Janice M. Beitz

Concept mapping. Navigating the learning process.

Critical thinking, meaningful learning, and concept synthesis are key phrases pervading nursing literature as educators strive to promote optimal learning and improve clinical instruction and problem solving across levels of nursing education. Concept mapping offers a state-of-the-art metacognitive approach to achievement of these important goals. The author explores concept mapping from the perspective of cognitive theory, analyzes its strengths and drawbacks, presents examples of various concept maps and graphic organizers, and suggests pragmatic applications to nursing clinical, classroom, curriculum, and research situations.

Issues and challenges in staging of pressure ulcers.

Wound assessment is a key element of effective wound care, and assessment of pressure ulcers includes accurate determination of wound stage. Although the original staging system established by Shea was based on his understanding of the pathology involved in pressure ulcer development, subsequent staging systems (and the one currently in use) were intended simply to establish the level of tissue damage. Recently, clinicians have drawn attention to numerous limitations associated with the current staging system, including the inability to differentiate between an inflammatory response involving intact skin and a deep tissue injury (deep bruising) underneath intact skin. This is a clinically significant difference because clinicians have noted that most inflammatory responses resolve with intervention, whereas most areas of deep tissue injury progress to full-thickness ulcers even when appropriate intervention is provided. A second area of controversy involves partial-thickness (Stage 2) lesions; because many of these lesions are caused by maceration and/or friction (as opposed to pressure) clinicians are frequently unclear regarding which of these lesions should be staged. In response to these concerns, the National Pressure Ulcer Advisory Panel convened a consensus forum and published white papers to clearly outline the issues; they solicited clinician feedback on the white papers and the Wound, Ostomy, Continence Nurses Society provided a written response. This article summarizes the key points of the white papers, WOCN Society response, and consensus forum discussion.

Sexuality and the person with a stoma: implications for comprehensive WOC nursing practice.

Pelvic surgery for bladder, colon, prostate, and gynecologic cancers or disease amelioration can affect sexual health and functioning for the long-term or short-term. A person with a permanent diversion is likely to experience longer term adjustment challenges and may suffer from serious sexual dysfunction. Wound, ostomy, and continence nurses caring for the whole person must consider this in their overall care plan. Being prepared with specific information and practical interventions can assist in this endeavor. This article targets sexuality issues for a person with an ostomy and provides suggestions for comprehensive nursing interventions.

The lived experience of having an ileoanal reservoir: a phenomenologic study.

OBJECTIVE Ileoanal reservoir (IAR) surgery or ileal pouch anal anastomosis is a relatively new surgical technique for people with ulcerative colitis or familial adenomatous polyposis. Little attention has been given to the experiences of people undergoing the procedure. The purpose of this qualitative study was to understand the lived experience of persons who have had construction of an IAR. DESIGN The study was grounded in the phenomenologic approach of Van Manen to capture the lived experience of having an IAR as perceived by those persons in their everyday world. SETTING AND SUBJECTS A purposive sample of 10 individuals with direct and personal knowledge of the experience were interviewed in detail. Subjects were recruited by contact with an IAR support group and a local WOCN group. All interviews were conducted in a private setting in a health care facility, school, or the participants home. METHODS Data collection involved face-to-face interviews lasting from 1 to 2 hours. Interviews were audiotaped and transcribed. MAIN OUTCOME MEASURES Demographic data from the interviews were tabulated. Analyses of transcripts revealed 10 essential thematic categories with multiple theme clusters of the IAR experience related to lived body, time, space, and relationships. Analyses were completed by the researcher and a faculty mentor. RESULTS The particular thematic categories that evolved from the data were (1) restricted life world, (2) living with uncertainty and fear, (3) seeking control, (4) vicious cycles: crisis and normalcy, (5) seeking and giving support, (6) alienation from the body, (7) living with bodily alterations, (8) the gift of time, (9) role and relationship changes, and (10) the end of the tunnel but relative results. All 10 theme categories were correlated with a literature review and other sources. CONCLUSION The study provides a portrait of courage and survival for individuals experiencing major surgical interventions and bodily invasion associated with IAR after years of living with UC. Implications for nurses and health care personnel and questions for future research are presented.

Strategies for online teaching and learning: lessons learned.

Distance learning and Web-based learning are accepted components of the American higher educational system. Strategies for teaching and learning in this medium require a different perspective on the teacher-student relationship and the educational process. The authors describe an innovative online learning endeavor focusing on a specialty practice area in contemporary healthcare: wound, ostomy, and continence nursing. Special emphasis is placed on the teaching-learning approaches that were successfully incorporated into the program.

Abdominal wound with enterocutaneous fistula: a case study.

The care of an elderly male surgical patient with an enterocutaneous fistula located in an abdominal wound is described. The fistula is believed to have been related to multiple surgeries, wound dehiscence, and malnutrition. This article presents a brief overview of enterocutaneous fistulas and a pictorial demonstration of an alternative wound management technique that was used intermittently over several months to contain corrosive intestinal effluent until a commercial wound manager could be instituted.

The traditions and terminology of wound dressings: Food for thought

During the past 40 years, health care professionals have witnessed an evolution of wound care traditions and terminology and an explosion in the number of wound care products and the amount of information. Unfortunately, these developments have not resulted in optimal wound care for all patients. Appropriate dressing selection and communication are hampered by a lack of clinically valid definitions, as well as ambiguous indications, contraindications, and instructions for their use. One method of setting the stage for a more therapeutic future would be to classify dressings based on their functions rather than the ingredients they contain.

Specialty practice, advanced practice, and WOC nursing: current professional issues and future opportunities.

Interest in clarification of the role of the WOC nurse as a specialized or advanced practice practitioner is increasing. Although much has occurred to delineate practice parameters, lack of expectations for specialty versus advanced nursing practice still exists. This article will differentiate advanced, specialty, and WOC nursing practice by examining their legal definitions, educational requirements, licensure, certifications, and practice milieus. Implications for the future of WOC nursing are posed within the context of the evolving American health care system.

A program evaluation approach to drug administration education.

To evaluate the education of undergraduate nursing students in drug administration, the faculty of La Salle University School of Nursing structured a program evaluation plan using a curriculum map. Faculty track the cognitive, affective, and psychomotor skills involved in drug administration. For example, all clinical nursing courses and the pharmacology course contain dosage and intravenous solution calculations in didactic material and tests. Program evaluation of the outcomes of medication administration education is continuous throughout the curriculum.

Faculty practice in joint appointments: implications for nursing staff development.

Faculty joint appointments can capitalize on the talents and unique knowledge of nurses in varied settings. Altered role expectations, recurring emphases on cost control, and demands for accountability in the transforming health care system urge academic nursing faculty and clinically-based nurses to work together to achieve requisite health care and educational outcomes. This article addresses the types of faculty practice models, discusses three major role types of joint appointments, and presents the benefits and challenges of faculty functioning in joint appointments. Implications for nursing staff development are examined.