From the Editor: Distinguish, not Disdain

  At the Wound Ostomy Continence Nurse Society’s annual gathering this past June, I was somewhat surprised that attendees/Society members were so overwhelmingly grateful for OWM’s coverage of the WOCN’s cycling fundraiser. Why wouldn’t we share news of Katherine Jeter’s efforts to increase awareness of and support for the WOCN cause? Who wouldn’t be impressed with the notion of the 72-year-old powerhouse and negative pressure wound therapy pioneer pedaling cross-country? Our two journals may compete for advertising dollars, but we are far from adversaries. We share the same mission: to enhance knowledge and improve wound, ostomy, skin, and continence care. We may have different publishing schedules and styles, both in print and online, that distinguish us, but we never disdain. Cooperative ventures are much more to our philosophies. More on that momentarily.

  Along the lines of distinguishing, yet celebrating differences, OWM planned an issue on transcultural care. We sought authors who have published on this very broad subject (eg, multicultural care providers, important aspects of care influenced by race and ethnicity) but received very few manuscripts. One is included in this issue (Dixon and Ratliff’s article on pressure ulcers related to braided hair), and one is a Notes on Practice online exclusive (Jiang et al’s article on managing diabetic foot ulcers with Chinese medicine).

  I was left to ponder why there were so few submissions on this subject. Is it simply a matter of potential authors lacking the time to compose manuscripts? Or are we so busy trying to be “politically correct” and establish fair and equitable protocols blinded to race, religious restriction, or even gender, that it becomes improper to acknowledge black skin or a certain culture’s reluctance to accept care? Is transcultural care perceived merely as the need to address language barriers?

  It is interesting to note that transcultural healthcare is mainly addressed in the nursing literature; there is an entire journal devoted to the subject. Are nurses the only ones aware of the necessary accommodations that must be made when patients are not the Caucasian, middle-aged men who seem to be the focus of most research (and thus, most evidence-based medicine)?

  Speaking of which, debate continues about the foundation of evidence-based wound care. Is the randomized, controlled trial (RCT) the true gold standard? In some instances, aren’t other types of research (cohort studies, retrospective chart reviews) just as valuable? Isn’t diversity in types of study as important as diversity in study populations?

  The shared mission of the Journal of Wound Ostomy and Continence Care and Ostomy Wound Management to improve patient care, and concerns that these debates may cause paralysis by analysis, led the editors of both journals to carefully examine this topic. In this issue of OWM, you can read how van Rijswijk and Gray examined the issues that may have slowed our progress to providing evidence-based wound care and collaborated to reframe and refocus the discussion on the provision of patient-centered care. They presented questions and ways to find answers to the three most important questions clinicians need to ask before using a product or protocol: Can it work? Does it work? Is it worth it? They conclude that the way forward requires that currently used dressing categories be abandoned in all research studies—including meta-analysis and evidence-based reviews —and that every research design is needed to assess treatment safety, efficacy, and effectiveness. In effect, their analysis underscores the need to keep an open mind and employ a trans-cultural investigational approach.

  Bringing this full circle, and fully aware that not-completely-understood forces (the fiesty determination of the body to heal? A higher authority?) are always at work in healthcare, I say we need to integrate as many factors as possible into every care plan and research endeavor in order to make it patient-centered, transcultural, and optimally truly evidence-based. Exclusionary care, research or debate causes myopathy and limits progress. We should distinguish and not disdain what makes people and studies different and make them factors to consider. And then (hint, hint) write about it.