Each participant met with the investigator at the start and end ofthe testing. STUDY OUTCOME: Outcomes included safety (peris-tomal skin conditions and unplanned changes) and performance(adhesive parameters, splashing sounds, wear time, product aware-ness and product preference). The investigator collected baselinedata and evaluated the peristomal skin at baseline, using theOstomy Skin Tool. The participants evaluated the performance ofsystem A and B and after using each pouching system, the partic-ipants then evaluated their own peristomal skin. Data was col-lected in a questionnaire. STATISTICS: Statistical analyses includedlogistic regression, chi-square test and parametric general linearmodels. Overall significance level: 0.05. RESULTS: Baseline charac-teristics and differences in skin conditions after using system A andB will be presented. Performance and safety parameters will becompared for System A and B.

Wound-Evidence-Based Interventions

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AN ASSESSMENT OF COGNITIVE SCHEMA FOR PRESSUREULCER STAGINGCindy Kiely, RN, MSN, CWOCN, cindy.kiely@chsli.org, GoodSamaritan Hospital Medical Center, West Islip, NY and WilliamRoberts, ACNP-BC, DNSc, wdroberts@adelphi.edu, AdelphiUniversity, Garden City, NY

Although the skin is the largest organ of the body, skin integritywas rarely, if ever considered a fundamental aspect of patientcare. The development of a pressure ulcer was thought of as anunfortunate outcome during a patient’s hospitalization. Today,they are considered a preventable occurrence of unnecessaryharm. So much so that the occurrences of pressure ulcers arenow deemed a nursing sensitive indicator. Recently, however,there has been a conflicting consensus regarding the accuracy ofthe current staging system available for nurses to use for stagingpressure ulcers. Clinicians indicate that there is little to no evi-dence that the current method of staging accurately representsthe clinical progression of a lesion caused by pressure necrosis.Doughty et al (2006). The purpose of this study is to understandthe decision-making process of nurses in the staging of pressureulcers. Specifically, this study seeks to determine if there is aprocess that a nurse uses to stage a pressure ulcer and whetheror not this process is systematic, standardized, and accurate.Once the decision-making process is better understood, futureresearch could be employed for the development, dissemina-tion, and evaluation of a staging tool to assist nurses in more ac-curate staging of pressure ulcers. This qualitative study willutilize cognitive evaluation methods to examine the schema,mental processes, and knowledge structure of nurses during astaging task.

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BATES-JENSEN WOUND ASSESSMENT TOOL (BWAT)©

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

Buckley et al (2005) attribute increased costs in wound care tovariability in wound assessment and inconsistency in documen-tation, demonstrating a need for accurate identification and doc-umentation of wound assessment findings to determine woundprogression or deterioration. The BWAT© tool contains thirteenitems to assess the wound: size, depth, edges, undermining,necrotic tissue type, amount of necrotic, granulation and epithe-lialization tissue, exudate type and amount, surrounding skincolor, edema and induration. Each item has five categories, one ofwhich the nurse must choose as the most appropriate response.In order to use the tool, nurses must have a working knowledgeof a wound vocabulary and wound assessment skills. Many nursesare visual learners which is the predominant learning style foradults. These learners like visual aids and colored handouts thatare visually stimulating (Avillion, 2005). This also applies tonovice nurses and nursing students, with as many as 78% beingvisual learners (Borucki and Krouse, 2005). A group of threeEnterostomal Nurses, and a Nursing Researcher, in partnershipwith the original author of the BWAT, undertook this project tocollect wound photographs that depicted each characteristic ofthe BWAT, and then to validate the photographs. Ethical approvaland informed consent to use the photographs for educationalpurposes was obtained. Enterostomal Therapy Nurses and onewound care specialty nurse participated in two validation exer-cises to finalize the photographic content to augment wound as-sessment and documentation using the BWAT tool. Thispresentation will review the methodology and results of the vali-dation project. Further plans for the Pictorial BWAT are to publishit in a journal that will allow free-online access of the guide for allhealthcare providers, and to test teaching interventions to exam-ine whether the new format helps to implement use of the paperBWAT tool.

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DEVELOPMENT OF AN EVIDENCE-BASED TREATMENTPROTOCOL FOR PILONIDAL SINUS WOUNDS HEALING BY SECONDARY INTENT USING A MODIFIED DELPHITECHNIQUEConnie L. Harris, RN, ET, MSc, connieharris@rogers.com,CarePartners, Waterloo, ON

This modified Reactive Delphi project utilized five rounds of ques-tionnaires to elicit opinion on what would constitute anevidence-based protocol for pilonidal sinus wounds healing bysecondary intent, including infected wounds. Participants werehealth-care professionals including surgeons, nurses andEnterostomal therapy nurses experienced in the care thesewounds. Item generation involved an extensive review of theliterature to identify key aspects of evidence-based wound careessential to wound healing in general, infected wounds andpilonidal wounds healing by secondary intent, and drawing onclinical experience. The participants responded via an electronicWeb site, using a four-point Likert rating scale and a ranking sys-tem. Comments were invited. Feedback to the participants at theend of each round was provided, that included comments, con-tent validity index (CVI), and additional information that pro-vided rationale and references, or minor revision if requested.New items were generated in rounds 3, 4 and 5 in response to par-ticipant’s comments. Consensus was confirmed for the items thatmet the inclusion criteria by further analysis for ConfidenceIntervals and Kappa Interrater Agreement. The resultant protocolcontains fifty-nine assessment indicators and interventions,including rationale and an algorithm for decision making. Topicsincluded treat the cause (surgery/debridement), prevent recur-rence, local wound care (cleansing methods, positioning, moist

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