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Each participant met with the investigator at the start and end of the testing. STUDY OUTCOME: Outcomes included safety (peristomal skin conditions and unplanned changes) and performance (adhesive parameters, splashing sounds, wear time, product awareness and product preference). The investigator collected baseline data and evaluated the peristomal skin at baseline, using the Ostomy Skin Tool. The participants evaluated the performance of system A and B and after using each pouching system, the participants then evaluated their own peristomal skin. Data was collected in a questionnaire. STATISTICS: Statistical analyses included logistic regression, chi-square test and parametric general linear models. Overall significance level: 0.05. RESULTS: Baseline characteristics and differences in skin conditions after using system A and B will be presented. Performance and safety parameters will be compared for System A and B.

Wound-Evidence-Based Interventions 3407
AN ASSESSMENT OF COGNITIVE SCHEMA FOR PRESSURE ULCER STAGING Cindy Kiely, RN, MSN, CWOCN, cindy.kiely@chsli.org, Good Samaritan Hospital Medical Center, West Islip, NY and William Roberts, ACNP-BC, DNSc, wdroberts@adelphi.edu, Adelphi University, Garden City, NY Although the skin is the largest organ of the body, skin integrity was rarely, if ever considered a fundamental aspect of patient care. The development of a pressure ulcer was thought of as an unfortunate outcome during a patient’s hospitalization. Today, they are considered a preventable occurrence of unnecessary harm. So much so that the occurrences of pressure ulcers are now deemed a nursing sensitive indicator. Recently, however, there has been a conflicting consensus regarding the accuracy of the current staging system available for nurses to use for staging pressure ulcers. Clinicians indicate that there is little to no evidence that the current method of staging accurately represents the clinical progression of a lesion caused by pressure necrosis. Doughty et al (2006). The purpose of this study is to understand the decision-making process of nurses in the staging of pressure ulcers. Specifically, this study seeks to determine if there is a process that a nurse uses to stage a pressure ulcer and whether or not this process is systematic, standardized, and accurate. Once the decision-making process is better understood, future research could be employed for the development, dissemination, and evaluation of a staging tool to assist nurses in more accurate staging of pressure ulcers. This qualitative study will utilize cognitive evaluation methods to examine the schema, mental processes, and knowledge structure of nurses during a staging task.

Buckley et al (2005) attribute increased costs in wound care to variability in wound assessment and inconsistency in documentation, demonstrating a need for accurate identification and documentation of wound assessment findings to determine wound progression or deterioration. The BWAT© tool contains thirteen items to assess the wound: size, depth, edges, undermining, necrotic tissue type, amount of necrotic, granulation and epithelialization tissue, exudate type and amount, surrounding skin color, edema and induration. Each item has five categories, one of which the nurse must choose as the most appropriate response. In order to use the tool, nurses must have a working knowledge of a wound vocabulary and wound assessment skills. Many nurses are visual learners which is the predominant learning style for adults. These learners like visual aids and colored handouts that are visually stimulating (Avillion, 2005). This also applies to novice nurses and nursing students, with as many as 78% being visual learners (Borucki and Krouse, 2005). A group of three Enterostomal Nurses, and a Nursing Researcher, in partnership with the original author of the BWAT, undertook this project to collect wound photographs that depicted each characteristic of the BWAT, and then to validate the photographs. Ethical approval and informed consent to use the photographs for educational purposes was obtained. Enterostomal Therapy Nurses and one wound care specialty nurse participated in two validation exercises to finalize the photographic content to augment wound assessment and documentation using the BWAT tool. This presentation will review the methodology and results of the validation project. Further plans for the Pictorial BWAT are to publish it in a journal that will allow free-online access of the guide for all healthcare providers, and to test teaching interventions to examine whether the new format helps to implement use of the paper BWAT tool.

DEVELOPMENT OF AN EVIDENCE-BASED TREATMENT PROTOCOL FOR PILONIDAL SINUS WOUNDS HEALING BY SECONDARY INTENT USING A MODIFIED DELPHI TECHNIQUE Connie L. Harris, RN, ET, MSc, connieharris@rogers.com, CarePartners, Waterloo, ON This modified Reactive Delphi project utilized five rounds of questionnaires to elicit opinion on what would constitute an evidence-based protocol for pilonidal sinus wounds healing by secondary intent, including infected wounds. Participants were health-care professionals including surgeons, nurses and Enterostomal therapy nurses experienced in the care these wounds. Item generation involved an extensive review of the literature to identify key aspects of evidence-based wound care essential to wound healing in general, infected wounds and pilonidal wounds healing by secondary intent, and drawing on clinical experience. The participants responded via an electronic Web site, using a four-point Likert rating scale and a ranking system. Comments were invited. Feedback to the participants at the end of each round was provided, that included comments, content validity index (CVI), and additional information that provided rationale and references, or minor revision if requested. New items were generated in rounds 3, 4 and 5 in response to participant’s comments. Consensus was confirmed for the items that met the inclusion criteria by further analysis for Confidence Intervals and Kappa Interrater Agreement. The resultant protocol contains fifty-nine assessment indicators and interventions, including rationale and an algorithm for decision making. Topics included treat the cause (surgery/debridement), prevent recurrence, local wound care (cleansing methods, positioning, moist

BATES-JENSEN WOUND ASSESSMENT TOOL (BWAT)© PICTORIAL GUIDE VALIDATION PROJECT Connie L. Harris, RN, ET, MSc, connieharris@rogers.com, CarePartners, Waterloo, ON; Rose Raizman, RN, ET, MSc, rraizman@yorkcentral.on.ca, York Central Hospital, Richmond Hill, ON; Minawatie Singh, RN, PhD, mina.singh@mail.atkinson. yorku.ca, York University, Toronto, ON; Nancy Parslow, RN, ET, nparslow@rogers.com, Southlake Regional Health Centre, Newmarket, ON and Barbara Bates-Jensen, RN, PhD, CWOCN, bbatesjensen@sonnet.ucla.edu, University of California, Los Angeles, Los Angeles, CA

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