Dr. Barbara Pieper investigates the causes of and best treatments for chronic wound care among indigent adults and persons who inject illicit drugs. Dr. Pieper, a professor at the College of Nursing at Wayne State University (Detroit, MI), has a joint appointment at the Detroit Medical Center's Detroit Receiving Hospital, where she established an outpatient wound service. She is a Fellow with the American Academy of Nurses and received the 2010 Mid-East Region Wound, Ostomy and Continence Nurses Society Professional Educator of the Year and President’s Award. The author of more than 100 articles and book chapters, Dr. Pieper frequently has shared her expertise with international visitors studying venous wound treatment in the United States.
Why Wound Care?
I became interested in wounds when I saw “new” products (other than gauze) entering the market in the early 1980s. This included the beginning of specialty beds. In 1989, I attended a wound, ostomy, and continence (WOC) educational program to learn more about the WOC nursing practice. In 1990, the dean of the College of Nursing at Wayne State University (Detroit, MI) and the nurse administrator at Detroit Receiving Hospital (DRH) wanted to initiate joint clinical-educational positions, one of which I filled. DRH provides care to a high indigent, inner city population. I saw patients with horrific wounds and suggested DRH begin an outpatient wound clinic for follow-up of these patients. Instead, they asked me to start a wound care practice in their indigent care primary care clinic. Because the federal, state, and county money to the clinic did not cover referral care, I could keep the patients in the clinic by doing their wound care and save money.
In October 1991, I began this practice with 2 patients who were active injection drug users and had lower extremity ulcers. I knew nothing about lower extremity wounds related to injection drug use. When they left, they took all my supplies. I had 2 critical goals: 1) become streetwise very fast to survive and 2) find literature about lower extremity ulcers related to injection drug use. After spending many hours at the library (before computerized libraries) with my husband on weekends, I learned there was little information about these wounds. Thus, I began my life career of clinical care and research about injection-related venous ulcers.
Counselors in drug treatment centers contacted me because they could not believe someone was providing wound care to these individuals. The collaboration with drug treatment centers provided sites for my research. The emergency department staff was very happy they had a place to send these individuals for wound care, which ended a revolving door of patients seeking wound care in the emergency department.
When I started this service, patients were in their 40s; now they are in their 60s. Besides injection-related venous ulcers, they have numerous other health issues (hepatitis C virus, diabetes, hypertension, cancer, and the like). Now there are wound care clinics everywhere. Who would have thought that this service would last 23 years? I have loved every second of my nursing and wound career. I have shared my clinical and research findings in many publications and presentations. Find a passion, even if it is not mainstream, and fly with it!