The sexuality experience of stoma patients: a meta-ethnography of qualitative research.

BACKGROUND: As the quality of life of stoma patients has become a research hotspot, sexual health as an integral part of patients' lives has received more and more attention. However, there is a lack of comprehensive reviews on the sexual experiences of patients with stomas. This study aims to synthesize the qualitative literature on the subjective experience of stoma patients' sexual life, to identify their sexual needs, and to provide evidence for the content and methods of sexual health interventions for healthcare professionals. METHODS: PubMed, Embase, Web of Science, CINAHL, and Scopus were searched for qualitative studies on the sexual experience of stoma patients (from the inception to January 2023). Titles, abstracts, and full texts were reviewed by two researchers. We used the Critical Appraisal Program (CASP) checklist to assess the quality of included articles. RESULTS: A total of 1388 articles were retrieved, and eight studies were included. Data was extracted, including three main themes: 1) sexual problems due to changes in physical function and psychological disorders; 2) the relationship with spouse changes; 3) the cognition of sexual life and the need for sexual knowledge. CONCLUSION: Healthcare professionals should pay attention to the sexual life status and sexual health needs of stoma patients and their partners, and give professional guidance and support in treatment and nursing to improve the quality of sexual life of stoma patients.

The effectiveness of preoperative stoma site marking on patient outcomes: A systematic review and meta-analysis.

AIMS: This study systematically reviews the literature regarding preoperative stoma site marking and discusses the effectiveness of the procedure on complication rates, self-care deficits and health-related quality of life (HRQOL). DESIGN: Systematic review and meta-analysis. DATA SOURCE: Our review was conducted following the PRISMA guidelines. PubMed, EMBASE, Cochrane and CINAHL databases were searched to obtain articles published in English. Articles were also retrieved from Korean databases as well. Our last search was conducted on 2 June 2019. REVIEW METHODS: Two reviewers independently selected relevant studies, evaluated their methodological quality and extracted data. Experimental and observational studies were included. Our main focus was on complication rates, self-care deficits and HRQOL. We conducted meta-analysis using the statistical software spss 25.0 and Stata 13.0. RESULTS: Of the 1,039 articles reviewed, 20 were included for review, and 19 were used for quantitative synthesis. Preoperative stoma site marking reduced complication rates (odds ratio [OR]: 0.47; 95% confidence interval [CI]: 0.36-0.62; I2 : 70.6%), lowered self-care deficits (OR: 0.34; 95% CI: 0.18-0.64; I2 : 0%), and increased HRQOL (standardized mean difference, 1.05; 95% CI: 0.70-1.40; I2 : 0%). Quality appraisal results for both the individual studies and the studies overall were excellent. The possibility of publication bias was low. CONCLUSIONS: Our findings indicate that preoperative stoma site marking improves patient outcomes: stoma-related complication rates and self-care deficits decrease and HRQOL rises. For this reason, preoperative stoma site marking should be a mandatory procedure in clinical settings. The practice should also be supported by policymakers and healthcare expert associations. IMPACT: Preoperative stoma site marking reduces overall complication rates by 53% and skin problems by 59%. Preoperative stoma site marking also improves self-care and health-related quality of life. We recommend that preoperative stoma site marking should be a mandatory procedure in clinical settings.

A novel technique for superficial complicated stomas using the Dacron vascular prosthesis.

BACKGROUND AND PURPOSE: Despite the advances achieved in surgical techniques in recent years, an intestinal stoma is still needed in many patients undergoing colorectal surgery. However, the intestinal stoma may be associated with serious complications and the need for a second surgical procedure. In extreme cases, when it is not possible to access the abdominal cavity, the management of a complicated stoma is challenging. The purpose of this study was to describe the use of a Dacron vascular prosthesis (DVP) in patients with intestinal stoma complications. METHODS: In patients with a shallow, superficial stoma or mucocutaneous separation (MCS), we sutured the prosthesis in the intestinal loop (at the edge of an intestinal fistula) to create a device to direct the fecal content to the collection bag. RESULTS: We included 9 patients in this series (colorectal cancer, n = 5; Crohn's disease, n = 2; giant abdominal hernia and morbid obesity, n = 2). The results obtained were promising since they showed good evolution in patients with severe intestinal complications and an impossibility of surgical correction of the stoma. Five patients presented complete healing, and two patients presented partial healing. There were two deaths caused by sepsis, which were not related to the surgical procedure. With this technique, there was a reduction in the leakage of intestinal contents into the peritoneal cavity and an increase in the healing of the peristomal dermatitis in most of the patients. The DVP could possibly represent a surgical alternative in selected patients with complicated stomas when surgical correction may not be a suitable option. CONCLUSIONS: The authors recommend this technique for selected complex cases of stoma complications after unsuccessful attempts to adapt collecting equipment. The placement of the DVP allowed the peristomal skin to heal and improved the contamination of the peritoneal cavity.

Laparoscopic parastomal herniorrhaphy utilizing transversus abdominis release and a modified Sugarbaker technique: A case report.

A 69-year-old woman was referred to our department with complaints of abdominal discomfort in the standing position. She had undergone robot-assisted radical cystectomy and ileal conduit urinary diversion for bladder cancer 10 months earlier. Abdominal CT revealed a parastomal hernia. Laparoscopic parastomal hernia repair using the Pauli technique was performed successfully with no recurrence after a 4-month follow-up. Although there are concerns about potential mesh-related complications and long-term results, this novel approach can be a successful option for parastomal hernia repair. As far as we know, this is the first English-language report on the application of Pauli parastomal hernia repair combined with a pure laparoscopic approach.

Tailored treatment of anastomotic leak after rectal cancer surgery according to the presence of a diverting stoma.

PURPOSE: A variety of clinical features of anastomotic leak occur during the surgical treatment of rectal cancer. However, little information regarding management of leakage is available and treatment guidelines have not been validated. The aim of this study was to evaluate the validity of currently proposed expert opinions on the management of anastomotic leak, after low anterior resection for rectal cancer. METHODS: A retrospective analysis was conducted for 1,786 patients who underwent sphincter-preserving surgery for rectal cancer between 2005 and 2015. Clinical outcomes including anastomotic leak-associated mortality and permanent stoma were analyzed. RESULTS: The overall incidence of anastomotic leak was 6.8% (122 of 1,786), including 6.1% (30 of 493 patients) with diverting stoma and 7.1% (92 of 1,293 patients) without diverting stoma (P = 0.505). A majority of patients without diversion were treated with diverting stoma (76 of 88 patients [86.4%]); 1 mortality (0.8%) was observed in this group. Treatments in the diversion group mainly included conservative treatment, local drainage, and/or transanal repair (26 of 30 patients [86.7%]). The anastomotic failure rates were 20.7% (19 of 92 patients) in the no diversion group and 53.3% (16 of 30 patients) in the diversion group. In the multivariate analysis, preoperative chemoradiotherapy (P < 0.001) and delayed diagnosis of anastomotic leak (P = 0.036) were independent risk factors for permanent stoma. CONCLUSION: Management of anastomotic leak should be tailored to individual patients. When anastomotic leak occurred, preoperative chemoradiotherapy and delayed diagnosis seemed to be associated with permanent stoma.

Effect of a Stoma Nursing Care Program on the Adjustment of Patients with an Ostomy / Efecto de un programa de atención de enfermería en estomaterapia en la adaptación de la persona a la ostomía de eliminación / Efeito de um programa de enfermagem em estomaterapia na adaptação da pessoa ao estoma de eliminação

ABSTRACT Objective: To evaluate the effect of a stoma nursing care program on the personal adjustment to an ostomy. Materials and methods: A quasi-experimental study with a control group. The sample of 105 patients with stoma was divided into two groups (intervention group and control group), with assessments in the first and sixth month after hospital discharge. Information was collected using the Elimination Ostomy Adjustment Scale. Student's t-tests analysis were performed. Results: One month after hospital discharge, the adjustment to the stoma was satisfactory and similar (p > 0.05) in both groups, and in the sixth month, statistically more favorable in the intervention group (p < 0.001); a statistically significant difference between the two assessments (p < 0.001) is found in the intervention group only. Conclusions: The intervention program has a positive influence on the adjustment to the stoma, and its contribution is significant six months after hospital discharge. Systematic interventions of an ostomy care specialized nurse have shown positive effects on ostomy adjustment, which is recommended since the preoperative period.

RESUMEN Objetivo: evaluar el efecto de un programa de atención de enfermería en estomaterapia en la adaptación de la persona a la ostomía de eliminación (OE). Materiales y métodos: estudio cuasiexperimental con grupo control. La muestra de 105 personas con OE se dividió en dos grupos (grupo de intervención y grupo de control), con evaluación en el primer y sexto mes después del alta hospitalaria. La información se recopiló mediante la Escala de Adaptación a la Ostomía de Eliminación. Se realizaron pruebas t de Student para el análisis estadístico. Resultados: en el primer mes después del alta hospitalaria, la adaptación a la OE fue satisfactoria y similar (p > 0,05) en los dos grupos y el sexto mes fue estadísticamente más favorable en el grupo de intervención (p < 0,001), con diferencias estadísticamente significativas en el grupo de intervención entre los dos momentos de evaluación (p < 0,001). Conclusiones: el programa influenció positivamente la adaptación a la OE y su contribución se hizo visible al sexto mes después del alta hospitalaria. La intervención sistemática de la enfermería en estomaterapia reveló un efecto favorable en la adaptación a la OE, por lo que es recomendable que se inicie en el período preoperatorio.

RESUMO Objetivo: avaliar o efeito de um programa de intervenção de enfermagem em estomaterapia na adaptação da pessoa à ostomia de eliminação (OE). Material e métodos: estudo quasi-experimental com grupo de controlo. A amostra de 105 pessoas com OE repartiu-se por dois grupos (grupo de intervenção e grupo de controlo), com avaliação ao primeiro e sexto mês depois da alta hospitalar. A informação foi recolhida com a Escala de Adaptação à Ostomia de Eliminação. Realizaram-se testes t-Student para análise estatística. Resultados: ao primeiro mês, a adaptação à OE era satisfatória e semelhante (p > 0,05) nos dois grupos, sendo ao sexto mês, estatisticamente mais favorável no grupo de intervenção (p < 0,001); com diferenças estatisticamente significativas entre os dois momentos de avaliação (p < 0,001), no grupo de intervenção. Conclusões: o programa de intervenção influenciou positivamente o percurso de transição para a adaptação à OE, sendo visível o seu contributo, ao sexto mês depois da alta hospitalar. A intervenção sistematizada da enfermeira estomaterapeuta revelou um efeito favorável na adaptação à OE, sendo recomendável desde o período pré-operatório.

Factors affecting the morbidity and mortality of diverting stoma closure: retrospective cohort analysis of twelve-year period.

Background Diverting stoma is often performed in rectal cancer surgery for reducing the consequences of possible anastomotic failure. Closing of stoma follows in most cases after a few months. The aim of our study was to evaluate morbidity and mortality after diverting stoma closure and to identify risk factors for complications of this procedure. Patients and methods At our department, we have performed a retrospective cohort analysis of data for 260 patients with diverting stoma closure from 2003 to 2015. Age, stoma type, patient's preoperative ASA score, surgical technique and time to stoma closure were investigated as factors which could influence the complication rate. Results 218 patients were eligible for investigation. Postoperative complications developed in 54 patients (24.8%). Most common complications were postoperative ileus (10%) and wound infection (5%). Four patients died (1.8%). There was no effect on complication rate regarding type of stoma, closing technique, patient's ASA status and patient age. The only factor influencing the complication rate was the time to stoma closure. We found that patients which had the stoma closed prior to 8 months after primary surgery had lower overall complication rate (p<0. 05). Conclusions To reduce overall complication rate, our data suggest a shorter period than 8 months after primary surgery before closure of diverting stoma. As diverting stoma closure is not a simple operation, all strategies should be taken to reduce significant morbidity and mortality rate.

O autocuidado em pacientes com estomia intestinal à luz de Dorothea Orem: da reflexão ao itinerário terapêutico / Self-care in patients with intestinal ostomy under Dorothea Orem's light: from reflection to therapeutic itinerary

A pessoa estomizada é toda aquela que é subemtida a uma intervenção cirúrgica com exteriorização do sistema digestório, respiratório e urinário, criando uma abertura artificial exteriorizada denominado estoma. A confecção de uma estomia resulta em mudanças na rotina da pessoa, que serão evidenciadas em todos os níveis da sua vida, onde pode-se citar as necessidade de realização do autocuidado para manutenção da qualidade de vida e rotina de atividade diárias deste paciente. No que tange ao autocuidado, Orem refere que todos os seres humanos têm potencial para desenvolver suas habilidades intelectuais e práticas, além da motivação essencial para o autocuidado. Refere ainda que o autocuidado tem como propósito o desempenho ou prática de atividades que os indivíduos realizam em seu benefício para manter a vida, a saúde e seu bem estar. O modelo propõe que todos os pacientes sejam encorajados a cuidar de si próprios e tenham participação ativa no processo de cuidados. Diante da problemática apresentada pode-se destacar como objeto de estudo o autocuidado do paciente estomizado a luz de Dorothea Orem. Esta pesquisa teve como objetivo: Discutir o autocuidado realizado pelo paciente estomizado à luz de Dorothea Orem. Em relação ao Método, tratou-se de um estudo exploratório descritivo, tendo como fonte de informação a pesquisa de campo e abordagem qualitativa sobre o autocuidado realizado pelo paciente estomizado em um município da Metropolitana II e foi realizada no Núcleo de Atenção à Saúde da Pessoa Estomizada no Hospital Orêncio de Freitas no município de Niterói, estado Rio de Janeiro. Os participantes foram os pacientes atendidos por demanda livre e agendados, que se enquadraram nos critérios de inclusão e aceitem, de livre e espontânea vontade, participar desta pesquisa. A coleta de dados foi realizada através de entrevista com roteiro semiestruturado, com gravação em áudio para melhor tratamento e transcrição dos dados posteriormente e, por sua vez, analisou-se os dados na ótica de Dorothea Orem. Como resultados deste estudo, frente às características dos 32 participantes, vislumbrou-se prevalência das estomias intestinais no sexo masculino, em sua grande maioria advinda do diagnóstico de câncer de reto, tendo evidencia significativa a baixa escolaridade dos sujeitos e, por sua vez, baixa remuneração familiar que pode ser visto com um grande ofensor para execução do autocuidado. Entretanto, os participantes da pesquisa evidenciaram que passam a viver melhor quando compreendem e aceitam o estoma e esse processo pode ser facilitado pelo enfermeiro, por meio da Consulta de Enfermagem, sobretudo quando adota na sua prática assistencial a teoria de autocuidado de Dorothea Orem, a qual preconiza três atividades: contato inicial com o paciente que demanda o cuidado que se traduz em um sistema que contempla as exigências terapêuticas e os meios de auxílio; continuidade desse contato para o desenvolvimento de ações de enfermagem, sendo inclusos os familiares ou responsáveis pelo cuidado para a atuação nos momentos atuais e futuros; e o estágio de preparação do paciente para conduzir ações de cuidado de maneira independente. Nessa fase, tanto o paciente quanto os familiares já estão treinados em relação aos cuidados básicos para realização da higiene e troca dos dispositivos intestinais, entre outros cuidados necessários. Por conseguinte, evidencia-se a importância da utilização do referencial teórico de Orem para a abordagem desta clientela, com a finalidade de ajudá-la a resolver seus déficits de autocuidado, fornecendo-lhes informações úteis, apoio emocional e psicológico. Portanto, é por meio do sistema de apoio-educação, que compõe a teoria dos sistemas de enfermagem, que este processo pode tonar-se eficaz

The stomized person is all that is subordinated to a surgical intervention with exteriorization of the digestive, respiratory and urinary system, creating an artificial exteriorized opening called stoma. The making of an omen results in changes in the person's routine, which will be evidenced at all levels of his life, where he can mention the need for self-care to maintain the quality of life and daily routine of this patient. In regard to self-care, Orem says that all human beings have the potential to develop their intellectual and practical skills, as well as the essential motivation for self-care. It also states that self-care is intended for the performance or practice of activities that individuals perform for their benefit to maintain life, health and well being. The model proposes that all patients be encouraged to take care of themselves and have an active participation in the care process. In view of the problematic presented, it is possible to emphasize as object of study the self-care of the patient estomizado the light of Dorothea Orem. This research had as objective: To discuss the self-care performed by the patient estomizado in the light of Dorothea Orem. Regarding the method, this was a descriptive exploratory study, having as information source the field research and qualitative approach on self-care performed by the stomized patient in a city of the Metropolitan II and will be held at the Center for Health Care of the Person Estomized at the Orêncio de Freitas Hospital in the city of Niterói, state of Rio de Janeiro. The participants were patients who were attended to by free demand and scheduled, who met the inclusion criteria and accepted, of their own free will, to participate in this research. The data collection was performed through an interview with semi-structured script, with audio recording for better treatment and transcription of the data later, and, in turn, the data were analyzed in the optics of Dorothea Orem. As a result of this study, the prevalence of intestinal stomies in the male sex was mainly due to the diagnosis of rectal cancer, in view of the characteristics of the 32 participating subjects, with a significant evidence of the subjects' low level of education and, in turn, low family compensation that can be seen with a large offender for self-care enforcement. However, the research subjects showed that they live better when they understand and accept the stoma, and this process can be facilitated by the nurse through the Nursing Consultation, especially when she adopts Dorothea Orem's theory of self-care in her care practice. which advocates three activities: initial contact with the patient who demands the care that translates into a system that contemplates the therapeutic requirements and means of assistance; continuity of this contact for the development of nursing actions, including family members or caregivers to act in current and future moments; and the stage of preparation of the patient to conduct care actions independently. In this phase, both the patient and family members are already trained in basic care for the hygiene and exchange of intestinal devices, among other necessary care. Therefore, it is important to use Orem's theoretical framework to approach this clientele in order to help them solve their self-care deficits by providing them with useful information, emotional and psychological support. Therefore, it is through the support-education system, which makes up the theory of nursing systems, that this process can be effective

La persona estomizada es toda aquella que está subordinada a una intervención quirúrgica con exteriorización del sistema digestivo, respiratorio y urinario, creando una abertura artificial exteriorizada denominada estoma. La confección de una estomia resulta en cambios en la rutina de la persona, que serán evidenciadas en todos los niveles de su vida, donde se pueden citar las necesidades de realización del autocuidado para mantener la calidad de vida y rutina de actividad diarias de este paciente. En lo que se refiere al autocuidado, Orem señala que todos los seres humanos tienen potencial para desarrollar sus habilidades intelectuales y prácticas, además de la motivación esencial para el autocuidado. El autocuidado tiene como propósito el desempeño o práctica de actividades que los individuos realizan en su beneficio para mantener la vida, la salud y su bienestar. El modelo propone que todos los pacientes sean alentados a cuidar de sí mismos y tengan participación activa en el proceso de cuidados. Ante la problemática presentada se puede destacar como objeto de estudio el autocuidado del paciente estomizado a la luz de Dorothea Orem. Esta investigación tuvo como objetivo: Discutir el autocuidado realizado por el paciente estomizado a la luz de Dorothea Orem. En cuanto al Método, se trató de un estudio exploratorio descriptivo, teniendo como fuente de información la investigación de campo y abordaje cualitativo sobre el autocuidado realizado por el paciente estomizado en un municipio de la Metropolitana II y se realizará en el Núcleo de Atención a la Salud de la Persona Estomizada en el Hospital Oréncio de Freitas en el municipio de Niterói, estado de Río de Janeiro. Los participantes fueron los pacientes atendidos por demanda libre y programados, que se encuadrar en los criterios de inclusión y aceptar, de libre y espontánea voluntad, participar de esta investigación. a recolección de datos fue realizada a través de una entrevista con un itinerario semiestructurado, con grabación en audio para mejor tratamiento y transcripción de los datos posteriormente y, a su vez, se analizaron los datos en la óptica de Dorothea Orem. Como resultado de este estudio, frente a las características de los 32 sujetos participantes, se vislumbró prevalencia de las estomias intestinales en el sexo masculino, en su gran mayoría proveniente del diagnóstico de cáncer de recto, teniendo evidencia significativa la baja escolaridad de los sujetos y, a su vez, baja remuneración familiar que puede ser visto con un gran ofensor para la ejecución del autocuidado. Sin embargo, los sujetos de la investigación evidenciaron que pasan a vivir mejor cuando comprenden y aceptan el estoma y ese proceso puede ser facilitado por el enfermero, por medio de la Consulta de Enfermería, sobre todo cuando adopta en su práctica asistencial la teoría de autocuidado de Dorothea Orem, que preconiza tres actividades: contacto inicial con el paciente que demanda el cuidado que se traduce en un sistema que contempla las exigencias terapéuticas y los medios de auxilio; la continuidad de ese contacto para el desarrollo de acciones de enfermería, siendo incluidos los familiares o responsables por el cuidado para la actuación en los momentos actuales y futuros; y la etapa de preparación del paciente para conducir acciones de cuidado de manera independiente. En esta fase, tanto el paciente como los familiares ya están entrenados en relación a los cuidados básicos para la realización de la higiene y el cambio de los dispositivos intestinales, entre otros cuidados necesarios. Por lo tanto, se evidencia la importancia de la utilización del referencial teórico de Orem para el abordaje de esta clientela, con la finalidad de ayudarla a resolver sus déficits de autocuidado, proporcionándoles informaciones útiles, apoyo emocional y psicológico. Por lo tanto, es a través del sistema de apoyo-educación, que compone la teoría de los sistemas de enfermería, que este proceso puede tonificarse eficaz

Construction and validation of simulated scenario for nursing care to colostomy patients / Construcción y validación de un escenario simulado para atención de enfermería a pacientes con colostomía / Construção e validação de cenário simulado para assistência de enfermagem a pacientes com colostomia

ABSTRACT Objective: to construct and validate a high fidelity clinical simulation scenario on nursing care to colostomy patients. Method: descriptive study of construction and validation of the appearance and content of a high fidelity clinical simulation scenario referring to nursing care for colostomy patients. To guide the elaboration of the scenario, a study was carried out in the literature on nursing care for the colostomy patient in the hospital environment. The scenario was constructed according to the items proposed by Fabri, based on the Bloom's Taxonomy. For the selection of the nine experts, the criteria proposed by Fehring were used. The scenario, after being structured, was tested by a group of students from the 3rd and 4th years of graduation in nursing in a clinical simulation laboratory of a public university. It was considered 80% level of agreement. Results: in the validation of the scenario, all the experts agreed with the proposed items, suggesting the inclusion of some references, book chapters, skills training, preparation of reading material and checklist follow-up of participants. This scenario test allowed the identification of relevant contributions for adjustments of the simulated activity and allowed to test the debriefing with the support of the checklist. It was also evidenced the need to include information in the patient medical record and to increase the time of development of the scenario to solve the proposed objectives. Conclusion: the results show that for practical simulated well defined and successful are required to careful preparation, validation and prior testing of the planned activities.

RESUMEN Objetivo: construir y validar un escenario de simulacro clínico de alta fidelidad sobre atención de enfermería a pacientes con colostomía. Método: estudio descriptivo de construccióny validación de aparienciay contenido de unescenario de simulacro clínico de alta fidelidad, referente a la atención de enfermería a pacientes con colostomía. Para orientar la elaboración del escenario, se realizó una investigación en la literatura sobre los cuidados de enfermería al paciente con colostomía en el ambiente hospitalario. El escenario se construyó según los ítems propuestos por Fabri, con base en la Taxonomía de Bloom. Para seleccionarlos nueve especialistas, se utilizaron los criterios propuestos por Fehring. El escenario, luego de ser estructurado, ha sido testeado por un grupo de estudiantes de 3º y 4º año de la carrera de grado en enfermería en un laboratorio de simulacro clínico de una universidad pública. Se consideró un nivel de concordancia del 80%. Resultados: en la validación delescenario, todos los especialistas concordaron conlos ítems propuestos, sugiriendola inclusión de algunas referencias, capítulos de libros, capacitación de habilidades, confección de material de lectura y checklist de acompañamiento a los participantes. Este test delescenario permitió identificar las contribuciones relevantes para los ajustes de la actividad simulada y testear el debriefing conel apoyo del checklist. También se puso en evidencia la necesidad de incluir informacionesen elinforme del paciente y de aumentar el tiempo de desarrollo delescenario para resolverlos objetivos propuestos. Conclusión: los resultados demuestran que para prácticas simuladas bien delineadas y exitosas son necesarias una elaboración criteriosa, una validación y untest previo de las actividades planificadas.

RESUMO Objetivo: construir e validar um cenário de simulação clínica de alta fidelidade sobre assistência de enfermagem a pacientes com colostomia. Método: estudo descritivo de construção e validação de aparência e conteúdo de um cenário de simulação clínica de alta fidelidade referente à assistência de enfermagem a paciente com colostomia. Para direcionar a elaboração do cenário, foi realizada uma pesquisa na literatura sobre cuidados de enfermagem ao paciente com colostomia no ambiente hospitalar. O cenário foi construído segundo os itens propostos por Fabri, com base na Taxonomia de Bloom. Para seleção dos nove peritos foram utilizados os critérios propostos por Fehring. O cenário, após estruturado, foi testado por um grupo de estudantes do 3o e 4o anos de graduação em enfermagem em um laboratório de simulação clínica de uma universidade pública. Foi considerado nível de concordância 80%. Resultados: na validação do cenário, todos os experts concordaram com os itens propostos, sugerindo a inclusão de algumas referências, capítulos de livros, treino de habilidades, confecção de material de leitura e checklist de acompanhamento aos participantes. Essa testagem do cenário permitiu identificar contribuições relevantes para ajustes da atividade simulada e permitiu testar o debriefing com o apoio do checklist. Evidenciou-se, ainda, a necessidade de incluir informações no prontuário do paciente e de aumentar o tempo de desenvolvimento do cenário para resolução dos objetivos propostos. Conclusão: os resultados mostram que para práticas simuladas bem delineadas e exitosas são necessárias a elaboração criteriosa, a validação e a testagem prévia das atividades planejadas.

The effect of purse-string approximation versus linear approximation of ileostomy reversal wounds on morbidity rates and patient satisfaction: the 'STOMA' trial.

BACKGROUND: Ileostomy reversal is associated with surgical site infection (SSI) rates as high as 37%. Recent literature suggests that employing a purse-string approximation (PSA) of the reversal wound reduces this rate of SSI. Thus we wished to perform a randomised controlled trial to compare SSI rates in purse-string versus linear closure (PLC) wounds following ileostomy reversal. METHODS: A randomised, controlled trial was conducted at University Hospital Limerick. Sixty-one patients undergoing ileostomy reversal were included. Thirty-four patients were randomised to PSA and 27 patients to linear closure. The primary endpoint was incidence of SSI and secondary endpoints measured were quality of life and satisfaction with cosmesis. Statistical analysis was performed on a per protocol basis using SPSS version 22.0. RESULTS: Three patients in the PSA group developed an SSI compared to 8 in the PLC group at 30 days (8 vs 30%, p = 0.03). The mean time to SSI diagnosis was faster in the PSA group (3 vs 12.3 days, p = 0.08). Patients who developed SSI experienced a longer mean length of stay (6.8 vs 11.4 days, p = 0.012). On multivariate analysis, PLC was the only predictive factor of SSI formation (p < 0.001). There was no difference in patient satisfaction between the two study groups (p = 0.14). CONCLUSIONS: PSA of wounds following ileostomy reversal significantly reduces SSI formation compared to linear approximation without any effect on patient satisfaction.

Patient education interventions for colorectal cancer patients with stoma: A systematic review.

OBJECTIVES: To describe the various types of patient education interventions for colorectal cancer patients with stoma and to examine their effects on quality of life, psychosocial skills and self-management skills. METHODS: A systematic review was performed. Six electronic databases were searched. Inclusion criteria were: studies about patient education applying quantitative methods including digestive stoma adults with colorectal cancer. The primary outcome was quality of life. Secondary outcomes were psychosocial and self-management skills. RESULTS: Thirteen studies were identified and included. Five studies examined quality of life and three reported improvements. Patient education improved some psychosocial and self-management skills. Contrasting findings were reported for specific-disease quality of life, emotional distress, length of hospital stay, stoma complications and readmission rate. CONCLUSIONS: Patient education has a positive impact on some psychosocial and self-management skills, indicating that this area should be developed. Contrasting findings were reported for quality of life. Methodologies are heterogeneous making it difficult to produce evidence-based guidelines. This article proposes tools to carry out further studies on this subject and to improve understanding. PRACTICE IMPLICATION: Further education intervention for stoma patients with colorectal cancer should be standardized in terms of intervention, duration and outcome measures to compare intervention and determine best practice.

Purse-String Versus Linear Conventional Skin Wound Closure of an Ileostomy: A Randomized Clinical Trial.

PURPOSE: Infection is one of the most frequent complications that can occur after ileostomy closure. The incidence of wound infection depends on the skin closure technique, but there is no agreement on the perfect closure method for an ileostomy wound. The aim of this study was to evaluate the incidence of infection, the patient's approval, and the patient's pain between purse-string closure (PSC) and the usual linear closure (LC) of a stoma wound. METHODS: This randomized clinical trial enrolled 66 patients who underwent a stoma closure from February 2015 to May 2015 in Sari Emam Khomeini Hospital. Patients were divided into 2 groups according to the stoma closing method: the PSC group (n = 34) and the LC group (n = 32). The incidences of infection for the 2 groups were compared, and the patients' satisfaction and pain with the stoma were determined by using a questionnaire. RESULTS: Infection occurred in 1 of 34 PSC patients (2.9%) and in 7 of 32 LC patients (21.8%), and this difference was statistically significant (P = 0.021). Patients in the PSC group were more satisfied with the resulting wound scar and its cosmetic appearance at one month and three months after surgery (P = 0.043). CONCLUSION: After stoma closure, PSC was associated with a significantly lower incidence of wound infection and greater patient satisfaction compared to LC. However, the healing period for patients who underwent PSC was longer than it was for those who underwent LC.

Purse-String Versus Linear Conventional Skin Wound Closure of an Ileostomy: A Randomized Clinical Trial

PURPOSE: Infection is one of the most frequent complications that can occur after ileostomy closure. The incidence of wound infection depends on the skin closure technique, but there is no agreement on the perfect closure method for an ileostomy wound. The aim of this study was to evaluate the incidence of infection, the patient's approval, and the patient's pain between purse-string closure (PSC) and the usual linear closure (LC) of a stoma wound. METHODS: This randomized clinical trial enrolled 66 patients who underwent a stoma closure from February 2015 to May 2015 in Sari Emam Khomeini Hospital. Patients were divided into 2 groups according to the stoma closing method: the PSC group (n = 34) and the LC group (n = 32). The incidences of infection for the 2 groups were compared, and the patients' satisfaction and pain with the stoma were determined by using a questionnaire. RESULTS: Infection occurred in 1 of 34 PSC patients (2.9%) and in 7 of 32 LC patients (21.8%), and this difference was statistically significant (P = 0.021). Patients in the PSC group were more satisfied with the resulting wound scar and its cosmetic appearance at one month and three months after surgery (P = 0.043). CONCLUSION: After stoma closure, PSC was associated with a significantly lower incidence of wound infection and greater patient satisfaction compared to LC. However, the healing period for patients who underwent PSC was longer than it was for those who underwent LC.

Determinantes biopsicossociais do processo de inclusão laboral da pessoa estomizada / Biopsychosocial determinants of the labor inclusion process of the person with a stoma / Determinantes biopsicosociales de la inclusión laboral de la persona estomizada

Estudo cujo objeto tratou dos determinantes biopsicossociais dos estomizados que facilitam e/ou dificultam sua inclusão laboral. Os objetivos foram identificar e analisar as dificuldades e facilidades das pessoas com estoma para inclusão no trabalho. Pesquisa descritivo-exploratória, qualitativa, realizada com 20 estomizados através de entrevista semiestruturada; utilizandose Análise Temática de Conteúdo. Os resultados revelaram que as principais dificuldades dos estomizados para adentrarem ao ambiente laboral foram a perda do controle esfincteriano, o isolamento social e a falta de oportunidades de empregos adequados à sua nova condição de saúde. Os principais agentes facilitadores foram a criação de banheiros adaptados e a flexibilidade de horários. Conclui-se que as mudanças biopsicossociais causadas pela presença do estoma podem dificultar a inclusão no trabalho do estomizado, porém, com o apoio social, podem-se criar condições flexíveis que os auxiliem em seu retorno às atividades laborativas.

This study focused the social determinants of people with an ostomy that facilitate and / or hamper their work inclusion. The objectives were to identify and analyze the difficulties and facilities for people with an ostomy for work inclusion. Descriptive exploratory, qualitative research, carried out with 20 stomized through semi-structured interviews, using the Thematic Content Analysis. The results revealed that the main difficulties of ostomy to step into the working environment were the loss of sphincter control, social isolation and lack of opportunities suitable to your health condition new jobs. The main facilitators were the creation of adapted toilets and flexible schedules. We conclude that the biopsychosocial changes caused by the presence of the stoma may hinder inclusion in the work of ostomy patients, however, with social support can be created flexible terms that help them in their return to work activities.

Estudio que se ocupó de los determinantes biopsicosociales de los estomizados que facilitan y/o dificultan su inserción laboral. Los objetivos fueron identificar y analizar las dificultades y facilidades para personas con estoma para su inclusión en el trabajo. Investigación cualitativa de tipo descriptivo exploratorio, con 20 estomizados por medio de entrevista semi-estructurada, utilizándose el Análisis de Contenido Temático. Los resultados revelaron que las principales dificultades de los estomizados para entrar en el ambiente de trabajo fueron la pérdida de control de esfínteres, aislamiento social y falta de oportunidades de empleo acordes con sus nuevas condiciones de salud. Los principales agentes facilitadores fueron la creación de baños adaptados y adopción de horarios flexibles. Se concluye que los cambios biopsicosociales causados por la presencia del estoma pueden obstaculizar la inclusión laboral del estomizado; sin embargo, con el apoyo social, se puede crear condiciones flexibles que les ayuden en su regreso a las actividades laborales.

Healthcare experiences of patients following faecal output stoma-forming surgery: a qualitative exploration.

BACKGROUND: Approximately 102,000 individuals live with an excretory stoma in the UK. Existing research shows huge variation in how individuals experience living with a new stoma but little is known of the individual experience of contemporary health care from the patient perspective. OBJECTIVE: To explore the individual experience of living with a new stoma and interactions with healthcare over time with the purpose of informing health care services. DESIGN: An existential phenomenological methodology underpinned interviews with twelve people with a new stoma at three, nine and fifteen months post-surgery. Ten healthcare professionals were interviewed on one occasion to provide adjunct data. METHODS: Open one-to one exploratory interviews lasting 35-90 min were conducted by one researcher using topic guides. A five-staged analytical framework facilitated iterative scrutiny of data to give a universal understanding of the experience. RESULTS: Three themes of healthcare experiences of people following stoma-forming surgery were identified: Relationships with health care professionals; being prepared; and regaining autonomy. They revealed how building a new sense of embodied self and increasing social confidence was facilitated by regaining physical capacity, mastering stoma function, purposeful care, and acceptance and support of others. Some conflict between the role of specialist and ward-based nurses is highlighted. Provision of responsive healthcare from all disciplines helped to establish patient self-determination in adaptation to and acceptance of self-with-a-stoma. CONCLUSIONS: The study contributes to defining a plan of care that assists individuals with a new stoma to adapt to and accept a changed sense of embodied self. It highlights the powerful influence of health care professionals in facilitating this process through their knowledge, experience and individual approaches to care. There is an identified need for on-going review of the work of nurses and others providing care for patients following stoma-forming surgery. The findings of this UK study can have resonance with patient healthcare experiences in other countries, if, despite cultural differences in delegation of professional duties and responsibilities, the global aim is to facilitate meeting individual patient needs.

O desafio do autocuidado de pacientes oncológicos estomizados: da reflexão à ação / The challenge of self-care of stomized cancer patients: from reflection to action

Trata-se de pesquisa qualitativa sobre o autocuidado do paciente oncológico estomizado que tem como objetivos: analisar os requisitos de autocuidado do paciente oncológico estomizado, descrever a trajetória do paciente oncológico com o estoma intestinal e identificar os requisitos de autocuidado referidos por estes pacientes. A pesquisa foi realizada no ambulatório de estomaterapia de um Instituto de tratamento oncológico localizado na região central da cidade do Rio de Janeiro com treze pacientes oncológicos adultos com estoma intestinal de eliminação definitivo ou não, matriculados na instituição que estavam em acompanhamento ambulatorial. Para a coleta de dados foi realizada entrevista semi-estruturada e, após análise de conteúdo temática, foram elaboradas as seguintes categorias: vivendo com o estoma intestinal; o desafio do autocuidado: da reflexão à ação e as expectativas e os sentimentos. Os resultados apontaram que o paciente oncológico vivencia uma trajetória marcada por surpresas, ansiedade, medo e falta de esperança, entretanto, durante o processo de adoecimento passa a refletir sobre sua vida buscando estratégias de enfrentamento e adaptação frente à doença e tratamento. A confecção de um estoma é uma etapa difícil do tratamento do câncer, pois os pacientes entendem o estoma intestinal como algo assustador que rompe com a normalidade do corpo, mesmo quando traz alívio das dores provocadas pela doença. O estoma intestinal provoca mudanças de ordem emocional, física, fisiológica e social no cotidiano desses pacientes, com repercussões na sua autonomia, independência e autoimagem que limitam sua convivência social. Os requisitos de autocuidado de maior importância referidos pelos sujeitos da pesquisa foram: provisão de cuidados associados com o processo de eliminação e os excrementos; manutenção do equilíbrio entre a solidão e a interação social e modificações do autoconceito e autoimagem, aceitando estar em determinado estado de saúde e necessitar de formas específicas de atendimento de saúde. Em contrapartida, constatou-se que passam a desenvolver habilidades para a limpeza do dispositivo coletor, mas não se sentem preparados para realizar a troca do dispositivo, necessitando da ajuda de um familiar ou amigo para essa atividade. Concluiu-se que frente às necessidades destes pacientes o enfermeiro precisa atuar implementando ações educativas que proporcionem suporte a esses pacientes, estimulando ainda um processo de conscientização junto com esses pacientes acerca do seu autocuidado e da necessidade de adotar estratégias frente aos desafios da vivência com o estoma, contribuindo assim para reduzir os riscos e agravos à sua saúde. Nesse sentido é necessário que o enfermeiro reflita sobre as necessidades e demandas desses pacientes visando promover um cuidado que contribua para sua recuperação, manutenção e adaptação a nova situação de saúde em uma relação dialógica em que conhecimentos e experiências sejam compartilhadas tendo como meta a melhoria da qualidade de vida desses pacientes

It is a qualitative research on the self-care of ostomate oncologic patient that has as objectives: To analyze the self-care requirements of the ostomate oncologic patient, to describe the trajectory of the oncologic patient with intestinal stoma and to identify the self-care requirements referred by these patients. The research was done in the stoma therapy of an oncologic treatment Institute located in the central region of Rio de Janeiro city with thirteen adult oncologic patients with intestinal stoma of definitive or not elimination, enrolled in the institution and who were in ambulatory treatment. For data collection it was done a halfstructured interview and, then, after analysis thematic contents the following categories were created: living with intestinal stoma; the challenging of self-care: from reflection to action and the expectative and feelings. The results indicated that the oncologic patient experiences a trajectory marked by surprises, anxiety, fear and lack of hope, although during the process of sickening he/she reflects on his/her life looking for strategies to face and get adapted to the sickness and the treatment. The confection of a stoma is a very hard step in the cancer treatment, since the patients understand the intestinal stoma as something scaring that breaks the normality of the body, even when it brings relief of the pain provoked by the illness. The intestinal stoma provokes changes of emotional, physic, physiologic and social aspects in the quotidian of these patients with repercussions in their autonomy, independence and self-image that limit their social relations. The self-care requirements of the greatest importance referred by the subjects of the research have been: provision of care associated with elimination process and the excrements/ maintenance of the balance between solitude and the social interaction and modifications of the self-concept and self-image, accepting to be in determined state of health and to need of specific ways of health attending. On the other hand it was found that they develop abilities for cleaning the collecting device, but they are not prepared to make the change of the device, needing the help of a family member or a friend to do this activity. One concludes that before the needs of these patients the nurse needs to act implementing educative actions that provide support to these patients, still stimulating a process of consciousness-raising of these patients about their self-care and the need of adopting strategies before the challenges of living with the stoma, contributing this way to reduce the risks and damages to their health. In this sense it is necessary that the nurse reflects on the needs and demands of these patients with the aim of promoting a care that can contribute to their recovery, maintenance and adaptation to the new health situation in a dialogic relation in which knowledge and experiences are shared, having as aim the improvements of the life quality of these patients

Tratase de pesquisa cualitativa sobre el autocuidado del paciente oncológico estomizado que tiene como objetivos: analizar los requisitos de autocuidado del paciente oncológico estomizado, describir la trayectoria del paciente oncológico con la estoma intestinal e identificar los requisitos de autocuidado referidos por eses pacientes. La pesquisa fue realizada en el ambulatorio de estomaterapia de un Instituto de tratamiento oncológico localizado en la región central de la ciudad de Río de Janeiro con trece pacientes oncológicos adultos con estoma intestinal de eliminación definitiva o no, matriculados en la institución que estaban en acompañamiento en ambulatorio. Para la coleta de datos fue realizada entrevista semi-estructurada y, después, análisis de contenido temática, fueran elaboradas las siguientes categorías: viviendo con la estoma intestinal; el desafío del autocuidado: de la reflexión a la acción y las expectativas y los sentimientos. Los resultados apuntaran que el paciente oncológico vivencia una trayectoria marcada por sorpresas, ansiedad, medo y falta de esperanza, entretanto durante el proceso de enfermarse pasa a refletar sobre su vida buscando estrategias de enfrentamiento y adaptación delante de la enfermedad y tratamiento. La confección de una estoma es una etapa difícil del tratamiento del cáncer, ya que los pacientes entienden la estoma intestinal como algo asustador que rompe con la normalidad del cuerpo, mismo cuando proporciona alivio de las dores provocadas por la enfermedad. La estoma intestinal provoca mudanzas de orden emocional, física, fisiológica y social en el cotidiano de eses pacientes, con repercusiones en su autonomía, independencia y auto-imagen que limitan su convivencia social. Los requisitos de autocuidado de mayor importancia referidos por los sujetos de la pesquisa fueron: provisión de cuidados asociados al proceso de eliminación y los excrementos; manutención del equilibrio entre la solitud y la interacción social y modificaciones del auto concepto y auto-imagen, aceitando estar en determinado estado de salud y necesitar de formas específicas de atendimiento de salud. En contrapartida, ha sido constatado que pasan a desenvolver habilidades para la limpieza del dispositivo colector, pero no se sienten preparados para realizar la troca del dispositivo, necesitando de la ayuda de un familiar o amigo para esa actividad. Concluyese que frente a las necesidades de eses pacientes el enfermero precisa actuar implementando acciones educativas que proporcionen suporte a eses pacientes, estimulando aún un proceso de concientización junto con eses pacientes acerca de su autocuidado y da necesidad de adoptar estrategias frente a los desafíos de la vivencia con la estoma, contribuyendo así para reducir los riscos y daños a su salud. En ese sentido es necesario que el enfermero reflexione sobre las necesidades y demandas de eses pacientes visando a promover un cuidado que contribuya para su recuperación, manutención y adaptación a la nueva situación de salud en una relación dialógica en que conocimientos e experiencias sean compartidas tiendo como meta la mejora de la cualidad de vida de eses pacientes

Laparoscopic mitrofanoff appendicovesicostomy: Our experience in children.

INTRODUCTION: The Mitrofanoff principle was originally described as a method to provide an alternative means to access the bladder. It creates a conduit to the bladder through which patients with a sensitive, absent, or traumatized urethra can perform clean intermittent catheterization (CIC) easily. We report our experience with complete laparoscopic Mitrofanoff appendicovesicostomy to promote a catheterizable abdominal stoma. MATERIALS AND METHODS: A 4-port transperitoneal approach was used to create a complete laparoscopic Mitrofanoff appendicovesicostomy. RESULTS: Six children with a mean age of 12.8 years (range 9-16 years) underwent laparoscopic Mitrofanoff appendicovesicostomy. Mean operative time was 139.6 min and Mean estimated blood loss was 46 cc. No cases of urinary leaks were noted. There have been no cases of either stomal stenosis or appendicovesical stenosis noted. CONCLUSIONS: Pure laparoscopic Mitrofanoff appendicovesicostomy is feasible and is associated with reasonable outcome with early recovery, resumption of normal activities and excellent cosmesis.