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The LINK - March 2008
Official Publication of the
Canadian Association for Enterostomal Therapy
L’Association canadienne des stomothérapeutes
ISSN: 1701-2473
Executive
President: Kathryn Kozell
President-Elect: Mary Hill
Treasurer: Theresa Henderson
Secretary: Debbie Miller
Executive Director: Catherine Harley
Regional Directors
BC/Yukon: Maureen Moster
Prairies/NWT/Nunavut: Marcie Lyons
Ontario: Virginia McNaughton
Québec: Tarik Alam
Atlantic: Jean Brown
Transitional Core Program Leaders:
Holly Murray
Dawn Christensen
Kathy Esligar
CAET Advisory Board:
Dr. Katherine Moore
Carla M. Wells
Joan Gordon (By-Laws)
Editor: Harvey Schwartz
Publisher, printing, mailing: Chaz Consultants
Certified Translator: Lucie Lefebvre
Project Manager: Pauline Huynh
Please forward any changes in membership status or address to:
Harvey Schwartz, CAET National Office
1720 chemin Norway, Town of Mont-Royal, QC, H4P 1Y2
Tel: (1-888) 739-5072, Fax: (514) 739-5072
E-mail: members@caet.ca
Website: http://www.caet.ca/membership.htm
The LINK, the official publication of the Canadian Association for
Enterostomal Therapy is published three times a year. It is indexed in
the Cumulative Index to Nursing and Allied Heatlh Literature database.
The LINK accepts contributions in the form of professional news,
research projects and findings, clinical papers, case studies, reports,
review articles, questions for clinical corner, and letters to the editor.
Advertising and news from industry are also welcome. The deadline
for submissions to the next edition of The LINK is February 15, 2008.
La revue The LINK est une publication officielle de l’Association
canadienne des stomothérapeutes publiée trois fois par année et
indexée dans la banque de données «Cumulative Index to Nursing and
Allied Health Literature». The LINK accepte toute contribution sous
les formes suivantes : nouvelles professionnelles, projets de recherches,
études cliniques, études de cas, rapports, revues d’articles, questions
destinées à la section clinique et lettres à l’éditeur. Les publicités et
nouvelles de l’industrie sont aussi les bienvenues. La date limite pour
la soumission d’un écrit à paraître dans le prochain numéro The LINK
est le 15 février 2008.
For further information or to submit content:
Pour de plus amples renseignements ou pour soumettre un écrit,
veuillez contacter:
Harvey Schwartz 1720 ch. Norway
Montréal, Québec, H4P 1Y2
Tel: (514) 739-5072, Email: link-editor@caet.ca
CAET Announcements
President’s Message ..............................................................2
Message de la présidente .....................................................2
Executive Director’s Report ................................................6
Rapport de la directrive exécutive .....................................6
CAET Academic Awards ....................................................8
Guest Editorial .................................................................. 10
Éditorial de notre invitée ................................................. 10
The Impact of Stigma in Health Care ............................. 10
ETNEP Director’s Report ................................................ 12
Onward with Certification! .............................................. 14
Allez de l’avant vers la certification! ................................ 16
Developing Competencies in Conservative Sharp Wound
Care Debridement ............................................................. 17
WUWHS Educational Stream Preview .......................... 18
CAET Meetings & Banquet ............................................. 20
Election Call ............................................ Centerfold Insert
2008 Conference Planning Schedule ............................... 22
WCET News ....................................................................... 22
The CAET Thanks Diane Garde ...................................... 24
Feature Articles
Wound Care Leaders ......................................................... 26
E.T. Leadership in Pressure Ulcer Prevention .............. 32
Industry News
Moldable Technology Celebrates One Year in Canada.. 38
La technologie Malléable célèbre son premier anniversaire
au Canada .......................................................................... 38
50 years since the first Disposable Ostomy Bag ............ 38
50 ans déjà depuis le premier sac de stomie jetable ...... 38
ET Community News
River Valley Health (RVH) Wound
Care Education Day .......................................................... 40
March 2008 - The LINK
1

CAET Announcements
President’s Message/Message de la présidente :
Leading from the Extreme/Faire preuve de leadeurship
by/par Kathryn Kozell
Since Kelowna 2004 the CAET has
been preparing for the moment that
as a professional association, we
would be ready and in a position
to demonstrate our Leadership as
ET Nurse Specialists. Our moment
has arrived. This year will mark
many opportunities where WE will
demonstrate through the power of
our knowledge, skills and attitude
the ability to influence meaningful
outcomes. Leading from the extreme
is the practice of going far beyond
the boundaries of conventional
expectations…it is the pursuit of
what may not seem possible to the
possible.
The CAET is proud to be a Co-Host
of the 3rd Congress of the World
Union of Wound Healing Societies in
Toronto, June 4-8, 2008. The mision
of the WUWHS, “To Enhance the Life
of Persons with Wounds Worldwide”
is one that we share in the CAET
Mission Statement, “ …the CAET
advocates for the highest quality of
specialized Enterostomal Therapy
nursing to individuals with challenges
in wound, ostomy and continence.” I
am proud to acknowledge that eleven
CAET members will present at this
prestigious educational event in
the Ostomy/Continence/Skin Care
Stream, and I know that many more
ETs will be there to support, learn
and further the dissemination of our
knowledge, skills and attitudes. This
is leadership.
CAET’s leadership will also be present
at the table of four other notable
initiatives. Our journey toward
Certification 2009 continues as the
phase of developing the certification
exam questions begins this spring
and summer. This will involve
many CAET members from across
Canada who will be called upon by
2 The LINK - March 2008
the Canadian Nurses Association to
participate in the writing of the exam
questions. Although not official I am
pleased to present the following as
the credentialing that will be used
to recognize certified ETs in both
English and French… CETN(c)
Certified Enterostomal Therapy Nurse
(Canada) and ICS(c) Infirmier(ère)
Certifié(e) en Stomothérapie
(Canada). This is leadership.
The CAET and 13 ETs, one RN
representing Long Term Care,
a Registered Dietician and Dr.
Mikel Gray, Editor of JWOCN
met in Toronto in January to begin
the development of Best Practice
Guidelines for Ostomy Care &
Management with the Registered
Nurses Association of Ontario
(RNAO). This will be a year long
project, which will see completion
in early 2009. This is leadership.
CAET received an invitation to
participate on the Colorectal
Cancer Team, an Ontario wide
initiative sponsored by Cancer Care
Ontario. This initiative will oversee
the execution of and evaluate a
comprehensive multi-year cancerspecific
work plan aimed at advancing
patient empowerment and improving
quality and efficiency of cancer
prevention and care. The CAET was
recognized for their expertise and
contribution to patient care. I am
delighted to announce that Debbie
Miller from Toronto has accepted
to be CAET’s representative. This is
leadership.
And if the above wasn’t exciting
enough the CAET research study,
“An Innovative Enterostomal Therapy
Nurse Model of Community Wound
Care Delivery: A Retrospective Cost-
Effectiveness Analysis” authored by
primary investigators Connie Harris
and Ronald Shannon is the feature
article in the JWOCN March/April
edition. I can share with you that
the article looks fabulous! But
most importantly, the message
this publication conveys is the
recognition of patient care and cost
benefits the role the ET nurse brings
to the care and management of
chronic wounds in the community.
The CAET is purchasing reprints of
this ground-breaking research for
distribution to all CAET members
so that you can have ‘the evidence’
that supports your role as an ET
nurse in Canada. This also marks
the beginning of a comprehensive
marketing campaign directed toward
key stake-holders, which will convey
the importance and implications of
this study to our health care practice
and system. This is leadership.
As this is my last message to you
as President, I want you to know
how tremendously honored I feel
to have been given this incredible
opportunity to work for, serve
and represent the CAET. Your
commitment and energy has
propelled the CAET to heights
far beyond previous expectations.
For these past four years, you have
entrusted to me your continued
vote of confidence and support to
navigate the CAET to a position
of professionalism, which is
truly recognized for its unique
contributions as an ET nursing
specialty within the nursing
profession, and within our Canadian
Health Care System. I wish to
express my sincerest appreciation
to the CAET Executive and Board
(2004-08) and the entire CAET
Membership for sharing the Mission,
Vision and Values. Together, and
with extreme passion and leadership
we have pursued and accomplished
excellence.
Français à la page 8/ French on page 8.

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Depuis Kelowna 2004, la CAET a
élaboré une mise en œuvre pour le
moment décisif où, à titre d’association
professionnelle, nous serions prêtes
et positionnées à démontrer notre
leadeurship comme infirmières
spécialisées en stomothérapie. Cette
année soulignera un grand nombre
d’occasions favorables au cours
desquelles, par l’ampleur de nos
connaissances, nos compétences et
notre attitude, NOUS témoignerons de
notre capacité à influencer des résultats
profitables. Faire preuve de leadeurship
est une démarche qui va bien au-delà du
périmètre des attentes traditionnelles…
elle représente la persévérance de ce qui
semblait impossible à réaliser.
La CAET est fière d’être l’hôte conjointe
du 3e congrès du World Union of
Wound Healing Societies qui aura
lieu à Toronto du 4 au 8 juin 2008. La
mission du WUWHS, « L’amélioration
de la vie des personnes souffrant de
plaies partout dans le monde », est l’un
des thèmes que partage la mission de
la CAET, « … la CAET préconise la
meilleure qualité en soins infirmiers
spécialisés en stomothérapie auprès
de personnes souffrant de plaies, de
stomie ou d’incontinence. » Je suis fière
de souligner qu’un groupe de onze
membres de la CAET agiront à titre
de conférencière lors de cet événement
éducationnel prestigieux dans le volet
stomie/incontinence/soins de la peau.
Je suis assurée qu’un grand nombre
de stomothérapeutes seront présentes
pour appuyer, apprendre et transmettre
leurs connaissances, leurs compétences
et leur attitude. Voilà ce que signifie
faire preuve de leadeurship.
La CAET fait également preuve de
leadeurship en étant présente à la table de
quatre autres initiatives remarquables.
Notre parcours vers l’agrément 2009
se poursuit, puisque nous entamerons
la phase de création des questions de
l’examen d’agrément à compter du
printemps et de l’été prochain. Cette
phase permettra à plusieurs membres
de la CAET, partout au Canada, de
participer à la rédaction des questions
de à la demande de l’Association des
infirmières l’examen et des infirmiers
du Canada. Bien que ce ne soit pas
4 The LINK - March 2008
encore officiel, c’est avec plaisir que je
vous présente les titres de compétences
anglophone et francophone qui
seront accordés aux stomothérapeutes
certifiées : CETN(c) Certified
Enterostomal Therapy Nurse (Canada)
et ICS(c) Infirmier(ère) Certifié(e) en
Stomothérapie (Canada). Une autre
preuve de leadeurship.
Une réunion a eu lieu à Toronto en
janvier dernier et réunissait la CAET,
treize stomothérapeutes, une infirmière
autorisée représentant le secteur des
soins de longue durée, une diététiste,
ainsi que le Dr Mikel Gray, éditeur du
JWOCN. Le but de cette rencontre
était d’amorcer le développement des
Directives de la pratique exemplaire
en gestion et soins de stomie en
collaboration avec la RNAO (Registered
Nurses Association of Ontario). D’une
durée d’un an, ce projet sera complété
au début de 2009. Une autre preuve de
leadeurship.
La CAET a reçu une invitation afin
de participer à l’équipe sur le cancer
colorectal, une initiative de l’Ontario
parrainée par Cancer Care Ontario.
Cette équipe supervisera l’exécution
et l’évaluation d’un plan de travail
pluriannuel axé sur le cancer, dont
l’objectif est le renforcement de
l’autonomie du patient et l’amélioration
de la qualité et de l’efficacité des soins
et de la prévention contre le cancer.
Je suis fière de vous annoncer que
Debbie Miller de Toronto a accepté
d’être la représentante de la CAET au
sein de l’équipe. Une autre preuve de
leadeurship.
En plus de toutes ces bonnes nouvelles,
l’étude rédigée par les principaux
investigateurs, Connie Harris et Ronald
Shannon, et intitulée « An Innovative
Enterostomal Therapy Nurse Model
of Community Wound Care Delivery:
A Retrospective Cost-Effectiveness
Analysis » (Un modèle innovateur de
stomothérapeute en soins des plaies :
Une analyse rétrospective en coûts et
en efficacité), sera publiée dans l’édition
de mars-avril du magazine JWOCN. Je
peux vous affirmer que les propos de
cet article sont des plus intéressants!
Mais plus important encore, le message
de cette publication transmet
l’importance en matière de soins du
patient, ainsi que les coûts-bénéfices
liés au rôle de la stomothérapeute
dans les soins et la prise en charge
des plaies chroniques dans la
communauté. La CAET procèdera à
l’achat d’exemplaires de cette étude
novatrice, afin de les distribuer auprès
des membres de la CAET et de vous
permettre de disposer « d’éléments de
preuve » qui appuient votre rôle à titre
de stomothérapeute au Canada. Cette
contribution souligne également le
début d’une campagne de marketing
détaillée visant les parties intéressées,
tout en transmettant l’importance et
les répercussions de cette étude dans
notre pratique et notre système de
soins de santé. Une autre preuve de
leadeurship.
Puisque je rédige peut-être ce
dernier communiqué à titre de
présidente, j’aimerais vous faire
part de ma grande fierté pour cette
incroyable opportunité qui m’a été
offerte de travailler, de contribuer
et de représenter la CAET. Votre
engagement et votre dynamisme ont
projeté la CAET vers des sommets
au-delà des attentes précédentes.
Depuis les quatre dernières années,
vous m’avez confié votre vote de
confiance et d’appui pour diriger
la CAET vers la réalisation d’une
position de professionnalisme. La
CAET est dorénavant reconnue pour
ses contributions uniques à titre de
spécialité en stomothérapie au sein de
la profession d’infirmière tout autant
qu’au cœur du système de soins de
santé canadien. Je désire exprimer ma
reconnaissance la plus sincère auprès
du Conseil et des membres exécutifs
de la CAET (2004-2008), ainsi qu’à
tous les membres de la CAET pour
avoir su partager la mission, la vision
et les valeurs de l’association. De façon
collective et animée par une passion et
un leadeurship extrêmes, nous avons
poursuivi et accompli l’excellence.
Mes plus sincères salutations,

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CAET Announcements
Executive Director’s Report: Nursing Leadership-
A Tribute to Kathryn Kozell
By Catherine Harley
The Canadian Nurses Association
has a position statement on Nursing
Leadership which includes the
following: “Nursing requires strong,
consistent and knowledgeable leaders
who are visible, inspire others and
support professional nursing practice.
Leadership plays a pivotal role in
the lives of nurses. It is an essential
element for quality professional
practice environments where nurses
can provide quality nursing care.
Key attributes of a nurse leader
include being a(n): advocate for
quality care, collaborator, articulate
communicator, mentor, risk taker,
role model and visionary”. [1]
The CAET vision supports nursing
leadership : “The Canadian
Association for Enterostomal Therapy
(CAET) is recognized as nursing
leaders in the specialty of wound,
ostomy and continence. “ There
are many individuals that could be
recognized as Canadian “Nursing
Leaders”. We have been fortunate that
over the past four years, we have had
a “nursing leader” , Kathryn Kozell,
in the role of the CAET President.
In 2004, Kathryn Kozell began her
term as the President of CAET. We
had just completed a three year
strategic business plan and started
to implement this plan under her
leadership. From working on the “ET
Nurse Cost Outcomes Study” to the
restructuring of the CAET, to the
C.N.A. Certification of Enterostomal
Therapists, Kathryn has demonstrated
the traits of a strong, consistent
and knowledgeable leader who is
visible, inspires others and supports
professional nursing practice.
I have personally witnessed the
collective energy of shared leadership
that Kathryn put into her role
as CAET President. This was
6 The LINK - March 2008
demonstrated by forming strong
networks and building relationships
that support the excellence of
Enterostomal Therapy Nursing
practice in Canada. Kathryn
participated in many late evening
conference calls, weekend project
work, weekend meetings and retreats
as well as regular communication to
the CAET Board. All of this was done
in addition to her full-time Nursing
position at the London Health
Sciences Center. She was always
present and ready to do more than
her share of the work, motivating the
group to prepare the CAET for the
next twenty – five years. I am sure that
I am only one of many people who are
honoured to have had the opportunity
to work with Kathryn Kozell. When
her term as CAET President winds
down in June 2008, the CAET can
move into the future confidently with
the benefit of having experienced a
true example of Nursing Leadership.
Un hommage à
Kathryn Kozell
pour ses qualités
de chef de file
par Catherine Harley
L’Association des infirmières et
infirmiers du Canada manifeste
une solide position en matière de
leadership en soins infirmiers, dont
l’énoncé est le suivant : « La profession
infirmière a besoin de chefs de file
solides, constantes et averties, qui sont
visibles, sont une source d’inspiration
et appuient la pratique professionnelle
des sciences infirmières. Le leadership
joue un rôle pivot dans la vie des
infirmières. C’est un élément essentiel
pour assurer l’existence de milieux
de pratique permettant de dispenser
des soins infirmiers de qualité.
Une infirmière chef de file a les
qualités clés suivantes, notamment
: défenseure des soins de qualité,
collaboratrice, communicatrice
avertie, mentor, preneuse de risques,
modèle et visionnaire. » [2]
La vision de la CAET appuie
les qualités de chef de file en
soins infirmiers : « L’Association
canadienne des stomothérapeutes
(CAET) est reconnue à titre de chef
de file en soins infirmiers dans la
spécialité de soins des plaies, de
stomie et d’incontinence. » Il y a
plusieurs infirmières qui pourraient
être reconnues à titre de « chef de file
en soins infirmiers » au Canada. La
CAET est privilégiée de compter dans
son équipe, Kathryn Kozell, qui agit
à titre de présidente de l’association
depuis les quatre dernières années
et qui a su démontrer ses qualités en
tant que chef de file.
En 2004, Kathryn Kozell a accepté
de remplir le mandat de présidente
au sein de la CAET. Nous étions
dans la phase finale de création d’un
plan stratégique échelonné sur trois
ans et nous avons amorcé sa mise
en œuvre sous la direction de la
nouvelle présidente. Ayant travaillé
sur de nombreux projets, dont
l’étude des résultats sur les coûts en
stomothérapie, la restructuration
de la CAET et la certification des
stomothérapeutes, Kathryn a su
démontrer les qualités d’un chef
de file solide, constante et avertie,
ainsiqu’une présence apportant une
visibilité, une source d’inspiration et
un appui à la pratique professionnelle
des sciences infirmières.
Suite à la page 8/ Continues on page 8.
1 The Canadian Nurses Association position
statement on leadership www.cna-aiic.ca
Énoncé de position sur le leadership de
l’Association des infirmières et des infirmiers du
Canada à l’adresse site Web : www.cna-aiic.ca

CAET Announcements
Suite de la page 6/ Continued from page 6.
Nous avons tous été témoins de
l’énergie collective d’un leadership
que Kathryn a su favoriser par son
rôle de présidente de la CAET. Cette
énergie a encouragé la formation de
réseaux solides et de relations fidèles
qui appuient l’excellence dans la
pratique professionnelle des soins en
stomothérapie au Canada. Kathryn
a participé à un grand nombre
de conférences téléphoniques, de
projets, de séances et de réunions
durant les week-ends, ainsi qu’en
communiquant régulièrement avec le
conseil d’administration de la CAET.
8 The LINK - March 2008
En plus de tous ces engagements,
Kathryn occupe un poste d’infirmière
à temps plein au London Health
Sciences Center. Elle a toujours été
présente et prête à en faire plus que
son lot de travail, tout en motivant
le groupe à préparer la CAET pour
les vingt-cinq prochaines années.
Nous sommes assurés qu’un grand
nombre d’entre vous a été honoré
de collaborer avec Kathryn Kozell.
Lorsque son mandat de présidente
de la CAET arrivera à terme en juin
2008, l’association sera en mesure
de progresser avec confiance vers
l’avenir, grâce aux privilèges d’avoir
vécu l’exemple réel des qualités d’un
chef de file.
Guest Editorial/ Éditorial de notre invité
by/par Harvey Schwartz, The LINK Editor/éditeur du LINK
Cheryle Gartley, President of the
Simon Foundation for Continence in
Ilinoisis an exceptionally impressive
person whom I worked with two
years ago for her presentation “Living
with Quigles” for the 14th Annual
Conference of the Developmental
Disabilities Nurses Association. I find
her message both compelling and
tremendously relevant for the CAET.
Cheryle accepted my invitation to
write a guest editorial on “The Impact
of Stigma in Healthcare”. I encourage
you to read her article and visit her
Living with Quigles Blog through the
Simon Foundation website:
www.simonfoundation.org.
Il y a deux ans, j’ai eu le plaisir de
travailler avec Cheryle Gartley,
Présidente de la Simon Foundation
for Continence au Illinois, pour sa
présentation « Living with Quigles »
lors de la 14e conférence annuelle de
la Developmental Disabilities Nurses
Association. Quelle personnalité
impressionnante! Le message de
sa présentation m’a paru à la fois
convaincant et extrêmement pertinent
à l’égard de la CAET.
Je suis particulièrement heureux
que Cheryle a accepté d’agir à titre
d’éditorialiste invitée et de nous parler
d’un sujet passionnant : « The Impact
of Stigma in Healthcare ». Je vous
invite à lire son article, ainsi qu’à visiter
sa chronique Web intitulée « Living
with Quigles » offerte sur le site Web
de Simon Foundation à l’adresse:
www.simonfoundation.org.
Have you renewed your
CAET membership?
You now have two options for
renewing your membership:
1) By mail sending in the
membership form with a cheque
2) New Online Membership
Renewal. Visit the CAET web site
(www.caet.ca). The process for on
line membership is easy! Just click
on the red flashing ATTENTION
MEMBERS sign on the CAET
website home page.
http://www.caet.ca/registration.htm

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CAET Announcements
The Impact of Stigma in Healthcare
by Cheryle Gartley
In 2003 The Simon Foundation for
Continence convened an international
conference as a first step to better
understand the stigma surrounding
incontinence. The purpose of this
conference was to find creative
solutions to stigma in healthcare.
It was exciting to have health care
professionals, scientists who study the
effects of stigma, and individuals who
have stigmatizing health conditions,
all working together. What better
group to lead the way to possible
solutions to stigma in our society, and
the healthcare system in particular?
Stigma in healthcare, the focus of
this article, is of course a subset
of stigmatization in society as a
whole. Stigmatization is personally,
interpersonally, and socially costly.
It is intrinsically apparent that the
scope of the problem in healthcare is
enormous. For example, how many
individuals carrying a given “stigma”,
let’s say incontinence, avoid seeking
healthcare for fear of being further
stigmatized? The increased cost of
medical care due to not seeking timely
intervention is incalculable.
For these reasons, let alone the impact
of stigma on an individual’s life, it is
important for nurses to understand the
phenomena of stigmatization in order
to incorporate this understanding into
how you care for individuals who are
stigmatized due to their healthcare
challenges.
Once you become a student of stigma
you’ll not only be able to spot it in
action but also to join the campaign to
defeat stigma in healthcare by creating
stigma-free medical environments.
Stigma, as defined by the recognition
of difference based on some
distinguishing characteristic or mark,
and a consequent devaluation of the
10 The LINK - March 2008
person, is a commonly used definition
of stigma. The sociologist Erving
Goffman, author of Stigma: Notes on
the Management of Spoiled Identity
created a very helpful word for talking
about stigma -“Quiggles.” Quiggles
is a made-up term to identify all of
the variations and differences of the
human body which occur either from
birth, daily wear and tear, accidents
or illness which can be, and will be,
stigmatized.
In the U.S. alone over 43 million
individuals live with a Quiggle; in fact
people with disabilities are America’s
largest minority and American Sign
Language is the third most commonly
used language after English and
Spanish.
There are many components of
stigma, unfortunately too numerous
for the scope of this article. However,
some basic components need to be
set out as a framework to understand
the impact of living with stigma.
One important concept is that of
discredited vs discreditable. It was
Goffman who drew this important
distinction regarding Quiggle holders.
The question is whether a Quiggle
holder’s difference is evident on the
spot (thus the person may immediately
be discredited) or not immediately
perceivable upon meeting (leaving
the person vulnerable to “discovery”).
In these terms, if one is among the
discredited life involves dealing with
never being free in public, being
stared at, and people’s ignorance as
to how to interface with a stigmatized
individual.
On the plus side, individuals in
this category have the option of
recognizing others in the same
circumstances and entering into
social interactions which might be
supportive.
In the category of discreditable, the
individual has the ability to pass;
that is to enter into society as a “normal”
individual. This ability is not
without expense, however. It leads
to all sorts of dilemmas regarding
information control. The agony of
deciding with new social contacts,
or old ones for that matter; who to
tell, when to tell, to lie or not to lie,
and the constant awareness that at
any time the choice may be taken
out of your control.
The concept of passing is very
relevant to “social continence.”
Social continence, the ability of an
individual to remain dry in public,
often by the use of drainage systems
or absorbent products, allows the
individual to pass in society. However,
the fear of an “accident’ in public is
a twenty-four/seven life companion.
And the dilemma as to when to
disclose the potentially discreditable
information (incontinence) in
intimate relationships is, for many,
a prospect so agony-filled that the
person chooses instead to completely
ignore the opportunity for closeness
in their life.
Cheryle Gartley
Suite à la page 34/ Continues on page 34.

3M and Tegaderm are trademarks of 3M. Used under license in Canada. © 2008, 3M. All rights reserved. 0802-1188 3M_SH_Matrix_Link_Ad_E_Feb0708.ai 2/13/08 9:07:10 AM
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May 2005; 3. Hoekstra M, et al. (2003). Poly Hydrated Ionogens regulate Matrix Metalloproteinases Expression and Reactive
Oxygen Species in Recalcitrant Wounds. European Tissue Repair Society Congress, September 2003; 4. Körber A, et al. (2006).
Erfolgreiche Behandlung therapierefraktärer chronischer Wunden mit DerMax (Successful treatment of therapy-refractory
chronic wounds with Tegaderm Matrix). Zeitschrift fur Wundheiling 6; 310-314; 5. van den Berg AJJ, et al. (2003).
A novel formulation of metal ions and citric acid reduces reactive oxygen species in vitro. J Wound Care 12(10).

CAET Announcements
ETNEP Director’s Report
by Susan Mills Zorzes, Director of Programs
Since my last report to you in the
December issue of The Link, the
ETNEP has continued its move into
an online program:
•Eleven students completed the pilot
first course, Ostomy and Fistula
Management, including a two week
preceptorship in January.
•Ten of these students have begun
the next pilot course, Continence
Management, with Dorothy Phillips
as their instructor.
•Two French speaking students have
enrolled in the French version of
Ostomy and Fistula Management
with Nicole Denis as their instructor.
We are very happy to welcome Nicole
back to the ETNEP for this pilot
course.
•Following some minor changes
to the curriculum and operations,
twenty-two enthusiastic new English
speaking students have begun the
second running of Ostomy and
Fistula Management with Virginia
McNaughton once again the
instructor.
Please refer back to my report in
the December Link which describes
in more detail the three - nineteen
week courses in the revised ETNEP
if the above discussion of “pilots”
and ”courses one and two” seems
somewhat confusing. As the program
continues to grow and change we
will be experiencing some personnel
changes as well:
•Kim LeBlanc has tendered her
resignation effective the completion
of her current ‘old program’ students.
Thank you, Kim for your hard work
and “fresh eyes”.
•Diane Gregoire is also supporting
the last of French speaking students
12 The LINK - March 2008
in the ‘old program’ to graduation and
will then retire. Thank you, Diane for
your patience and all that translation!
•Once she completes the Ostomy
and Fistula Management course with
a second class of students, Virginia
McNaughton will be moving to the
Wound course for the first delivery in
September.
•Don Ardiel, our project manager,
has accepted an architectural project
management job overseas. He has
transferred the day-to-day operation
of our learning management system
(Moodle) to our Administrative
Assistant managed by Harvey
Schwartz. Don will continue
to be involved with the ETNEP
redevelopment project, but in a less
‘hands on’ capacity. Don’s expertise
and persistence with this project has
been invaluable. We look forward
to continued collaboration when he
returns sporadically to Canada.
The following work is in progress:
•The Wound subject matter experts
met face to face (f2f) recently in
Toronto. Alot was accomplished
and the group will continue to
work on their individual sections in
preparation for a September course
start.
•The Professional Practice subject
matter experts will meet at the end of
March to develop the two remaining
modules. As you will recall from
my previous report, the Professional
Practice module is the final module in
each of the 3 courses.
•An evaluation plan for the
redevelopment process and the
new program will be presented for
discussion by the CAET Board of
Directors at the Preconference board
meeting.
Finally, I ask you to stay tuned for eblasts
from your Regional Directors
encouraging you to get involved
with the ETNEP as a preceptor or
Academic Advisor and to seriously
consider applying. As I’ve said in
this column before, the strength of
an ET nursing education program is
the student’s opportunity to practice
what he/she has learned while
observing an excellent role model!
With the increase in preceptorship
to 225 hours as recommended by
both preceptors and students, the
ETNEP needs you as a preceptor
Academic Advisor positions will
also be available in the near future
as we expand our Academic Advisor
pool.
The strength of our Academic
Advisors is that they are also full or
part time practicing ET nurses. A
larger pool of Advisors will allow
individuals more flexibility in the
time they choose to devote to the
ETNEP, their practice or other
projects.
British Commonwealth Air Training Plane
June 2007
Susan Mills Zorzes, ETNEP Director of Programs

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CAET Announcements
Onward with Certification!
by Sharon Evashkevich & Diane St-Cyr
On January 17 and 18th, the eight
members of the CAET /CNA
Enterostomal Therapy Certification
Examination Committee met at CNA
House in Ottawa with staff from
ASI and CNA to begin the formal
development of the Certification
examination process. Members of the
committee collectively bring extensive
years of experience in all aspects if
ET Nursing to the activities of this
committee and represent all regions
of Canada.
The first meeting day was led by
Karine Georges, our very proficient
Project Consultant from Assessment
Strategies, Inc. (ASI). ASI will be
developing the actual examination
document. The agenda for the day
was to review, confirm and rate
the core competencies as identified
previously by membership through
the competency validation survey
which was conducted during
the spring of 2007 and to ensure
accurate representation of these core
competencies on the examination
questions.
The second day was facilitated by the
amazing team from CNA, Leslie Anne
Patry and Lucie Vachon, who manage
all the CNA Certification programs.
Enterostomal Therapy Nurses will be
the 18th specialty to gain certification
status under the CNA umbrella.
Leslie and Lucie led the committee
in reviewing and finalizing all policy
guidelines around the certification
examination for ET Nurses including
eligibility criteria, selection of
specialty designation credential, and
strategies for promotional activities
designed to initiate and sustain
membership commitment to ET
nursing certification.
The next steps will be the writing of the
examination questions themselves.
ET Nurses from across Canada will
14 The LINK - March 2008
CAET/CNA Enterostomal Therapy Certification Exam Committee - January 18, 2008
From left to right - Top row: Dorothy Phillips, Nancy Parslow, Susan Mills Zorzes
Middle row: Vivian Wass, Kathy Mutch, Kathryn Kozell
be selected and invited by CNA to
participate in this key activity. Two
groups of “item writers” will travel to
Ottawa in the spring and early summer
and will spend five days developing
exam questions related to the core
competencies under the leadership of
ASI. Prior to attending these meetings
in Ottawa, all participants will receive
a two hour tutorial on item writing.
The Examination Committee will
then meet again in September to
review and approve all examination
questions, and set the pass mark for
the exam.
Reflecting back on my experience
of participating as a member of this
committee to date, I must say that
I feel both honored and privileged
to have been invited by CAET, and
approved by CNA, to represent the
membership from BC on this historic
endeavor. Working with my esteemed
colleagues on the committee, I was
struck with how quickly we all came
to consensus on virtually every
issue. There seemed to be a synergy
of focused and committed minds
moving forward to achieve a common
goal that we clearly and collectively
shared a passion for.
I have been an ET Nurse since 1974
and was actively involved at the Board
level when CAET was first established
as an entity, separate from the original
US parent organization.
Front row: Sharon Evashkevich, Diane St-Cyr
We have come such a long way
since then, and now, preparing
for certification within the CNA
structure, I feel a great sense of pride
in who we are as a organization.
I also have a distinct sense of
validation that the services we deliver
to our patients, residents, clients and
colleagues are highly valued and
truly make a difference in the lives
of the population we touch.
Respectfully submitted,
Sharon Evashkevich
When I was first approached
by CAET to be a member of
the CAET /CNA Enterostomal
Therapy Certification Examination
Committee, I felt honored and so
excited to be part of this final step
towards ET Certification. As I had
been part of the first focus group to
work on this project in early 2000,
I felt I had this unique opportunity
of being part of the conception
and birth of such an important
professional project. It was great
to join some initial members and
get to meet other colleagues from
across Canada. The variety, harmony
and extent of expertise among
committee members was energizing
and gave me a feeling of synergy
towards this ultimate shared goal,
ET certification.
Suite à la page 16/ Continues on page 16.

CAET Announcements
Suite de la page 14/ Continued from page 14.
It was my first visit to the CNA office
in Ottawa. I was impressed by the
special features of the building. I
found out later in the meeting that
CNA’s head office is an architecture
award winning building; which
reminded me of the uniqueness of
our nursing specialty. The feeling of
pride of being a nurse, and my unique
chance of working with CAET and
CNA towards the advancement of
our nursing specialty was a wonderful
experience.
As the Quebec representative and
French speaking committee member,
I felt a genuine intent by the CNA to
make the certification process as easy
and accessible for either English or
French speaking colleagues. The rigor
of the process to translate exams and
workbooks impressed me. I hope to
be able to encourage Quebec members
to engage in the certification process
without fear of being at a disadvantage
due to language.
I am looking forward to the next
steps of the process and I hope that
other CAET members will have the
chance of participating in this ground
breaking project for our nursing
specialty.
Respectfully submitted ,
Diane St-Cyr
Allez de
l’avant vers la
certification!
par Sharon Evashkevich & Diane St-Cyr
Les 17 et 18 janvier dernier, les
huit membres qui composent le
Comité d’examen de certification en
stomothérapie de la CAET/AIIC se
sont rencontrés à la Maison de l’AIIC
à Ottawa, en compagnie de membres
du personnel de l’Association des
infirmières et des infirmiers du
Canada (AIIC) et de Stratégies en
évaluation (ASI), dans le but d’amorcer
le développe ment officiel du pro-
16 The Link - December 2007
cessus de l’examen de certification. Le
comité est composé de professionnelles
de toutes les régions du Canada, ayant
un parcours collectif qui cumule un
nombre impressionnant d’années
d’expérience, dans toutes les sphères
des soins infirmiers en stomothérapie;
ainsi elles enrichissent les activités de
ce comité.
La première journée de réunion s’est
amorcée sous la direction de Karine
Georges, notre consultante désignée,
experte en projet de l’ASI. Cette société
spécialiste dans le développement
d‘examens de certification au Canada
sera responsable du développement
de notre premier examen de
certification.. L’ordre du jour
comportait la révision, la confirmation
et le classement des compétences
essentielles afin de s’assurer d’une
représentation conforme de ces
compétences essentielles dans les
questions de l’examen. Il importe de
préciser que ces dernières avaient
déjà été déterminées par le biais d’un
questionnaire distribué aux membres
au printemps 2007.
La deuxième journée a été dirigée
par une équipe formidable de l’AIIC,
composée de Leslie Anne Patry et de
Lucie Vachon, qui sont responsables de
tous les programmes de certification
de l’AIIC. La stomothérapie sera la
18e spécialité à obtenir le statut de
certification sous l’égide de l’AIIC.
Leslie et Lucie ont dirigé le comité
dans la révision et la mise au point
des lignes directrices de la politique
encadrant l’examen de certification
pour les stomothérapeutes, incluant
les critères d’admissibilité , la
sélection du certificat attribué à cette
spécialité. Les stratégies d’activités
promotionnelles ont également
été discutées afin d’amorcer et de
maintenir l’engagement à titre de
membre certifié en stomothérapie.
La prochaine étape sera consacrée à la
rédaction des questions de l’examen.
Des stomothérapeutes de toutes
les régions du pays seront choisies
et invitées par l’AIIC à participer
à cette activité primordiale. Deux
groupes de «rédacteurs/rédactrices
des questions» seront invités à venir à
Ottawa au printemps et au début de
l’été, dans le but de consacrer cinq
jours à développer les questions de
l’examen relatives aux compétences
essentielles sous la tutelle de l’ASI.
Tous les participant(e)s suivront
d’abord une
séance de tutorat d’une durée de
deux heures sur la rédaction de
questions avant d’assister à ces
réunions à Ottawa.
Une rencontre des membres du
Comité d’examen de certification
aura ensuite lieu entre en septembre
afin de réviser et d’approuver toutes
les questions de l’examen, ainsi que
pour fixer la note de passage de
l’examen.
En repensant à mon expérience
jusqu’à présent à titre de participante
et membre de ce comité, je suis
sincèrement honorée et privilégiée
d’avoir été invitée par la CAET,
et approuvée par l’AIIC, afin de
représenter les membres de la
Colombie-Britannique à l’égard de
cette mise en œuvre historique. En
travaillant collectivement avec mes
collègues respectées de ce comité,
j’ai été agréablement surprise par la
facilité avec laquelle nous sommes
parvenues à rapidement atteindre
un consensus sur pratiquement
tous les sujets. La présence d’une
synergie entre les membres réunis
dans une même détermination vers
la progression de ce processus a
grandement contribué à atteindre
un objectif commun dont nous
partageons toutes une passion
collective.
Je suis stomothérapeute depuis 1974
et j’ai participé activement au niveau
du conseil, lorsque la CAET a été
fondée en tant qu’entité entièrement
distincte de l’organisation mère
américaine. Quel chemin parcouru
depuis cette époque! En préparant
maintenant l’entrée de la certification
au sein de la structure de l’AIIC, je
ressens une grande fierté envers
l’organisation et les services
hautement qualifiés que nous offrons
à nos patients, résidents, clients
et collègues tout en améliorant
véritablement leur qualité de vie.
Le tout respectueusement soumis,
Sharon Evashkevich

Lorsque la CAET m’a invitée à être
membre du Comité d’examen de
certification en stomothérapie de
la CAET/AIIC, je me suis sentie
honorée et emballée de participer à
cette dernière étape relative à la certification
en stomothérapie.
Ma présence au sein du premier
groupe de consultation à mettre à
l’œuvre ce projet au début de l’an
2000 m’a permis de participer à la
conception et au développement
d’un projet professionnel des plus
importants. Ce fut donc avec grand
plaisir que je me suis jointe à certains
membres du projet initial et que j’ai
fait la rencontre d’autres collègues
des différentes régions duau Canada.
La variété, la complémentarité et la
vaste expertise des membres du
comité ont été des plus stimulantes
et m’ont procuré un sentiment de
synergie vers notre objectif ultime,
la certification en stomothérapie.
Il s’agissait de ma toute première
visite à la Maison de l’AIIC à
Ottawa et j’ai été impressionnée par
le caractère distinctif de l’édifice.
J’ai découvert plus tard, lors de la
réunion, que le siège social de l’AIIC
avait gagné un prix en matière de
design architectural; ce qui m’a fait
penser au caractère unique de notre
spécialité en soins infirmiers.
Le sentiment de fierté que j’éprouve
envers la profession d’infirmière
jumelé à ma chance unique de
travailler collectivement avec la
CAET et l’AIIC, dans le but de faire
progresser notre spécialité en soins
infirmiers, m’a permis de vivre une
expérience formidable. À titre de
représentante du Québec et comme
membre francophone du comité, j’ai
ressenti une volonté authentique de la
part de l’AIIC envers la création d’un
processus de certification facile et
accessible à la fois pour les collègues
anglophones et francophones. J’ai
été impressionnée par la rigueur du
processus de traduction des examens
et des cahiers d’exercices. Mon
mandat sera donc d’encourager les
membres québécois à prendre part
au processus de certification sans
crainte de désavantage en raison de
la langue.
Je suis impatiente de connaître les
prochaines étapes du processus de
certification et je souhaite que les
autres membres de la CAET aient la
chance de participer à ce projet
inaugural de notre spécialité en soins
infirmiers.
Le tout respectueusement soumis,
Diane St-Cyr
Developing
Competency in
Conservative
Sharp Wound
Debridement - How
do we do that?
by Sharon Evashkevich
The Vancouver Coastal Health Region
is in the process of writing clinical
practice guidelines and competency
requirements for the specialized
skill of conservative sharp wound
debridement. It seems to me that this
project presents an ideal situation to
employ collaborative practice, so I
would like to inquire if there are other
regions or clinicians across Canada
who have already developed similar
guidelines and/or competencies or
are in the process of doing so.
Under the BC Health Professions Act,
wound care has been designated to be
under the domain of nursing and the
College of Registered Nurses of BC
(CRNBC) has clarified in their new
charter that all RN’s in the province
can carry out wound care procedures
without an order. They have, however,
identified sharps debridement as a
reserved action of wound care and
have put limits and conditions on
it – the limits and conditions being
that the RN must “complete further
education prior to performing
CSWD”. This additional education is
to be provided through the employing
agency and not through CRNBC.
We have been asked, however, to
approach the development of an
education program at the provincial
level rather than from an individual
employer perspective.
CAET Announcements
Our regional Skin and Wound Care
Committee has been working on this
document for the past year and we
have completed the final draft of our
Clinical Practice Guideline. Our CPG
identifies that wound care clinicians
are covered to perform CSWD once
they have completed an accredited
WOCN/ETN education program or
wound management specialty course
and that an RN may perform CSWD
once the nurse has completed a recognized
course in CSWD.
We now need to develop the program
to provide the “additional education”
as required by the provincial nurses
association. The logistical challenges
of developing and administering such
a competency education package are
many - developing course content,
availability of qualified staff to
present the course, best methodology
of teaching the course considering
geography, etc. One option that
we have considered is contracting
services from a company from the
US who presents a debridement
competency workshop and who
would bring the program to us and
customize it to our needs.
I am curious to know how each
province is approaching sharp
debridement – are you in the
same situation as BC where it is
designated as a reserved action under
your provincial association or is it
designated as a transfer of functions.
For instance, I have received
information from Alberta where it is
a reserved action and from Manitoba
where it is a transfer of functions.
I would be most grateful to receive
any information, comments and
suggestions to assist in developing
our competency education package.
Please contact Sharon Evashkevich at
sharon.evashkevich@vch.ca
with any information.
March 2008 - The LINK
17

18 The LINK - March 2008

Where there is something for
everyone.
by Jessica Black, WUWHS 2008 Senior Project Manager
You know the old saying, ‘we can please some of the people all of
the time and all of the people some of the time’? Well, why can’t
we please all of the people all of the time? The answer is we can.
And we will – with the comprehensive curriculum planned for the
upcoming World Union Congress 2008.
Understanding that wound care professionals have different levels
of experience, unique requirements for continuing education, and
personal areas of interest, Congress 2008 is all about choice. With
10 concurrent evidence based streams featuring more that 100
educational sessions, delegates have the ability to design a program
of learning ideally suited to their needs. For example, if the focus
is on treating acute wounds, there are 10 comprehensive sessions
focused exclusively on burns, surgical, traumatic wounds and other
acute wounds, enabling the creation of an in-depth, highly focused
agenda. The same inclusive agenda exists for pressure ulcers, diabetic
foot ulcers, ostomy/continence/skin care, leg ulcers, and complex
wounds – all accredited by the University of Toronto.
If one of these sessions is not of interest, then perhaps a theme based
curriculum would be. Congress 2008 has it. With 6 themes woven
throughout the streams it’s easy to pursue one area of interest. These
include infection, evidence/education, quality of life, health care
systems, local wound care, and research.
And there’s more. Free papers will be presented by 150 wound care
professionals on a variety of topics from global perspectives and
research to the management of complex wounds. There will be
200 key opinion leaders from the field of wound care participating
to ensure delegates receive the most current clinical information
available as well as training in best practices that can be applied to
invigorate your wound care practice.
With a stimulating pre-conference day, three plenary sessions
featuring internationally acknowledged speakers, and the world’s
largest wound care trade exhibition, there truly is something for
everyone at this unique conference.
Don’t wait. Register today for Congress 2008 at:
www.worldunion2008.com.
If you do, you’ll be pleased
© WUWHS 2008 · Image © Olga Skalkina/Shutterstock
One Problem –
One Voice
Third Congress of the
World Union of
Wound Healing
Societies
June 4 – 8, 2008 · Toronto, Canada
Hosted and Accredited by
University of Toronto
REGISTER NOW!
Don’t miss the most
important wound care
conference of 2008. This
congress is for all levels
of experience, expertise
and interest.
Featuring a faculty of
key opinion leaders
from around the world,
over 100 sessions and
800 abstracts.
For complete
information visit our
Web site.
For detailed information and updates please visit
www.worldunion2008.com
March 2008 - The LINK
19

The 2008 CAET Conference will be combined with the World Union of Wound Healing Meeting
which will take place in Toronto June 4 to 8, 2008. The CAET is a co-hosting society of the World
Union of Wound of Wound Healing Societies meeting.
Schedule of Events
June 2, 2008 – CAET Pre-Board Meeting
June 3, 2008 – CAET Annual General Meeting followed by CAET Banquet
June 4 to 8, 2008 – World Union of Wound Healing Societies Meeting
Date of Ostomy/Continence Stream : June 8, 2008
Guide to Registration
For the CAET Annual General Meeting please confirm your attendance by e mailing the CAET
Executive Director: catherine.harley@sympatico.ca
For the “not to be missed “ CAET banquet, please register on line at www.caet.ca and click on
conference ( Book now- tickets are selling fast!)
For further information on this exciting WUWHS meeting and to register for the educational
sessions please go KCI to www.wuwhs2008.com
Horiz 7-5X4-9-Healing.QXE 1/23/07 10:48 AM Page 1
The CAET wants to thank the following corporate partners for supporting the CAET
pre-meetings and CAET banquet:
nal_ad_07-HighPage 1 22/02/2008 4:38:03 PM Corporate
20 The LINK - March 2008
Changing the standard of healing
Advanced Therapies Innovative therapeutic medical devices that promote
Proven outcomes
wound healing and treat complications of immobility.
Honoured Working Corporate with health care professionals Partners
everywhere
Cost-Effective
to help change the standard of healing.
KCI Medical Canada Inc.
95 Topflight Drive • Mississauga • Ontario L5S 1Y1
Canada • Toll free 1 800 668 5403
Tel 1 905 565 7187
Fax 1 905 565 7270
www.kci-medical.com
Partners
2005 KCI Liscensing, Inc. All rights reserved. All trademarks and service marks designated herein are the property of KCI and its affiliates and licensors. Those KCI trademarks designated with the “®” or “TM”
symbol are registered in at least one country where this product/work is commercialised, but not necessarily in all such countries. The V.A.C. ® (Vacuum Assisted closure ® ) System is subject to patents and/or pending patents.
Note: Specific indications, contraindications and precautions and safety tips exist for this product and therapy. Please consult your physician, product instructions and safety tips prior to applications.

The 2008 CAET Conference will be combined with the World Union of Wound Healing Meeting
which will take place in Toronto June 4 to 8, 2008. The CAET is a co-hosting society of the World
Union of Wound of Wound Healing Societies meeting.
Schedule of Events
June 2, 2008 – CAET Pre-Board Meeting
June 3, 2008 – CAET Annual General Meeting followed by CAET Banquet
June 4 to 8, 2008 – World Union of Wound Healing Societies Meeting
Date of Ostomy/Continence Stream : June 8, 2008
Guide to Registration
For the CAET Annual General Meeting please confirm your attendance by e mailing the CAET
Executive Director: catherine.harley@sympatico.ca
For the “not to be missed “ CAET banquet, please register on line at www.caet.ca and click on
conference ( Book now- tickets are selling fast!)
For further information on this exciting WUWHS meeting and to register for the educational
sessions please go KCI to www.wuwhs2008.com
Horiz 7-5X4-9-Healing.QXE 1/23/07 10:48 AM Page 1
The CAET wants to thank the following corporate partners for supporting the CAET
pre-meetings and CAET banquet:
nal_ad_07-HighPage 1 22/02/2008 4:38:03 PM Corporate
20 The LINK - March 2008
Changing the standard of healing
Advanced Therapies Innovative therapeutic medical devices that promote
Proven outcomes
wound healing and treat complications of immobility.
Honoured Working Corporate with health care professionals Partners
everywhere
Cost-Effective
to help change the standard of healing.
KCI Medical Canada Inc.
95 Topflight Drive • Mississauga • Ontario L5S 1Y1
Canada • Toll free 1 800 668 5403
Tel 1 905 565 7187
Fax 1 905 565 7270
www.kci-medical.com
Partners
2005 KCI Liscensing, Inc. All rights reserved. All trademarks and service marks designated herein are the property of KCI and its affiliates and licensors. Those KCI trademarks designated with the “®” or “TM”
symbol are registered in at least one country where this product/work is commercialised, but not necessarily in all such countries. The V.A.C. ® (Vacuum Assisted closure ® ) System is subject to patents and/or pending patents.
Note: Specific indications, contraindications and precautions and safety tips exist for this product and therapy. Please consult your physician, product instructions and safety tips prior to applications.

CAET Announcements
WCET NEWS
The 17th Congress of the
World Council of Enterostomal
Therapists (WCET) is being
held in Ljubljana, Slovenia
June 15 – 19, 2008 (www.
wcet2008.org) The theme of
the Congress is “All roads lead
us together” and will bring
colleagues together from all
over the world.
WCET aspires to the core
values of respect, integrity,
communication, holistic care
and scientific approach. One
of its vision is “to ensure
specialized nursing care is
available worldwide for all
22 The LINK - March 2008
people with a need for ostomy,
wound [and] or continence
care”.
Being a WCET member
and / or attending a WCET
Congress gives an individual
an opportunity of world
networking and learning
about research, education and
common / diverse themes of
the ET nursing community
at a global level. Currently
Canadians, past and present,
have and are participating in
key roles at the executive level.
I encourage ET nurses across
Canada to consider being a
member of the WCET
(www.wcetn.org).
Respectfully submitted,
Lorraine Sinclair,
Acting Canadian
International Delegate

14 THE LINK... APRIL, 2005

CAET Announcements
CAET Thanks Diane Garde
Kathryn Kozell, President On behalf of the CAET Board and the CAET Membership
Monuments stand for historical
meaning of achievement and
worthiness. These words all stand
for Diane Garde. And it is with these
words that the CAET expresses our
sincerest THANKS to Dianne for her
24 The LINK - March 2008
years of tenure and service as
Professional Assistant and holding
down the activities of our former
CAET Head Office in Mississauga.
January marked the end and beginning
of a new era for the administrative
activities for the CAET and the
ETNEP.
The CAET National Office has been
moved to Mount Royal, Quebec. And
with this move came the closing of
the Mississauga location and Diane’s
role. However, we know Dianne ‘all
too well’ and in her own words, “I’m
not quite ready to retire yet!” So, the
CAET hopes that we can coax Diane
to continue to serve as that monument
by providing the LINK and Website
with “Historical CAET Moments”.
KCI Woundhealing Horiz 7-5X4-9.QXE 1/24/07 12:54 PM Page 1
V.A.C. ® Therapy
Decreases wound volume
Removes excess fluid
Assists granulation*
acute/traumatic wounds
dehisced wounds
flaps and grafts
subacute wounds
pressure ulcers
chronic wounds
diabetic ulcers
Time Heals all Wounds?
As a healthcare provider you do not have all the time in the world. Neither does your patient.
V.A.C. ® Therapy is one of the most innovative therapies for effective wound healing on
the market. Using negative pressure, in combination with unique dressing systems,
V.A.C. ® Therapy is designed to deliver controlled, consistent and safe therapy.
If time is important to you why not find out more about V.A.C. ® Therapy?
To find out more about V.A.C. ® Therapy visit
www.kci-medical.com or call us at 1-800-668-5403
Jim & Diane Garde
Diane, our sincerest Best Wishes
and deepest appreciation for all
that you have done for us, and the
CAET.
*Joseph, et al, WOUNDS 2000; 12 (3); 60–67. Additional articles and studies on file and available upon request. Data on file and available on request. 2005 KCI Liscensing, Inc. All rights reserved.
All trademarks and service marks designated herein are the property of KCI and its affiliates and licensors. Those KCI trademarks designated with the “®” or “TM” symbol are registered in at least
one country where this product/work is commercialised, but not necessarily in all such countries. The V.A.C. ® (Vacuum Assisted closure ® ) System is subject to patents and/or pending patents.
Note: Specific indications, contraindications and precautions and safety tips exist for this product and therapy. Please consult your physician, product instructions and safety tips prior to applications.

2008 marks the 40th anniversary of the WOCN conference. This conference promises the opportunity to
celebrate historical events and milestones in the field, reunite with former friends and colleagues all while attending
top-notch and practical educational sessions. If you are providing wound, ostomy and/or continence care, you can’t
afford to miss this event!
For more information, please contact the WOCN National Office at 1-888-224-WOCN (9626) or via e-mail wocn_info@wocn.org.
15000 Commerce Parkway, Suite C, Mt. Laurel, NJ 08054-2212 • Stay up-to-date on all activities by visiting www.wocn.org.

Featured Article
Wound Care Leaders
by Harvey Schwartz, The LINK Editor
In this pre-conference issue of the
LINK, I invited Wound Care Leaders
from across the country to be
interviewed. To follow are excerpts
from interviews with three of the
respondents.
Dans cette édition du LINK précédant
la conférence, j’ai invité des chefs de
file en matière de soins des plaies
provenant des quatre coins du pays
dans le but d’être interviewés. Nous
vous présentons les extraits des trois
infirmier(ère)s qui ont gentiment
accepté de se soumettre à une
entrevue.
Sharon Evashkevich, BScN, ET
Vanvouver, British Columbia
1. What is your current position
at The Vancouver Community/
Residential Care?
My position is with Vancouver
Community/Residential Care. I am
the Skin & Wound Management
Clinician for 31 different Residential
Care Facilities located throughout
Vancouver.
2. How long have you been in this
role?
I have actually been providing
service to the facilities for just over
four years now. When I first started
doing this, I was with the Wound,
Ostomy, Continence Nursing Team at
Vancouver General, and Vancouver
Community was contracting services
from the VGH team. That changed
just a little under a year ago and
my position was relocated to the
Residential Care Practice Team within
the Vancouver Community portfolio.
3. Could you define your area of
Wound Care in Long Term Care
settings for us?
I am responsible for providing
education and direct consultation to
all the facilities for any skin and/or
wound management issues. It’s a
pretty big portfolio, covering over
3600 beds, so I focus on education for
all staff in developing their knowledge,
experience and confidence in
26 The LINK - March 2008
of non-complex wounds on their
own, and I provide direct consultation
for complex wound care.
4. We understand that Wound Care
in the Long Term Care is an area that
you have experience in. How often
do you see patients with wound
issues in this setting?
How frequently I see each resident will
depend entirely on the complexity of
their needs and the resources within
the facility – each facility is different.
That’s what makes this position fun
and challenging.
5. How do these patients present
themselves?
They are referred by the staff at the
facilities and I see them on site in
their facility either during scheduled
wound rounds or as a specific consult
for complex wound management. I
also have several of my facilities on
the Pixalere wound documentation
program, so manage many consult
requests in that way.
6. Could you walk us through the
assessment of a patient with a
wound?
I pretty much follow the traditional:
location, identify cause, remove
or control cause, identify other
contributing factors, identify
desired outcome, presence of critical
colonization/infection, do wound
measurements, assess wound bed,
edges, periwound skin, exudate, odour,
pain. Teaching the staff to do this on
a consistent basis can sometimes be
challenging – they often still want to
jump straight to what dressings to put
on the wound.
7. What are the Wound Care
management techniques in your
current practice (within the last
year or two) that present the greatest
challenge in the Long Term Care
setting?
Complex wound management as a
whole. Both the cost of wound care
products/modalities required for
some wounds and the time required
for delivering the wound care itself
can be very challenging for a facility
to fit into their budgets and staffing
ratio. We are sometimes restricted
in our wound management choices
as well as ability to accommodate a
resident with complex wounds in a
facility. There is presently no
program in BC that assists the
facility with such costs and they have
to cover it out of their regular budget
allotment.
8. Are there members of your
wound care team who play a key
role with these patients?
Absolutely – skin & wound
management is always a team effort.
9. Who are they and what role do
they play?
Pretty much anyone who has any
interaction with the resident starting
with the Care Aides and Health
Care Workers right through to the
interdisciplinary staff such as OT,
PT , dietician, infection control,
palliative/pain control clinician,
and of course, the physician staff,
podiatry, etc. They all contribute
expertise within their role. Whenever
possible we conduct interdisciplinary
wound rounds so all members can
contribute and learn together.
10. How do you go about teaching
these patients and their families?
The facility staff is responsible for
a lot of the teaching. Any patient
teaching that I do is usually staff
focused, but certainly the resident
will receive any relevant teaching if
I am on site for wound rounds or for
a complex wound consult. My main
focus is to teach the staff so they
can be independent in their skin
& wound care, including resident
teaching.
11. Is there a particular case that
you could share with us?
Actually, rather than a specific case,
I would just like to say that one of
the true successes of our program
is the decrease we have seen in the
incidence of wounds developing
within the facilities, especially
pressure wounds. The focus on
prevention has been well received
and has made such a difference. I
have found residential care to be
quite unique and challenging. It
has certainly been rewarding, as
having this position within the
residential care program has made
such a difference with many positive
outcomes.
Suite à la page 28/ Continues on page 28.

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Featured Article 3. Could you define your area of D.S.: Je travaille depuis de nombreuses
Suite de la page 26/ Continued from page 26.
Tarik Alam RN, BscN, ET
(English answers) &
Wound Care for us?
T.A.: Our department’s main area
of wound care consists of inpatient
and outpatients. Common types of
années comme consultante en soins
de plaies, ce qui m’amène à évaluer et à
traiter avec l’équipe interdisciplinaire
d’innombrables clients qui
Diane St-Cyr RN, BscN,MMed, ET wounds that we see in these patient présentent une ou plusieurs plaies.
(French answers)
populations include pressure ulcers, L’évolution des types de pansements
1. What is your current position at
McGill University Health Centre/
Montreal General Hospital?
Tarik: I am employed as an
Enterostomal Therapy Nurse, fulltime.
The majority of my work is spent
at the Montreal General Hospital,
one of five hospitals associated with
the McGill University Health Center
(MUHC). I occasionally travel
to the other hospitals for patient
consultations and administrative
tasks. My major focus is the adult
population.
Diane: Je travaille comme infirmière
stomothérapeute à temps partiel,
3 jours/semaine. Je travaille
principalement au site de l’Hôpital
Général de Montréal, l’un des six sites
du Centre de santé de l’Université
McGill (CUSM). D’ici la construction
du nouvel hôpital, je suis appelée à
intervenir occasionnellement comme
personne ressource clinique ou pour
collaborer à des projets qui impliquent
tous les sites du CUSM (p.ex : étude
de prévalence annuelle pour les
plaies de pression. Je suis également
un instructeur clinique à la faculté
des Soins infirmiers de l’Université
McGill pour les soins de plaies.
2. How long have you been in this
role?
T.A.: I have worked in the Enterostomal
Therapy Department since 2000. I
graduated from the ETNEP program
in 2004.
D.S.: J’ai commencé à travailler
comme infirmière stomothérapuete
à temps complet en janvier 2000 et
à temps partiel à compter de 2002
à temps partiel. J’ai commencé à
travailler en stomothérapie depuis
1984 et j’ai terminé ma formation de
stomothérapeute en 1986. J’ai ainsi
travaillé dans 3 centres hospitaliers
universitaires pour développer le rôle
de l’infirmière stomothérapeute.
surgical wounds, diabetic foot ulcers,
traumatic wounds, arterial and venous
ulcers, and peristomal wounds. Less
common types of wounds would
include autoimmune wounds, thermal
wounds and metastatic wounds.
D.S.: Les soins de plaies sont
très diversifiés dans notre milieu
clinique. Cependant, la majorité des
consultations sont effectuées pour les
clients hospitalisés. Notre institution
est un centre de traumatologie de
type 1, ce qui entraîne le traitement de
plaies chirurgicales et traumatiques
graves et complexes (p.ex.: dégantage,
fistule entérocutanée). Une panoplie
de plaies chroniques d’étiologies
variées sont aussi traitées au
quotidien soit des plaies de pression,
des plaies vasculaires (veineuses,
artérielles et mixtes) et des ulcères du
pied diabétique. Des plaies d’origine
systémique et des plaies oncologiques
(métastases cutanées et brûlures de
radiothérapie) sont également traitées
dans notre pratique clinique.
4. We understand that Wound Care
is an area that you have experience
in. How often do you see patients
with wound issues?
T.A.: I have seen thousands of patients
with wounds over the past eight
years. I have been fortunate to have
worked with all of these patients as
I learn from each one. I see patients
who have wounds every day. At any
given point, our service follows 40-
50 inpatients that have some type of
wound. The MUHC is a wonderful
place to obtain experience in wound
care. For example, our center is one
of two level one trauma centers on
the island of Montreal. We see some
of the worse traumatic wounds in
Quebec. Recently, our department
has become involved with internet
and telephone wound consultations
from the northern regions of Quebec.
Internet consultations often are
accompanied by digital images of the
et des modalités adjuvantes nous
aident quotidiennement à favoriser
la cicatrisation de plaies qui jadis
auraient été jugées incurables, même
chez des clients qui ont plusieurs
maladies concomitantes.
5. Could you walk us through the
assessment of a patient with a
wound?
T.A.: A baseline patient assessment is
usually performed first and includes
obtaining information on the past
medical history, wound etiology,
social and environmental data, and
caregiver support. It is important to
establish the goal of care as this will
guide treatment decisions. I usually
try to approach a patient with a
wound in a systematic fashion.
The CAWC quick reference guide
(preparing the wound bed) assists
me to assess these patients in a
consistent and systematic approach.
The four main sections in this
guide consist of (1) identifying and
treating the cause, (2) addressing
patient centered concerns, (3)
providing local wound care, and (4)
providing organizational support.
This approach enables the health
care professional to look at the whole
patient before treating the wound.
I encourage anyone interested in
wound assessment to read the CAWC
best practice recommendations for
preparing the wound bed.
D.S.: Une évaluation exhaustive
du client qui souffre d’une plaie
est effectuée initialement. Celleci
comporte l’histoire de santé du
client, la description de l’avènement
de la plaie actuelle (évènement
déclencheur, durée d’évolution),
l’étiologie et les paramètres cliniques
de l’évaluation physique de la plaie,
les facteurs de risque et ceux qui
sont nuisibles à la guérison, les
facteurs d’ordre psychosociaux et
économiques liés aux soins de la
plaie.
28 The LINK - March 2008
wound.
Suite à la page 30/ Continues on page 30

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Featured Article
Suite de la page 28/ Continued from page 28.
Cette évaluation permet de fixer les
objectifs de soins et de traitement de la
plaie en collaboration avec les membres
de l’équipe interdisciplinaire. Le
paradigme du soin de plaies préconisé
par l’association canadienne du soin
des plaies (1. identifier et traiter les
causes, 2. aborder les préoccupations
individuelles du client, 3. procurer les
soins locaux de la plaie et 4. procurer
un soutien organisationnel) est le
cadre de référence qui guide notre
pratique clinique afin d’optimiser
les soins de plaies à la clientèle et
d’appliquer les pratiques exemplaires
qui sont beaucoup plus vastes que les
soins locaux à prodiguer à la plaie.
6. What are some key things that we
should be looking for?
T.A.: Assessing a patient’s ability
to heal is critical. Decreased blood
supply will impede wound healing
and some wounds will not heal
in the presence of severe arterial
insufficiency. Addressing a patient’s
concerns such as quality of life and
pain may lead to better outcomes.
Providing education usually leads
to increased adherence to treatment
plans. Debridement, infection
control and moisture balance play
important roles in the treatment of
wounds. A team approach involving
many different types of health care
professionals usually provides the best
strategy to managing wound care.
D.S.: L’évaluation du potential de
cicatrisation de la plaie est un aspect
crucial de l’évaluation. Par exemple,
une diminution de l’apport sanguin
à une plaie située sur un membre
inférieur peut compromettre la
possibilité de guérison de la plaie.
Trouver des solutions pour diminuer
les préoccupations du client, telles
que la diminution de la douleur, de
la fatigue chronique et l’isolement
social causé par la plaie, favorisent
la guérison optimale de la plaie.
L’enseignement à la clientèle favorise
une meilleure adhérence au plan de
soins et de traitements. Finalement
l’approche interdisciplinaire est la
meilleure stratégie particulièrement
pour le soin de plaies complexes.
30 The LINK - March 2008
7. What are the greatest challenges
within your department?
T.A.: Establishing a team approach
to certain types of wounds has been
my greatest challenge. For example,
patients with diabetic foot ulcers
require the involvement of many
health care disciplinesThe MUHC
does not have an interdisciplinary
diabetic foot team. This results in
suboptimal and fragmented treatment
for these patients.
D.S.: L’implantation d’une équipe
interdisciplinaire formelle en soins de
plaies est l’un des plus grands defies
auquel nous sommes confrontés.
Par exemple, pour intervenir de
manière optimale auprès de la
clientèle qui souffre d’un ulcère
diabétique, il est crucial de travailler
en équipe interdisciplinaire afin de
pouvoir traiter les causes de la plaie,
d’intervenir sur les préoccupations
individuelles du client et de prodiguer
les soins locaux pour favoriser une
cicatrisation rapide et durable de la
plaie. Il en résulte parfois une approche
plus fragmentée qui ne génère pas des
résultats optimaux de cicatrisation.
8. How do you go about teaching
these patients and their families?
T.A.: I integrate the principles of adult
learning into my practice. . I start with
a needs assessment to determine what
the learner perceives to be important
and what topics need to be addressed.
I then formulate objectives and create
a teaching plan. Once the teaching
plan has been implemented, the
knowledge acquired by the patient
will be assessed. When possible, I try
to include family members, significant
others or caregivers in the teaching
sessions.
D.S.: Les principes d’andragogie sont
appliqués dans la pratique clinique afin
de favoriser l’enseignement des autosoins
et l’utilisation des pansements.
Il faut d’abord déterminer les
besoins d’enseignement et les sujets
spécifiques à aborder avec le client et
sa famille. Une fois l’enseignement fait
il est important d’évaluer les acquis
à l’aide d’une méthode d’évaluation
formelle ou informelle. La famille
et les personnes significatives sont
intégrées dans le plan d’enseignement
afin d’optimiser la prise en charge de
plaies complexes.
9. Is there a particular case that you
could share with us?
(Background, issue , treatment and
outcome)
T.A.: I had an interesting wound
consult last year. I received a call
from a nurse in the outpatient
oncology department with a request
to debride a leg wound. The 50 year
old gentleman had been diagnosed
with a pretibial leg sarcoma and had
been treated with radiotherapy. He
had been told that he was cancer
free and that the wound should
heal in a few months. I had the
patient come up to my clinic the
same day as I received the consult.
I was astounded to find a large 15
by 10 cm foul smelling lesion on
his lower leg that was completely
covered in loose yellow slough and
had three prominent nodules within
the wound base. The patient stated
that the one biopsy taken after the
radiotherapy was negative for cancer.
Suspecting that the cancer was still
present, I contacted the oncology
nurse and strongly suggested rebiopsying
the wound. I did not
receive any further news from
the patient or from the oncology
department until three months later,
when a home care nurse called me
to discuss his wound. The nurse
was concerned because the wound
was treated with negative pressure
therapy and getting larger. A biopsy
taken 2 months prior was negative.
I contacted our nurse clinician in
dermatology, emphasizing that the
clinical presentation of the wound
along with the wound etiology
did not correlate to the negative
biopsies. The patient underwent
two biopsies within the wound, one
at the wound margin and the other
within the wound. The biopsies
revealed a recurrence of the sarcoma
and the patient subsequently
underwent a below knee amputation.
Unfortunately, the cancer had spread
to the inguinal lymph nodes.

Featured Article
E.T. Leadership In Pressure Ulcer Prevention
by Nancy Parslow, RNET
Short Biography: I am presently
the Wound Care Specialty Nurse at
Southlake Regional health Centre in
Newmarket. I am also on the RNAO
development panel for the new
Ostomy Guideline. In the past I was
on the RNAO development panels
for the BPG’s for Risk Assessment
and Prevention of Pressure Ulcers,
Assessment and Treatment of Stage
1-4 Pressure Ulcers, Assessment and
Management of Venous leg Ulcers.
I am also involved on the CAET
certification examination committee
and cirriculum development for the
revised educational program.
Pressure ulcer development
increases length of hospital stay,
complexity of care needs, morbidity
and mortality rates, and suffering
from complications associated
with pressure ulcers (Foster, Frisch,
Denis, Forler, and Jago, 1992). The
use of a program to prevent pressure
ulcers should decrease costs, length
of hospital stay and reduce patient
suffering.
A study conducted across Canada
by Woodbury and Houghton in
2004 identified that the problem
with pressure ulcer development is a
significant occurrence in a variety of
health care settings with an average
prevalence of 26.2 % of patients
having a pressure ulcer.
A review of the evidence presented
in the RNAO Guideline; Risk
Assessment and Prevention of
Pressure Ulcers 2005, estimates
that “10% of patients admitted to
hospital will develop a pressure ulcer,
the elderly are at highest risk with
approximately 70% of all pressure
ulcers occurring in elders. Of those
patients who develop pressure ulcers,
approximately 60% occur in the acute
care setting – usually within the first
two weeks of admission with 15% of
elderly patients estimated to develop
ulcers within one week of admission.
Several studies report mortality rates
32 The LINK - March 2008
as high as 60% for elders with a
pressure ulcer within one year of
discharge from hospital.” (RNAO, pg
20, 2005)
The publication of Best Practice
information such as that developed by
the Canadian Association of Wound
Care (CAWC) and Registered Nurses
Association of Ontario (RNAO) have
created national awareness of the need
to prevent pressure ulcers and has
established standards of care that can
be used as quality of care indicators.
Programs such as the CAWC Pressure
Ulcer Awareness Program, patient
safety initiatives and accreditation
standards stress the necessity of early
intervention for those patients at risk
of developing pressure ulcers (RNAO,
pg. 20- 21 2005). Studies indicate
that the majority of pressure ulcers
are preventable with appropriate
interventions.
The development and implementation
of a formalized program to prevent
pressure ulcers is often confronted
by many challenges that must be
overcome before a change in practice
can be effectively incorporated.
Issues related to staff shortages, lack
of available time, lack of leadership
and support for the creation of a
program may be common roadblocks
to success. Many clinicians struggle to
obtain the resources and support that is
necessary to implement best practices
for pressure ulcer prevention.
I was very fortunate to be selected as
a site champion to pilot the CAWC
Pressure Ulcer Awareness Program
(PUAP) for my community hospital.
The PUAP utilizes a structured team
approach to advocate for Pressure
Ulcer (PU) prevention by providing
a supported, organized program
ready for implementation by the
site champion. The ET nurse who
provides leadership and expertise in
skin and wound management is the
ideal candidate to lead a pressure
ulcer prevention program such
as the PUAP. All site champions
receive mentorship from the
CAWC program leader and other
site champions to support the
development of leadership skills to
overcome challenges and implement
the PUAP program successfully.
This ongoing link to a supportive
network facilitates the development
of creative strategies to manage
adversity and obtain the support
and recognition necessary to
incorporate an interdisciplinary
pressure ulcer prevention program
into everyday practice.
Recognition of the ET nurse as
a leader and expert in pressure
ulcer prevention and management
was enhanced by the role of the
PUAP facilitator. As the various
components of the program were
implemented staff, patients and
families began to identify simple
steps that could be incorporated
into daily routines to maintain
skin integrity without increasing
workload. Colourful posters,
pamphlets, buttons, certificates and
prizes effectively raised awareness
and reinforced goals. Chart audits
and interdisciplinary high risk skin
rounds provided opportunities
for education at the bedside
with staff, patients and families
promoting increased knowledge
and skills. Audits also monitored
progress, promoted accountability
and provided progress reports for
individual units which created
excitement and enthusiasm as each
area strived to improve their patient
outcomes.
Implementation of best practices
promoted a change in patient
outcomes. Re-introduction of the
Braden risk assessment with a
focus on its use as a care planning
tool prompted the development of
individualized plans of care targeted
at interventions to manage the
identified risk factors.
Suite à la page 34/ Continues on page 34.

Featured Article
E.T. Leadership In Pressure Ulcer Prevention
by Nancy Parslow, RNET
Short Biography: I am presently
the Wound Care Specialty Nurse at
Southlake Regional health Centre in
Newmarket. I am also on the RNAO
development panel for the new
Ostomy Guideline. In the past I was
on the RNAO development panels
for the BPG’s for Risk Assessment
and Prevention of Pressure Ulcers,
Assessment and Treatment of Stage
1-4 Pressure Ulcers, Assessment and
Management of Venous leg Ulcers.
I am also involved on the CAET
certification examination committee
and cirriculum development for the
revised educational program.
Pressure ulcer development
increases length of hospital stay,
complexity of care needs, morbidity
and mortality rates, and suffering
from complications associated
with pressure ulcers (Foster, Frisch,
Denis, Forler, and Jago, 1992). The
use of a program to prevent pressure
ulcers should decrease costs, length
of hospital stay and reduce patient
suffering.
A study conducted across Canada
by Woodbury and Houghton in
2004 identified that the problem
with pressure ulcer development is a
significant occurrence in a variety of
health care settings with an average
prevalence of 26.2 % of patients
having a pressure ulcer.
A review of the evidence presented
in the RNAO Guideline; Risk
Assessment and Prevention of
Pressure Ulcers 2005, estimates
that “10% of patients admitted to
hospital will develop a pressure ulcer,
the elderly are at highest risk with
approximately 70% of all pressure
ulcers occurring in elders. Of those
patients who develop pressure ulcers,
approximately 60% occur in the acute
care setting – usually within the first
two weeks of admission with 15% of
elderly patients estimated to develop
ulcers within one week of admission.
Several studies report mortality rates
32 The LINK - March 2008
as high as 60% for elders with a
pressure ulcer within one year of
discharge from hospital.” (RNAO, pg
20, 2005)
The publication of Best Practice
information such as that developed by
the Canadian Association of Wound
Care (CAWC) and Registered Nurses
Association of Ontario (RNAO) have
created national awareness of the need
to prevent pressure ulcers and has
established standards of care that can
be used as quality of care indicators.
Programs such as the CAWC Pressure
Ulcer Awareness Program, patient
safety initiatives and accreditation
standards stress the necessity of early
intervention for those patients at risk
of developing pressure ulcers (RNAO,
pg. 20- 21 2005). Studies indicate
that the majority of pressure ulcers
are preventable with appropriate
interventions.
The development and implementation
of a formalized program to prevent
pressure ulcers is often confronted
by many challenges that must be
overcome before a change in practice
can be effectively incorporated.
Issues related to staff shortages, lack
of available time, lack of leadership
and support for the creation of a
program may be common roadblocks
to success. Many clinicians struggle to
obtain the resources and support that is
necessary to implement best practices
for pressure ulcer prevention.
I was very fortunate to be selected as
a site champion to pilot the CAWC
Pressure Ulcer Awareness Program
(PUAP) for my community hospital.
The PUAP utilizes a structured team
approach to advocate for Pressure
Ulcer (PU) prevention by providing
a supported, organized program
ready for implementation by the
site champion. The ET nurse who
provides leadership and expertise in
skin and wound management is the
ideal candidate to lead a pressure
ulcer prevention program such
as the PUAP. All site champions
receive mentorship from the
CAWC program leader and other
site champions to support the
development of leadership skills to
overcome challenges and implement
the PUAP program successfully.
This ongoing link to a supportive
network facilitates the development
of creative strategies to manage
adversity and obtain the support
and recognition necessary to
incorporate an interdisciplinary
pressure ulcer prevention program
into everyday practice.
Recognition of the ET nurse as
a leader and expert in pressure
ulcer prevention and management
was enhanced by the role of the
PUAP facilitator. As the various
components of the program were
implemented staff, patients and
families began to identify simple
steps that could be incorporated
into daily routines to maintain
skin integrity without increasing
workload. Colourful posters,
pamphlets, buttons, certificates and
prizes effectively raised awareness
and reinforced goals. Chart audits
and interdisciplinary high risk skin
rounds provided opportunities
for education at the bedside
with staff, patients and families
promoting increased knowledge
and skills. Audits also monitored
progress, promoted accountability
and provided progress reports for
individual units which created
excitement and enthusiasm as each
area strived to improve their patient
outcomes.
Implementation of best practices
promoted a change in patient
outcomes. Re-introduction of the
Braden risk assessment with a
focus on its use as a care planning
tool prompted the development of
individualized plans of care targeted
at interventions to manage the
identified risk factors.
Suite à la page 34/ Continues on page 34.

Featured Article
Suite de la page 32/ Continued from page 32.
Routine skin assessments for patients
identified to be at risk prompted
early identification of stage 1 injuries
facilitating the prevention of further
deterioration. Documentation also
improved significantly and staff found
that they were actually spending
less time caring for open pressure
ulcers. Many staff expressed pride
that they were able to protect many
of their patients from pressure ulcers.
They were especially proud when
their efforts were mentioned by the
accreditation team.
Positive outcomes of leading the
program were many including a 35%
reduction in pressure ulcer prevalence,
and a recognizable shift in staff
attitudes and behaviour to include an
awareness & sense of responsibility to
identify patients at risk for skin
34 The LINK - March 2008
breakdown and implement early
interventions. The effectiveness of
utilizing an interdisciplinary team
approach was also demonstrated
as well as the need for additional
resources such as offloading devices
and nutritional supplements to
optimize the prevention of pressure
ulcers.
Personally as a site champion I was
empowered to lead our team to
obtain the support and resources
required to effectively change clinical
practice at the bedside. Patients and
families were aware that they were key
members of the team and together
we were working to prevent the
development of pressure ulcers. The
PUAP provided the framework and
network for mentorship to support
the leadership of the site champion
to ensure successful implementation
References;
Canadian Association of Wound Care
(CAWC) Pressure Ulcer Awareness Program
accessed from the Internet January 27,
2008. http://www.preventpressureulcers.
ca/decision-maker/decision-maker.html
Foster, C., Frisch, S., Denis, N., Forler, Y.,&
Jago, M.,(1991). Prevalence of Pressure
Ulcers in Canadian Institutions. CAET
Journal 11(2) 23-31.
Registered Nurses’ Association of Ontario
(RNAO). Best Practice Guideline: Risk
Assessment and Prevention of Pressure
Ulcers – Revised 2005. Toronto:
RNAO 2005
The Impact of Stigma in Healthcare- Continued from page 10
by Cheryle Gartley
Language is also a very important
component of stigma; think of the
tremendous social and political
changes that are implied by the terms
“girls,” “ladies,” and “women”; or to give
another example, “Colored,” Negro,”
Black” and “African American.”
Terminology both presages and
mirrors important sociopolitical
movements; it might even be argued
that the changes in terminology reflect
paradigm shifts. To use an example
regarding stigma in healthcare, listen
very closely to “wheelchair bound”
versus “rides a chair.”
“Rides a Chair” Illustration by Sam Schiller,
Lemont, Illinois. Used with permission.
Doesn’t one description say helpless,
poor thing, “there but for the grace of
God go I”; while the other description
actually, dare I say it, sounds a little
like fun!
Here, in the area of the spoken word,
is where I believe nurses can have a
huge impact on defeating stigma in
healthcare. No matter how twisted
your tongue becomes, person
first language is essential because
language not only reflects, but also
creates reality. The word “wrong” is
a good example of creating reality.
Wrong is a word I hope you will strike
forever from your own vocabulary.
Individuals with stigmatized health
conditions are constantly asked by
complete strangers, “What is wrong
with your leg, arm, nose, etc.” Like
multiple impressions in advertising, I
wonder how many times it takes for
an individual with a stigma to hear
the word wrong before the person
internalizes it? Unfortunately, there
are many nonverbal messages that
can communicate stigma also; the
most obvious among them is staring.
Woodbury MG, Houghton PE, Prevalence
of pressure ulcers in Canadian healthcare
settings. Ostomy/Wound Management.
2004;50(10):22-38.
Although you can never be sure how
people will react to you, as a Quiggle
holder myself I can attest to one
thing you can be sure of…they ARE
going to stare.
Sadly, it is not just the public that
communicates a message of stigma
to the person with health problems;
it can also be immediate family,
friends, or even healthcare providers
themselves.
These messages are perhaps even
more impactful than those of strangers.
Healthcare professionals often
fall into the trap of stigmatizing
people with health challenges with
statements such as “your lung X-ray
is here” referring to the person with
lung cancer rather than a piece of
celluloid. Individuals with incontinence
report to the Simon Foundation
not only their feelings of shame and
embarrassment regarding their incontinence,
but how stigmatized they
often feel in a healthcare setting.
Suite à la page 36/ Continues on page 36.

for additional resources such as offloading
devices and nutritional
supplements to optimize the prevention
of pressure ulcers.
Personally as a site champion I was
empowered to lead our team to obtain
the support and resources required
to effectively change clinical
practice at the bedside. Patients and
families were aware that they were
key members of the team and together
we were working to prevent the
development of pressure ulcers. The
PUAP provided the framework and
network for mentorship to support
the leadership of the site champion
to ensure successful implementation
and sustainability of best practices
for PU prevention.
1-800-441-8227
www.healthpoint.com
References: 1. Data on file. Healthpoint, Ltd, Fort Worth, TX 76107.
2. Brown-Etris M, Cutshall WD, Hiles MC. A new biomaterial derived
from small intestine submucosa and developed into a wound matrix
device. Wounds. 2002;14:150–166.
OASIS is a registered trademark of Cook Biotech, Inc.
© Copyright 2006, Healthpoint, Ltd. TM0608C-0406
When wounds fail to progress after
2–4 weeks with your standard care…
OASIS ® enables the body to
get things moving again.
Simple application, proven results 1
Significantly improves wound management 1
Supports the body’s natural wound response by
replacing the missing extracellular matrix (ECM) 2
An easy addition to your standard wound care
In the office, off the shelf for once-weekly application
In a recent clinical study, the average cost of OASIS ®
for 12 weeks in venous stasis ulcers was $320 (US dollars) 1
INTRODUCE
Sheet of OASIS ® Wound Matrix
Get things moving again

Featured Article
Suite de la page 34/ Continued from page 34.
While the provider is focusing on
fixing the health problem the person is
often experiencing something far less
than help. For instance, a resident in
a long term care facility who reported
her feelings of stigma when staff
ignored her pleadings to remove from
public view the bladder diary posted
on the wall over her bed.
As you can see, stigma is a multifaceted
challenge, and thus defeating
stigma in healthcare will not only
take creative solutions, but time and
enormous effort by those who care
deeply about the quality of life of their
patients.
KCI Horiz 7-5X4-9-Healing.QXE 1/23/07 10:48 AM Page 1
Advanced Therapies
Proven outcomes
Cost-Effective
36 The LINK - March 2008
Changing the standard of healing
Innovative therapeutic medical devices that promote
wound healing and treat complications of immobility.
Working with health care professionals everywhere
to help change the standard of healing.
KCI Medical Canada Inc.
95 Topflight Drive • Mississauga • Ontario L5S 1Y1
Canada • Toll free 1 800 668 5403
Tel 1 905 565 7187
Fax 1 905 565 7270
www.kci-medical.com
You can order posters at:
www.simonfoundation.org
I believe there is no better place to
begin the campaign to defeat stigma
in healthcare than by educating
specialty nursing communities (whose
patient base is comprised of highly
stigmatized health conditions) to the
nuances of how stigma can creep into
all of our lives in the most insidious
ways. Being alert to stigma is the first
step in creating a stigma free world.
2005 KCI Liscensing, Inc. All rights reserved. All trademarks and service marks designated herein are the property of KCI and its affiliates and licensors. Those KCI trademarks designated with the “®” or “TM”
symbol are registered in at least one country where this product/work is commercialised, but not necessarily in all such countries. The V.A.C. ® (Vacuum Assisted closure ® ) System is subject to patents and/or pending patents.
Note: Specific indications, contraindications and precautions and safety tips exist for this product and therapy. Please consult your physician, product instructions and safety tips prior to applications.

Industry News
ConvaTec Moldable Technology
Celebrates One Year in Canada
Montreal – ConvaTec Moldable
Technology (CMT) celebrates its first
anniversary in March 2008.
CMT was first introduced to ET’s
through a Canadian Multicenter
product evaluation program. The
objective of the evaluation was to
collect and record Canadian ET
Nurse and individual’s experiences
with ConvaTec Moldable Technology
skin barriers. A total of 49 ET’s and
287 individuals living with an ostomy
participated in this product evaluation
program.
The results of the evaluation program
were presented by Jo Hoeflok, RN,
BSN, MA, ET, CGN (C) Advanced
Practice Nurse and principle
CMT evaluator at the 2007 CAET
Conference in Halifax, NS. The results
demonstrated that individuals living
with an ostomy and ET’s had very
high levels of satisfaction with SUR-
FIT Natura® Moldable Skin Barriers.
To learn more about CMT, receive
samples or to schedule a product
evaluation, please contact your
dedicated ConvaTec territory
Manager at 1-866-331-3134 or
our Customer Relations Center at
1-800-465-6302.
La Technologie Malléable de ConvaTec
Célèbre son premier anniversaire au
Canada
Montréal – La technologie malléable
de ConvaTec (CMT) célèbre son
premier anniversaire en mars 2008.
La technologie malléable de ConvaTec
a été introduite aux stomothérapeutes
à travers un programme d’évaluation
multicentrique canadien. L’objectif
de l’évaluation était de recueillir et de
consigner la rétroaction du personnel
infirmier stomothérapeute et des personnes
vivant avec une stomie sur la
nouvelle barrière cutanée dotée de la
technologie malléable de ConvaTec.
38 The LINK - March 2008
Un total de 49 stomothérapeutes
et 287 personnes vivant avec une
stomie ont participés au programme
d’évaluation du produit.
Les résultats du programme
d’évaluation ont été présentés par
Jo Hoeflok, inf., B. Sc. Inf., M. A.,
Stomothérapeute, ICSG (en cours) et
évaluatrice principale de la technologie
malléable de ConvaTec, à la conférence
du CAET de 2007 à Halifax, Nouvelle-
Écosse. Les résultats ont montré que
les personnes vivant avec une stomie
et les stomothérapeutes étaient
extrêmement satisfaits de la barrière
cutanée malléable SUR-FIT Natura®.
Pour plus d’information sur la
technologie malléable de ConvaTec,
pour recevoir des échantillons ou pour
planifier une évaluation de produit,
veuillez contacter votre gestionnaire
de territoire au 1-866-331-3134 ou
notre Centre des relations avec la
clientèle au 1-800-465-6302.
More than 50 years since Coloplast
brought the world’s first disposable
ostomy bag to the market
“I’m very pleased to see that sales
of SenSura are again exceeding our
expectations. It’s been more than 50
years since we brought the world’s
first disposable ostomy bag to the
market by listening to individual
users, and that is still a valid approach
today,” says Coloplast CEO Sten
Scheibye, and he continues: “We
need to stay in front of everyone
else when it comes to ‘listening and
responding’.”
Plus de 50 ans déjà depuis que
Coloplast a introduit sur le marché
le premier sac de stomie jetable au
monde
“Je suis heureux de constater que les
ventes de SenSura dépassent encore
une fois nos attentes. Plus de 50
années se sont écoulées depuis que
nous avons introduit sur le marché
le premier sac de stomie jetable au
monde en écoutant les utilisateurs,
ce qui demeure encore aujourd’hui
une approche valide », dit Sten
Scheibye, chef de la direction chez
Coloplast, avant d’ajouter : « nous
devons nous maintenir premier
lorsqu’il est question d’écouter et de
répondre à nos utilisateurs.”
Sten Scheibye, President, CEO
Coloplast

Biatain.
Proven to make
wounds heal faster.
Simple as that
A secondary dressing needs to be applied to keep the non-adhesive Biatain dressing in place
The unique combination of superior exudate management and patient comfort
Biatain Ibu is the fi rst wound dressing that
combines superior exudate management with local
release of ibuprofen 1 . A unique solution that is proven
to deliver fast wound healing 1 and in addition may
reduce wound pain both at dressing change and
persistent pain caused by tissue damage 1,2,3 .
1. A new and improved foam dressing range. In prep 2. Severin &n Kristensen. New test method for measuring absorption in foams. Poster presented at joint
Scientifi c meeting of ETRS, EWMA and DGfW, 2005 3. Thomas et al. An in-vitro comparison of the physical characteristics of hydrocolloids, hydrogels, foamsand
alginate/CMC fi brous dressings. www.dressings.org,2005
Coloplast and Biatain are registered trademarks of Coloplast A/S or related companies. © 2007-08, All rights reserved Coloplast A/S. 350 Denmark
Biatain Biatain Ag Biatain-Ibu
To learn more about how the variety of foam
dressings in the Biatain range can help you and
your patients with a more effective and comfortable
healing of exuding wounds please visit
www.biatain.coloplast.com
www.coloplast.ca
1.888.880.8605

ET Community News
River Valley Health (RVH) Wound Care Education Day
by Katherine Esligar
On January 25, 2008 ,RVH hosted
an education day in wound care
for health care professionals. The
event titled “Set Sail into the 2nd
Annual Wound Care Day” was held
in Fredericton, N.B. Presentations
included melanoma, charcot
deformity, pressure mapping, wound
outcomes, negative pressure wound
therapy and dressing selections.
THEBEST
JUSTGOTBETTER
40 The LINK - March 2008
UpgradedlineofIntegridermpressureredistribution
mattresses
Allmodelsnowavailableassealedunitsorwithremovable
covers
AnatomicallycontouredVeri-flexengineeredpolymerfoam
withzonedareasofpressurereduction
Engineeredtopreventbottomingout
Antimicrobial,antistatic,nonallergenicanddurable
Respurtexcover
Internalsiderailsformorepatientsecurity
Superiorwarrantyprogram
Dr. Gwyneth deVries & Katherine Esligar
Formoreinformation,pleasecontactyourrepresentative
Tel.:1-800-361-4964
e-mail:info@mip.ca
www.mipinc.com
Over 140 health care team
members participated in this event
as we strive to improve wound
care management in River Valley
Health.
Dr. Gwyneth deVries, orthopaedic
surgeon was one of the presenters
and Katherine Esligar was the
conference organizer.

Your patients will
welcome our newest
arrivals.
Introducing ALLEVYN Ag, ALLEVYN Gentle
and ALLEVYN Gentle Border.
ALLEVYN Gentle and ALLEVYN Gentle Border minimize pain at dressing
changes while maximizing comfort. ALLEVYN Ag capitalizes on the proven
antimicrobial protection of silver sulfadiazine (SSD). Combined with the
superior fluid management known to ALLEVYN, our dressings offer the
very best in patient care. Embrace it! Your patients will be thankful.
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Targeting bacteria and
protecting the skin.
Two advanced technologies. One antimicrobial dressing.
Only Mepilex ® Ag combines the best of two superior technologies – the antimicrobial
action of ionic silver with the benefits of Safetac ® soft silicone technology.
n Inactivates pathogens within 30 minutes 1 of application and maintains sustained
release action for up to 7 days 2
n Safetac ® soft silicone protects the peri-wound skin, reduces the risk of maceration
and minimizes trauma and pain at dressing change 3,4,5
n Activated charcoal in conjunction with anti-bacterial effectiveness for optimal
odour control 6
For more information contact your Mölnlycke Health Care representative at 1-800-494-5134.
1,2 Data on file.
3 Dykes, P.J., Heggie, R., and Hill, S.A. Effects of adhesive dressings on the stratum corneum of the skin. Journal of Wound Care, Vol. 10, No. 2, February 2001.
4 Dykes, P.J. and Heggie, R. The link between the peel force of adhesive dressings and subjective discomfort in volunteer subjects. Journal of Wound Care,
Vol 12, No 7, July 2003
5 Williams C. British Journal of Nursing. Vol 4, No 1, 1995
6 Meaume S., Van De Looverbosch D., Heyman H., Romanelli M., Ciangherotti A., Charpin S. Ostomy. A study to compare a new self-adherent soft silicone
dressing with a self-adherent polymer dressing in Stage II pressure ulcers. Wound Management 2003; 49(9): 44-51.
CA089550701EN