Our team of wound, ostomy, and continence nurses are key players in preventing hospital-acquired pressure injuries and sepsis—both strategic priorities for HHS. Here, nurse Enza Browne shows how to change a stoma bag so that the skin around the stoma (surgically created opening in the abdomen) is protected.
How pressure injuries develop
People can get stress injuries in their home environment. But sometimes pressure injuries start in the hospital. Pressure injuries, also called pressure sores or bedsores, are damage to the skin and tissues under the bony part of the body that has been pressed against a surface such as a mattress or wheelchair.
Because of the pressure, less blood gets into these areas and over time, an ulcer can form. It can start as a red area and develop into a very serious ulcer that exposes cartilage or bone. If left untreated, pressure injuries can lead to sepsis, a life-threatening condition caused by an uncontrolled response to infection.
Increasing the pressure – on a pressure injury
Preventing hospital-acquired pressure injuries and sepsis is a strategic priority at Hamilton Health Sciences (HHS), and our team of wound, ostomy and continence nurses are key players in this important, life-saving work. The 10-person team, comprised of full-time, part-time and nurse practitioners, covers all HHS hospitals.
In order to specialize in this area, these nurses must earn a Nurse Specialist in Wound, Ostomy and Incontinence Canada (NSWOCC) designation. They are equally skilled in all three areas and their expertise is essential in treating the skin changes that can occur in ulcers, stoma and incontinence.
In addition to providing direct patient care, these nurses are an invaluable resource to healthcare teams throughout HHS – providing training, guidance and the latest information on best practices.
Patient care is enhanced by the hospital’s new digital medical record system, called Epic, which provides healthcare teams with instant access to best practices for identifying, preventing and managing pressure injuries. The hospital also uses a monitoring system that provides clinical teams with information on how they are managing stress injuries, as well as staff and patient education.
Meet four nurses who specialize in this field:
Enza Browne, HHS Hamilton General Hospital (HGH)
“People often assume we’re simply changing a patient’s dressing, but there’s so much more to our work,” says Enza Browne, patient care provider at HHS Hamilton General Hospital (HGH). “The truth is we are a very specialized team.
Browne spends much of her time caring for trauma patients with severe wounds. The packaging that Browne and her teammates specialize in is often highly complex, with technology that continues to evolve. Another group of patients she often sees are people with diabetes who develop leg and venous ulcers. These open, often painful sores can take weeks or even months to heal.
Preventing pressure injuries is a top priority at all HHS hospitals, Browne says. “From our youngest patients to our oldest, the healthcare team checks the skin for signs of pressure injuries. They identify patients who may be at risk, monitor them closely, and continually assess them to ensure they don’t develop pressure injuries. My team supports these wider hospital teams in this work, as well as providing direct patient care.”
Rebecca Dyck, Satellite Health Facility (SHF)
SHF is primarily for patients who no longer require care as inpatients and are awaiting transfer to a community setting such as a nursing home or long-term care facility. Most patients are older adults, so the greatest need tends to be wound and skin care, says Rebecca Dyck.
Nurses specializing in wounds, ostomies and skin care look at the whole patient – including blood work, diet, medications and existing medical conditions. “We’re digging deep into the patient’s history because so many other factors come into play in wound management,” says Dyck.
Diet also plays an important role in healing. “If a patient doesn’t eat enough food, or get enough protein, they won’t have the nutrients needed for the wound to heal properly.” They need protein because that’s the main building block for closing the wound.”
Andrea Gambale, Juravinski Hospital and Cancer Center (JHCC)
Andrea Gambale works at JHCC, where a strong focus is on supporting cancer patients undergoing ostomy surgery. This procedure creates an opening in the abdomen so that faeces can drain into a bag that is attached to the patient’s abdominal area. These patients need help learning how to change and manage the pouch system and keep the area clean so they don’t get skin damage.
“It’s a life-changing surgery, especially when it’s permanent,” says Gambale, whose role includes teaching people how to take care of the skin at the site and change and manage their stoma system.
“It can be very frustrating for a patient – who is already dealing with a cancer diagnosis – to wake up after surgery with the added challenge of having to use a stomp bag, possibly for the rest of their life,” says Gambale. “There really is an art to how we support these patients through this difficult journey.” We help them adapt to this change and move on with their lives, so they can go back to doing what they love when they return home.”
Prior to joining the JHCC team, Gambale worked at the HHS Regional Rehabilitation Center with spinal cord injury patients. “These patients usually have significant challenges with mobility and movement, so there is an emphasis on preventing pressure injuries,” says Gambale.
In this patient population in particular, pressure injuries can begin in just a few hours. “We can’t always prevent stress injuries, but we can catch them early and work with the patient and our teams to manage the injury and help them heal.”
Stephanie Furtado, West Lincoln Memorial Hospital (WLMH) and McMaster Children’s Hospital (MCH)
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