Joyce Stechmiller

University of Florida | UF · College of Nursing Biobehavioral Nursing

The purpose of this study was: (1) to characterise the association of wound area, wound exudate C‐reactive protein (CRP), broad‐spectrum matrix metalloprotease protein (MMPs), and symptoms of fatigue and pain in individuals with chronic venous leg ulcers (CVLUs) over time and (2) to identify factors associated with the wound healing trajectory in C...

Objective: Pain affects wound healing, treatment, and quality of life because it has significant impacts on physical, psychological, and social wellbeing. Despite the fact that more than half of chronic venous leg ulcer (CVLU) patients experience mild to moderate pain, the multidimensional characteristics of CVLU pain are not well documented. The...

Introduction: Little research has been done to determine if the wound pain markings correlate with the changes in measured wound size. For cancer patients, wound pain could be caused by the tumor or cancer treatments. The study purpose was to evaluate the validity of patient pain markings (body surface area) as an indicator of wound size and change...

Significance: Approximately 6.5 million people in the United States suffer from chronic wounds. The chronic wound population is typically older and is characterized by a number of comorbidities associated with inflammation. In addition to experiencing wound-related pain, individuals with chronic wounds commonly experience multiple concurrent psych...

Significance: It is estimated that up to 50% of hospitalized patients are malnourished. Malnutrition can lead to longer hospital stays, altered immune function, and impaired skin integrity and wound healing. Malnutrition has been found to be a significant factor influencing pressure injury (PI) risk and wound healing. While PI prevention requires m...

The prevalence and incidence of chronic venous leg ulcers (CVLUs) are increasing worldwide, as are the associated financial costs. Although it has long been known that their underlying etiology is venous insufficiency, the molecular aspects of healing versus nonhealing, as well as the psychoneurologic symptoms (PNS; pain, cognitive dysfunction, fat...

Background: There is a knowledge gap regarding factors that influence the intensity of pain associated with pressure injuries. Objectives: We examined the influence of age, sex, race, and comorbidity on the relationships between pressure injuries, psychological distress, and pain intensity in hospitalized adults. Methods: This study was a cros...

Objective: Scientific literature suggests pressure ulcer (PU) risk increases as immobility increases, indicating that more extensive paralysis confers a greater risk of PU. Yet the specific level of paralysis (ie, hemiplegia vs paraplegia vs quadriplegia), apart from neurodegenerative diagnoses, has never been examined in the long-term care (LTC)...

The VA Nutrition Classification Scheme documented by dietitians was found to be superior in assessing nutritional risk and predicting the development of pressure ulcers in acutely ill hospitalized veterans compared with use of the Braden nutrition subscale.

Purpose: To provide information on risk factors associated with pressure ulcers (PrUs), including suspected deep tissue injury (sDTI), in nursing home residents in the United States. Target audience: This continuing education activity is intended for physicians and nurses with an interest in skin and wound care. Objectives: After participating...

Although pressure ulcers are a prevalent condition, pain associated with pressure ulcers is not fully understood. Indeed, previous studies do not shed light on the association between pressure ulcer stages and the experience of pain. Especially, pain characteristics of suspected deep tissue injury, which is a new category that was recently added by...

Clinical reports suggest that superficial pressure ulcers produce pain, but that pain decreases as the wound advances in stage. This study of the relationship between pressure ulcer stage and bodily pain intensity in nursing home residents was a secondary analysis of the national Minimum Data Set 3.0 assessment data in long-term care facilities, co...

To enhance the learner's competence by providing research about pressure ulcer-related pain in nursing home residents with cognitive impairment. This continuing education activity is intended for physicians and nurses with an interest in skin and wound care. After participating in this educational activity, the participant should be better able to:...

The aforementioned discussion contains a bewildering number of similar sounding organization names and a multitude of abbreviations. It seems neither feasible nor wise to gain every certificate for which one is eligible. While the initial fees may seem affordable, it is worth reiterating that recurring annual fees can significantly increase the tot...

Chronic wounds are a signi�cant health problem in the United States, with annual associated costs exceeding $20 billion annually. Traditional wound care consists of surgical debridement, manual irrigation, moisture retentive dressings, and topical and/or systemic antimicrobial therapy. However, despite progress in the science of wound healing, the...

This study sought to determine if a parsimonious pressure ulcer (PU) predictive model could be identified specific to acute care to enhance the current PU risk assessment tool (Braden Scale) utilized within veteran facilities. Factors investigated include: diagnosis of gangrene, anemia, diabetes, malnutrition, osteomyelitis, pneumonia/pneumonitis,...

Many chronic wounds fail to heal with conventional therapy, resulting in disability and impaired quality of life. New technologies using recombinant growth factors, autologous growth factors, or bioengineered skin-tissue substitutes have been shown to be effective, but these treatments are costly. An effective, low-cost treatment to improve healing...

Optimal wound healing requires adequate nutrition. Nutrition deficiencies impede the normal processes that allow progression through stages of wound healing. Malnutrition has also been related to decreased wound tensile strength and increased infection rates. Malnourished patients can develop pressure ulcers, infections, and delayed wound healing t...

This retrospective descriptive study explored the prevalence of wet-to-dry dressings ordered for wound care of open wounds healing by secondary intention. Research questions included the following: How frequently are healthcare providers ordering wet-to-dry dressings for wound care? Which specialties of healthcare providers are most frequently orde...

Compelling evidence suggests that nitric oxide (NO*), a metabolite of arginine, plays an important role in wound healing. Arginine is a semi-essential amino acid that is metabolized by nitric oxide synthase and arginase. One model for wound-healing regulation suggests the importance of strict reciprocal control of these enzymes in wounds. The purpo...

Introduction: Compelling evidence suggests that nitric oxide (NO•) plays an important role in wound healing. Not only does it possess cytotoxic properties, but also regulatory functions on various cells involved in inflammation and proliferation. In wounds, inducible NO synthase (iNOS) catalyzes arginine to citrulline and NO•, whereas arginase conv...

Purpose: The purpose of this study was to determine the current use of wet-to-dry dressings as the principal wound care modality ordered by health care providers. In addition, this study describes the types of wounds wet-to-dry dressings are currently used for, the specialty of health care providers most likely to order these dressings, and associa...

Introduction: Negative pressure wound therapy (NPWT) is an established treatment of chronic wounds. There is limited understanding of the molecular biological mechanisms of NPWT. The purpose of this study was to characterize changes in the biochemical composition of wound fluid collected from chronic pressure ulcer wounds in adults treated with NPW...

The Wound Healing Society is a professional organization of physicians, nurses, physical therapists, basic scientists, clinical researchers, and industrial researchers dedicated to assuring that every patient receives optimal wound care. Its mission is to advance the science and practice of wound healing. To that end, the following comprehensive, e...

To assess whether an experimental nutritional formula (EXP) supports immune function in seniors living in long-term care facilities. Prospective, randomized, double-blind, controlled trial conducted September 2002 through January 2003. North central Florida nursing homes. Subjects aged 65 and older (n = 157). Subjects received 240 mL/d of EXP or st...

The purpose of this pilot study was to characterize changes in concentrations of tumor necrosis factor (TNF)-alpha, interleukin (IL)-1 beta, matrix metalloproteinase (MMP)-3, MMP-9, and tissue inhibitor of metalloproteinase (TIMP)-1 in wound fluid collected from pressure ulcers in adults treated with negative pressure wound therapy (NPWT; V.A.C.(R)...

To determine the association between the Mini Nutritional Assessment (MNA) or MNA Screening Form and standard indicators of nutritional status in male elders with pressure ulcers. Cross-sectional study. MNA and MNA Screening Form scores were related to nutritional indicators using the Pearson correlation. Residents (79+/-1 years, N=23 men) of Veter...

The purpose of this study was to determine whether arginine supplementation enhances in vitro (neutrophil burst and mitogen-induced lymphocyte proliferation) and in vivo (delayed-type hypersensitivity [DTH] and serum nitric oxide) measures of immune function in nursing home elders with pressure ulcers. Twenty-six elders, 65 years of age or older, w...

Modern advances in nutritional therapies have led to the specific use of arginine supplementation for protein synthesis, cell signaling through the production of nitric oxide, and cell proliferation through its metabolism to ornithine and to polyamines. Arginine is classified as a nonessential amino acid that becomes a conditionally essential subst...

Malnutrition is prevalent in elders with pressure ulcers and is associated with increased morbidity and mortality. This study compared nutritional status, assessed by the Mini Nutrition Assessment (MNA), to immune function in nursing home elders with pressure ulcers. Nutritional status was assessed in nursing home residents (>65 years) with a stage...

Introduction: Proinflammatory cytokines TNF-α, IL-1β, and matrix metalloproteinases (MMPs) are elevated in chronic wounds and their levels decrease during healing. TNF-α and IL-1β stimulate the production of MMPs which cause degradation of growth factors. Wound fluid from the V.A.C.® is of interest when investigating the mechanisms by which V.A.C.®...

Commercial enteral nutritional formulas for enhancement of the immune system are widely used in critical care. Immunonutrition with arginine can enhance inflammatory and immunologic responses in animal models and in humans. Although clinical improvements in surgical patients have been reported, benefits in critically ill patients with systemic infl...

To assess whether an experimental nutritional formula, given as a supplement, would reduce days of symptoms of upper respiratory tract infection (URTI) and affect antibody and lymphocyte proliferative responses to influenza vaccine. A prospective, randomized, double-blind, controlled trial was conducted between October 1999 and April 2000. Assisted...

Protein-energy malnutrition and its consequences can have considerable impact on the quality of life of the elderly. Healthcare providers working with older adults are challenged to recognize individuals at risk for undernutrition and to initiate early nutritional assessment and intervention strategies to prevent malnutrition. In so doing, they can...

The nursing shortage is seriously challenging hospitals to provide safe, quality care to acute and critically ill patients. Most frequently reported are the registered nurse (RN) shortages in intensive care units (ICUs) and step-down units. Issues surrounding the nursing shortage are multifaceted and require comprehensive solutions. Although work p...

Chronic wounds mainly affect elderly individuals and persons with comorbid diseases due to a compromised immune status. An age-related decline in immune function deters proper healing of wounds in an orderly and timely manner. Thus, older adults with 1 or more concomitant illnesses are more likely to experience and sufferfrom a nonhealing wound, wh...

Background: The enhancement of immune function and nutritional status is a challenge in the care of HIV-infected persons. The semiessential amino acid, L-arginine, has been shown to enhance immune function by promoting T-cell proliferation and nitrogen retention in animal and human models. Objective: We studied the effect of three levels of arginin...

Immune function declines with age, increasing risk for infection and delaying wound healing. Arginine enhances immune function and healing of standardized wounds in healthy elderly persons. The purpose of this study was to determine what level of arginine supplementation was orally and metabolically tolerated and effective in enhancing immune funct...

Arginine (Arg) in pharmacologie doses has been shown to enhance immune function and wound healing. No studies have examined the metabolic effects of supplementation with this nitrogen-rich, semiessential amino acid in the medically-compromised elderly. The purpose of this study is to evaluate oral and metabolic tolerance of supplemental Arg in nurs...

Critically ill patients are susceptible to injury of the intestinal mucosa, changes in gut permeability, and failure of intestinal defense mechanisms. These conditions put the patients at risk for infection and multiple organ dysfunction syndrome. Specific therapies are needed to prevent gut failure during critical illness. The purpose of this lite...

Although oral hygiene is difficult to perform in orally intubated, critically ill patients, oropharyngeal status may be related to acquisition of nosocomial organisms and should therefore be addressed. To develop a clinical tool for assessment of the mouth in orally intubated patients. Sixteen orally intubated patients from one surgical and one med...

This study was undertaken to determine differences between caloric intake and requirements of critically ill, enterally fed, neurosurgical and neurotrauma patients and to determine the nature and frequency of interruptions in enteral feedings in this same population. This descriptive, prospective study was conducted in a surgical intensive care uni...

Total coronary artery occlusion and reperfusion result in attenuation of coronary blood flow reserve, regional myocardial dysfunction, and myocardial leukocyte infiltration. To examine the effects of intracoronary adenosine on these occlusion and reperfusion-induced perturbations, we subjected 14 dogs to total left anterior descending (LAD) coronar...

To develop a conceptual path model to explain the effects of a set of personal and occupational independent variables and the dependent variables of situational stress, job stress, job satisfaction, and job motivation on burnout among critical care nurses. A prospective descriptive study using a conceptual path model. Nine hospitals in the northeas...

This study investigated complications of enteral feeding in hospitalized patients with artificial airways. A prospective chart review, using a descriptive design, was used in this study of 51 inpatients in a large southeastern teaching hospital. A low (5.9%) incidence of pulmonary aspiration was found. Diarrhea was also found to be an infrequent co...

To develop a conceptual path model to explain the effects of a set of personal and work-related independent variables and the dependent variables of situational stress, job stress and job motivation on job satisfaction among critical care nurses. A prospective descriptive study using a conceptual path model. Nine hospitals licensed for at least 250...

The purpose of this report is to determine what characteristics are most closely associated with nurses and physicians who favor a living will. A statistical analysis called classification and regression trees (CART) was used on the data set from a previous study. The five predictor variables that were analyzed were chosen following incorporation o...

Pneumopericardium resulting in cardiac tamponade may be caused by a variety of phenomena. The onset of cardiac tamponade can indicate the presence of a rare underlying condition. As a rare complication of mechanical ventilation and PEEP, our patient experienced pneumopericardium that resulted in cardiac tamponade. Perhaps the most crucial therapy o...

Based on the results of this study, it appears that critically ill patients may receive nutritional supplements through the use of a small-gauge, flexible enteral feeding tube without significant danger of pulmonary aspiration. However, the potential for aspiration of tube feedings in any critically ill patient still exists, and further research in...

To assess the prognostic validity of "low risk" classification at 24-36 hours as the basis for early transfer to an intermediate coronary care unit, Killip and Hutter/Sidel criteria for risk classicication were applied to 410 patients with acute myocardial infarction (MI) and prospectively compared with respect to mortality and morbidity. Six perce...

A nurse rehabilitator, supplementing routine physician/nursing coronary care unit (CCU) care, was found to be effective in increasing the return to work rate (p less than .05) and decreasing smoking (p less than .05) in a randomized trial of 102 patients with acute myocardial infarction (MI). These outcomes were thought to be due to the nurse rehab...