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he need for wound management and wound care is a common denominator across the continuum of care, but especially among our long-term care clientele. With a high percentage of these residents experiencing chronic wounds, the need for experienced professionals who care for these patients is growing.
       Assessing, treating, and preventing chronic wounds, such as pressure ulcers, diabetic and neuropathic ulcers, and arterial and venous ulcers, are critical issues for the long-term care provider. Utilizing an educated and certified wound care professional is crucial in the care of the chronic wound resident.
       How are these individuals educated? What type of curriculum do they follow? How are they tested? What type of continuing education programs must they attend? These are probably some of the very questions that you have asked yourself when hiring a consultant or employee to join your team and head up the wound care cavalry or perhaps you've thought about becoming one of these experts yourself! The following article, written by a certified wound specialist (CWS) and a certified wound, ostomy, and continence nurse (CWOCN), will provide you with a little history and answer all of your questions regarding wound care programs across the continuum of care.

Wound, Ostomy, Continence Nursing (WOCN) Accredited Educational Programs
       In the 1950s, Dr. Rupert Turnbull, Jr., MD, trained Norma Gill to rehabilitate individuals with ostomies and coined the term "enterostomal therapist (ET)." In the 1960s, Norma Gill and Dr. Turnbull began training ETs at the Cleveland Clinic. Over the years, enterostomal therapy evolved beyond the practice of ostomy patient care into today's wound, ostomy, and continence (WOC) nursing. The expanded role includes acute and rehabilitative care of patients with these select disorders of the gastrointestinal, genitourinary, and dermal systems. More specifically, the full scope includes persons with wounds, fistulas, pressure ulcers, incontinence, and ostomies.
       The WOC nurse is a registered nurse who has a minimum of a baccalaureate degree in nursing and can practice within all care settings (long-term care, home care, acute care, outpatient clinic, research, and industry) and may be self employed or contract for services. Utilizing a collaborative practice and case management approach, the WOC nurse is commonly responsible for technical, educational, and psychosocial aspects of managing a patient with a wound, ostomy, or continence dysfunction. Within healthcare systems, the WOC nurse frequently has decision-making responsibilities regarding care organization and delivery, purchasing, and evaluation of outcomes. WOC nurses are recognized for delivering high quality, cost-effective care, essential in today's healthcare environment. The WOC nurse is a graduate of a WOCN-accredited WOC nursing education program or has successfully completed the written WOCNCB certification examination.
       WOCN-accredited programs may offer full scope, specialty scopes, or both. Full scope WOC students study wound, ostomy, and continence care nursing. Completion of a full scope program enables the graduate to take the board certification examination for the WOC nurse. Specialty scope education in the wound or ostomy or continence care specialty enables the graduate to take the board certification examination for that specific specialty scope of practice. Graduate or continuing education credits may be available upon successful completion of coursework for qualified applicants at various WOCN-accredited programs.
       Traditionally, WOC nursing has been taught on site at select medical centers in the US. In the 1990s, split options became available. Split option means the students travel to the programs, spend four weeks on site, and go home to do clinical with a qualified preceptor nearby. Today, there are additional options available that offer less or no travel through distance learning. Home study or correspondence courses are an approach to distance learning and may include an on-site immersion experience as well. Web-enhanced learning may occur when the faculty member utilizes the Internet for specific parts of the curriculum delivery, posting a syllabus, e-mail, etc. Web-based online learning usually means that the classroom and all content (except an immersion experience) are accessed on a computer screen. Online can be live, real time, interactive, and available 24 hours a day, seven days a week.
       At the time of publication, the following WOCN accredited educational programs are available. Interested individuals should seek more detailed information through the individual programs and the Wound, Ostomy and Continence Nurses Society (http://www.wocn.org/).

Accredited WOC and Specialty Program Options
       Emory University School of Medicine WOC Nursing Education Center, Atlanta, Georgia
       Offerings: Traditional on site, split option, and distance
       Contact: Dorothy Doughty, MN, RN, FNP, CWOCN, FAAN; JoAnn Waldrop, MN, RN, CWOCN; Janet Ramundo, MN, RN, FNP, CWOCN
       Phone: (404) 778-4067
       E-mail: cindy_strickland@emory.org
       WOC Nursing Education Program Sponsored by Wicks Educational Associates, Inc., Mechanicsburg, Pennsylvania
       Offerings: Home study/on-site combination programs
       Contact: Lucy J. Wicks, MSN, RN, CWOCN
       Phone: (717) 737-2770 or (800) 807-WICKS
       E-mail: wicks@epix.net
       Website: www.igateway.com/clients/weai
       La Salle University School of Nursing, Philadelphia, Pennsylvania
       Offerings: Split option
       Contact: Janice M. Beitz, PhD, RN, CS, CNOR, CETN; Jo Ann Catanzaro, MSN, RN, CWOCN
       Phone: (215) 951-1413 or (215) 951-1430
       Rupert B. Turnbull, Jr., School of ET Nursing Cleveland Clinic Foundation, Cleveland, Ohio
       Offerings: Traditional on site, split option
       Contact: Paula Erwin-Toth, MSN, RN, CETN
       Phone: (216) 444-5966
       University of Texas M.D. Anderson Cancer Center--WOC Nurse Education Program, Houston, Texas
       Offerings: Traditional on site, split option
       Contact: Kathy Froiland, MSN, RN, AOCN, CWOCN
       Phone: (713) 745-0219/745-0216
       E-mail: swoolems@mdanderson.org
       webWOC Nursing Education Program in partnership with Metropolitan State University, Minneapolis, Minnesota
       Offerings: Distance learning, Web based, interactive
       Contact: Ruth A. Bryant, RN, MS, CWOCN; Bonnie Sue Rolstad, RN, BA, CWOCN
       Phone: (612) 331-4601
       E-mail: partners@webwocnurse.com
       Website: webwocnurse.com
       Medical University of South Carolina, Wound Care Specialty Course, Charleston, South Carolina
       Offerings: On-site wound specialty course or Web-enhanced distance learning, wound specialty course
       Contact: Phyllis Bonham, RN, MSN, CWOCN
       Phone: (843) 792-265
       E-mail: bonhamp@musc.edu
       Website: www.musc.edu/nursing/continue/wound/wcsc.htm
       University of Washington Wound Management Education Program, Seattle, Washington
       Offerings: On-site wound specialty course
       Contact: Renee Anderson, MSN, RN, CWOCN; Betty Hanrahan, MSN, ARNP, RNC, CWCN
       Phone: (206) 543-1047
       E-mail: cne@u.washington.edu
       Website: www.uwcne.org
       University of Southern California Department of Nursing Enterostomal Therapy and Wound Care Program, Los Angeles, California
       Offerings: On-site advanced practice enterostomal therapy program (Master of Science in Nursing, Enterostomal Therapy and Post Master's Certificate)
       Contact: USC Department of Nursing Office or Admissions and Student Affairs; 1540 Alcazar, CHP Room 222, Los Angeles, CA 90089-9012
       Phone: (323) 442-2020
       Website: uscnurse.usc.edu

Multidisciplinary Wound Care Education and Other Certifications
       Several multidisciplinary (physicians, nurses, and physical therapists) programs and certifications offer the healthcare professional education and credentials in wound care and wound management. They are each outlined separately below.
       The American Academy of Wound Management (AAWM). The AAWM is a national multidisciplinary certifying board for healthcare professionals involved in wound care. The AAWM is a voluntary, not-for-profit organization established for the purpose of credentialing multidisciplinary practitioners in the field of wound management. The organization was founded by individuals with experience in wound care who are dedicated to helping patients who suffer from acute and chronic wounds of various etiology. The board of advisors is an interdisciplinary panel of experts in the field of wound care consisting of practitioners, academicians, and researchers. The AAWM is a full voting member of the National Organization for Competency Assurance (NOCA).
       The AAWM is dedicated to the multidisciplinary team approach in promoting the science of prevention, care, and treatment of acute and chronic wounds. The primary function is to establish and monitor a national certification process, recognize competency, promote education and research, and elevate the standard of care across the continuum of wound management.
       Why certification? Certification:
* Recognizes competency of those who have met the eligibility requirements for board certification
* Identifies a standard of knowledge essential for developing a comprehensive wound management program
* Advances cooperation and resource exchange among the various disciplines and organizations involved in the treatment of patients with chronic wounds
* Encourages continued professional growth and development of individuals and the field of wound management
* Establishes a code of ethics, responsibility, and high professional standards by all certified individuals.
       Levels of certification. The AAWM offers four levels of certification. A membership category also exists for those who are professionally involved in wound care but do not meet the eligibility requirements or do not pass the examination for certification.
       Diplomat status may be awarded to physicians, nurses, physical therapists, and other healthcare providers who have been granted a Doctorate degree from an accredited university and who have two years of clinical or research experience in wound care.
       Fellow status may be granted to those individuals who are trained at the Masters level in related healthcare disciplines with two years of approved clinical or research experience in wound care.
       Clinical Associates status is available to registered nurses, certified physician assistants, individuals with a baccalaureate degree, or other licensed healthcare providers with extensive training and background in wound care. Additionally, individuals must have five years of documented clinical or research experience in the field of wound care.
       Research Associate status may be granted to nonclinical individuals with a baccalaureate (or higher) degree. Documentation of five years of research experience in wound care or wound-related fields is required.
       AAWM board certification by examination. The National Examination for Board Certification in Wound Management from the AAWM is held every April and October at selected testing centers nationwide. Applicants for certification must achieve a passing score on the examination to earn the designation Certified Wound Specialist® (CWS®). Multidisciplinary questions cover general knowledge, anatomy, pathophysiology, diagnosis, physiology, therapeutics, and psychosocial topics.
       The AAWM does not produce any seminars or review courses. A number of wound care meetings, seminars, and courses are available to the wound care professional and, although not recommended or endorsed by the AAWM, are posted on their website at http://aawm.org/.
       There is not one standard textbook recommended for studying for the CWS examination; however, questions may come from the following books as well as industry journals.
* Wound Care: A Collaborative Practice Manual for Physical Therapists and Nurses by Carrie Sussman and Barbara Bates-Jensen (editors) (January 1998). Aspen Publishers, Inc.; ISBN: 0834207486
* Chronic Wound Care: A Clinical Source Book for Healthcare Professionals, Third Edition, by Diane Krasner, Gary Sibbald, George T. Rodeheaver (editors) (April 2001). HMP Communications; ISBN: 0970651406
* Acute and Chronic Wounds: Nursing Management by Ruth Bryant (editor) (June 2000). Mosby Inc.; ISBN: 1556644108
* Clinical Wound Management by Prem P. Gogia (January 1995). Slack, Inc.; ISBN: 1556422342
* Wound Healing: Alternatives in Management (Contemporary Perspectives in Rehabilitation), Third Edition, by Joseph M. McCulloch and Luther C. Kloth (editors) (August 2001). F A Davis Co; ISBN: 0803608330
* The Molecular and Cellular Biology of Wound Repair (The Language of Science), Third Edition, by R. A. F. Clark (editor) (April 1998). Plenum Pub Corp; ISBN: 0306427168
* Clinical Guide to Wound Care, Fourth Edition, by Cathy Thomas Hess (January 2002). Lippincott Williams & Wilkins; ISBN: 1582551693
* Levin and O'Neal's the Diabetic Foot, Sixth Edition, by John H. Bowker and Michael A. Pfeifer (January 2001). Mosby-Year Book; ISBN: 155664471X.

University of Toronto Interdisciplinary Wound Care Course
       The University of Toronto's Continuing Education Office of the Department of Medicine offers the Interdisciplinary Wound Care Course (IIWCC) as a formal certificate course in wound care. This course is provided through collaboration between The Department of Medicine, the University of Wales, College of Medicine, United Kingdom, and the Department of Surgical Services Greater Baltimore Medical Centre. The diverse faculty includes clinicians and educators from Canada and beyond and is co-chaired by R. Gary Sibbald, BSc, MD, FRCPC (Med, Derm), MACP, DABD, and Heather Orstead, RN, BN, ET.
       Covering such modules as holistic patient care, healthcare delivery, local wound care, infection, vascular, neuropathic, and diabetic ulcers, pressure ulcers, malignant ulcers, state of the science, and evidence-based care, this eight-day course is offered to physicians, nurses, and other healthcare professionals working in the field or in related sciences and involved in wound care with some training and experience. It is accredited for 50 classroom hours of education by the Maintenance of Certification Program of the Royal College of Physicians and Surgeons of Canada. Members of the American Academy of Family Physicians are eligible to receive up to 50 prescribed hours of attendance at this meeting due to reciprocal agreement with the College of Family Physicians of Canada and HMP Communications approved by the California Board of Registered Nursing. Upon completion of the IIWCC course, participants earn a certificate in wound management. The course is offered on site in Toronto, Ontario, Canada.

The Wound Care Course
       This two-day multidisciplinary course taught by a multidisciplinary faculty is offered at Nix Medical Center in San Antonio, Texas. The curriculum is designed to help physicians, nurses, physical therapists, and other healthcare professionals to understand the principles of modern, moist, interactive wound care and application of advanced therapeutic technologies. A case-based approach is used to examine the principles of treating the underlying cause in pressure ulcers, vascular insufficiency, chronic venous insufficiency, and diabetic/neuropathic foot ulcers. Participants are also introduced to advanced wound care products during lectures and breakout session demonstrations. For more information about this program, contact Education Department, 414 Navarro, Suite 502, San Antonio, Texas 78205; phone (210) 614-3688; fax (210) 223-4864; e-mail: education@hyperbaricmedicine.com; www.hyperbaricmedicine.com.

The American Professional Wound Care Association
       The American Professional Wound Care Association (APWCA) is a new hybrid organization unlike any other organization. The APWCA incorporates all of the various medical specialties involved in treating complex wounds. Seminars bring these fields together and facilitate an integrated, multidisciplinary approach. The mission of the Association is to help decrease the rate of complications from chronic wounds, accelerate wound healing, and preserve and/or enhance the quality of life for these patients.
       APWCA offers its members the opportunity to enhance their education, while they meet, learn, and network with various healthcare providers nationally and in their geographic area. It provides the ability to establish one's interest in the treatment of chronic and complex wounds.
       As is customary with like organizations, start-up membership is attained through a "Grandfathering" pathway. Utilizing this pathway allows one to become a "Charter Member." Case submission is currently not required and neither is the application fee that may be required to cover the costs of reviewing submitted cases should this become part of the application process at a later date.

The Dermatology Nurses' Association
       The Dermatology Nurses' Association (DNA) was established as a non-profit organization in 1981 and serves its members through a national structure, regionally and locally, in the US and internationally. Licensed registered nurses, licensed practice nurses/licensed vocational nurses, and individuals involved or interested in the care of the dermatology patient are eligible for membership in the association.
       Certification provides an added credential beyond licensure and demonstrates by examination that the registered nurse has acquired a core body of specialized knowledge, five percent of which is related to wounds and ulcers, and adheres to specialized nursing standards. Although not completely committed to wound management, this association and credentials focus on the practice of dermatology nursing, which encompasses all areas of skin assessment and care. It assures consumer protection and confers peer and public recognition to those individuals who prove proficient in their practice.
       Various articles from the official journal of the DNA, the Dermatology Nursing Journal, along with several other texts and the Dermatology Nurses' Association Dermatology Core Curriculum, Dermatologic Surgery Core Curriculum, and the Phototherapy Administration Symposium serve as the study material for the certification exam. There is no specific training or education program for this exam.
       Certification is awarded to those who have successfully completed the certification process by meeting the eligibility criteria and passing a multiple choice written examination. The designated credential is dermatology nurse certified (DNC). Certification is valid for a period of three years. Recertification may be attained through contact hours of continuing education credit or by examination.

Continuing Education Programs and Wound Care Symposiums
       Various continuing education programs (CEU programs) are available throughout North America covering an array of wound management topics. Some are offered on site at your particular long-term care facility or hospital, or they can take place in a partial-day or full-day seminar format set up at a hotel or off-site venue or may be virtual and/or accessible online. These programs usually have a small fee to attend, but many manufacturers and distributors may offer them at no cost as a value-added perk. Check with your local representatives or go to the company's website for more information regarding education.
       Wound care meetings and educational symposia scheduled around the country and throughout the year are a great opportunity to learn the latest techniques, get caught up with the "state of the science," and see the newest wound-related products. There are too many to mention all here, but some of the best that we've attended include:
* Annual Symposium on Advanced Wound Care and Medical Research Forum on Wound Repair; HMP Communications and the Association for the Advancement of Wound Care: (800) 237-7285, www.woundcaresymposium.com
* WOCN Annual Conference: www.wocn.org
* Clinical Symposium on Advances in Skin and Wound Care: (800) 346-7844, ext. 6591, www.symposiumonwoundcare.com
* The Wound Healing Society Annual Educational Symposium and Exhibition: (888) 434-4234, www.woundheal.com
* The American Professional Wound Care Association (APWCA) Annual National Symposium: (215) 364-4100, www.apwca.org
* Annual Conference and Exposition of the American Physical Therapy Association: (703) 684-2782, www.apta.org.

Beyond "Expert"
       The key to finding the right credentialed professional to assist you and your facility in developing comprehensive wound care programs, training and education, and prevention and treatment protocols for acute and chronic wounds lies in his or her education, certification, and experience. Make sure that the person filling those shoes is truly well versed in wound management. Anyone can call himself or herself a "wound care specialist" or expert; few have the board certification and credentials to prove it! For more information about the programs and credentialing discussed in this article, the authors encourage you to surf the websites and suggested reading below for more detailed information.