。
Smart在其特邀社论中,更是分享了一则临床实践的智慧宝典。他强调,让患者毫无干扰地讲述自身故事,对于发展和谐医患关系至关重要。Smart认为,临床医生只需花费短短两分钟时间,就能有力地促进临床信任、开放性、依从性的建立,同时也能促使患者更好地接受自身状况。
Appoo等人在一篇名为“探索免疫抑制剂与伤口愈合的关系:叙述性综述”的文献综述中探讨了免疫抑制剂与伤口愈合这一复杂主题。文中提到了皮质类固醇、钙调神经磷酸酶和mTOR抑制剂、单克隆和多克隆抗体及抗増殖剂等各类免疫抑制剂,并讨论了它们的使用适应症及其对伤口愈合的影响。结论指出,大多数免疫抑制剂对伤口愈合的影响呈现多样性。其中,皮质类固醇和雷帕霉素机械靶蛋白抑制剂被认为是最可能对伤口愈合产生不利影响的免疫抑制疗法。因此,文中强调了将接受免疫抑制剂治疗的伤口患者尽早转诊至伤口管理专家处进行复查的重要性。
Carter在其案例研究中描述了一位住在疗养院且患有记忆丧失的老年女性患者,其大面积下肢血肿演变成复杂慢性伤口时所面临的管理挑战。此外,需要克服的其他因素还包括消费者行为对临床护理的影响,以及COVID-19所带来的限制。Carter介绍了如何运用循证评估和临床决策框架来指导伤口管理原则,并且详细说明了选择硅胶接触层和非粘性泡沫敷料的方法。
Haesler综合了关于低收入和中等收入国家使用高锰酸钾(康迪晶体)治疗伤口以及土豆皮敷料治疗表皮烧伤的证据。尽管自19世纪50年代以来,康迪晶体因其抗菌和收敛特性被用于减少各种伤口和皮肤病的渗出液,但目前缺乏足够的证据建议使用康迪晶体促进伤口愈合。同样,关于土豆皮敷料促进烧伤愈合也缺乏证据。据报道,在所回顾的少量研究中,这两种治疗方法都存在较高水平的偏倚。
在造口护理领域,与他人分享专业知识,为临床实践提供参考,对于伤口愈合、无法愈合伤口的维护以及提高生活质量至关重要。此外,在Hollister和Dansac支持的期刊増刊中,还强调了回顾造口凸面装置的命名、研究和循证实践的重要性,以及在术后即刻使用造口装置以预防造口周围皮肤并发症的重要性。
期待在格拉斯哥与大家相聚,交流经验。
谨致问候
Jenny
Author(s)
Jenny Prentice
PhD BN RN STN FAWMA
References
- https://wcetn.org/page/MissionVisionandValues
- Hauss K. What are the social and scientific benefits of participating at academic conferences? Insights from a survey among doctoral students and postdocs in Germany. Res Eval. 2020 Aug 27:rvaa018. doi: 10.1093/reseval/rvaa018. PMCID: PMC7499794.
- Fisher JW, Trautner BW. Maximizing the Academic Conference Experience: Tips for Your Career Toolkit. J Grad Med Educ. 2022 Apr;14(2):144-148. doi: 10.4300/JGME-D-21-00943.1. Epub 2022 Apr 14. PMID: 35463162; PMCID: PMC9017252.