Preparing for the Ostomy Certification Exam

Nurses preparing for a certification examination commonly ask, “What content should I study?” The Wound Ostomy Continence Nursing Certification Board (WOCNCB) certification examinations all have examination content outlines. Many potential certificants may wonder how the WOCNCB determines what subjects and tasks to include on our examinations; such decisions are guided by a role delineation study. The WOCNCB conducts a role delineation study every 5 years by surveying WOCNCB-certified practicing wound, ostomy, continence (WOC), and foot care (FC) nurses to gather data related to the tasks, knowledge, skills, and abilities they are using in performing their WOC and FC nurse professional roles. The electronic data collection tool measures both the frequency and the importance of specific activities performed by the clinician. From the information collected, the statisticians from our examination vendor are able to statistically identify entry-level tasks, knowledge, skills, and abilities of the WOC and FC nurse. These data form the basis of the WOCNCB examination content outline. Content outlines are included in the examination preparation handbooks available on the WOCNCB Web site at http://www.wocncb.org/certification/wound-ostomy-continence/eligibility. Certification examination questions are written based on the examination content outline. The process assures that each examination has content validity and is congruent with current clinical practice. The examination content outline is also the framework used in creation of the WOCNCB Ostomy Flashcards, which became available in early 2015. Testing has a direct effect on knowledge retention. Using flashcards to study is a form of retesting. Research has shown that retesting is superior to restudying in terms of skill and/or knowledge acquisition and retention. The retrieval of information that occurs when one answers a test question (be it on a WOCNCB flashcard or a WOCNCB self-assessment examination) strengthens one's memory of that information.1 Task 6 on the ostomy examination content outline refers to the assessment and management of continent fecal diversions. Examples of these are the Kock pouch, Barnett continent intestinal reservoir, or ileal pouch anal anastomosis (IPAA). Although the IPAA is currently the most commonly performed procedure for ulcerative colitis treatment, the ostomy specialist job analysis identified the need to be familiar with other surgical options. 1. Schmidmaier R, Ebersbach R, Schiller M, et al. Using electronic flashcards to promote learning in medical students: retesting versus restudying. Med Educ. 2011;45:1101–1110. Practice Questions 1. The Kock pouch is a: Continent colon pouch Incontinent pelvic pouch Continent ileal pouch Incontinent cecal pouch Content Outline: Task 6a Cognitive Domain: Recall The correct answer is C. The ostomy nurse must recognize that a Kock Pouch is a continent ileal reservoir. While this procedure has waned in popularity, it is still performed, especially in patients who wish to be converted from an ileostomy or have experienced failure of a pelvic pouch. Approximately 45 cm of terminal ileum is used, 30 cm to construct the reservoir and 15 cm to create the intussuscepted continence mechanism. Cohen Z. A tribute to Nils G. Kock, 1924-2011. Canadian Journal of Surgery. 2012;55(3):153–4. Doughty D. History of stoma creation and surgical advances. In: Colwell JC, Goldberg MT, Carmel JE, ed. Fecal & Urinary Diversions: Management and Principles. St Louis: Mosby; 2004:8–10,97. 2. After the first stage of a 3-staged restorative proctocolectomy with IPAA procedure, the most important information that the ostomy nurse must teach the patient is: How to irrigate the continent pouch How to apply an ostomy appliance How to protect the perianal skin How to recognize symptoms of pouchitis Content Outline: Task 6b Cognitive Domain: Application The correct answer is B. The ostomy nurse should understand the steps of a 3-stage procedure for the treatment of ulcerative colitis: Stage 1—Subtotal colectomy with end ileostomy Stage 2—Ileoanal pouch anastomosis with loop ileostomy Stage 3—Ileostomy closure The patient will need to understand how to apply an ostomy pouch and empty the stool from it. The other information is not critical until after the third surgery. Heppell J. Surgical management of ulcerative colitis. Up to Date. 2014. http://www.uptodate.com/contents/surgical-management-of-ulcerative-colitis?source=machineLearning&search=ileal+pouch+anal+anastomosis&selectedTitle=2%7E24&sectionRank=1&anchor=H165136853#H165136853. Accessed November 19, 2014. Kiran RP, Fazio VW. Inflammatory bowel disease: surgical management. In: Colwell JC, Goldberg MT, Carmel JE, eds. Fecal & Urinary Diversions: Management and Principles. St Louis: Mosby; 2004:93–95. 3. At the 6-month follow-up appointment after IPAA surgery, a patient reports vague symptoms of pelvic discomfort, low-grade fever, diarrhea, and anorexia. She reports that she has just returned from a vacation in London. The ostomy nurse suspects the most likely cause of the symptoms is: Pouchitis Clostridium difficile infection Recurrent inflammatory bowel disease Dehydration Content Outline: Task 6c Cognitive Domain: Analysis The correct answer is A. Pouchitis is the most prevalent long-term complication after the IPAA. It is an idiopathic inflammatory condition occurring in up to 50% of patients after the IPAA for ulcerative colitis. It is believed to be caused by the interactions between the patient's immune system and the overgrowth of bacteria present in the pouch. Symptoms include tenesmus, diarrhea, pelvic discomfort, hematochezia, malaise, low-grade fever, and anorexia. C. difficile infection occurs most commonly after a course of antibiotic therapy. A restorative proctocolectomy with IPAA surgery eliminates the inflammatory bowel disease. The most common symptoms of dehydration include thirst, dry mucous membranes, decreased urine output, muscle cramps, and lethargy. Kiran RP, Fazio VW. Inflammatory bowel disease: surgical management. In: Colwell JC, Goldberg MT, Carmel JE, eds. Fecal & Urinary Diversions: Management and Principles. St Louis: Mosby; 2004:95. Landy J, Al-Hassi HO, McLaughlin SD, et al. Etiology of pouchitis. Inflamm Bowel Dis. 2012;18(6):1146–1155.

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