What, you may wonder, is a wound, ostomy, continence, foot care nurse? Most people who ask what I do have had some type of experience with wound care, even if only an accidental cut, scrape or burn. Few know what an ostomy is, and since the title is so long, the continence and foot care are forgotten for the sake of time. In order to acquire my CWOCN and CFCN credentials, in addition to being a registered nurse, I needed a bachelor’s degree and to successfully complete a course of study from an accredited program that included clinical, hands-on hours. After passing the course, my competency was verified and certified by taking a WOC Nursing Board (or WOCNCB®) examination for each certification. This is how the public knows I have a high level of competency in these areas. WOCNCB® credentials are accredited by the Accreditation Board of Specialty Nursing Certification and the National Commission for Certifying Agencies. Physicians and other health care providers appreciate the expertise a wound, ostomy, continence and foot care nurse brings to patient care.
[See: 14 Things You Didn’t Know About Nurses.]
Types of Care
Wounds are generally classified as acute or chronic. An acute wound is a new wound, such as a surgical wound or a wound caused by trauma. As a wound care nurse, I recommend and initiate a treatment to promote timely wound healing. Chronic wounds are wounds that do not follow the normal wound-healing pattern. These wounds may be present a few weeks or even years. It is my role to assist in determining why the wound is not healing and to recommend a treatment to facilitate wound healing.
An ostomy refers to a surgically created opening in the body for the discharge of body wastes (stool or urine). A stoma (which is the Greek word for opening) is the actual end of the ureter or small or large bowel that can be seen protruding through the abdominal wall. The stoma varies in size but is easily concealed under clothing. A pouching system is placed over the stoma to contain the stool or urine. As an ostomy nurse, I educate patients on how to manage the pouching system and to adjust to the change in their bodies. I also help patients understand they can live a normal life with an ostomy. If there are problems later on with the pouching system, or any other concerns about the ostomy, I will help the patient find a solution.
Continence nursing involves evaluating why someone is having problems with incontinence. Continence nurses may assist the patient with bowel and bladder training and other nonsurgical, nonpharmacological interventions to reduce or eliminate incontinent episodes. It also involves management of skin issues that may result from incontinence. Continence nurses also help patients with constipation. When needed, the individual with bowel and bladder problems may be referred to a physician or advance practice continence nurse for further testing and medication.
The goal of foot care nursing is prevention of ulcers and amputations of the lower extremities. Individuals are evaluated for sensory changes, foot deformities, circulation, gait (how they walk), skin condition and footwear, as well as receiving toenail care if needed. As a foot care nurse, I teach patients how to care for their feet, check their feet and what problems to report to their doctor, podiatrist or foot care provider. Regular foot checks are important to the prevention of foot ulcers and amputation.
[See: 12 Questions to Ask Before Discharge.]
A Day in the Life
My day begins in a 267 bed acute care hospital at a computer, where I review the list of patients referred for wound, ostomy, continence and/or foot care consult and treatment. Each patient is unique, and by reviewing the chart, I gather information that will assist in making better decisions and recommendations about patient care. When I see the patient, I perform a detailed assessment of the patient, keeping in mind I am not just treating a condition, but a person. Additionally, I must keep in mind what the patient’s living situation, resources, insurance and support systems are, when making recommendations for treatment. Everyone is unique, and what may work for one patient may not work for another.
The wound care patients I have today include a woman with a cancer wound who is dying and needs a treatment that will be as painless as possible and help control the wound odor. The family member is upset and feels very badly that her mother also has a pressure ulcer. As a wound care nurse, I explain the skin is the largest organ of our body, and as we die, that organ, like other organs, can also fail. Failing skin may develop sores in spite of the most solicitous care. A palliative care consult is requested to help keep this patient as comfortable as possible until death.
Another patient was found at home after lying on the kitchen floor for several days. This patient has multiple pressure ulcers that require treatment, including some that need referral to surgery. Each wound is documented and treated. Orders are obtained from the attending physician at the hospital assigned to the patient. This patient will also need a dietitian consult for nutrition, which is important in wound healing, plus physical and occupational therapy to help with strengthening.
A new ostomy patient had emergency surgery for a perforated bowel. This patient has awakened from surgery to find a new colostomy on his abdomen, covered by a pouch. It is my privilege to teach this patient how to care for the ostomy, address fears and answer questions. My next ostomy patient is a young woman who found out she has colon cancer after battling Crohn’s disease since grade school. The patient knew she was getting the ostomy, and by the time she’s ready to leave the hospital, is asking about volunteering as a home visitor for other new ostomy patients.
There’s also a patient with a diabetic foot ulcer. Not only will I recommend the wound care treatment, but I’ll spend time teaching the patient what is needed to help heal this wound, and how to avoid developing another ulcer. I will debride (in other words, remove) the callous around the ulcer and initiate wound treatment. I’ll also make referrals to a diabetic nurse educator and dietitian, plus discuss referrals needed for discharge with the patient’s primary nurse and the patient.
Another patient has a fistula, an abnormal passageway from an organ to the skin. In this case, I manage the drainage and promote healing of the skin, which has been irritated by the drainage. Another patient is incontinent and has badly damaged skin, so I recommend treatment to help heal the dermatitis. Another patient has very bad constipation, and we discuss and plan a bowel regimen to help with regularity. The recommendations for this patient are discussed with the hospital physician as well.
Several patients with diabetes need nail care for long, deformed, thick nails. They do not have insurance that covers podiatry care. The nails are painful, and for at least one patient, it’s difficult to wear shoes and walk. I’m often teased about giving pedicures, but I remind patients and staff that I don’t have that license and don’t have nail polish!
In addition to seeing patients, I provide education to newly hired hospital staff in pressure ulcer prevention and wound care, provide assessment and teaching for patients in an outpatient ostomy clinic, participate in research, investigate and try new products, and write or revise policies and procedures. I also volunteer monthly with the local ostomy support group.
Every day in the life of a certified wound, ostomy, continence, foot care nurse is filled with wonderful patients, opportunities to improve the lives of others and new challenges. Successful patient outcomes are never the result of single health care provider’s efforts. Each day, I work with the patients and collaborate with other team members, such as physical and occupational therapists, registered dietitians, diabetic nurse educators, bedside nurses, physicians, surgeons, care managers and family members, to provide the best care and outcome for patients. As Helen Keller said: “When we do the best we can, we never know what miracle is wrought in our life, or in the life of another.” Often as a WOC nurse and foot care nurse, I am a witness to the small miracles taking place in the lives of the patients I am privileged to meet and serve, even if only for a brief period of time.
[See: Who’s Who at Your Doctor’s Office.]
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A Day in the Life of a Wound, Ostomy, Continence and Foot Care Nurse originally appeared on usnews.com
