Skin maceration is widely recognized as a main factor for incontinence associated dermatitis（IAD）and a risk factor for pressure ulcers. However, the structural and functional alterations in macerated skin have not clarified. Our recent research revealed that skin maceration induced a decreased number of cell processes in the stratum spinosum and basale, as well as a disruption of intercellular lipid structures in the stratum corneum. These structural alterations induced the transdermal penetration of huge molecules, such as dextran and albumin, into the deep layer of the dermis. According to these results, we would like to propose a new definition of skin maceration as follows, “Skin maceration is a functional disorder of the barrier for irritants and tolerance for force due to structural alterations of intercellular lipid layers and junctions between keratinocytes in the epidermis.”

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　The purpose of this study was to develop an assessment scale to measure cooperation skill of wound, ostomy and continence nurses（WOCNs）to facilitate the management of pressure ulcers（PUs）systematically in the hospital. The study subjects were WOCNs working in hospitals in Japan. Questionnaires were mailed to the subjects. The reconstructed scale consisted of 6 domains with 64 items. The domains of 'skills to communicate with a nurse manager in the ward', 'skills to collaborate with physicians', 'skills to communicate with the hospital manager', 'skills to organize multi-professional teams', and' skills to treat PUs' consisted of one factor. 'Skills to educate staff nurses in each ward' consisted of 3 factors. Validity was assessed through factorial validity. The cumulative proportion after extracting the factors was 46.0-61.0%. Total score in the group with 3 or more years of experience as WOCNs was significantly lower than the group with less than 3 years of experience, confirming the validity of the scale. The WOCNs in the hospitals that had introduced a reimbursement system for PUs had significantly lower total scores in 5 domains than the group of WOCNs in the hospitals without the system. The WOCNs who conducted independent cross-sectional activities had significantly lower total scores in 6 domains than the group of WOCNs who have less autonomy in their activities. These results demonstrated concurrent validity. Cronbach's α of all but one factor were more than 0.8, confirming internal consistency. The results showed this scale can be a useful educational reference for WOCNs.

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