Effects of hospital-family holistic care model on the health outcome of patients with permanent enterostomy based on the theory of 'Timing It Right'.

AIMS AND OBJECTIVES: To explore the effects of hospital-family holistic care model based on 'Timing It Right' on the health outcome of patients with permanent colostomy. BACKGROUND: Colorectal cancer is a common malignant tumour of digestive system, which seriously threatens human life and health. Colostomy is one of the main treatments for colorectal cancer, which effectively improves the 5-year survival rate of patients. However, the postoperative psychological and physiological rehabilitation nursing is still faced with great challenges due to the change of body image and defecation pathway caused by colostomy. METHODS: A randomised controlled trial was conducted, and 119 patients with permanent enterostomy were randomly divided into two groups, with 60 cases in the intervention group and 59 cases in the control group. The intervention group received routine care follow-up and hospital-family holistic care intervention based on 'Timing It Right', while the control group received routine care and follow-up. The resilience, self-care ability, complications and life quality of patients with permanent enterostomy were compared between two groups before intervention, at discharge, 3 months and 6 months after discharge. CONSORT checklist was applied as the reporting guideline for this study (see Appendix S1). RESULTS: A total of 108 patients with permanent enterostomy completed the study (90.76%). At 3 months and 6 months after discharge, the resilience and quality of life in the intervention group were significantly better than those in the control group (t = 4.158 vs. 7.406, t = 4.933 vs. 8.611, p < .05), while the complications in the intervention group were significantly lower than that in the control group (25.5% vs. 41.51%, 14.45% vs. 30.19%; p < .05). The self-care ability of the intervention group was significantly better than that in the control group (t = 1.543 vs. 3.656 vs. 6.273, p < .05) at discharge, 3 months and 6 months after discharge. The interaction between time and grouping showed that the effect of time factor varied with the grouping. After intervention, there were significant differences in psychological resilience, self-care ability, complications and quality of life between the two groups at different observation points (p < .01). The three evaluation indices of intervention group increased with the migration of observation time points and were significantly better than those of control group, especially the quality of life (84.35 ± 4.25 vs. 60.45 ± 8.42, p < .01). CONCLUSIONS: The hospital-family holistic care model based on 'Timing It Right' can effectively improve the psychological resilience, self-care ability and quality of life; reduce complications; and improve the health outcomes of patients with permanent enterostomy. RELEVANCE TO CLINICAL PRACTICE: Patients with permanent enterostomy have different needs for nursing care at different stages of the disease, and they are dynamically changing. The hospital-family holistic care model based on 'Timing It Right' can effectively improve the health outcomes of patients with permanent enterostomy, which is worthy of clinical application.

Evaluación de la calidad de la técnica de enfermería "vacuidad del intestino" en Cirugía Pediátrica / Quality assessment for the nursing technique gut irrigation in children surgery

Introducción: el personal de enfermería debe estar bien entrenado en la preparación del paciente que va a ser intervenido por cirugía en afecciones gastrointestinales o con fines investigativos, para lograr una excelente vacuidad del intestino. Objetivo: evaluar la calidad de la técnica de enfermería "vacuidad del intestino" en cirugía pediátrica. Métodos: se realizó un estudio descriptivo retrospectivo en el Servicio de Cirugía Pediátrica del Hospital Provincial General Docente "Dr. Antonio Luaces Iraola" de Ciego de Ávila, en el período 2010-2013. El universo quedó constituido por 74 pacientes que requirieron limpieza del intestino. La calidad de la técnica fue evaluada de excelente, buena, regular y mala. La información se obtuvo de la historia clínica y procesada con la utilización de frecuencias absolutas y porcentajes. Resultados: el 67,56 por ciento de los niños tenía menos de seis años, el 71,62 por ciento eran del sexo masculino, el 32,43 por ciento de los pacientes fueron preparados en la limpieza del colon con fines diagnósticos y el 67,56 por ciento con fines quirúrgicos. Se evaluó de excelente el 100,00 por ciento de los procedimientos "gastroclisis para cierre de colostomía" realizados, y el 98,64 por ciento de los procedimientos "Irrigación total del intestino para otros procederes". Conclusiones: la técnica de enfermería "vacuidad del intestino" en cirugía pediátrica realizada con los procedimientos de gastroclisis y de irrigación total del intestino para otros procederes fue evaluada de calidad. La experiencia del personal de enfermería es notable, evidenciado en los excelentes resultados obtenidos(AU)

Introduction: The nursing staff should be well trained in preparing the patient to undergo surgery for surgery in gastrointestinal diseases, or research purposes for excellent bowel emptiness. Objective: To evaluate the quality of nursing technique "intestine emptiness" in pediatric surgery. Methods: A retrospective study was conducted at the Pediatric Surgery Provincial General Teaching Hospital "Dr. Antonio Luaces Iraola "Ciego de Avila, in the period 2010-2013. The universe was composed of 74 patients who required bowel cleansing. The quality of the data was assessed as excellent, good, fair and poor. The information was obtained from the clinical history and processed using absolute frequencies and percentages. Results: 67,56 percent of children had less than six years, 71,62 percent were male, 32,43 percent of patients were prepared in cleansing the colon for diagnostic purposes and 67,56 percent for surgical purposes. It was evaluated excellent 100,00 percent of procedures "gastroclisis colostomy closure" made, and 98,64 percent of procedures "whole bowel irrigation for other procedures." Conclusions: nursing technique "intestine emptiness" pediatric surgical procedures performed with gastroclisis and whole bowel irrigation for other procedures was assessed quality. The experience of nursing staff is remarkable, as evidenced by the excellent results obtained(AU)

Randomized controlled trial of laxative use in postcolostomy surgery patients.

PURPOSE: We compared a standardized postoperative laxative protocol to laxatives provided on an ad hoc basis by the surgical team. SUBJECTS AND SETTING: Forty-five patients who underwent colostomy surgery participated in the study. The research setting was 2 acute care facilities in south-eastern Sydney, New South Wales, Australia. METHODS: A randomized controlled trial was conducted. The intervention group (n 5 19) received a standardized laxative protocol postsurgery. Two types of laxatives were selected for first-line treatment: sterculia and frangula bark (Normacol Plus), a bulking agent and stimulant; and liquid paraffin (Agarol), a stool softener. An iso-osmotic polyethylene glycol macrogel (Movicol) was chosen as second-line treatment. The comparison group (n = 26) received laxative intervention(s) as preferred by the surgical team. Constipation, measured as fecal loading on plain abdominal film, stomal therapy nurse activity, patient comfort, and length of hospital stay were compared between intervention and control groups. RESULTS: The presence of fecal loading favored the intervention group (1 episode in the treatment group vs 7 episodes in the comparison group; χ5 = 3.8; P = .05). This finding suggests that the laxative protocol given to the treatment group was more likely to prevent fecal loading/constipation when compared to the ad hoc laxative group. Stomal therapy nurse activity in terms of the number of empty bag changes was significantly higher in the comparison group (F 5 4.8; P 5 .03). CONCLUSION: The findings of this study support the benefits of a standardized laxative protocol for prevention of constipation. Data collection was discontinued after 3 years due to a contamination effect developing, because our surgeons observed the utility of the laxative protocol and incorporated it into their routine practice. Further experimental research is needed to explore the best constipation prevention approaches for postcolostomy surgery patients.

[Therapeutic education at the heart of the patient treatment pathway]. / L'education thérapeutique au coeur du parcours de soins du patient.

The surgical treatment of bowel cancer often results in a digestive stoma, either temporary or permanent. Stoma patients must learn to live with this changed body and intestinal function. They must also adapt their lifestyle to these changes. It is in this direction which the stoma therapy nurse supports the patient.

An update on stoma appliance flanges and base-plates.

Coping with a stoma can be difficult for many reasons; leakage and skin breakdown are two common problems faced by ostomates (people with a stoma). A flange or base-plate adheres to the patient's abdomen. A secure and well designed flange is essential to the ostomate when adjusting to their newly formed stoma. Selecting the correct type of appliance and flange is an important part of holistic assessment. This article is the second in a series of three and focuses on the newer flanges that are available. It can be difficult for community nurses to keep abreast of all the new developments within the stoma appliance field; therefore, this article aims to highlight some of the key aspects concerning the functionality of available flanges.

Intestinal diversion (colostomy or ileostomy) in patients with severe bowel dysfunction following spinal cord injury.

BACKGROUND: Spinal cord injury (SCI) affects motor and sensory nervous integrity resulting in paralysis of lower or both upper and lower extremities, as well as autonomic nervous system function resulting in neurogenic bowel. SCI leads to diminished or lost sensations of the need to defecate or inability to distinguish the presence of gas versus liquid versus solid stool in the rectal vault. Sensory loss, incomplete evacuation of stool from the rectal vault, immobility, and reduced anal sphincter tone increase the risk of fecal incontinence. Gastrointestinal symptoms are associated with depression, anxiety, and significant impairments in quality of life (QOL) in a significant portion of persons with SCI. OBJECTIVES: 1. To compare clinical, functional, or quality of life outcomes in spinal cord injured patients with gastrointestinal symptoms managed by conservative measures versus intestinal diversion (colostomy or ileostomy). 2. To identify complications associated with ostomy surgery in patients with bowel dysfunction and SCI. SEARCH STRATEGY: A systematic review of electronic databases MEDLINE and CINAHL (from January 1960 to November 2007) was undertaken using the following key words: (1) ostomy, (2) stoma, (3) colostomy, and (4) ileostomy. Boolean features of these databases were used to combine these terms with the key word "spinal cord injuries." Prospective and retrospective studies that directly compared clinical, functional, QOL outcomes or satisfaction among patients with intestinal diversions to patients managed by conservative means were included. RESULTS: Creation of an ostomy in selected patients provides equivocal or superior QOL outcomes when compared to conservative bowel management strategies. Both colostomy and ileostomy surgery significantly reduce the amount of time required for bowel management. Patients who undergo ostomy surgery tend to be satisfied with their surgery, and a significant portion report a desire to be counseled about this option earlier. There are no clear advantages when functional, clinical, or QOL outcomes associated with colostomy are compared to those seen in SCI patients undergoing ileostomy. IMPLICATIONS FOR PRACTICE: 1. The WOC nurse plays a pivotal role in both conservative bowel management and the decision to undergo ostomy surgery. 2. Preoperative stoma site marking is vital for the best surgical outcome. 3. The system best suited to an individual is based on a variety of factors including but not limited to stoma location, type of effluent, peristomal plane and contours, and the individual's capabilities and preferences. 4. Some individuals with a sigmoid or descending colostomy may benefit from colostomy irrigation as a management method. 5. Postoperatively, assessment of pressure points for signs of tissue breakdown, evaluation of treatment methods for existing pressure ulcers with suitable modification, and support surface assessment should be included in ongoing annual follow-up visits.

Ostomy care and rehabilitation in colorectal cancer.

OBJECTIVES: To review ostomy care in colorectal cancer, current trends in assessment, management, and treatment, and the role of the enterostomal therapy (ET) nurse in cancer care. DATA SOURCES: Published literature and the author's clinical experiences in ostomy wound care. CONCLUSION: Care of the patient with colorectal cancer requiring an ostomy involves both physical and psychological rehabilitation. The education and skills of an ET/wound, ostomy, and continence (WOC) nurse can provide a valuable service to the patient/family, surgeon, oncology nurse, and other health care providers. IMPLICATIONS FOR ONCOLOGY NURSES: An ostomy is not a handicapping procedure. Living well with a colostomy can be achieved through proper patient preparation, education, and planning. Provision of individualized comprehensive care facilitates physical and psychological rehabilitation.

Discharge planning in rehabilitation following surgery for a stoma.

Discharge planning and establishing goals for rehabilitation after stoma surgery is an ongoing process, which should be preceded by an holistic assessment, ideally carried out by a specialist practitioner with knowledge and experience in this area. The practitioner needs to have effective listening skills to ensure that both practical and psychological care are patient-centred. The patient and his/her carers must be involved in all aspects of care planning and establishing goals for rehabilitation. The specialist practitioner should adopt an evidence-based approach to care, ensuring that important aspects of care, such as the early teaching of stoma management skills, are not neglected. The specialist practitioner may not be able to meet all the patient's needs and should refer on to other specialist staff where these services are available. Such multidisciplinary input, utilizing appropriate problem-solving approaches with the involvement of patients and their carers, can only enhance the quality of care delivered and optimize the process of rehabilitation.

Elective colostomy in the patient with a spinal cord injury: an ET nurse's perspective.

The patient with a spinal cord injury presents significant challenges to the nurse seeking to promote an optimal state of physical wellness and maximum independence with self-care. This article describes the nature of spinal cord injuries and their long-term effects on the gastrointestinal system. The preoperative and postoperative needs that the WOC nurse must consider when designing a care plan for the patient with a spinal cord injury and a colostomy are discussed, as well as the indications and efficacy of elective colostomy surgery as a management alternative for the neuropathic bowel.