WOC Nurses Research Articles

Availability of Public Toilets in Parks and Recreational Sites in Selected US Cities.

The principal aim of this study was to map and describe the availability of parkland public toilets in major US cities per population and area. Observational and descriptive. Data were collected from the following cities: Austin, Texas; Minneapolis-St Paul (MSP), Minnesota; Nashville, Tennessee; New York City (NYC), New York; Philadelphia, Pennsylvania; San Francisco, California (SFC); Seattle, Washington; and Tampa, Florida. These cities are located throughout the United States. Data from the US Census and cities' parks/recreation departments about publicly owned and operated permanent toilet facilities were analyzed and then mapped using geographic information systems. Toilet density by population and residential area (mi) was calculated, and toilet distribution was visualized. When calculated per 100,000 residents, MSP had the most parkland public toilets with 24; Tampa, Seattle, and Philadelphia had 17 to 22; and Nashville, NYC, and SFC had the fewest, around 7 toilets. Parkland public toilet density per residential area was highest in NYC and Philadelphia (>2/mi), followed by MSP, Seattle, and SFC (1/mi), then Tampa, Austin, and Nashville (<1/mi). The proportion of Census tracts containing parkland public toilets was more than 0.4 in MSP, Seattle, Tampa, and Philadelphia, more than 0.20 in Nashville and Austin, and less than 0.20 in the other cities. Toilet mapping showed fairly even distribution across Census tracts in MSP, Seattle, Tampa, and Philadelphia. Availability of parkland public toilets was highest in MSP and lowest in SFC. Findings inform WOC nurses for counseling incontinent patients about self-management strategies. Urban planning that provides an adequate number and distribution of parkland public toilets may improve quality of life.

A Day in the Life of a WOC Nurse.

A Day in the Life of a WOC Nurse.

Evaluation of Validity and Reliability of a Revised Incontinence-Associated Skin Damage Severity Instrument (IASD.D.2) by 3 Groups of Nursing Staff.

The purpose of this study was to evaluate a revised version of the Incontinence-Associated Skin Damage Severity instrument (IASD.D.2) using 3 different groups of nursing staff. Revisions to the instrument included renumbering 1 body area where incontinence-associated dermatitis (IAD) occurs into 2 areas (right and left), which raised the total possible score from 52 to 56, and defining the borders of the body areas. Observational, evaluative design. Five clinical experts certified in wound, ostomy, and/or continence (WOC) nursing evaluated content validity. Evaluators were attendees at the WOC Nurses (WOCN) Society 2014 conference, hospital nurses, and nursing staff at a nursing home. Evaluators were attendees at the WOCN Society's 2014 National Conference, hospital nurses at a community hospital with Magnet designation, and nursing staff at a skilled nursing home in the Midwestern United States. The evaluator group comprised 198 conference attendees (all nurses; age 53 ± 8.2 years, mean ± SD), 67 hospital nurses (age 37 ± 11 years), and 34 nursing home nursing staff (age 45 ±13.8 years). The majority of evaluators (>75%) in each of the groups were female. Clinical experts evaluated the content validity of the revised instrument. Evaluators scored 5 to 9 photographic cases using the revised instrument. Four of the cases were scored by all evaluators. The agreement of case scores among all evaluators was analyzed to assess interrater reliability. The scores of evaluators grouped by evaluators' self-identified skin color or nursing experience (<10 years vs ≥10 years) were also tested for differences. To provide evidence for criterion validity, the agreement of evaluators' scores with experts' scores (considered a "gold standard" in this study) was analyzed. The agreement of the IASD.D.2 scores among all evaluators within each group ranged from 0.74 to 0.79, suggesting good interrater reliability. The agreement of each group of evaluators with the experts for all case scores ranged from 0.82 to 0.85, suggesting good criterion validity. There was no significant difference in scores by evaluators' skin color or nursing experience. The revised IASD.D.2 has good content and criterion validity and interrater reliability. The instrument has potential to standardize reporting of IAD severity in research and clinical practice and assist communication about IAD among nursing staff.

Wound, Ostomy, and Continence Nursing: Scope and Standards of WOC Practice, 2nd Edition: An Executive Summary.

Wound, ostomy, and continence (WOC) nursing was recognized as a nursing specialty by the American Nurses Association in February 2010, and the Society published the original scope and standards of WOC nursing practice in May 2010. The Wound, Ostomy, and Continence Nursing: Scope and Standards of Practice, 2nd Edition is the definitive resource promoting excellence in professional practice, quality care, and improved patient outcomes in WOC specialty practice. It can be used to articulate the value of WOC nurses to administrators, legislators, payers, patients, and others. The second edition also provides an overview of the scope of WOC nursing practice including a description of the specialty, the history and evolution of WOC nursing, characteristics of WOC nursing practice, and description of the trispecialty. The document describes various WOC nurse roles, populations served, practice settings, care coordination, and collaboration. Educational preparation, levels of practice within WOC specialty nursing, certification, mandate for continuous professional development, ethics, current trends, future considerations and challenges, and standards of WOC nursing practice and professional performance with competencies for each standard are provided. The purpose of this Executive Summary is to describe the process for developing the scope and standards document, provide an overview of the scope of WOC nursing practice, and list the standards of practice and professional performance along with the competencies for each level of WOC nurse provider. The original document is available from the WOCN Society's online book store (www.wocn.org).

The Use of Immersion Therapy Mattress With Low Air Loss in Patients With Myocutaneous Flaps.

In our hospital, air-fluidized therapy beds were used for all patients undergoing surgery for the creation of myocutaneous flaps. These beds were associated with staff injuries and patients reported dissatisfaction. The WOC nurses were asked to find an alternative support surface for postmyocutaneous flap patients. We report findings from 5 patients placed on a low air loss immersion mattress after myocutaneous flap surgery. On week 2, per our hospital's clinical pathway, all were transferred to our critical access hospitals with the immersion therapy mattress. Upon discharge, all flap incisions were approximated and closed. Our experiences with these 5 cases suggest that a support surface combining immersion and low air loss feature is a viable alternative to an air-fluidized bed for postoperative management of patient undergoing myocutaneous flap surgery for the management of full-thickness pressure injuries.

Sexual Experiences of Chinese Patients Living With an Ostomy.

The purpose of this study was to examine the sexual experience of Chinese patients with ostomy and associated factors. A prospective descriptive study using self-report questionnaires. Seventy-five Chinese participants who underwent ostomy surgery in a large cancer specialist hospital in the Hunan province between 2008 and 2013. Data were collected face-to-face by the investigators in an outpatient setting from 75 participants who completed the Arizona Sexual Experience Inventory Scale (ASEX). The t test was used to compare variances between sexual function and dysfunction subgroups. A multiple linear regression model was used to analyze factors influencing sexual life after ostomy surgery. The mean ASEX score was 20.56 (5.378) years, which is higher than the standard for sexual dysfunction. The main subsection of sexual dysfunction included sexual arousal, orgasm ability, vaginal lubrication/penile erection, and sexual satisfaction. Significant differences in the ASEX score were observed in subgroups of age, gender, educational level, family relations, operation modes, stoma type, operation time, complications, supporters, self-care ability, and sexual life guidance. Multiple stepwise regression analysis indicated that family relations, operation modes, ostomy type, complications, and sexual life guidance affected sexual experience. The findings of this study demonstrate that patients with ostomy experience sexual dysfunction and many factors influence their quality of sexual life. WOC nurses and other healthcare providers should consider providing sexual health education for both the patient and spouse to improve the self-care capacity and quality of sexual life following ostomy surgery.

Institution of a Preoperative Stoma Education Group Class Decreases Rate of Peristomal Complications in New Stoma Patients.

The purpose of this study was to compare selected postoperative complications (including stomal and peristomal complications), hospital length of stay, and readmission rates in a group of patients who attended a preoperative educational intervention to a retrospective group of patients who did not receive the intervention. Retrospective, comparison cohort study. The intervention group comprised 124 patients who attended an educational session for persons with fecal ostomies at a single tertiary care center in the Northeastern United States. They were compared to findings from a group of 94 individuals who underwent ostomy surgery during a 1-year period before initiation of the class. Patients undergoing emergent procedures or who had previous stomas were excluded. We found no significant differences between the 2 cohorts with respect to age, gender, comorbidities, open versus minimally invasive procedures, or colorectal diagnoses. A preoperative 2-hour stoma education class was led by certified WOC nurses for all patients undergoing colorectal surgeries in which the creation of a stoma was anticipated. This session included a didactic portion outlining postoperative expectations in the management of new ostomies (including dietary changes, prevention of dehydration, and an overview of ostomy supplies), as well as a hands-on portion to practice stoma care skills. We compared postoperative complications within 30 days (particularly stoma-related complications, including pouch leakage due to loss of seal, and peristomal skin irritation) between the group attending the education session and the control group. We also compared length of stay and 30-day readmission rates. Patients who participated in the educational intervention experienced significantly fewer peristomal complications than did patients in the historic control group (44.7% vs 20.2%, P = .002). Logistic regression analysis revealed that participation in the group was associated with a lower likelihood of peristomal skin complications (odds ratio = 0.35; 95% confidence interval, 0.18-0.67). Their length of stay (median 6 days vs 5 days, P = NS), and the proportion who experienced 30-day readmission (20.2% vs 15.3%, P = NS), did not significantly differ. A preoperative stoma education group class significantly reduced the likelihood of frequent leakage from the ostomy pouching system and peristomal skin irritation.

North America Wound, Ostomy, and Continence and Enterostomal Therapy Nurses Current Ostomy Care Practice Related to Peristomal Skin Issues.

PURPOSE:The purpose of this study was to describe the practice of 796 ostomy nurses in North America in 2014 related to peristomal skin issues.DESIGN:Descriptive study.SUBJECTS AND SETTING:Participants were 796 wound, ostomy, and continence (WOC) and enterostomal therapy (ET) nurses currently practicing in the United States or Canada and caring for patients with ostomies. The collection of data occurred in conjunction with an educational program on peristomal skin complications and practice issues and solicited the participant's perception on the incidence and frequency of peristomal skin issues as well as on practice patterns.METHODS:Participants attended an educational program. They were also asked to anonymously respond to multiple-choice questions on ostomy care management via an audience response system followed by discussion of each item and their responses. This descriptive study reports on the answers to the questions as well as the pertinent discussion points.RESULTS:Participants estimated that approximately 77.70% of their patients developed peristomal skin issues. The most commonly encountered problem was irritant contact dermatitis (peristomal moisture-associated skin damage). Contributing factors were inappropriate use of a pouching system owing to lack of follow-up after hospital discharge. Reported interventions for the prevention and management of peristomal skin issues included preoperative stoma site marking, use of a convex pouching system, and barrier rings. However, subsequent discussion revealed that the frequency of use of these products varied considerably. Participants identified shortened hospital stays, absence of preoperative stoma marking, and limited outpatient follow-up as contributing to development of peristomal skin problems.CONCLUSION:WOC and ET nurses estimate that more than three-quarters of persons living with an ostomy develop peristomal skin problems. Multiple interventions for managing these problems were identified, but some variability in management approaches emerged.

Attitudes of Nursing Students About Pressure Injury Prevention.

The objective of this study was to examine the attitudes of baccalaureate nursing students toward their role in pressure injury prevention (PIP) and describe how clinical experiences influence their attitudes. Understanding students' attitudes and experiences related to PIP may facilitate development of evidence-based interventions for PIP by nurses. Qualitative exploratory descriptive design. Participants were 16 senior nursing students enrolled in a prelicensure baccalaureate nursing program in an accredited school of nursing. Half of the participants had completed their first 2 years of the nursing major in the baccalaureate program. The remaining participants completed their first 2 years in a community college associate degree nursing program. Semistructured, in-depth, open-ended interviews were conducted. Interviews were digitally recorded and transcribed verbatim; data were analyzed for key themes using content analysis. Four categories of attitudes about PIP were identified: (1) ambivalence, (2) emerging awareness, (3) committed, and (4) passionate. Diverse clinical experiences in pediatrics, the operating room, trauma units, and long-term care facilities enhanced nursing students' learning related to PIP. Experiences observing WOC nurses and other staff role models engaged in PIP were associated with student commitment and passion for PIP. Findings from this study can be used to guide interventions to enhance attitudes of commitment to PIP. WOC nurses, clinical preceptors, and clinical staff can involve nursing students in intentional PIP learning activities to improve clinical practice and patient outcomes. Intentionally incorporating key learning activities about PIP in the nursing curriculum is recommended.

Supervision Requirements: Criteria for the Nurse and Auxiliary Staff When Providing Patient Care Visits.

Physician or advanced care clinicians' (advanced practice nurses, physician assistants) orders are routinely carried out by nursing staff, with the goals of implementing treatment plans and improving patient outcomes. In the outpatient setting, nurses must consider the regulations imposed by the Centers for Medicare & Medicaid Services when initiating care and billing for services. Nurses, advanced practice nurses, and other clinicians may deliver care ordered by physicians without the physician being physically present in the room. Such services are considered to be "incident to" the physician's care, and there are requirements of supervision that must be met pertaining to the specific care setting. These guidelines and the implications for WOC nurses are the focus of this article.

Colostomy Irrigation: Issues Most Important to Wound, Ostomy and Continence Nurses.

The purpose of this study was to describe issues that WOC nurses find most important related to colostomy irrigation (CI). This is an additional analysis of a study focusing on qualitative responses to a survey querying WOC nurses about CI practices. The target population was members of the Wound, Ostomy and Continence Nurses Society. Of the 985 nurses who responded to the survey, 338 (34.3%) answered the optional open-ended question asking for additional comments. A 1-time online survey was conducted. In addition to demographic, educational information, and forced-choice questions about CI, an open-ended question asked for any additional comments about their experience with irrigation and WOC practice. Content analysis was used to identify common themes identified by WOC nurses. Three hundred thirty-eight out of 985 WOC nurses (34.3%) answered the optional open-ended question asking for additional comments; analysis for this study is based on these responses. WOC nurses who responded to the open-ended question had similar characteristics to those who responded to the entire survey but were significantly more experienced (15.1 vs 11.0 years; P < .001). Multiple themes were identified that were related to forced-choice questions in the survey, such as equipment, lack of teaching time, and increased control, while several new themes emerged, including age-related recommendations, economic/ecologic benefits, cultural implications, and misconceptions of CI. Many WOC nurses feel that CI is a valued modality of ostomy care and should be reestablished, although dissenting opinions were expressed. Additional research to increase the evidence base for this procedure is needed. New opportunities to educate WOC nurses and other healthcare professionals and teach eligible patients irrigation techniques are recommended.

The Effect of Adjuvant Chemotherapy on Stoma-Related Complications After Surgery for Colorectal Cancer: A Retrospective Analysis.

To assess stoma-related complications of colorectal cancer patients undergoing surgery with curative intent who received adjuvant chemotherapy compared to those who underwent surgery alone. A retrospective analysis of a prospectively maintained colorectal cancer clinical audit database was completed. Patients undergoing curative surgery for colorectal cancer with the formation of a stoma (end ileostomy, loop ileostomy, end colostomy) between 1999 and 2011 at a single hospital in Lanarkshire, United Kingdom. Patients who underwent neo-adjuvant chemotherapy were excluded. Two hundred twenty-two patients comprised the study sample; 130 (59%) were male. Seventy-five (34%) patients comprised the chemotherapy group and 147 (66%) made up the surgery-only group. Patients in the chemotherapy group were younger (61.6 vs 65.4 years; P = .001) and had higher stage colorectal cancer (P < .001). There was no difference in baseline (day 10) stoma scores between the chemotherapy or surgery-only groups. Postoperative stoma-related complications were serially assessed using a stoma complication scoring tool; scores were calculated at 10 days and 3 months postoperatively. Scores of patients receiving adjuvant chemotherapy were compared to scores of participants who underwent surgery alone. A composite stoma function score was calculated for each patient after assessment of stoma-related complications. The overall score included a global assessment of stoma quality (stoma retraction, prolapse, stenosis, parastomal hernia, skin changes) and patient-reported stoma function (leakage, soiling, nighttime emptying, odor). At 3 months, the mean loop ileostomy stoma function score was poorer among the chemotherapy group when compared to the surgery-only group (4.55 vs 1.53; P = .041). No differences were found when colostomy (2.00 vs 2.62; P = .411) or end ileostomy (1.00 vs 2.00; P = .170) function scores were compared at 3 months. Patients undergoing curative surgery for colorectal cancer resulting in a loop ileostomy who received adjuvant chemotherapy had higher stoma complication scores at 3 months compared to those who underwent surgery with no chemotherapy. This difference was not seen in patients with colostomies or end ileostomies. Patients, WOC nurses, and medical staff must be alert to the potential of increased loop ileostomy-related complications with adjuvant chemotherapy. Fully informed patient consent coupled with timely support and advice may reduce stoma-related morbidity and improve quality of life for such patients.

Implementation of a Bowel Management Program in Critical Care.

The purpose of this study was to examine the effectiveness of a unit-based, educational program on implementation of a sustainable bowel management program in a critical care setting. Two hundred thirty nurses in 6 critical care units within a 750-bed level I trauma hospital and 400-bed university academic teaching hospital participated in the study. Data collection and analysis were guided by a quasi-experimental pre-/postdesign. An evidence-based, interactive Web-based education program was developed. The education program consisted of 3 components: (1) knowledge acquisition (Web-based education module), (2) skill acquisition (unit-based skill session performance and competency), and (3) mastery experiences (self-efficacy). Data collected included pre- and posteducation module test scores, skill-acquisition competency, and self-efficacy scores. The Web-based education module pre- and posttest scores for 225 participants showed significant (P < .001) improvement in knowledge scores. All participants (100%) completed the skill acquisition sessions successfully during the unit-based performance session. Nurses' self-efficacy scores significantly improved (P < .001) over the course of this study period. Eighty-six percent (n = 125) of critical care nurses reported enhanced collaboration with the WOC nurses and clinical nurse specialists. Study findings support the use of a structured, evidence-based educational program incorporating a multimethod approach to implement practice change for critical care.

WOCN Society and ASCRS Position Statement on Preoperative Stoma Site Marking for Patients Undergoing Colostomy or Ileostomy Surgery.

Marking the optimal location for a stoma preoperatively enhances the likelihood of a patient's independence in stoma care, predictable pouching system wear times, and resumption of normal activities. Colon and rectal surgeons and certified ostomy nurses are the optimal clinicians to select and mark stoma sites, as this skill is a part of their education, practice, and training. However, these providers are not always available, particularly in emergency situations. The purpose of this position statement, developed by the Wound, Ostomy and Continence Nurses Society in collaboration with the American Society of Colon and Rectal Surgeons and the American Urological Association, is to provide a guideline to assist clinicians (especially those who are not surgeons or WOC nurses) in selecting an effective stoma site.

WOCN Society and AUA Position Statement on Preoperative Stoma Site Marking for Patients Undergoing Urostomy Surgery.

Marking the optimal location for a stoma preoperatively enhances the likelihood of a patient's independence in stoma care, predictable pouching system wear times, and resumption of normal activities. Urologists and certified ostomy nurses are the optimal clinicians to select and mark stoma sites, as this skill is a part of their education, practice, and training. However, these providers are not always available, particularly in emergency situations. The purpose of this position statement, developed by the Wound, Ostomy and Continence Nurses Society in collaboration with the American Urological Association and the American Society of Colon and Rectal Surgeons, is to provide a guideline to assist clinicians (especially those who are not surgeons or WOC nurses) in selecting an effective stoma site.

Analysis of qualitative interviews about the impact of information technology on pressure ulcer prevention programs: implications for the wound, ostomy and continence nurse.

The purpose of this study was to compare pressure ulcer prevention programs in 2 long-term care (LTC) facilities with diverse Information Technology Sophistication (ITS), one with high sophistication and one with low sophistication, and to identify implications for the WOC nurse. Secondary analysis of narrative data obtained from a mixed-methods study. The study setting was 2 LTC facilities in the Midwestern United States. The sample comprised 39 staff from 2 facilities, including 26 from a high-ITS facility and 13 from the low-ITS facility. Respondents included certified nurse assistants, certified medical technicians, restorative medical technicians, social workers, RNs, licensed practical nurses, information technology staff, administrators, and directors. This study is a secondary analysis of interviews regarding communication and education strategies in 2 LTC agencies. This analysis focused on focus group interviews, which included both direct and nondirect care providers. Eight themes (codes) were identified in the analysis. Three themes are presented individually with exemplars of communication and education strategies. The analysis revealed specific differences between the high-ITS and low-ITS facilities in regard to education and communication involving pressure ulcer prevention. These differences have direct implications for WOC nurses consulting in the LTC setting. Findings from this study suggest that effective strategies for staff education and communication regarding PU prevention differ based on the level of ITS within a given facility. Specific strategies for education and communication are suggested for agencies with high ITS and agencies with low ITS.

Revisiting colostomy irrigation: a viable option for persons with permanent descending and sigmoid colostomies.

Colostomy irrigation (CI) is the regular irrigation of the bowel for persons with a permanent colostomy of the descending or sigmoid colon. Although this technique was first described in the 1920s, a recent study of 985 WOC nurses found that almost half (47%) do not routinely teach CI to persons with colostomies. In a systematic review (Evidence-Based Report Card) published in this issue of the Journal, we summarized current best evidence concerning the effect of CI on bowel function and found that irrigation reduces the frequency of bowel elimination episodes and allows some patients to reduce or eliminate ongoing use of a pouching system. This article describes techniques for teaching CI and discussed additional findings associated with CI.

Colostomy irrigation: current knowledge and practice of WOC nurses.

This study builds on the authors' previous studies that demonstrate that persons living with a colostomy who practice colostomy irrigation (CI) experience quality-of-life benefits. Studies also reveal that patients may not be taught about CI. The purpose of this study was to determine current knowledge, attitudes, and practices of WOC nurses on CI. The target population was ostomy nurses who were members of the Wound, Ostomy and Continence Nurse's Society. Nine hundred eighty-five nurses out of a possible pool of 4191 members responded, providing a response rate of 24%. Their average age was 53 years (range, 25-79 years). Respondents averaged 12 years' experience as a WOC nurse (range, 1-40 years) and 90% (n = 875) were certified. Participants practiced in a variety of settings, including acute and long-term care facilities, home health, and ambulatory clinics. They saw an average of 37 ± 60.5 (mean ± SD) ostomy patients per year (range, 0-1100). A 1-time online survey (SurveyMonkey) of members of the Wound, Ostomy and Continence Nurses (WOCN) Society was conducted. In addition to demographic and educational information, questions also included (1) CI advantages and disadvantages; (2) CI content routinely taught; (3) challenges in assisting patients to learn CI; and (4) where preparation was received for teaching this procedure. Nurses were asked whether they believe CI is evidence-based. More than half identified irrigation as an evidence-based practice (59%), but half indicated they do not routinely teach CI. Multiple factors correlated with nurses' decisions to teach CI, including years of experience (P = .03), specific CI education (P < .001), and considering the intervention evidence-based (P < .001). Factors influencing CI instruction are multifactorial; they include nurses' attitudes, experience base, education, medical indications, setting characteristics, and patient interest and physical abilities. Education on this procedure is urgently needed for ostomy nurses unprepared and/or unfamiliar with CI, as well as staff nurses in acute care units who could offer accurate information and additional resources to patients to increase their informed decisions.

Stomal and peristomal complications: prioritizing management approaches in adults.

The objectives of this study were to establish additional content validation data for proposed stomal and peristomal complications interventions and to identify optimal interventions for the specified complications based on experts' clinical judgment. Following pilot testing of the researcher-designed instrument, the survey was mailed to 1000 systematically randomly selected expert WOC nurses via a national mailing to a representative sample of participants who identified in their WOCN Society description as having ostomy certification and/or clinical expertise. Two hundred eighty-one nurses returned the survey, comprising a response rate of 28%. A cross-sectional, quantitative descriptive design with qualitative components was used for this study. Respondents were asked to quantify degree of validity (relevance or appropriateness) of the survey's stated stomal and peristomal complications interventions. They were asked to rank interventions for each stomal and peristomal complication for being first-line (most preferred), second-line, and third-line treatment. Hand-written qualitative comments of the participants were transcribed and analyzed, and themes were derived. On a scale of 1 to 4, the mean score for all interventions was 3.47 ± 0.29 (relevant/very relevant, mean ± SD). The overall survey's Content Validity Index was 0.84 out of 1.00. Some items had lower mean scores and content validity index scores, especially peristomal interventions. Ranking of most preferred treatments revealed clearly preferred approaches in some clinical situations and some less so. Qualitative analysis of participants' comments about each stomal and peristomal complication intervention and about the whole instrument and research process was conducted generating positive and negative themes. The proposed stomal and peristomal interventions were rated as generally valid substantiating results of our earlier study. The ranking of most preferred treatments for stomal and peristomal complications provides, to the authors' knowledge, the world's first research support for prioritized approaches and evidence-based practice in ostomy care.

Refinement of an Instrument for Assessing Incontinent-Associated Dermatitis and Its Severity for Use With Darker-Toned Skin

The purpose of this study was to refine an instrument for assessing incontinence-associated dermatitis (IAD) and its severity for use on lighter- and darker-toned skin, the Incontinence-Associated Dermatitis and its Severity Instrument-D (IADS-D), and to test its validity and reliability among WOC nurses. Revisions to the existing instrument included examples of colors of normal and IAD-damaged skin that would be observed on light-, medium-, and dark-toned skin using pixels from patient photographs, additional photographs of IAD manifestations on different skin tones, and training materials. Four certified WOC nurse consultants and 2 WOC nurse clinical experts assessed the face and content validity of the IADS-D instrument. The IADS-D instrument was tested for criterion validity and interrater reliability using photo cases by attendees at the Wound, Ostomy, and Continence Nurses Society 2012 conference. The IADS-D instrument had good face and content validity. The overall average intraclass correlation coefficient (ICC) of IADS-D scores for all photo cases of testers (n = 266, 95% female, age 53.0 ± 7.9 years, mean ± SD) and those of investigators, experts, and consultants serving as the criterion was 0.90. The overall ICC for interrater reliability between all nurse testers was 0.99 and the ICC for tester skin tone was 0.99. The IADS-D instrument has excellent validity and interrater reliability among WOC nurses. Its refinement for use with lighter- and darker-toned skin addresses the lack of a much-needed instrument in nursing practice and research. Results support continued development and evaluation of the instrument's use in clinical and research settings.